Atrial Brillation Research Articles

CLINICO-ETIOLOGICAL PROFILE OF PATIENTS WITH NEWLY DETECTED ATRIAL FIBRILLATION : A RECORD BASED STUDY IN A TERTIARY CARE HOSPITAL IN MANDYA

Atrial brillation is the most common sustained arrythmia charecterised by disorganised rapid and irregular atrial activation and with irregular ventricular rate. A record based retrospective study was conducted at a tertiary care hospital to know the clinico-etiological prole of atrial brillation . Datas of 130 patients admitted in the hospital in the past 6 months were obtained and analysed . It was observed that the most common presenting complaint was breathlessness seen among 70.76% of patients and palpitation was seen in 60 % of patients followed by bilateral lower limb swelling seen among 36.92% patients. The most common etiology in this study was rheumatic heart disease ( 56.15%) followed by ischemic heart disease ( 20%) and hypertension ( 10%). This article has provided many insights on potential risk factors for the occurrence of atrial brillation. This would help in early diagnosis and prompt treatment of AF and the possible risk factors.

ETIOLOGICAL PROFILE OF PATIENTS WITH ATRIAL FIBRILLATION WITH SPECIAL REFERENCE TO VALVULAR HEART DISEASES.

Background : Atrial brillation is the most commonly encountered quivering or irregular heart beat(arrhythmia) in our population and it is the disordered supraventricular (atrial) event characterised by irregular heart rhythm, thereby altered atrial electrical and mechanical function. Atrial brillation often inuences the quality of life as atrial brillation may be associated with disability, anxiety, cognitive impairment, chest pain, hospitalization and even absence from work. Many diseases have been implicated to the development of atrial brillation; amongst which Rheumatic valvular heart disease, systemic hypertension, ischemic heart disease, thyroid disease is very important. Alcohol and smoking add up to risk factors leading to development of atrial brillation. Although various studies had been reported from different parts of the country, not much clinical data is available on etiological and clinical prole of Atrial fribillation in north eastern part of the country hence this study has been undertaken. In this Hospital ba Materials and Methods: sed observational Study conducted in the department of Medicine, Jorhat Medical College and Hospital, Jorhat, Assam among 90 patients etiology of valvular and non-valvular atrial brillation was taken into account. In our study, mean age of study populat Results: ion was 46.5±5.09 years, for valvular etiology mean age 34.8± 2.05 years, for non valvular mean age 51.64± 3.08 years. 55.57% of study population were males, 44.43% were females. Valvular atrial brillation was found in 30% cases, non valvular etiology found in 70% cases.

CLINICAL PROFILE AND PREDICTORS OF ATRIAL FIBRILLATION IN ACUTE MYOCARDIAL INFARCTION: AN OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL

Background and aims: Acute myocardial infarction (AMI) frequently results in atrial brillation, which has a documented incidence ranging from 2.3 to 21%. This paper aims to evaluate the incidence of atrial brillation in a setting of myocardial infarction and the effect of this arrhythmia on the outcome. Materials and methods:This institution - based observational study was conducted on 110 patients attending the different units of Medicine Department and Cardiology Department of Gauhati Medical College and Hospital during the period from 1ST July 2021 to 30th June 2022. All patients had undergone Routine blood investigations, 12 – lead ECG, 2D ECHO, Serum Electrolytes, Cardiac Markers Results: the study showed that 9 patients out of 110 had new onset atrial brillation in the hospital course i.e. in this study overall incidence of AF in AMI is 8.18% of which, 44.4% succumbed to death. Incidence of AF in AMI in patients with age ≥60 years is 13.33%. Conclusion: The occurrence of AF in a setting of AMI is worth studying as there are numerous challenges in the management and follow up of these groups of patients. Elderly individuals, patients with tachycardia (HR>100/min), hypotension (SBP<100 mm of Hg) and heart failure with Killip class ≥3 are more prone to develop AF after AMI

NEWLY DETECTED SEVERE RHEUMATIC HEART DISEASE IN ELDERLY AND THE CHALLENGES IN ITS MANAGEMENT—A CASE REPORT

A 60-year-old man with a history of frequent lower respiratory tract infections presented with symptoms of face pufness, swelling of bilateral limbs, palpitation, and shortness, but subsequent diagnostic testing at the hospital revealed rheumatic heart disease with poorly managed atrial brillation, severely enlarged left atrium, and mitral valve area 1.1 cm2. It was determined that replacing the patient's mitral valve with a mechanical prosthesis would be the best course of action. Our choice was inuenced by the fact that the patient will require chronic anticoagulation for atrial brillation anyway, despite the common trend of employing bio prosthesis in the elderly. Our case presentation demonstrates a late-presenting example of RHD with unexpected connections and the difculties in selecting the most effective treatment.

Comparison of Patients with Atrial Fibrillation Without Structural Heart Disease and Normal Population In Terms of Urine Catecholamines.

This study aimed to compare the sympathetic nervous system activity of atrial ���brillation patients without structural heart disease and the normal population in terms of urinary metanephrine levels. Our study was conducted with 40 paroxysmal or persistent patients without structural heart disease and CHA2DS2VASc score of 0 or 1 and 40 healthy controls. Laboratory parameters, demographic characteristics, and 24-hour urine metanephrine levels were compared between the 2 groups included in the study. Metanephrine value in urine was found to be signi���cantly higher in the atrial ���brillation group (atrial ���brillation group 97.50 �� 17.19 ��g/day vs. control group 74.27 �� 15.55 ��g/day; P < 0.001). The body mass index of the atrial ���brillation group was found to be signi���cantly higher than the control group (atrial ���brillation group 27.26 �� 2.97 kg/m2 vs. control group 24.05 �� 2.24 kg/m2; P < 0.001). In multivariate linear regression analysis, body mass index (beta: 0.266, P =.02) and urinary metanephrine level (beta: 0.522, P = 0.002) were found to be independent risk factors. According to receiver operating characteristic analysis, it was determined that urinary metanephrine value (area under the curve = 0.834, P < 0.001) and body mass index (area under the curve = 0.803, P < 0.001) predicted the development of atrial ���brillation. Our study found that urinary metanephrine levels were higher in patients with atrial ���brillation without structural heart disease than those without atrial ���brillation, and metanephrine values predicted the development of atrial ���brillation.

STUDY OF CLINICAL OUTCOME AND CARDIOVASCULAR SEQUELAE IN COVID-19 PATIENTS

Cardiovascular complications in COVID-19 include deep vein thrombosis, stroke, angina, myocardial infarction, heart failure and cardiogenic shock.ECG changes including sinus tachycardia, sinus bradycardia and atrial brillation . Incidence of cardiovascular complications is directly linked to severity of disease which in turn correlate with inammatory markers including CRP, LDH, Ferritin, D Dimer and IL-6. Raised Inammatory markers also suggest poor outcome of patients. Therefore it is advisable to do inammatory markers in admitted patients for management. Followup study at 3 and 6 months revealed new onset cardiovascular complications while no new complications were documented at 12months follow up.Thus regular health checkup is recommended post COVID infections for atleast 6months.

A STUDY ON CLINICO-ETIOLOGICAL PROFILE OF ATRIAL FIBRILLATION AT SVRRGH, TIRUPATI

Background: Atrial brillation is one of the most commonly encountered cardiac arrhythmias. It is characterized by irregularly irregular cardiac rhythm altering the electrical and mechanical function of the atria. The incidence and prevalence of atrial brillation is increasing in older patients greater than 60 years of age. A large number of the patients with atrial brillation are underdiagnosed. Some of them are asymptomatic but in due course of time they develop a number of complications like cardiomyopathy, heart failure and cardio embolic stroke. This study is undertaken to nd out the presenting symptoms and etiology of atrial brillation in Indian setting which facilitates an early diagnosis and initiation of appropriate treatment strategies.Methods: Ahospital based cross sectional study was carried out on 100 patients who presented to SVRRGH, Tirupati between October 2021 to September 2022. Patients &gt; 18 years with clinically and electrocardiographically proven atrial brillation who were haemodynamically stable were taken into the study. Results: In my study, breathlessness was present in majority-74% of patients followed by palpitations-57%, pedal edema-32%, chest pain-29%, giddiness-7%, weakness of limbs-6%, others-4%. Regarding etiology, past history of Rheumatic heart disease was present in 56% of patients, CAD in 24% of patients. Past history of Hypertension was present in 27% of patients, Diabetes Mellitus in 21% of patients, COPD in 11% of patients and 10% of patients had other diseases like hyperthyroididm, dilated cardiomyopathy, atrial septal defect. Conclusion: Rheumatic heart disease was the most common etiology for atrial brillation in our study. Hypertension was the second most common cause. Breathlessness was the most common complaint followed by palpitations. Males were more affected than female. Atrial brillation should therefore be suspected clinically, diagnosed earliest and treated appropriately to reduce further compications.

INCIDENCE OF ACUTE LIMB ISCHEMIA IN COVID POSITIVE PATIENTS IN RGGGH, CHENNAI

Acute Limb Ischemia is dened as any sudden decrease in limb perfusion causing potential threat to limb viability. It can be caused by embolism or thrombosis. Commonly affects arteries of lower extremities. The risk factors for ALI can be multifactorial. The commonest include embolic predisposition like atrial brillation or coronary artery disease, trauma or thrombosis due to atherosclerosis or hypercoagulable state like malignancy, leukemia, Antiphospholipid syndrome, protein C /S/ antithrombin deciency, polycythemia vera, thrombocytosis. Thrombosis of a bypass graft is common in western countries which occurs at the site of anastamosis. A sudden and signicant increase of COVID-19–infected patients who were presenting with ALI has been noted at our institutions recently. A prothrombotic state, is present in patients with severe COVID-19 illness, where increased brin and brin degradation products are noted. This has been shown to adversely increase the severity of ALI and affect outcomes

A STUDY ON ATRIAL FIBRILLATION AND ITS CORRELATION WITH LEFT ATRIAL SIZE

Introduction-Atrial brillation is characterized by disorganized, rapid and irregular atrial activation with loss of atrial contraction and an irregular ventricular rate determined by atrio-ventricular nodal conduction. Atrial brillation is the most common sustained arrhythmia and major public health problems. The present study aimed to nd out possible underlying etiologies for atrial brillation. Method- In this study, total of 100 patients of age &gt;18 years with patients with clinically and electrocardiographically proven atrial brillation were included. However, patients of age &lt;18 years with Arrhythmia other than atrial brillation were excluded. The etiology of atrial brillation is evaluated using electrocardiogram and transthoracic echocardiogram, and correlation with the ndings of parasternal long-axis view of left atrial size. Results- The majority of patients were between the ages of 49 and 55, with a mean age of 50.74 ±15.3. Additionally, the male/female ratio in the overall enrolled cases was 23:27, indicating female dominance. The mean body mass index and initials of the patients were gathered. The mean size of the left atrium was 5.00±1.10. Majority of the patients fell in 5-6 cm left atrial size with rheumatic heart disease diagnosis followed by 4-5 cm left atrial size with dilated cardiomyopathy diagnosis. Conclusion- Most patients had rheumatic heart disease, as opposed to dilated cardiomyopathy or ischaemic heart disease. The systemic hypertension, age, electrolytes imbalance and obesity are the major leading cause to causes the arrhythmic changes. Statistically, a signicant difference association of diagnosis with left atrial size were observed.

NEWER APPROACHES IN HYPERTENSION MANAGEMENT; A NARRATIVE REVIEW

Introduction: High blood pressure is implicated in heart disease and stroke. Approximately a third of people with high blood pressure are now undiagnosed, and half of those who are diagnosed are not taking antihypertensive medication. The World Health Organization (WHO) reports that hypertension causes at least nine million deaths globally each year, either directly or indirectly. To evaluate how emergingReview Rationale: technologies might help improve the identication and treatment of hypertension in various populations, including the elderly, pregnant women, and people with atrial brillation. There is a growing trend of empowering individuals to help with hypertension screeningRecent Discoveries: and diagnosis, and multiple studies have shown that telemonitoring, especially when combined with co-intervention, can improve hypertension treatment. Smartphones and Bluetooth-enabled telemonitoring, for example, are emerging as major players in hypertension therapy,Summary: with particular potential in pregnant women and developing nations. An essential requirement is that these new technologies be thoroughly studied and clinically veried before being available to the general public.

BETWEEN THE DEVIL AND DEEP BLUE SEA - ANTICOAGULATION IN CARDIOEMBOILC STROKE

Stroke is the commonest cause of mortality and morbidity after coronary artery disease. According in India stroke factsheet updated in 2021, the estimated age-adjusted prevalence rate for stroke ranges between 84-262/100,000 in rural and 334-424/100,000 in urban areas. Ischemic stroke is the commonest followed by cardioembolic which is 20% which may be higher in developing countries because of illiteracy and lower socioeconomic status. Cardioembolic strokes are usually severe in presentation and prone for early recurrence. The risk of long term recurrence and mortality are also high. Hemorrhagic transformation occurs in up to 71% of cardioembolic strokes. Atrium, ventricle and valves are the high-risk origins. This article highlights the importance of balancing between thromboembolism and bleeding risks while making therapeutic decisions. Anticoagulation is indicated both for primary and secondary stroke prevention. The role of Novel oral anticoagulant versus warfarin and they edge over as they don't need INR monitoring .Thrombogenic atrial substrate even in the absence of atrial brillation can predispose to atrial thromboembolism.TEE allows better visualization (aortic atheromas, patent foramen ovale, atrial septal aneurysms) of earlier crytogenic lesions elucidating a cause and thereby reducing the embolic risk. Because of varied etiology and presentation, a tailored individual approach is needed

RESULT OF SLOW INFUSION OF STREPTOKINASE THERAPY IN LEFT SIDED PROSTHETIC VALVE THROMBOTIC OCCLUSION- A CASE SERIES FROM A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Prosthetic valve thrombosis (PVT) is a life threatening complication seen after heart valve replacement and is associated with high mortality and morbidity. Surgical approach or brinolysis and heparin therapy are considered as treatments of choice according to the clinical status of the patient. Thrombolytic therapy has been tried in cases with acute prosthetic valve thrombosis as an alternative to emergency operation with variable results. But fear of peripheral embolism has limited its use in left-sided valve occlusions. The incidence of complications decreases with low dose and slow infusion of brinolytic therapy. In this study we are presenting our experience of thrombolytic therapy with streptokinase in 40 patients who had presented with acute or subacute left-sided prosthetic valve thrombosis. In this study the mean age was 40.9 years (SD-11.2, range-19 to 64 year) with majority (77.5%) were below 50 year of age. Duration of valve replacement was 2.95 ± 1.74 years (1 to 7 years). Average time of presentation since onset of symptoms was 4.75 ± 2.77 days (1 to 12 days). Majority was presented with NYHA class IV symptoms (22/40) and 50% patients presented with cardiogenic shock. 85% patients had atrial brillation and the anticoagulation status was inadequate in 62.5% cases. Overall aortic valve involvement was 37.5% (15 patients) and mitral valve involvement was 62.5% (25 patients). Average mean gradient for aortic valve was 64.5 ±4.2 mm of Hg and that in case of mitral valve was 23.4±3.7 mm of Hg. Duration of thrombolytic therapy was individualized. Average total dose of streptokinase per patient was 25,25000 ± 8,69350 U (ranging from 20,00000 to 50,00000 U) with majority (28/40) had received a total 20,00000U of streptokinase. Patients were re-evaluated after thrombolysis with clinical, echocardiographic, and cine-uoroscopic evaluation. Total complications (both major and minor bleeding) occurred in 8 patients. Most of them were minor like injection site hematoma, gum bleeding transient GI bleed (hematemesis), hemoptysis and those were resolved spontaneously with conservative management/observational care. Thrombolysis was unsuccessful in 2 patients and death due to massive hemorrhagic CVA occurred in 2 patients. Overall success rate was 90% (36/40). In conclusion, the present study demonstrates the feasibility of thrombolytic therapy for left-sided prosthetic valve occlusion.

STUDY OF CLINICAL, ETIOLOGICAL AND ECHOCARDIOGRAPHIC PROFILE OF PATIENTS WITH ATRIAL FIBRILLATION IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Atrial Fibrillation (AF) is the most common sustained arrhythmia in clinical practice. In our country, most of the data related to AF has been derived from international studies with an Indian cohort. We studied etiology, left atrial size and the incidence of left atrial appendage clot in patients with atrial brillation at our institution so that guidelines could be formulated to manage the patients of AF in the hours of emergency. The study population consisted of 203 hemodynamically stable patients with AF over a period of 1 year. After getting ethical committee clearance, appropriate clinical examination and investigations including detailed 2D echocardiography were carried out. Mean age of the patients in our study was 42.6 ± 13.4 years. Maximum number of patients was in the age group of 20-39 years (42.4%). Majority were females (65.5%). The most common symptom was shortness of breath (64.5%) followed by palpitation (59.6%). 57.6% cases were due to RHD and 13.8% due to systemic hypertension. Most common Valvular abnormality was found to be combined MS and MR (43.6%) followed by isolated MS (22.2%). The mean LA diameter was 46.3 ± 7.0 mm. Out of 117 RHD patients, 42.7% had severely abnormal LA diameter. LA clot was present in only 4.9% of the patients who all had RHD. 7.4% had some embolic complications. Mean LA diameter was signicantly different between RHD and non-RHD cases (48.97 ± 7.5 mm vs 42.66 ± 4.1 mm). There was a signicant association between severity of MS and LA diameter. No signicant difference was found between different category of MV abnormality and mean LA diameter. There was signicant increase in the rate of heart failure with increase in LA diameter abnormality.

A STUDY ON CLINICAL PROFILE OF PATIENTS WITH ATRIAL FIBRILLATION

Background: Atrial brillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. This study is about the etiological and clinical prole of paroxysmal, persistent and permanent AF. T Aim: he aim of this article was to review the clinical epidemiological features of atrial brillation. A hospital-based descriptive study was conduct Materials and methods: ed among 50 patients, diagnosed as atrial brillation in Medicine Department of DMCH, from June 2019 to May 2020. Out of 50 pati Results: ents with atrial brillation, 32% were aged between 60 – 69 years and 42(84%) were females and 8 (16%) were males. Permanent AF was seen in 56% patients. Palpitation Conclusions: followed by dyspnoea was the major symptoms encountered with atrial brillation, and in females within the age group of 50 years and above are prone to develop AF.

SPECTRUM OF CARDIAC COMPLICATIONS IN COVID 19 DEATHS- A RETROSPECTIVE CASE RECORD ANALYSIS AT A DEDICATED COVID CARE HOSPITAL IN CENTRAL INDIA

Background: Limited studies are there regarding adverse cardiac events found in patients of COVID 19,especially in India.This study aims to nd th the spectrum of cardiac complications in COVID 19. Methods: Data from May 1 to 12 October,2020 collected retrospectively from medical records department and analysed for demography,comorbidities and spectrum of cardiac events in COVID 19 deceased. Results: 300 COVID-19 positive patients died during this period. 24% had cardiac complications during hospital stay. Most of the complications developed within 1-3 days of admission. Out of them, 57.14% had raised troponin levels. NSTEMI (36%) was the most common adverse cardiac event, followed by STEMI (27.7 % ) &amp; Cardiac Ischemia. Apart from Inuenza like illness ,only 6 had chest pain as presenting complaint..11 patients without comorbidities had acute coronary syndrome and sudden cardiac deaths. High incidence of cardiac arrythmia was seen- sinus tachycardia, bundle branch blocks, ectopics, ventricular tachycardia- brillation&amp; sinus bradycardia. One case of PSVTand 4 cases of atrial brillation were also found. Conclusion: This study supports that cardiac complications are seen in this disease in signicant number of patients. All spectrum of cardiac complication are seen including STEMI, NSTEMI and sudden cardiac death. There were few patients who had new onset acute coronary syndrome without any comorbidity, which signies COVID-19 can directly lead to cardiac mortality. Arrythmia including sinus tachycardia, bradycardia and conduction blocks are also commonly seen.

An efficient method for Secure ECG Feature Based Cryptographic Key Generation

A novel method to generate ECG feature oriented cryptographic keys is proposed. Due to the advantage of the uniqueness and randomness properties of ECG’s main feature, this feature is achieved. As the production of key depends on four reference- free ECG main features, Low-latency property is obtained. These features are obtained in short time. This process is referred as (SEF)-based cryptographic key production. The SEF has the following features like: 1) identifying the appearance time of ECG’s fiducial values by means of Daubechies wavelet transform to calculate ECG’s main features conversely; 2) A dynamic method is used to denote the best quantity of bits that can be obtained from the main ECG feature, which consists of PR, RR, PP, QT, and ST time periods; 3) Generating cryptographic keys by the ECG features extracted in the method mentioned above and 4) Making the SEF method as strong with cryptographically secure pseudo-random number generators. Fibonacci linear feedback shift register and recent encryption traditional algorithms are executed as the pseudo-random number generator to improve the safety stage of the produced cryptographic keys. This method is executed to 239 subjects’ ECG signals consisting of normal sinus rhythm, arrhythmia, atrial brillation, and myocardial infraction. Normal ECG rhythms have slightly better randomness when compare with the abnormal.The output results proves that the SEF method is faster than the present existing key production methods. It produces higher security level when compared to existing methods.

Weighing In The Evidence: Lifestyle Modification In The Treatment Of Atrial Fibrillation

Imagine if you suddenly felt your heart “jumping out of your chest” – this is the case for an estimated 1 in 4 Canadians who experience this rapid and chaotic heartbeat characteristic of atrial brillation (AF). The healthy heart works continuously to beat regularly under the control of electrical impulses originating from the sinoatrial (SA) node, the heart’s natural pacemaker. In AF, electrical impulses do not originate in the SA node, but rather, from a different part of the atrium or in nearby pulmonary veins. These abnormal electrical signals become rapid and disorganized, radiating throughout the atrial walls in an uncoordinated manner. This can cause the walls of the atrium to quiver, or brillate, which results in irregular electrical transmission from the atria to the ventricles. A normal heart rate at rest should be between 60-100 beats per minute at rest, but in AF, it can be considerably higher than 140 beats per minute1. Affecting more than 33 million individuals worldwide, AF is the most common sustained irregular heart rhythm encountered in clinical practice2. The progression and maintenance of AF results in adverse events, including an increase in hospitalizations and a ve-fold increase in the risk of stroke3. Given this evidence and anticipated increases in life expectancy within the next several decades, there are clear public health implications for the aging Canadian population.

Decision Support through Data Integration: Strategies to Meet the Big Data Challenge

Objectives: Presentation of an overview of the reasons why data integration initiatives should be seen as enablers for e ective decision support in data-intensive healthcare settings. Methods: Typical challenges rising from the information requirements of clinical decision support systems are high- lighted. We then propose a methodological solution where several heterogeneous data sources are integrated by the means of a common data model on top of which the DSS is built. Results: We report on two successful case studies based on the DSSs developed in the context of the MobiGuide and Mosaic projects, funded by the European Union in the Seventh Framework Program. The MobiGuide patient guidance system has been success- fully validated during a recent pilot study involving 30 pa- tients (10 with atrial brillation and 20 with gestational diabetes), while Mosaic is currently undergoing a valida- tion phase involving 1000 type 2 Diabetes patients. Conclusions: In the era of big data, e ective data integra- tion strategies are an essential need for medical informatics solutions and even more for those intended to support de- cision processes. Building generic DSSs based on a stable (but easily extensible) data model, speci cally designed to meet the information requirements of DSSs and analytics, has proven to be a successful solution in the two presented use cases.

Dabigatran: ‘One-dose-fits-all’ approach raises risks

Dabigatran: ‘One-dose-fits-all’ approach raises risks

Spontaneous resolution of large acute subdural hematoma and the value of neurological exam in conservative management of high risk patients

84 year old female presented after a fall with a brief loss of onsciousness and minor facial injury. Her condition declined in he emergency room necessitating a STAT head computed tomoram (CT). At that point the patient was lethargic but arousable, her upils were sluggish and symmetric, was not following commands, as able to say some words and she had minimal movements n all extremities; Glasgow Coma Scale of 11 (E3V3M5). The scan emonstrated a large (1.6 cm) left sided aSDH with significant mass ffect with what appeared to be the beginning of uncal herniaion (Fig. 1). Past medical history is significant for chronic atrial brillation for which she was on Coumadin with an international ormalized ratio (INR) of 2.06. Patient was started on vitamin K nd was admitted for observation and comfort measures given her