Sinusitis goals

Compare and contrast the risk factors for and the features, mechanisms, etiologies, symptoms, and goals of therapy of (1) sinus bradycardia (2) atrioventricular (AV) nodal blockade (3) atrial fibrillation (AF) (4) paroxysmal supraventricular tachycardia (PSVT) ... 

Maintenance of Sinus Rhythm/Reduction in the Frequency of Episodes of Paroxysmal AF In many patients, permanent maintenance of sinus rhythm following cardioversion is an unrealistic goal. Many, if not most, patients experience recurrence of AF after cardioversion. Therefore, a more realistic goal for many... 

The desired outcome depends on the underlying arrhythmia. For example, the ultimate treatment goals of treating AF or atrial flutter are restoring sinus rhythm, preventing thromboembolic complications, and preventing further recurrences. 

The goals of treatment of acute sinusitis are the reduction in signs and symptoms, achieving and maintaining patency of the ostia, limiting antimi-... 

Several treatment options are available when confronted with AF dependent on its clinical effect and duration. The hemodynamic effects and/or cardiac ischemia due to a rapid ventricular rate can seriously complicate a catheter procedure and can even be life threatening in some instances, Therefore, one goal can be to alleviate the clinical repercussions of the arrhythmia in order to finalize the procedure. The second goal is to restore sinus rhythm if possible. To achieve the first goal, a strategy called "rate control" might be sufficient if allowed by the hemodynamic... 

The second form of chronic therapy to be considered (at least in those patients in whom maintenance of sinus rhythm is a goal) is antiarrhythmic drugs to prevent recurrences of atrial fibrillation. With some exceptions (postoperative situations), atrial fibrillation often recurs after initial cardioversion because most patients have irreversible underlying heart or lung disease. Large atrial size, poor LV function, and the presence of long-standing atrial fibrillation are factors that make the restoration and maintenance of sinus rhythm difficult, if not... 

The goal in treatment of sinusitis is eradication of infection with clearance of the infected material from the sinuses. While the use of an appropriate antibiotic is necessary, the use of ancillary therapy is also of utmost importance. Steam and nasal saline, decongestants, topical corticosteroids, and mucoevacuants are given in an attempt to reduce nasal obstruction, increase sinus ostia size, promote improved mucociliary function, decrease mucosal inflammation, and thin secretions. In selected patients who fail to respond to aggressive medical therapy, functional endoscopic surgery can often provide relief. In patients with poorly controlled asthma, treatment of underlying sinusitis has been shown to dramatically improve the asthmatic state. 

Patients with diastolic heart failure are typically dependent upon preload to maintain adequate cardiac output. While patients with symptomatic volume overload will benefit from careful modulation of intravascular volume, volume reduction should be accomplished gradually and treatment goals reassessed frequently. In addition to cautious volume management, it is important to maintain synchronous atrial contraction in such patients, which maintains adequate left ventricular filling during the latter phase of diastole. Cardiac function is often severely impaired if patients with diastolic heart failure develop atrial fibrillation, particularly in the context of sub-optimal ventricular rate control. Meticulous control of the ventricular rate with drugs that slow AV conduction is mandatory (see Chapter 34) and restoration of sinus rhythm should be considered. It is also important to evaluate and treat conditions that are associated with dynamic abnormalities of diastolic function, such as myocardial ischemia and poorly controlled systemic hypertension. 

AAI/R Single-chamber atrial pacing will potentially address all of these goals although there remains the risk of AV block. In sinus node dysfunction patients this annualized risk is reported to be as high as 4.5% although if patients are carefully selected, the risk is in the vicinity of 0.6% per year. 

Gwaltney JM Jr., Jones JG, Kennedy DW. Medical management of sinusitis educational goals and management guidelines. The International Conference on sinus disease. Ann Otol Rhinol Laryngol Suppl 1995 167 22-30. 

The osteopathic treatment of sinusitis has several goals to relieve obstruction and pain to improve venous and lymphatic flow from the area to affect reflex changes and to improve mucociliary clearance. Several manual techniques have been designed to aid in achieving these goals. Although only one set of sinuses may produce pain, the entire series of techniques should be performed to assist drainage of all the sinus areas. 

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