...Atrial fibrillation is a heart condition which can cause an abnormally fast and irregular heart rhythm (see appendix one). AF can be initiated when the normal impulses produced by the sinus node are overwhelmed by rapid electrical discharges from the atria and neighbouring parts of the pulmonary veins (Klabunde, 2005). Episodes of AF are not always accompanied by symptoms, however chest pains, palpitations and shortness of breath can occur sporadically. The exact causes of AF can be debated, however it may be more common in specific groups of people. People suffering with hypertension, atherosclerosis and heart valve disease may be more prone to experiencing AF (NHS, 2013). Genetics may also be a growing factor in the pathogenesis of AF (Hong and Xiong, 2014). Studies have shown that 30% of individuals with atrial fibrillation had parents with atrial fibrillation (Fox, 2004). Treatments for AF may differentiate between individuals due to factors such as age, overall health and type of AF. Cardiologists may first try to discard the possibility of any underlying triggers for AF, such as hyperthyroidism. The main risk factor for AF sufferers can be increased chance of strokes occurring, therefore treatments may usually include anticoagulant medicines such as warfarin. Cardioversion (electric...
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...structures on the plant. It is incredibly intricate in its function and there are multiple steps utilized in pumping blood through this organ. Because there are so many things that need to go right in order to do its job, that means there are multiple things that can go wrong. Cardiac disease is one of number one cause of death in America today. There are multiple different cardiac disorders but two important one are atrial and ventricle fibrillation. What is atrial fibrillation? The Mayo Clinic describes it as, “An irregular and often rapid heart rate that can increase your risk of stroke, heart failure and other heart-related complications.” When atrial fibrillation, or AFIB, the heart's two upper chambers known as the atria beat erratically. That means they are out of synchronization with the two lower chambers which are called the ventricles. This can cause symptoms often include heart palpitations, shortness of breath and weakness. Incidents of AFIB can happen at any time or it can develop into something that it doesn't go away and may require treatment. Atrial fibrillation itself usually isn't life-threatening but it should not be ignored. It has the possibility to turn into a serious medical condition that sometimes requires emergency treatment....
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...European Journal of Echocardiography (2011) 12, 421–430 doi:10.1093/ejechocard/jeq175 REVIEW Left atrial function: physiology, assessment, and clinical implications Gustavo G. Blume 1, Christopher J. Mcleod 1, Marion E. Barnes 2, James B. Seward 1, Patricia A. Pellikka 1, Paul M. Bastiansen 1, and Teresa S.M. Tsang 2* 1 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA; and 2Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada Online publish-ahead-of-print 12 May 2011 The interest in the left atrium (LA) has resurged over the recent years. In the early 1980s, multiple studies were conducted to determine the normal values of LA size. Over the past decade, LA size as an imaging biomarker has been consistently shown to be a powerful predictor of outcomes, including major public health problems such as atrial fibrillation, heart failure, stroke, and death. More recently, functional assessment of the LA has been shown to be, at least as, if not more robust, a marker of cardiovascular outcomes. Current available data suggest that the combined evaluation of LA size and LA function will augment prognostication. The aim of this review is to provide a critical appraisal of current echocardiographic techniques for the assessment of LA function and the implications of such assessment for prediction and disease prevention. ------------------------------------------------------------------...
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...occupational therapist and also accompany her during a home visit. A few of the health conditions that I came across that benefit from occupational therapy include limitations following a stroke or heart attack, arthritis, multiple sclerosis, or other serious chronic conditions, spinal cord injuries, or amputations, broken bones or other injuries from falls. Occupational therapists provide a service that is customized to improve a person's ability to perform daily activities. Occupational therapists use a variety of interventions including biofeedback, relaxation, goal setting, problem solving, planning in order to rehabilitate patients. During the home visit we visited an 87year-old gentleman with a history of falls, cardiac failure, atrial fibrillation and dementia. The patient felt dizzy when he stood up and at one point burned himself while standing next to the radiator and did not notice the injury, he also struggled to carry out activities of daily living like getting in and out of the bath, in and out of bed and going up the stairs. The occupational therapist played a fundamental role to ensure safety of this patient. The patient was offered a hand rail in the bath to help when standing up, rails along the stairs so he could hold on to when going up and down the stairs. A stool to sit on while in the bath, a mat to prevent slipping. She also offered the patient to raise his arm chair in order to make it easy to stand up and also raise the bed to make it easier so get in and...
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...Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: a systematic review and meta-analysis. Lip GY, Edwards SJ. Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK. g.y.h.lip@bham.ac.uk Abstract OBJECTIVE: To compare the effectiveness of aspirin, warfarin, and ximelagatran as thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF). METHODS: Systematic review of randomised controlled trials in patients with NVAF treated with adjusted-dose warfarin and aspirin, fixed low-dose (FLD) warfarin, ximelagatran or placebo. Outcome measures studied were ischaemic stroke, systemic embolism, mortality and haemorrhage. Meta-analysis was performed using a fixed effects model. RESULTS: We identified 13 trials (n=14,423 participants) of sufficient quality to be included in the analysis. Adjusted-dose warfarin significantly reduced the risk of ischaemic stroke or systemic embolism compared with aspirin (relative risk [RR] 0.59; 95% confidence interval [CI]: 0.40 to 0.86), FLD warfarin (RR 0.36; 95% CI: 0.23 to 0.58), or placebo (RR 0.33; 95% CI: 0.24 to 0.45). However, aspirin and placebo had a lower risk of major bleeding compared to warfarin (RR 0.58; 95% CI: 0.35 to 0.97 and RR 0.45; 95% CI: 0.25 to 0.82, respectively). The oral direct thrombin inhibitor, ximelagatran was as effective as adjusted-dose warfarin in the prevention of ischaemic strokes...
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...Atrial Fibrillation Seminar Case 1 CC: “My chest seems to be pounding fast and it will not go away” HPI: MJ is a 66-year-old Caucasian male who presents to his PCP because of increased chest palpitations. The patient stated that he started feeling chest palpitations about 2 weeks ago. At first he barely noticed them and attributed them to some bad heartburn from eating too much spicy food. However, the palpitations have become progressively more prominent over the last 4-5 days and therefore the patient thought he should visit the doctor. The patient states that he has had no recent medication changes and has been on the same medication regimen for about 2-3 years now. The patient also stated that he felt similar chest pounding about 4 months ago but it seemed to go away really quick and decided he did not need to do anything about it. PMH: Meds: DM Type 2 ASA 81 mg PO daily HF (LVEF ~35%) (13 years ago) Furosemide 20 mg PO daily HTN KCL 10 mEq PO daily s/p MI (16 years ago) Lisinopril 20 mg PO daily Hypercholesterolemia Atorvastatin 40 mg PO daily Gout Metoprolol succinate XL 25 mg PO daily Glipizide XL 20 mg PO daily Allopurinol 150 mg PO daily Allergies: NKDA SH: Lives with wife; employed as a construction foreman; quit drinking alcohol after HF diagnosis; quit tobacco after MI; tries to stay active and does moderate exercise at the gym at least 3 times/week. Plays golf every other weekend. FH: non-contributory Today’s...
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...(Figueroa & Peters, 2006). 2. Digoxin toxicity, Digoxin toxicity is caused by high levels of digoxin in the body a drug Mr Marshall is currently prescribed. His digoxin levels are 2.4 ng/mL and the therapeutic range is 0.6 to 1.3 ng/mL showing increased levels beyond the therapeutic range (Chan, Bradley & Harrigan, 2002). Mr Marshall’s irregular pulse as well as his nausea and vomiting are clinical symptoms of digoxin toxicity (Ehle, Patel, Chandni & Giugliano, 2011). Question 1.2 Explain why Mr Marshall is prescribed the following medications in relation to his past medical history. Include in your response the related medical condition, drug action and category. Digoxin; this medication is prescribed to Mr Marshall to treat atrial fibralation a past condition of the patient....
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...Introduction For the purpose of this assignment I have chosen to review a client with atrial fibrillation in a primary care setting. I will discuss the patient’s original presentation, including analysis and interpretation of his 12 lead electrocardiogram (ECG), diagnosis and subsequent management. Throughout the assignment I will discuss local and national guidelines and the evidence behind the chosen management for this client. For the purpose of this assignment the client will be referred to as Mr. Jones. Cardiac arrhythmias affect more than 700,000 people in England is one of the top ten reasons for hospital admission (Department of Health 2005). Atrial fibrillation (AF) is the most common and important cardiac arrhythmia, it the most common of all the arrhythmias seen in general practice. AF affects 5% of the UK population over the age of 65 years, rising to 10% in those over 75 years of age (Kirby 2005). The principal significance, both to the patient and the healthcare system is the increased risk of embolic stroke. Atrial fibrillation is associated with 15% of all strokes and with 36% of strokes in patients over the age of 60 (Hobbs 1999). Having a diagnosis of AF increases the risk of stroke five fold. It is an arrhythmia associated with serious morbidity, mortality and health service utilisation. AF and its complications now consume 1% of the United Kingdom National Health Service budget (Watson, Shanstila, and Lip 2007). Despite this it is an area that frequently...
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...CASE STUDY: Mrs. F., a 56 year old Caucasian woman, was admitted to the Cardiac Step-Down unit with complaints of increasing shortness of breath on exertion, weight gain of 10 pounds in the last month, and difficulty sleeping without sitting straight up on three pillows. History: CABG X 2 with aortic value replacement in 1991, mitral valve regurgitation, HTN, CHF, hyperlipidemia, Type II DM, asthma, DJD, anxiety, and recently diagnosed with sleep apnea following 3 sleep studies with a CPAP prescribed at HS. Mrs. F. works as a cosmetologist instructor. She states she has been unable to walk across the school campus without stopping several times to “catch her breath”. She states she has faithfully been taking her medications. She has not been sick or around anyone with any type of infection recently. Assessment: Neurological- able to follow commands, moves all extremities without difficulty, A&OX3. Respiratory-Lungs sounds are diminished in all lobes both anteriorly and posteriorly. No wheezing or crackles present. Respirations are 20 with noted use of accessory muscles. SATs are 96% on 4L of O2 via nasal cannula. Cardiovascular-Heart rate is regularly-irregular at 65 bpm. Telemetry monitor shows NSR with controlled a fib. Trace pitting edema in noted bilaterally in the lower extremities. GI-Patient is obese. Abdomen is slightly distended. Last BM was this am. A cardiac, 1800 ADA diet is prescribed. GU-Patient voids clear yellow urine without difficulty...
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...Atrial Fibrillation And Nursing Considerations As a nurse one must provide holistic care. To better understand aspect of providing holistic nursing care one must have an in-depth understanding of primary body systems and their pathology. This paper will educate the prudent nurses who read it with detailed information about the specific cardiac pathology of atrial fibrillation. Written with a basic understanding of human heart function/structure as a prerequisite, this paper will first discuss key terms one must be familiar with before providing researched information explaining the pathophysiology of atrial fibrillation (AF). Next, it will discuss the etiology, clinical manifestations, common laboratory diagnostics, and interventions. Lastly, this paper continues by providing readers with nursing diagnoses and patient teachings associated with AF. Key Terms As a nurse one must become a scientist of sorts and must be familiar with technical nursing terminology. Atrial fibrillation, or AF, is a cardiac dysrhythmia in which “multiple rapid impulses from many atrial foci depolarize the atria in a totally disorganized manner at a rate of 350 to 600 times per minute” [ (Ignatavicius & Workman, 2010) ]. A dysrhythmia is a disorder of the heartbeat involving a disturbance in cardiac rhythm and an irregular heartbeat; whereas an arrhythmia is basically a fast or irregular heartbeat caused by a disorder in the heart's electrical system. Tachydysrhythmia is an abnormal...
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...Adult Cardiology 11th Floor POB Adult Cardiology at RUMC • Treat a variety of congenital and chronic cardiac conditions – Range in acuity • Has 8 specialized programs that focus on disease and prevention • Ranked 21st in the nation by U.S. News and World Report Clinical Staff • 20 Cardiology M.D.s at Rush – 2 Cardiology M.D.s at Rush Oak Park Hospital • 1 Nurse Practitioner • 2 Check-In Clinic Coordinators • 3 Discharge Clinic Coordinators • 5 Certified Medical Assistants • 2 Call Center Coordinators • 3 Registered Nurses – Coumadin Clinic – Phone Triage Physician Education • Medical Degree or Doctor of Osteopathic Medicine • Residency in Internal Medicine – 3 years • Cardiology Fellowship Training – 3-4 years per ACGME guidelines 4 Outpatient Clinic Volumes • On average the clinic will see between 115-140 per day • Staffed with 5-7 Attending seeing patients per day • Roughly a patient volume of 29,000 outpatient visits per year – Monday-Thursday: 115-150 patients – Friday: 80 patients Outpatient Check-In Patients are greeted by two Clinic Coordinators • Verify patients appointment by asking for their name and date of birth • Scan a copy of patients insurance card • If the patient has not verified their insurance with hospital Registration prior to appointment, they would do so at this time • Patient is called to their clinic room by Medical Assistant Check-Out Cardiology utilizes 3-4 Clinic Coordinators who check out patients following...
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...Complete Assessment of Mr. Smith Jackie McManus University of Missouri Saint Louis Biographical Data Thomas Smith is a 95-year-old Caucasian male who resides in Saint Charles Missouri. He was born in Saint Louis on June 29, 1917. He is currently married to his wife of 71 years. He is retired from appliance sales and general maintenance. He has lived in Saint Charles, Missouri his entire life except for four years when he served in the United States Army during World War II. While he was in the Army he served in Germany, this was the only time Mr. Smith has been outside the United States. Source and Reliability Mr. Smith and his daughter Lynn are my source of information to complete my assessment. Lynn has been a nurse for 40 years and is his durable power of attorney, making any medical decisions. She cares for her parents daily by planning their evening meals and setting out their daily meds. Reason for Seeking Health Care Mr. Smith is seeking healthcare for follow up due to recent falls at home and increased weakness. He complained of weakness in his legs and states that his legs “give out”. He states that his weakness started a couple days prior to going to the hospital and gradually got worse. He was admitted for observation and test where run to determine a mild stroke. History Mr. Smith is in generally good health. He is 6 feet 1 inch and weighs 175 pounds. He is getting stronger and is feeling better after his stroke. He states that he has an allergy to...
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...COVER ARTICLE PRACTICAL THERAPEUTICS Acute Management of Atrial Fibrillation: Part I. Rate and Rhythm Control DANA E. KING, M.D., LORI M. DICKERSON, PHARM.D., and JONATHAN L. SACK, M.D. Medical University of South Carolina, Charleston, South Carolina Atrial fibrillation is the arrhythmia most commonly encountered in family practice. Serious complications can include congestive heart failure, myocardial infarction, and thromboembolism. Initial treatment is directed at controlling the ventricular rate, most often with a calcium channel blocker, a beta blocker, or digoxin. Medical or electrical cardioversion to restore sinus rhythm is the next step in patients who remain in atrial fibrillation. Heparin should be administered to hospitalized patients undergoing medical or electrical cardioversion. Anticoagulation with warfarin should be used for three weeks before elective cardioversion and continued for four weeks after cardioversion. The recommendations provided in this two-part article are consistent with guidelines published by the American Heart Association and the Agency for Healthcare Research and Quality. (Am Fam Physician 2002;66:249-56. Copyright© 2002 American Academy of Family Physicians.) I Members of various family practice departments develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family Medicine at the Medical University of South Carolina. Guest editor of the series is ...
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...Introduction Pharmacology of Advair Diskus Fluticasone Propionate (FP), a component of Advair Diskus, is a corticosteroid primarily used in the treatment of asthma, allergic rhinitis (AR), or chronic obstructive pulmonary disease (COPD).1,2,3,4 In patients with allergic rhinits, is it most often used intranasally, falling under the class of “intranasal corticosteroids”, or INS.3 However, in the case of asthma, the drug is classified as an “inhaled corticosteroid” or ICS.5 Typically short-acting β2 adrenoreceptor agonists are used to rapidly treat the symptoms of asthma, but corticosteroids like FP are utilized when long-term contol is required.6 FP has been obsered to have synergistic effects when used in co-therapy with these short-acting β2 adrenoreceptor agonists, yielding a greater improvement in lung treatment and symptom control than when either of the two drugs is adminstered alone.6 The corticosteroid drug class has been around since the 1950s with some degree of success, but high toxicity. In 1973 beclomethasone was successfully developed as a pressurized aerisol with virtually zero side effects, and the field has since revolved around developing more potent molecules with better safety profiles.3 Modern INSs and ICSs are largely regarded as the best examples of using chemical structure modification to yield optimal therapeutic effects, as they have a near perfect therapeutic index.3 In particular, pulmanory drug delivery leads to an imporoved safety index, largely...
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...Atrial fibrillation By Mark DeVries Fibrillation of the Heart For English 101 Teacher Pat Moran C.T.U. 03/10/2013 Atrial fibrillation is affecting millions of Americans today. This condition is of great concern, because most Americans afflicted with this disease don’t know they have it. This is a condition of heart disease called atrial fibrillation. The Mayo Clinic (2012) defines it as “an irregular and often rapid heart rate that commonly causes poor blood flow to the body”. This condition is where the four parts of the heart don’t work in rhythm. The upper two chambers basically miss fire, causing an abnormal beat or missed beat. This can lead to a blood clot forming in the top of the heart, greatly increasing the chances of a stroke. The heart is controlled by electrical impulses from the brain; which regulates the way your heart works. While in atrial fibrillation also known as AFIB. This condition of the heart causes a lack of oxygen and nutrients to travel to the extremities of the body. The symptoms can be common or uncommon, along with risk factors that contribute to the disease. Thankfully with the advancement in medicines, treatment today is very possible and effective. AFIB is becoming more prevalent in Americans today; although it’s a serious disease with a high mortality rate, with today’s medicines and treatments this condition can be found and controlled. Generally most people don’t even notice that they have a problem with AFIB; however there...
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