ABSTRACT
La fibrilación auricular es la arritmia más sobresaliente a la que se enfrenta el médico general. Fuertemente asociada al envejecimiento y a la vasculopatía crónica, su presencia se relaciona con el riesgo de aumentar la morbimortalidad tromboembólica. Como objetivo se planteó actualizar pertinentemente el abordaje clínico terapéutico ante la fibrilación auricular. Se realizó una búsqueda en las bases de datos SciELO Cuba, SciELO Regional, Pubmed, Cumed y Clinical Key, de todo lo relacionado con el tema en el período comprendido entre los años 2012-2015. Se utilizaron las palabras las siguientes palabras clave: fibrilación auricular, diagnóstico, terapéutica y atención integral. El abordaje en la fibrilación auricular es integral, multidisciplinario e individualizado. El método clínico juega un papel trascendental a la hora de reconocer y registrar sus principales manifestaciones clínicas, su fisiopatología y etiología, y los exámenes complementarios que confirman su presencia o sus complicaciones. Se clasificaron formas variadas para protocolizar la conducta médica y garantizar la seguridad del paciente, en cuanto a: control de frecuencia, cardioversión, prevención de recurrencias y de la tromboembolia sistémica. El arma más poderosa ante el reto de la fibrilación auricular es la visión integradora y con enfoque individual y social, enarbolada por el médico en el largo y difícil camino que impone esta disritmia cardíaca (AU).
The auricular fibrillation is the most outstanding arrhythmia the general physician affronts. Tightly associated to ageing and chronic vascular disease, its presence is related to the risk of increasing the thromboembolic morbimortality. The objective of the work is consequently updating the clinic-therapeutic approach to auricular fibrillation. A bibliographic search was carried out in SciELO-Cuba, SciELO-regional, PubMed, CUMED and Clinical Key, looking for everything related to the theme in the period 2012-2015. The following key words were used: auricular fibrillation, diagnosis, therapeutics and integral care. The approach in auricular fibrillation is integral, multidisciplinary and individualized. The clinical method plays an important role at the moment of recognizing and recording the disease´s main clinical manifestations, physiopathology and etiology, and complementary tests confirm its presence or complications. Several forms were classified for standardizing medical behavior and ensuring the patient´s safety, in relation with frequency control, cardioversion, recurrence prevention and systemic thromboembolism. The most powerful weapon against the challenge of the auricular fibrillation is the integrative vision, with a social and individual view, hoisted by the physician in the long and difficult way this heart dysrhythmia imposes (AU).
Subject(s)
Humans , Atrial Fibrillation/diagnosis , Therapeutics/methods , Arrhythmias, Cardiac/complications , Review Literature as Topic , Cardiovascular Diseases/complications , Cardiovascular Diseases/diagnosis , Comprehensive Health Care/methods , General Practitioners/standardsABSTRACT
Un trombo móvil en la aurícula derecha implica un riesgo elevado de embolismo pulmonar y la presencia del mismo en un paciente con fibrilación auricular en el curso de un infarto agudo de miocardio, es infrecuente. Se presentó una paciente con infarto agudo de miocardio, fibrilación auricular y trombo móvil en aurícula derecha con riesgo embólico pulmonar, que desapareció luego de tratamiento antiagregante plaquetario y anticoagulante...
A mobile thrombus into the right auricle leads to a high risk of pulmonary embolism and its presence in a patient with auricular fibrillation during a acute myocardial infarction is uncommon. This is the case of a female patient presenting with acute myocardial infarction, auricular fibrillation and a mobile thrombus in right auricle with risk of pulmonary embolism, which disappeared after platelet, anticoagulant and anti-aggregating treatment...
Subject(s)
Humans , Female , Aged , Pulmonary Embolism/prevention & control , Atrial Fibrillation/etiology , Heparin/therapeutic use , Myocardial Infarction/complications , Platelet Aggregation Inhibitors/therapeutic use , Warfarin/therapeutic useABSTRACT
El tratamiento invasivo de la fibrilación auricular en pacientes con miocardiopatía dilatada con sospecha de taquicardiomiopatía representa una decisión difícil y controversial. En esta presentación se describe el caso de un paciente de 57 años, internado por insuficiencia cardíaca congestiva progresiva. En el electrocardiograma se evidenció fibrilación auricular de alta respuesta ventricular y en el ecocardiograma, miocardiopatía dilatada con deterioro grave de la función del ventrículo izquierdo e insuficiencia mitral grave sin compromiso orgánico valvular. Se descartó enfermedad coronaria. Se planteó la ablación por radiofrecuencia como la mejor alternativa para su cuadro. El paciente recuperó ritmo sinusal, con el cual permanece desde hace 2 años, con evolución asintomática y mejoría de todos los parámetros ecocardiográficos.
Invasive treatment of atrial fibrillation in patients with dilated cardiomyopathy and suspicion of tachycardia induced cardiomyopathy is a difficult and controversial decision. We describe the case of a 57 year-old patient who was hospitalized due to progressive congestive heart failure. The electrocardiogram showed atrial fibrillation with high ventricular response and the echocardiogram revealed the presence of dilated cardiomyopathy with severe left ventricular dysfunction and severe mitral regurgitation with no evidence of organic compromise of the mitral valve. Coronary artery disease was ruled out. Radiofrequency ablation of atrial fibrillation was the best option to treat the arrhythmia. Sinus rhythm was restored and the patient remains without arrhythmia 2 years after the procedure. He is asymptomatic and presents improvement of the echocardiographic parameters.
ABSTRACT
Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.
ABSTRACT
Objective: To calculate the prevalence of chronic auricular fibrillation (CAF), how much of it is considered high-risk (CAFhr) and the degree of coverage with oral anticoagulation treatment (OAT). Design: Multi-centre descriptive study. Setting: 9 health districts. The Terres de l'Ebre Primary Care Service. Participants: Randomised sample of 375 patients with CAF, of whom 150 met the criteria of CAFhr during 2002. Main measurements: Profile of patients with CAFhr; coverage with OAT; place of follow-up; presence of vascular complications; and the time relationships between the diagnosis of CAF, vascular complications and the start of OAT. All the INR determinations taken from the patients included in the study were used. Results: There was 2.2% prevalence of CAF (95% CI: 1.2-3.3). 40% of CAF had criteria of CAFhr. 74.2% were treated with OAT. In 41.7% the diagnosis of CAF coincided with the incidence of some vascular complication. There were no differences between the overall results of the INR obtained in hospital and in PC. The expected efficacy of OAT for thromboembolism prevention in our high risk sample was 61.12%. Conclusions: 40% of the CAF are high risk. In over a third of patients OAT was indicated after a vascular complication linked to a unknown CAF. The INR between 2-3 is similar in PC centres and the corresponding haematology service
Objetivo: Investigar la prevalencia de la fibrilación auricular crónica de alto riesgo (FACar) y su cobertura con tratamiento anticoagulante oral (TAO) y comparar los resultados a nivel primario y hospitalario. Diseño: Estudio descriptivo, multicéntrico, de selección al azar. Emplazamiento: 9 áreas básicas de salud. Participantes: 375 pacientes con FAC, de los que 112 reunían los criterios de FACar durante 2002. Mediciones principales: Perfil de pacientes con FACar, cobertura con TAO, lugar de seguimiento, presencia de complicaciones vasculares y la relación temporal entre el diagnóstico de FAC, las complicaciones vasculares y el inicio del TAO. Se utilizaron todas las determinaciones INR practicadas a los pacientes incluidos en el período de estudio. Resultados: La prevalencia de FAC es del 2.2% (IC 95%: 1.4-3.3). El 40% de las FAC tienen criterios de FACar en pacientes mayores de 64 años. Un 74.2% está tratado con TAO. En un 41.7% el diagnóstico de la FAC coincide con la incidencia de una complicación vascular. No hay diferencias en los resultados globales de los INR obtenidos en el hospital y en atención primaria. La efectividad esperada del TAO en la prevención tromboembólica en nuestra población de alto riesgo es del 61.12%. Conclusiones: El 40% de las FAC son de alto riesgo. En más de un tercio de los pacientes el TAO fue indicado después de una complicación vascular asociada a una FAC desconocida. Hay un retraso del TAO en su inicio. La proporción de INR entre 2-3 obtenida en los centros de atención primaria es similar a los del servicio de hematología de referencia.
Subject(s)
Humans , Primary Health Care , Atrial Fibrillation , Thromboembolism , Diagnosis , AnticoagulantsABSTRACT
@#ObjectiveTo compare the effect of amiodaron and propafenone on the cardioversion of paroxysmal auricular fibrillation (PAF). Methods58 PAF (≤48 h) cases were radomly divide into two groups: 30 cases who accepted amiodaron 150 mg intravenous injection, and 0.6～1.0 mg/min intravenous drip afterwards in amiodaron group, other 28 cases who accepted propafenone 1.4～2.0 mg/kg vein injection, and 0.28 mg/min intravenous drip afterwards in propafenone group.If propafenone was not effective, the cases in propafenone group were given amidoaron. ResultsThe successful reversion rate was 86.7% (26/30) in amidoaron group while 57.1% (16/28) in propafenone group(P<0.05). The mean time of recovering was (101±95) min (6～508 min) in amidoaron group, while (172±148) min (11～608 min) in propafenone group(P<0.05). ConclusionIt is more rapid and effective of amidoaron on the cardioversion of paroxysmal auricular fibrillation than propafenone is.
ABSTRACT
Objective To assess the therapeutic effects of Wenxin Pellet(Steady Heart Pellet) for congestive heart failure(CHF)patients suffered with paroxysmal auricular fibrillation(PAF).Methods Sixty four CHF patients complicated with PAF were randomly allocated into two groups: the treatment group(n=30) was treated with Wenxin Pellet and routine treatment,and control group(n=30) with routine treatment.After 12-week treatment,the walking distance within 6 minutes and ultrasonic cardiogram were observed,and the onset times of PAF and lasting time of PAF attack were monitored by 24-hour dynamic electrocardiogram.Results After treatment,the cardiac function in the two groups was improved,and the improvement in treatment group was superior to that in control group(P
ABSTRACT
Plasma levels of artial natriuretic polypeptide (ANP), cyclic GMP (cGMP), renin activity (PRA), angiotensin II (AT II) and arginine vasopressin (AVP) were measured by radioimmunoassay in 30 patients with acute heart failure (AHF), 30 chronic heart failure (CHF), 30 chronic atrial fibrillation (CAF) and 27 paraxysmal atrial fibrillation and supraventricular tachycardia (SVT). The results showed that plasma ANP and cGMP levels in all these four groups were significantly higher than those in the normal group (P