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8.
N Engl J Med ; 382(10): 974, 2020 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-32130824
9.
N Engl J Med ; 382(10): 974, 2020 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-32130825
10.
N Engl J Med ; 382(10): 974-975, 2020 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-32130826
11.
N Engl J Med ; 382(10): 975, 2020 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-32130827
12.
13.
Orv Hetil ; 161(11): 434-436, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32148097

RESUMEN

The aVR-sign can indicate left main or multivessel coronary disease, but the sign is not STEMI eqvivalent and is not a sensitive sign for coronary disese. The following case is an example of this. An 89-year-old woman was admitted with chest pain, atrial fibrillation and multiple lead ST-segment depression but ST-segment elevation in lead aVR. The aVR-sign indicated urgent angiography with negative result. A spontaneous sinus conversion was observed with repolarization normalisation. Later the ECG demonstrated SA-blocks, and sinus arrest. Sick sinus syndrome was diagnosed and the patient was treated with pacemaker and oral anticoagulant. Orv Hetil. 2020; 161(11): 434-436.


Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/etiología , Dolor en el Pecho/etiología , Angiografía Coronaria/métodos , Electrocardiografía/métodos , Marcapaso Artificial , Síndrome del Seno Enfermo/diagnóstico por imagen , Síndrome Coronario Agudo , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Enfermedad de la Arteria Coronaria , Diagnóstico Diferencial , Femenino , Humanos , Síndrome del Seno Enfermo/cirugía , Resultado del Tratamiento
16.
MMW Fortschr Med ; 162(2): 28, 2020 02.
Artículo en Alemán | MEDLINE | ID: mdl-32016723
17.
Medicine (Baltimore) ; 99(7): e19156, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049843

RESUMEN

RATIONALE: Atrial fibrillation (AF) is encountered rarely in pregnancy. Management of maternal AF is challenging as it poses a threat to both maternal and fetal well-being. PATIENT CONCERNS: We report a case of a 35 weeks pregnant woman who presented in emergency with sudden-onset palpitations and mild shortness of breath with no personal/family history of cardiac diseases. DIAGNOSES: Patient's pulse was irregularly irregular with an average rate of 179 beats per minute. The obstetric examination was normal. DIAGNOSIS: High-sensitive cardiac troponin T (hs-cTnT) was elevated. The 12 lead electrocardiogram (ECG) confirmed AF. The obstetric ultrasound, electronic fetal heart rate (EFHR) trace, and maternal echocardiography were normal. INTERVENTIONS: The patient was admitted under joint cardiology and obstetric care and monitored with continuous telemetry. She was commenced on a therapeutic dose of low-molecular weight heparin (LMWH) and intravenous fluid. She received a single 200 Joule synchronized direct current (DC) shock under general anesthesia in operation theater, which reverted the rhythm back to normal. EFHR monitoring was normal pre- and post-DC cardioversion. We acknowledge the unwise use of therapeutic dose of LMWH before DC cardioversion (DCCV) because of a potential need for emergency cesarean delivery for maternal and/or fetal compromise. OUTCOME: The patient remained well and in sinus rhythm after cardioversion. She was discharged home the following day on Flecainide (anti-arrhythmic) and therapeutic dose of low molecular weight heparin (LMWH) and followed up in outpatient clinics frequently. She had a baby at term and received prophylactic LMWH for 10 days post-cesarean. She was discharged from cardiology clinic when she was 10 weeks postnatal, and Flecainide was discontinued. LESSONS: We are reporting this case because of the rarity of the condition and successful use of DCCV for treating maternal AF. High-sensitive cardiac troponin T (hs-cTnT) level is a useful laboratory indicator to gauge the severity of AF in pregnancy. We emphasize to make the arrangements for EFHR monitoring and potential cesarean delivery and advocate cautious use of thromboprophylaxis while planning for electrical cardioversion (ECV) for maternal AF.


Asunto(s)
Fibrilación Atrial/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Adulto , Fibrilación Atrial/diagnóstico , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico
18.
Herzschrittmacherther Elektrophysiol ; 31(1): 91-94, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32020272

RESUMEN

In adults with congenital heart disease, atrial fibrillation occurs at a lower age due to the increased atrial stress compared to structurally normal hearts. The ablation target thus results from the underlying heart defect and the specific arrhythmia: in the case of atrial fibrillation, pulmonary vein isolation with left atrial substrate modification can be performed safely and effectively taking into account the individual cardiac lesion, which is often related to difficult transseptal access. This case is a representative example of catheter ablation of atrial fibrillation in a patient with a functional univentricular heart using intracardiac echocardiography-guided double transseptal puncture.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Atrios Cardíacos , Humanos , Resultado del Tratamiento
19.
Herzschrittmacherther Elektrophysiol ; 31(1): 33-38, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32048010

RESUMEN

Pulmonary hypertension is newly defined as an elevation of the mean pulmonary arterial pressure >20 mmHg and a pulmonary vascular resistance ≥3 Wood units. Arrhythmias are an increasing problem in patients with pulmonary hypertension. Pathophysiological aspects leading to supraventricular arrhythmias are atrial fibrosis caused by increased right atrial pressure and dilation. An increased sympathetic tone leads to prolongation of action potential and delayed polarisations causing arrhythmias. Therapy of arrhythmias includes drugs (preferred amiodarone) and electrophysiological therapy like electric cardioversion and ablation, which is safe in patients with pulmonary hypertension.


Asunto(s)
Taquicardia Supraventricular , Amiodarona , Fibrilación Atrial , Cardioversión Eléctrica , Humanos
20.
Herzschrittmacherther Elektrophysiol ; 31(1): 20-25, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32055925

RESUMEN

Atrial fibrillation, the most common cardiac arrhythmia in the daily clinical routine, is a challenge in in-hospital and prehospital emergency medicine and is associated with increased morbidity and mortality if left untreated. Especially tachyarrhythmia, caused by atrial fibrillation, leads to various unspecified symptoms and in some cases to severely impaired circulation. Thus, an individualized therapeutic regimen is required. A fundamental distinction between rhythm control and rate control strategies must be made. In symptomatic but hemodynamically stable patients rate control is the method of choice. This applies in particular to patients with no pre-existing anticoagulation, especially if left atrial thrombi are not excluded. In hemodynamically unstable patients, considering the potential complications of sedation, electrical cardioversion is preferred. Pharmacological therapy of atrial fibrillation has to be divided into AV conduction modulating drugs-like short- or long-acting ß­blockers, calcium antagonists or cardiac glycosides-and the heterogeneous group of antiarrhythmic drugs aiming for rhythm control. Pulmonary vein ablation is the current long-term treatment of choice for symptomatic drug-refractory atrial fibrillation.


Asunto(s)
Fibrilación Atrial , Antiarrítmicos , Cardioversión Eléctrica , Humanos , Venas Pulmonares , Taquicardia
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