RESUMO
Atrial fibrillation (AF), a common and serious cardiac rhythm disturbance, is responsible for substantial morbidity and mortality in the population. Currently about 2.3 million people in the US are diagnosed with AF and, based of the US census, this number is expected to rise to 5.6 million by 2050. It doubles in prevalence with each decade of age, reaching almost 9% at age 80-89 years. It has increased in prevalence over the calendar decades, reaching 'epidemic' proportions. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50-59 years of age to up to 23.5% for such patients aged 80-89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatment is not. We aimed to discuss how rhythm control of atrial fibrillation can best be achieved in elderly patients, the controversy over the rhythm versus rate control, and prevention of thromboembolism.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/terapia , Cardioversão Elétrica , Fibrinolíticos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Quimioterapia Combinada , Frequência Cardíaca/efeitos dos fármacos , Humanos , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Romênia/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Resultado do TratamentoRESUMO
Neuropsychiatric systemic lupus erythematosus (NPSLE) has become a popular term designing all neurological and psychiatric complications in patients with systemic lupus erythematosus (SLE). It occurs in up to two thirds of all SLE patients and it covers a vast array of disorders ranging from peripheral neuropathy to stroke, psychosis, and dementia. Mechanisms associated with the pathogenesis of NPSLE include anti-neuronal antibodies, antiphospholipid antibody associated thrombosis, emboli from cardiac source and, rarely, vasculitis by immune complex depositions. Although the most common manifestations is cognitive dysfunction (50%), NPSLE may also present itself as peripheral neuropathy (15%), psychosis (10%), or other central nervous system abnormalities (stroke, organic brain syndrome, seizures). In lupus patients, one should always look for secondary causes of the neuropsychiatric manifestation, including infection, toxic metabolic abnormalities, and hypertension. We present two cases of SLE, which developed neuropsychiatric manifestations.