Cardiovascular changes with aging
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Atrial fibrillation (AF) is found in approximately 3%–4% of subjects over age 60 (Table 1.4), a rate 10-fold higher than the general adult population (169,170); the prevalence in octogenarians approaches 10% (171). Chronic AF is most commonly due to CAD and hypertensive heart disease, mitral valvular disorders, thyrotoxicosis, and sick sinus syndrome. The association between hyperthyroidism and AF is observed almost exclusively in the elderly (172); this arrhythmia may be the sole clinical manifestation of so-called apathetic hyperthyroidism in geriatric patients. In the Framingham population, AF without identifiable cause, so-called lone AF, represented 17% of men and 6% of women with AF, with mean ages of 70.6 and 68.1 years, respectively (173). These individuals with lone AF suffered over four times as many strokes as those in sinus rhythm during long-term follow-up, although their rates of coronary events or congestive heart failure were not increased (173). Atrial flutter is a rare arrhythmia in any age group and is usually associated with organic heart disease.
Electrocardiography and arrhythmias
Neil Herring, David J. Paterson in Levick's Introduction to Cardiovascular Physiology, 2018
Typical atrial flutter is a macro re-entry tachycardia around the right atrium in which a wave of excitation passes counterclockwise down the lateral wall of the right atrium, across the cavotricuspid isthmus (between the inferior vena cava and tricuspid valve), up the interatrial septum and across the roof of the right atrium (Figure 5.16). This circuit produces a characteristic saw-tooth pattern on the ECG with AV conduction occurring every other circuit (2:1 block) or less frequently (3 or 4:1 block). As with AT, the rapid atrial rate can cause palpitations, breathlessness and light-headedness, and carries a thromboembolic risk. Atrial flutter can be difficult to rate control with AV blocking drugs. Percutaneous ablation of the cavotricuspid isthmus is highly successful (>90%) in blocking the re-entry circuit and preventing reoccurrence.
Bioelectric and Biomagnetic Signal Analysis
Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam in Introduction to Computational Health Informatics, 2019
In Atrial Flutter (AFlu), the electric impulses circulate in the atria causing a circulating current that causes depolarization at the rate of 250–300 beats/minute. It occurs due to uneven delay in conduction in different parts of the heart-muscles caused by the inactivation of sodium ion-channels. The discharge of depolarizing current from the reentrant loops causes negative P-waves 90% of the time, and P-wave may be missed around 10% of the time. Sometimes negative P-waves get superimposed with T-waves showing up as a missing T-wave or a T-wave with reduced magnitude. The waveforms for atrial flutter in lead II are given in Figure 7.12c. Atrial flutter occurs in patients suffering from cardiomyopathy, hypertension and diabetes.
Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting
Published in Scandinavian Journal of Primary Health Care, 2019
Thomas Lindow, Josefine Kron, Hans Thulesius, Erik Ljungström, Olle Pahlm
For the purpose of this study, atrial fibrillation was defined as an irregular supraventricular rhythm and absence of discernible P waves. Atrial flutter was defined as a supraventricular rhythm with regular flutter waves (F waves) with an atrial rate of 200–340/min and absence of an isoelectric baseline between discernible F waves. ECGs were re-assessed by one experienced ECG reader (TL, >10 years of experience of ECG interpretation including computer interpretation overreading) and one expert ECG reader (OP, >30 years of experience). ECGs with an incorrect diagnosis of atrial fibrillation or atrial flutter were assessed also by a third reader with vast experience in invasive electrophysiology studies, including ablation treatment for atrial fibrillation and atrial flutter (EL, >20 years of experience). A definitive rhythm diagnosis was determined by consensus. ECGs with an incorrect diagnosis were assessed for signal quality and for each ECG presence of either no, minor or major signal disturbances were noted.
Cardiomyopathy and heart failure secondary to anabolic-androgen steroid abuse
Published in Baylor University Medical Center Proceedings, 2022
Onyedika J. Ilonze, Chioma O. Enyi, Chibuzo C. Ilonze
An electrocardiogram (Figure 1a) showed atrial flutter with rapid ventricular response with 2:1 atrioventricular conduction. His heart rate was 130 to 150 beats/min, and his blood pressure was 109/64 mm Hg. He received intravenous adenosine 18 mg and a diltiazem bolus. He developed acute respiratory distress and was intubated and mechanically ventilated. Computed tomography of the chest showed bilateral interstitial pulmonary edema with pleural effusions. Transesophageal echocardiogram on day 2 showed severe left ventricular (LV) dysfunction with a left ventricular ejection fraction (LVEF) of 15%, mitral regurgitation, biatrial enlargement, and no left atrial appendage thrombus. He underwent direct current cardioversion with restoration of sinus rhythm; however, atrial flutter recurred within 24 hours. Pharmacologic therapy to maintain sinus rhythm included intravenous amiodarone followed by oral amiodarone.
Atrial fibrillation and anticoagulation in patients with breast cancer
Published in Scandinavian Cardiovascular Journal, 2019
Maria D’Souza, Laerke Smedegaard, Christian Madelaire, Casper Bang, Dorte Nielsen, Christian Torp-Pedersen, Gunnar Gislason, Morten Schou, Emil Fosbøl
All female patients diagnosed with BC from 1st of January 2000 to 31st of November 2015 were identified and included after a quarantine period of 30 days. The quarantine period ensured that BC and AF were not diagnosed during the same hospitalization, and that BC preceded AF in the individuals of the study population. Patients who developed incident AF within 3 years after this date were included in the study, and the index date was 14 days after the discharge date following hospitalization for AF. AF was defined as being discharged after hospitalization with AF as the primary diagnosis (ICD-10 code I-48 AF or atrial flutter). The definition has been shown to have a positive predictive value of 93% and a 6% proportion of patients with atrial flutter. Exclusion criteria were age <18 or >100 years at index, AF prior to BC, anticoagulation or antiarrhythmic therapy within 6 months preceding AF hospitalization, prior valvular heart disease, missing data or emigration before the index date. The patients were grouped according to anticoagulation at baseline. Receiving anticoagulation treatment was defined as having a prescription for anticoagulation filled during the first 14 days following hospitalization for AF. Later prescription fillings were not assessed. The patients were then followed for 3 years and observed for the outcomes thromboembolism and bleeding and the competing risk of death. Censoring was performed at the end of follow up (maximum 3 years) or if a patient emigrated during the study period.
Related Knowledge Centers
- Arrhythmia
- Palpitations
- Shortness of Breath
- Supraventricular Tachycardia
- Syncope
- Tachycardia
- Electrocardiography
- Heart
- Atrium
- Hypertension
- Shortness of Breath