Utilización de la anticoagulación en fibrilación auricular no reumática para profilaxis de accidentes cerebrovasculares / Use of anticoagulation in non-rheumatic atrial fibrillation for stroke prevention

INTRODUCCIÓN: la fibrilación auricular es la arritmia cardiaca sostenida más frecuente. Se asocia con tasas aumentadas de morbilidad y mortalidad por accidente cerebrovascular y otros trastornos tromboembólicos, para lo que está indicado el uso profiláctico de tratamiento antitrombótico, según la valoración por escalas de riesgo (CHA2DS2­VASc). OBJETIVO: determinar la frecuencia de utilización de la anticoagulación en la fibrilación auricular no reumática para profilaxis de trastornos tromboembólicos. MÉTODOS: se realizó un estudio observacional descriptivo retrospectivo en pacientes con fibrilación auricular atendidos en el Hospital "Hermanos Ameijeiras" aplicando la escala de riesgo para enfermedad tromboembólica CHA2DS2­VASc. Se aplicaron pruebas estadísticas descriptivas. RESULTADOS: de 89 pacientes con fibrilación auricular, la edad promedio fue 77,1 ± 9,5 años, hubo predominio del sexo masculino (56,2 %). El factor de riesgo que más se asoció a la fibrilación fue la hipertensión arterial en 71,9 % de los casos. Al aplicar la escala de riesgo, se clasificaron como de alto riesgo 88 pacientes, de los que no recibió tratamiento el 69,3 %, con antiagregación simple el 15,7 %, con antiagregación doble el 1,1 % y solo en el 13,6 % se empleó la anticoagulación. Ningún paciente con fibrilación auricular de alto riesgo para trastornos tromboembólicos tuvo puntuación mayor de 3 y, por lo tanto, sin contraindicación para el uso de anticoagulantes, según la escala de riesgo de sangrado HAS-BLED. CONCLUSIÓN: es insuficiente el uso de la anticoagulación oral en los pacientes que ingresan en nuestro servicio con el diagnóstico de fibrilación auricular y alto riesgo de accidente cerebrovascular.

INTRODUCTION: atrial fibrillation is the most common sustained cardiac arrhythmia. It is associated with increased morbidity and mortality from stroke and other thromboembolic disorders. A antithrombotic treatment is indicated for prophylactic use, as assessed by risk scores (CHA2DS2-VASc). OBJECTIVE: determine the frequency of anticoagulation use in non-rheumatic atrial fibrillation prophylaxis of thromboembolic disorders. METHODS: a retrospective observational study was conducted in patients with atrial fibrillation treated at Hermanos Ameijeiras Hospital applying the risk scale for thromboembolism CHA2DS2-VASc. Descriptive statistics tests were applied. RESULTS: out of 89 patients with atrial fibrillation, the mean age was 77.1 ± 9.5 years, there was a predominance of males (56.2 %). The risk factor most frequently associated with atrial fibrillation was hypertension in 71.9 % of cases. In applying the risk scale, 88 patients were classified as high risk, 69.3 % of them received no treatment, 15.7 % had single antiplatelet therapy, 1.1 % had dual antiplatelet therapy, and only 13.6 % had anticoagulation. No patients with atrial fibrillation at high risk for thromboembolic disorders had a higher score of 3 and, therefore, there was no contraindication for the use of anticoagulants, according to the bleeding risk scale HAS-BLED. CONCLUSION: it is insufficient the use of oral anticoagulation in patients admitted to our service with a diagnosis of atrial fibrillation and high risk of stroke.

Effect of Health Education on Compliance of Senile Non-rheumatic Atrial Fibrillation Patients Receiving Anticoagulative Drug Treatment / 中国康复理论与实践

@#Objective To investigate the effect of health education on compliance of the senile non-rheumatic atrial fibrillation patients receiving anticoagulative drug treatment.Methods 188 senile inpatients with on-rheumatic atrial fibrillation and receiving anticoagulative drug treatment were given the health education in three different manners:group instruction,individual instruction and self-study in the hospital for three to four weeks by a team consisted of nurses and doctors.Results After education,the average test scores were higher than before education(P33<0.05).The self-care skill and knowledge such as self-monitor of bleeding were improved.Conclusion Health education is an important method for the senile patients to learn anticoagulative knowledge and improve the ability of self-management.

A Study of Pure Aortic Valvular Stenosis in Adult

BACKGROUND: There has been a change in the causes of aortic stenosis when comparence of rheumatioc aortic stenosis in recent year. Therefore, we studied the etiology factor of pure aortic stenosis. METHODS: The gross surgical pathologic features of the aortic valves were reviewed in 92 patients with pure aotic stenosis whom underwent aortic valve replacement at Yonsei University, Cardiovascular center between July 1989 and June 1994. RESULTS: The three most frequent causes were 1) calcification of congenital bicuspid valve in 30%, 2) degenerative calcification of aortic valve in 22%, 3) rheumatioc valvular change in 48%. The mean age at the time of aortic valve replacement for the entire series of patients was 54.4 years. The range of age was from 18 years to 77 years. Males predominated for degenerative disease and congenital bicuspid valves, but there were reversed rheumatic origin. One or more complications occured in 17% of patients undergoing operation. The surgical mortality was 3.3%. CONCLUSION: Our data suggest that more common cause of aortic stenosis is non-rheumatic disease rather than rheumatinc origin.

A Study of the Assessment of Left Vertricular Function in Non-Rheumatic Aortic Stenosis after Aortic Valve Replacement

BACKGROUND: The nature of depressed left ventricular ejection performance in chronic pressure-overload hypertrophy due to aortic stenosis is controversial. Patients with aortic stenosis and congestive heart failure who responded well and those who responded poorly to aortic valve replacement may represent two distinct groups, rather than opposite ends of a spectrum. Whereas excess afterload accompanied by inadequate hypertrophy of functioning cardiac muscle was been suggested as the cause of impaired left ventricular shortening, intrinsic depression of contractility of the hypertrophied myocardium was also been considered, at least in part, to be the cause of altered ejection performance. METHOD: We studied 20 patient with non-rheumatic aortic stenosis using echocardiogram and cineangiocardiography. The patients were divided into two groups according to the level of LVEF and New York Heart association [NYHA] functional class. In group 1, 7 patients had an echocardiographically determined LVEF less than 40% and clinical presentation of severe congestive heart failure(NYHA functional class III or IV). In group 2, 13 patients had LVEF more than 40% and NYHA functional class I or II. Left ventricular volumes and ejection fraction were determined from the echocardiogram obtained in short axis view. As a measure of left vertricular afterload, meridional end-systolic wall stress was calculated. This method is based on the determination of end-systolic left ventricular dimension, wall thickness and peak systolic pressure. RESULTS: 1) End-systolic meridional wall stress was significantly elevated in the patient with aortic stenosis & severe congestive heart failure(group 1) compared with the patient with aortic stenosis and mild congestive heart failure(group 2)(320.09+/-72.09 vs 177.52+/-76.43 dyne x 10(3)/cm2, p<0.005). With group 1 and group 2, there was a significant inverse linear relationship between LVEF and end systolic meridional wall stress(r=-0.907, p<0.001). 2) There was significantly more decreased ratio of end-systolic meridional wall stress to end-systolic volume index(ESWS/LVESVI) of group 1 than that of group 2(5.64+/-2.65 vs 15.30+/-7.77 dyne x 10(3)cm2/ml/m2, p<0.05). And there was a significant linear relationship between LVEF and end-systolic meridional wall stress to end-systolic volume index(ESWS/LVESVI)(r=0.86, p<0.001). 3) Twenty of 20(100%) survived after surgery : 19 of these 20 showed clinical improvement. There was significant improvement of ejection performance(LVEF, % FS) in group 1 except from 1 patient(LVEF 35.43+/-6.90 VS 47.29+/-3.45%, % FS 18.76+/-4.87 vs 28.20+/-3.40, p<0.05). CONCLUSION: Thus, both altered contractility and increased afterload are operative in depressed left vertricular ejection performance in patients wth aortic stenosis ; which one predominates may have major prognostic importance. We found encouraging results for aortic valve replacement in patient with depressed preoperative left ventricular function. The majorty of patients in this series had left ventricular failure because of excessive afterload predominantly.