...that I chose is whether or not alcohol consumption of moderate quantities, and binge drinking, are associated with a higher risk of incident atrial fibrillation in a large cohort of people who already have cardiovascular disease or diabetes with end-organ damage. The type of study used was a cohort study, most likely a prospective cohort study. The cohort studied patients who had no heart failure and were at a high risk for cardiovascular events. Alcohol consumption was determined by a questionnaire. Regular alcohol consumption was considered to be at least one drink/week of a standard glass of beer, wine, or shot. Moderate consumption was up to 2 drinks/day or 1-14 drinks/week for women and 3 drinks/day or 1-21 drinks/week for men. High consumption was more than 2 drinks/day for women and more than 3 drinks/day for men. Binge drinking was defined as having more than 5 drinks/day. The exposed group was the level of alcohol consumed. The not exposed group were those who consumed one drink/week or less. The outcome was whether or not the participant suffered an atrial fibrillation. The no-outcome group was those who did not suffer any atrial fibrillations. The measure of association used for this study was the incident rate, which is the number of incident cases divided by the person-time. The incidence rate of atrial fibrillation for the low-level alcohol consumption group was 14.2 per 1000 person-years. The incidence rate in the moderate drinker group was 17.5 per 1000...
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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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...drug is required to cause muscle contraction opposite to the muscle relaxation, as was caused by the dose of anaesthesia. Some of the common side effects associated with the drug use are nausea, vomiting, diarrhoea, stomach cramps, involuntary urination, faintness, muscle cramps or twitching. These symptoms however, due not require any medical treatment. Some other severe problems associated with this drug are slow heart rate, shortness of breath, severe rashes, irritation, swollen face , convulsions, etc. these however, require immediate medical attention. After Vercuronium, a dose of 1.25mg of Neostigmine is very ineffective. A minimum dose of 2.5mg or 5mg is required to produce the desired effect. Neostigmine should not be used in case of Asthma, Epilepsy, Low blood pressure, Parkinson’s disease, Peptic ulcers, People with recent heart attacks, etc....
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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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...Effects of Disease on the Health Care Industry: Cardiovascular disease HCS/245 Patricia Talbert Due: 03/16/2015 University of Phoenix Material Effects of Disease on the Health Care Industry: Cardiovascular Health Complete the table below for 2 diseases that you have chosen that affects cardiovascular health. In each box, you are required to list 3-5 bulleted statements regarding the heading of that box. Cite your sources using APA format. This section is due in Week Three. |Chosen Cardiovascular Disease |Treatment Modalities |Cultural Beliefs/Practices |Epidemiological Statistics |Available Consumer Resources |Impact on Society | |or Disorder | |Affecting this Disease | |(ex. financing, information, support) | | |Coronary Artery Disease |Quitting smoking and avoiding |Heart disease is a man's disease. |Cardiovascular diseases cause |The CDC addresses heart disease. Great |According to the Centers for Disease | | |secondhand smoke. |(MYTH) |nearly one-third of all deaths |source for researching information. |Control and Prevention, heart disease | | | | ...
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...Atrial Fibrillation Pathophysiology March 20, 2016 Introduction Atrial Fibrillation, commonly known as A-Fib or AF, is the most common type of persistent cardiac arrhythmia. AF effects only 2% of the population under the age of 65, but 9% of those over the age of 65 (Centers for Disease Control and Prevention [CDC], 2015). Many other cardiac diseases are seen with AF, either as a cause, or as a result of the atrial fibrillation. Left untreated, AF can result in tachycardia that causes ventricular dysfunction and/or heart failure, along with a significantly increased risk of thromboembolic stroke. I recently conducted an interview with my father who has had AF for nearly 20 years and I compared my findings in the literature against his experiences with the disease. Pathophysiology Atrial Fibrillation is a supraventricular tachyarrthymia. In the heart, ventricular rate is controlled by the conduction and refractory properties of the AV node and the progression of wave fronts entering the AV node. Calcium channels are accountable for the major depolarizing current in AV nodal cells. Beta-adrenergic receptor stimulation boosts AV nodal conduction, whereas vagal stimulation impedes AV nodal conduction. Sympathetic activation and vagal withdrawal, as with illness or exertion, speeds up the ventricular rate. After each atrial excitation wave that depolarizes AV nodal tissue, those cells become refractory for a time, preventing subsequent impulses from propagating...
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...Running Head: CASE STUDY IN INEFFECTIVE PHARMACOLOGICAL MANAGEMENT Case Study in Ineffective Pharmacological Management Southern University A&M College Graduate Nursing 652 Dr. Blair April 23rd, 2015 Introduction In the case study of Mr. J; he has been exhibiting dyspnea upon exertion and fatigue. His blood pressure was 170/95 mmHg. After reviewing his labs; his LDL level was 200 mg/dl. Upon physical examination, he was found to have peripheral edema and jugular vein distention. A chest X-ray revealed cardiomegaly and pleural effusion. An echogram has also been scheduled. Based on his signs and symptoms, the physician suspects Mr. J has new onset Stage C heart failure. Mr. J has multiple prescribed drugs for Hypertension, Hyperlipidemia, Parkinson’s, Gout and Depression. After careful reviewing Mr. J’s medications there is concerns ineffective pharmacological management. Ineffective pharmacological management refers to medication therapy prescribed that does not take into account the patient’s age, diagnoses and comorbidities; therefore leading to complications of existing health problems. Side effects, adverse reactions and drug to drug interactions have to also be considered when reviewing a patient’s medication regimen. The drug categories most commonly involved in adverse reaction are cardiovascular agents, antibiotic, diuretics, anticoagulants, hypoglycemic, steroids, opioids, anticholinergic...
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...Transforming an Electrophysiology Practice To Impact Timeliness of Care Studies of the U.S. healthcare system have indicated that timely access to appropriate providers improves the delivery, quality, and outcomes of care. Conversely, delayed or limited access contributes to patient/provider frustration, poorly coordinated care, unnecessary emergency room visits, and potential increases in the burden and cost of disease. A recent high-profile crisis in health care focused on prolonged and unfair wait times at Veterans Health Administration (VHA) facilities that led to potentially preventable morbidity and mortality. In response to this, the Institute of Medicine (IOM) was commissioned by the VA to understand experiences and opportunities throughout the nation related to the scheduling of and access to health care. In a very recent publication from October 2015, the IOM summarized their findings and established that inappropriate scheduling practices are a systemic problem across the entire nation and called for an end to arbitrary scheduling standards, for more transparency, more accountability, and for more attention to be paid to the “corrosive culture” that led to the manipulation of data in the system (1). The report also concludes that opportunities exist to implement enhanced practices and strategies. Appropriate Access To Care Within 48 Hours has been identified as one of the top priorities of the Spectrum Health System. To measure access, Spectrum Health uses...
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...Adult ACLS 2010 อ.นพ.อนทนนท อมสุวรรณโครงการจัดตัวรรณ โครงการจัดตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คดตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยงภาควชาเวชศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยรฉุกเฉิน คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์àeกเฉุกเฉิน คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์àeน คณะแพทยศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยร มหาวทยา"ยธรรมศาสุวรรณโครงการจัดตัตั้งภาควิชาเวชศาสตร์ฉุกเฉิน คณะแพทยร Key changes from the 2005 ACLS Guidelines Continuous quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal t ube placement Cardiac arrest algorithms are simplified and redesigned to emphasize the importance of hig h-quality CPR Key changes from the 2005 ACLS Guidelines Atropine is no longer recommended for routine use in the management of PEA/asystole There is an increased emphasis on physiologic monitoring to optimize CPR quality and detec t ROSC Key changes from the 2005 ACLS Guidelines Chronotropic drug infusions are recommended as an alternative to pacing in symptomatic and unstable bradycardia Adenosine is recommended as a safe and potentially effective therapy in the initial mana gement of stable undifferentiated regular mono morphic wide-complex tachycardia Topic in ACLS 2010 Management Management of Cardiac Arrest of Symptomatic Bradycardia and Tachycardia Management of Cardiac Arrest Management of Cardiac...
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...Use of Intravenous Heparin by North American Neurologists Do the Data Matter? Ahmad Al-Sadat, MD; Mohammad Sunbulli, MD; Seemant Chaturvedi, MD Background and Purpose—Our aim was to determine current usage patterns of intravenous heparin for patients with acute ischemic stroke. Methods—A survey was undertaken of 280 neurologists from the United States and 270 neurologists from Canada. Brief vignettes were presented for the following 5 scenarios: stroke in evolution, atrial fibrillation-related stroke (A FIB), vertebrobasilar stroke, carotid territory stroke, and multiple transient ischemic attacks. The effect of medicolegal factors was also ascertained. Statistical comparisons were done with chi-squared testing. Results—US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin for patients with stroke in evolution (51% versus 33%, P0.001), vertebrobasilar stroke (30% versus 8%, P0.001), carotid territory stroke (31% versus 4%, P0.001), and multiple transient ischemic attacks (47% versus 9%, P0.001). The vast majority of US and Canadian neurologists would use intravenous heparin for acute stroke patients with A FIB (88% and 84%, respectively). US neurologists more often cited medicolegal factors as a potential influence on the decision-making process than Canadian neurologists (33% versus 10%, P0.001). Conclusions—In several clinical scenarios, US neurologists were significantly more likely than Canadian neurologists...
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...Dark chocolate keeps getting better and better, and I’m not just talking about its taste. It is well known dark chocolate has beneficial effects on cardiovascular health. What you may not know is that a recent study has found chocolate may prevent the development of atrial fibrillation (AF). Mostofsky et. al published a prospective cohort study that found an association between moderate chocolate intake and a lowered risk of AF.1 This isn’t just great news for chocolate lovers, but also for individuals who want to maintain their cardiovascular health. Especially since AF is the most common irregular heart rhythm, affecting over 350,000 Canadians.2 AF is characterized by an irregular heart rhythm, also known as an arrhythmia, which originates in the atria of the heart.2 In a normal heart rhythm, an electrical impulse is generated in the sinoatrial node which travels to the atrioventricular node and then to the ventricles.2 This electrical impulse allows the atria and ventricles to contract to pump blood through the heart.2 In AF the electrical signals are highly disorganized and rapid, resulting in ineffective atrial contraction and an irregular ventricular rhythm.2 Clots may form in the atria, because of the...
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...Biol 1120 Cardiovascular Case Study Name ______________________________________________ A 32-year old nurse who has rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary congestion. Cardiac evaluation resulted in the following information: Cardiac output (CO) 3.2L/min. SV = 40mls Blood pressure (BP) 100/58 mm Hg Left Atrial pressure (LAP) 16 mm Hg Right ventricular pressure (RVP) 44/8 mm Hg Heart sounds revealed valvular regurgitation 1. Answer all questions with material that explains your answer. Yes/no answers receive NO credit. 2. Submit this as a hard copy double spaced typed paper. 3. Total possible 25 points 1. Based on the information provided, which A-V valve is incompetent? Why did you choose this set of valves? What is this condition called? (3pts) Based on the information it looks like the mitral valve is incompetent. According to Web MD, the mitral valve is a valve that lets blood flow from one chamber of the heart, the left atrium, to another called the left ventricle. The mitral valve is most likely to blame here for the regurgitation because of the left atrial and left ventricular problems, which allowed the backflow into the left atrium. This patient’s mitral valve is malfunctioning, this condition is called mitral valve prolapse. Mitral valve prolapse...
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...Stroke Case Study Scenario: You are at base when you get dispatched code 4 to 100 Me She Ka St, Christian Island, Ontario for a 75 y/o female patient possible CVA. On arrival you find a frantic husband stating the patient (his wife) was making breakfast when she suddenly collapsed. The symptoms started 10 minutes prior to calling 911. The patient is suffering from left sided paralysis with slurred speech. She lives on Christian Island and needs to take a ferry to get to the nearest hospital. She has a history of atrial fibrillation and TIA’s, and the patient also smokes 2 packs of cigarettes a day. She’s on ASA, digoxin, ramipril, metoprolol. She has an allergy to penicillin and bee stings. The patient shows a-fib on the monitor and vital signs and GCS are normal. Pupils are PEARL at 3mm. Patient name: Myrtle Bellamee Birthday: 1938/01/10 Health card number: 1284569735 VR Treatment with the Ontario Stroke Strategy The Ontario Stroke System (OSS) is a comprehensive and integrated approach that aims to decrease the incidence of a stroke and improve patient care and outcomes for those who’ve experienced a stroke. The treatment plan that Mrs Myrtle Bellamee would have been on before this incident would be a very common strategy due to her history of cerebrovascular accident (CVA) or a stroke, atrial fibrillation and her previous transient ischemic attack (TIA). She would have been on a low dose antiplatelet...
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...Case Study James Morasco College of Southern Nevada – Nursing 211 Clinical Professor Judith Alewel, MSN, RN October 15, 2012 Introduction AV is a 57 year old male whom presented to the Emergency Department of Valley Hospital Medical Center in Las Vegas, NV on September 7, 2012 with the classic signs and symptoms of a left-sided middle cerebral artery (MCA) infarct and was admitted to the medical intensive care unit (MICU). These signs included left sided facial drooping, non-reactive left pupil, right sided weakness in the upper and lower extremities, and the inability to speak. Along with the signs and symptoms of the stroke, a 12-lead EKG revealed that he also has atrial fibrillation. The initial computerized tomography (CT) scan of his brain revealed nothing, but a subsequent MRA (magnetic resonance angiogram) concluded that he did, in fact, have an occluded branch of the left MCA that eventually converted to become hemorrhagic and he was admitted to the MICU. The MRA also found a persistent left trigeminal artery, which is insignificant to his presenting disease process. Along with all of this, a two dimensional echocardiogram revealed some significant hearts problems that will be discussed later. I cared for this patient during the clinical shift on September 18, 2012. History and Physical The only history and physical that was available in this patient’s chart was some narrative comments from his daughter notated by the physician, and this is most likely due to...
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...Calcium and vitamin D combination therapy has been accepted as the baseline treatment for osteoporosis. Calcium and vitamin D3 supplementation reduced the risk of hip fractures and other non-vertebral fractures among elderly women in a three year clinical study and also show significant benefit after 18 months.60 Bisphosphonates Bisphosphonates are the most commonly prescribed drugs to treat osteoporosis. The first bisphosphonate approved by the FDA was Alendronate, a once daily oral medication. Now other drug have been added to the list such as pamidronate; alendronate; ibandronate; etidronate, clodronate; risedronate prescribed daily, weekly, or monthly at varying doses; Zoledronic acid with a single intravenous transfusion annually. Bisphosphates...
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