Atrial fibrillation chronic

A 76-year-old woman, who had a history of hypertension, valvular heart disease (mitral regurgitation) with chronic atrial fibrillation, chronic obstructive airways disease, diverticular disease of the sigmoid colon, and generalized anxiety disorder, developed severe hypotension with a tachycardia after taking alprazolam for 7 days. She also had severe weakness, depressed mood, and impaired gait and balance, without clinical features of neuromuscular disease. 

Coumarin is also widely used for long-term anticoagulation in chronic atrial fibrillation (particularly to avoid cardioembolic strokes), to prevent DVT or PE in patients with chronic hypercoagulability (e.g., congenital AT or protein C deficiency), or to prevent... 

Mitral stenosis or regurgitation Mitral valve prolapse Chronic obstructive pulmonary disease Pulmonary embolism Idiopathic ("lone" atrial fibrillation) Thoracic surgery ... 

FIGURE 6-2. Algorithm for the treatment of acute (top portion) paroxysmal supraventricular tachycardia and chronic prevention of recurrences (bottom portion). Note For empiric bridge therapy prior to radiofrequency ablation procedures, calcium channel blockers (or other atrioventricular [AV] nodal blockers) should not be used if the patient has AV reentry with an accessory pathway. (AAD, antiarrhythmic drugs AF, atrial fibrillation AP, accessory pathway AVN, atrioventricular nodal AVNRT, atrioventricular nodal reentrant tachycardia AVRT, atrioventricular reentrant tachycardia DCC, direct-current cardioversion ECG, electrocardiographic monitoring EPS, electrophysiologic studies PRN, as needed VT, ventricular tachycardia.)... 

Indications for CG are (1) chronic congestive heart failure and (2) atrial fibrillation or flutter, where inhibition of AV conduction protects the ventricles from excessive atrial impulse activity and thereby improves cardiac performance (D). Occasionally, sinus rhythm is restored. 

Digitoxin is used for chronic cardiac insufficiency, tachyarrhythmia form of atrial fibrillation, paroxysmal ciliary arrhythmia, and paroxysmal supraventricular tachycaria. Synonyms of this drag are cardigin, cordalin, crystodigin, purodigin, and others. 

Atrial fibrillation Peak digoxin body stores larger than the 8 to 12 mcg/kg required for most patients with heart failure and normal sinus rhythm have been used for control of ventricular rate in patients with atrial fibrillation. Titrate doses of digoxin used for the treatment of chronic atrial fibrillation to the minimum dose that achieves the desired ventricular rate control without causing undesirable side effects. Data are not available to establish the appropriate resting or exercise target rates that should be achieved. 

Oral Premature atrial, AV junctional and ventricular contractions paroxysmal atrial (supraventricular) tachycardia paroxysmal AV junctional rhythm atrial flutter paroxysmal and chronic atrial fibrillation established atrial fibrillation when therapy is appropriate paroxysmal ventricular tachycardia not associated with complete heart block maintenance therapy after electrical conversion of atrial fibrillation or flutter. Parenteral When oral therapy is not feasible or when rapid therapeutic effect is required. 

Ventricular proarrhythmic effects in patients with atrial fibrillation/flutter A review of the world literature revealed reports of 568 patients treated with oral flecainide for paroxysmal atrial fibrillation/flutter (PAF). Ventricular tachycardia was experienced in 0.4% of these patients. Of 19 patients in the literature with chronic atrial fibrillation (CAF), 10.5% experienced ventricular tachycardia (VT) or ventricular fibrillation (VF). Flecainide is not recommended for use in patients with CAF. Case reports of ventricular proarrhythmic effects in patients treated with flecainide for atrial... 

Kieny JR, Sacrez A, Facello A, et al. Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy. Eur. Heart J. 1992 13 1290-5. 

Peters KG, Kienzle MG. Severe cardiomyopathy due to chronic rapidly conducted atrial fibrillation complete recovery after restoration of sinus rhythm. Am. J. Med. 1988 85 242-4. 

Procainamide is an effective antiarrhythmic agent when given in sufficient doses at relatively short (3-4 hours) dosage intervals. Procainamide is useful in the treatment of premature atrial contractions, paroxysmal atrial tachycardia, and atrial fibrillation of recent onset. Procainamide is only moderately effective in converting atrial flutter or chronic atrial fibrillation to sinus rhythm, although it has... 

Ventricular proarrhythmic effects have been observed in patients with atrial fibril-lation/flutter. This drug is not recommended in patients with chronic atrial fibrillation. 

Patients with chronic atrial fibrillation have a strongtendency to revert after conversion to sinus rhythm. Treatment to maintain sinus rhythms carries risks. Patients should be carefully selected for ibutilide therapy. 

Arrhythmias, including prevention of recurrent paroxysmal supraventricular tachycardia and control of ventricular resting rate in chronic atrial fibrillation or flutter (with di-goxin) PO 240-480 mg/day in 3-4 divided doses. 

Digoxin Na +, K+ ATPase inhibition results in reduced Ca2+ expulsion and increased Ca2+ stored in sarcoplasmic reticulum Increases cardiac contractility cardiac parasympathomimetic effect (slowed sinus heart rate, slowed atrioventricular conduction) Chronic symptomatic heart failure rapid ventricular rate in atrial fibrillation Oral, parenteral duration 36-40 h Toxicity Nausea, vomiting, diarrhea cardiac arrhythmias... 

The toxicity of thyroxine is directly related to the hormone level. In children, restlessness, insomnia, and accelerated bone maturation and growth may be signs of thyroxine toxicity. In adults, increased nervousness, heat intolerance, episodes of palpitation and tachycardia, or unexplained weight loss may be the presenting symptoms. If these symptoms are present, it is important to monitor serum TSH (Table 38-2), which will determine whether the symptoms are due to excess thyroxine blood levels. Chronic overtreatment with T4, particularly in elderly patients, can increase the risk of atrial fibrillation and accelerated osteoporosis. 

Recent evidence indicates that many patients with atrial fibrillation—a very common arrhythmia in the elderly—do as well with simple control of ventricular rate as with conversion to normal sinus rhythm. Measures (such as anticoagulant drugs) should be taken to reduce the risk of thromboembolism in chronic atrial fibrillation. 

Budesonide for collagenous colitis caused Cushing s syndrome in a patient with chronic renal insufficiency taking amiodarone for paroxysmal atrial fibrillation (477). 

Of 308 patients 73% had contraindications, risk factors, or intercurrent illnesses necessitating withdrawal of metformin (31) 19% had renal impairment, 25% heart failure, 6.5% respiratory insufficiency, and 1.3% hepatic impairment 51% had advanced coronary heart disease, 9.8% atrial fibrillation, 3.3% chronic alcohol abuse, 2% advanced peripheral arterial disease, and 0.7% were pregnant. 

In addition to inherited mutations in RyR2, several cardiac disorders have been associated with acquired defects in RyR2 (Vest 2005 Wehrens 2005b Phrommintikul 2006). Changes in the subunit composition or the regulation of the RyR2 channel complex have been reported in chronic heart failure, cardiomyopathy, and atrial fibrillation. 

Christ, T., Boknik, P., Wohrl, S., Wettwer, E., Graf, E. M., Bosch, R. F., Knaut, M., Schmitz, W., Ravens, U., and Dobrev, D. (2004). L-Type Ca2+ Current Downregulation in Chronic Human Atrial Fibrillation is Associated with Increased Activity of Protein Phosphatases. Circulation 110(17) 2651-7. 

Ohkusa, T., Ueyama, T., Yamada, J., Yano, M., Fujumura, Y., Esato, K., and Matsuzaki, M. (1999). Alterations in Cardiac Sarcoplasmic Reticulum Ca2+ Regulatory Proteins in the Atrial Tissue of Patients with Chronic Atrial Fibrillation. J Am Coll Cardiol 34(1) 255-63. 

Cardiovascular Effects. No studies were located regarding cardiovascular effects of various forms of aluminum following intermediate- or chronic-duration oral exposure in humans. Acute-duration oral exposure to aluminum phosphide has been shown to cause tachycardia, hypotension, cardiovascular electrocardiographic abnormalities, subendocardial infarction, and transient atrial fibrillation in persons who either ingested it accidentally or in suicide attempts (Chopra et al. 1986 Khosla et al. 1988). However, toxicity was probably due to the formation of highly toxic phosphine gas rather than to aluminum exposure. 

Bianconi L, et al. Effects of oral propafenone administration before electrical cardioversion of chronic atrial fibrillation a placebo-controlled study. J Am Coll Cardiol 1996 28(3) 700-706. 

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