Alcoholism
Mark S. Gold, R. Bruce Lydiard, John S. Carman in Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
In patients with mitral valve prolapse, treatment of panic symptoms with propranolol is often effective. These patients will usually present with predominant cardiac symptoms such as tachycardia, palpitations, and chest pain. Propranolol can be started in doses as low as 10 mg three times daily, and is often effective in low doses. Dosage can be increased as indicated clinically. Generally, since propranolol is a recognized “medical” medication, as opposed to an antidepressant, alcoholics are less conflicted about taking it. We have used propranolol extensively in the treatment of alcoholics with panic disorder. It is often effective and can also be used in combination with antidepressants.
Cardiac Disease
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
In an international prospective pregnancy registry, rheumatic mitral valve disease was present in 390 patients with 75% from developing countries. Mitral stenosis was severe by the current definition, mitral valve area < 1.5 cm2 in 161 patients (∼40%). There was one death, but ∼50% developed heart failure. Even in those with mild mitral stenosis, 16% developed heart failure. Thirty percent of heart failure occurred in the first week postpartum (in part secondary to the increase in preload). In a subset of pregnant patients with moderate to severe mitral regurgitation, 23% developed heart failure [27]. Beta-blockers are an important mainstay of medical therapy in significant mitral stenosis, as higher heart rates are associated with increased mitral valve gradients and thereby pulmonary venous hypertension and heart failure. Tachycardia should be avoided. This is particularly relevant if atrial fibrillation ensues because not only is the rapid ventricular response poorly tolerated, but also the loss of atrial contraction. Peak heart rate and cardiac output during pregnancy occur at 28–32 weeks’ gestation. The best time to intervene on symptomatic mitral stenosis is after the fourth month [14]. Mitral valve balloon valvuloplasty is preferred if rheumatic, no significant mitral regurgitation and an appropriately low Wilkins score is determined. Invasive hemodynamic monitoring via pulmonary artery catheterization may be appropriate in certain situations. Avoid decreases in systemic vascular resistance and increases in pulmonary vascular resistance. Echocardiography is important in determining mitral valve area, concomitant mitral regurgitation, biventricular function, and estimating pulmonary artery pressure.
Supraventricular rhythms
Andrew R Houghton in Making Sense of the ECG, 2019
Sinus tachycardia is sinus rhythm with a heart rate of greater than 100/min (Figure 7.4). The characteristic features of sinus tachycardia are: The heart rate is greater than 100/minP wave morphology is normal (e.g. upright in lead II and inverted in lead aVR)Every P wave is followed by a QRS complex
Treatment of brief episodes of highly symptomatic supraventricular and ventricular arrhythmias: a methodological review
Published in Expert Review of Medical Devices, 2021
Rita B. Gagyi, Mark Hoogendijk, Sing-Chien Yap, Tamas Szili-Torok
Pace mapping is a technique generally used to identify the site of origin of mostly focal ventricular, and sometimes for atrial tachycardias. A recorded electrocardiogram (ECG) during the clinical tachycardia is conventionally used as reference. Pace mapping is performed by visually or automatically comparing the QRS or P wave morphology during overdrive pacing to the recorded reference ECG [12,13]. Anatomic reconstruction of the atrium or ventricle is initially performed using a three-dimensional electroanatomical mapping system during sinus rhythm. Bipolar pace mapping is then systematically performed at the areas of interest based on the algorithm of QRS or P wave morphology of the tachycardia on surface ECG. Later, the expected area and surrounding area are paced, according to specific structure. If one of these areas obtains a good match of the QRS complex or P wave, denser pace mapping is performed close to the good-paced match site to obtain best-paced match site. The CA target of the tachycardia is defined as best-paced site [13].
Monomorphic ventricular tachycardia in a young female: look out for the zebras
Published in Acta Cardiologica, 2021
Abhinav Shrivastava, Jaskaran Singh Gujral, Ranjit Kumar Nath
A 22-year-old pregnant patient (32 weeks of gestation) presented to casualty with a history of syncope resulting in a fall. On examination, she was having tachycardia with hypotension. Electrocardiograph (ECG) (Figure 1, Panel A) revealed a broad QRS (≈160ms) tachycardia with monophasic and broad R wave with qR pattern in lead V1, R/S < 1 in lead V6 and a North-West axis with a positive R wave in aVR. All these features were suggestive of monomorphic ventricular tachycardia (MVT). Differential diagnoses included aetiologies like myocarditis, spontaneous coronary artery dissection, sarcoidosis, idiopathic left ventricular tachycardia (VT) (posterior fasicular type), and arrhythmic cardiomyopathy. She was immediately cardioverted with a 200 J synchronised biphasic shock, after which sinus rhythm was attained and the patient became hemodynamically stable. ECG after cardioversion (Figure 1, Panel B) showed a 3 mm ST-segment elevation in leads V1 with coving and inversion of T-waves, suggestive of Brugada type I pattern. The pattern persisted over several days of admission. Serial troponins were negative and the 2D transthoracic echocardiogram was normal. After the fall, there was an absence of foetal movements. The obstetric ultrasound revealed intrauterine foetal death, which was delivered vaginally. An autopsy was refused.
Selenium, a dietary-antioxidant with cardioprotective effects, prevents the impairments in heart rate and systolic blood pressure in adolescent rats exposed to binge drinking treatment
Published in The American Journal of Drug and Alcohol Abuse, 2021
M Luisa Ojeda, Paula Sobrino, Rui Manuel Rua, María del Carmen Gallego-Lopez, Fátima Nogales, Olimpia Carreras
From a cellular point of view, Se supplementation to BD-exposed rats decreased caspase-3 and NF-kB activation in myocytes, mainly by decreasing OS and preventing apoptosis and inflammation. These actions are intimately related to the higher GPx4 expression in the heart which protects mitochondria from oxidation, preventing apoptosis. It is also inversely related to NF-kB activation in different tissues such as endothelial cells (43,44). GPx4 specifically interferes with NF-kB activation by interleukin-1, decreasing the synthesis of leukotrienes and prostanoids, which modulate inflammatory processes (45). When determining other possible mechanisms of action associated with Se supplementation in BD-exposed adolescent rats on cardiovascular regulation, it is important to remember that this therapy decreased the activation of HPA and SRAA under the same experimental methods used for BD-exposed rats (24). Furthermore, although it was not measured in the present study, the antioxidant Se could be decreasing vascular ROS. Vascular ROS decreases baroreceptor activity (46), increasing these receptors’ activity and function on HR and vagal control. All of these actions affect heart function by sharply decreasing HR, preventing tachycardia. Despite Se supplementation’s important protective roles in heart function, this therapy only partially decreased SBP, and for this reason vascular studies were undertaken.
Related Knowledge Centers
- Heart Rate
- Pulse
- Exercise
- Syncope
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- Virchow'S Triad
- Thrombosis
- Adrenergic Storm
- Anemia
- Anxiety