scholarly journals Adverse Drug Reactions and Atrioventricular Conduction Disorders - A Female Gender Related Aproach

2021 ◽  
Vol 18 (5) ◽  
pp. 15-29
Author(s):  
Dragoș Traian Marius Marcu ◽  
Cătălina Arsenescu-Georgescu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Adverse Drug Reactions ◽  
Systolic Dysfunction ◽  
Female Gender ◽  
Left Ventricular ◽  
Atrioventricular Conduction ◽  
Study Group ◽  
Drug Reactions ◽  
Conduction Disorders

Abstract Introduction. Although cardiovascular disease remains the leading cause of mortality regardless of gender, the female gender has remained an underrepresented population in studies in this field. Sustained initiatives by the European Society of Cardiology have brought to the fore the importance of studying gender differences regarding the safety profile of cardiovascular drugs in women. Common cardiovascular adverse drug reactions include atrioventricular conduction disorders. Materials and methods. The present study followed the clinical and paraclinical features of female patients with a primary diagnosis of bradycardia in relation to bradycardic medication. We included a group of 359 female patients, divided according to the presence or absence of bradycardia medication into a study group (n=206) and a control group (n=153). Results. Patients with associated bradycardic medication frequently required emergency admission (P < 0.001), with prolonged hospitalization (P < 0.001). The main atrioventricular conduction disorders identified were atrial fibrillation with slow ventricular response (P = 0.028), sinus bradycardia (P = 0.009) and sinus pauses (P = 0.009). Among comorbidities, heart failure (P<0.001) and chronic kidney disease (P<0.001), were common in the study group. Echocardiographic parameters of left ventricular (P=0.002) and biatrial (P<0.001) dilatation, as well as severe left ventricular systolic dysfunction (P=0.009), showed statistical significance in this group. The most used drugs were beta-blockers, amiodarone, and digoxin. Conclusions. Our results indicate, as factors associated with medication-related bradyarrhythmias in female gender: heart failure with severe systolic dysfunction, renal dysfunction, atrial fibrillation, and left ventricular dilatation.

HFrEF pharmacological treatment: beta blockers

ESC CardioMed ◽  
2018 ◽  
pp. 1851-1862
Author(s):  
Simon Alistair ◽  
Stuart Beggs ◽  
Roy Stuart Gardner
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Systolic Dysfunction ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Black Patients ◽  
Patients With Heart Failure ◽  
Obstructive Airways Disease ◽  
Practical Guidance

By incremental steps over several decades of research, beta blockers have evolved ‘from bench to bedside’, emerging as a keystone of modern optimal pharmacotherapy for heart failure. This chapter starts by detailing the story of their development, focusing on the randomized trials that established their clinical efficacy in reducing hospitalization and death. Subsequently, issues such as the potential heterogeneity among different beta-blocker agents and the appropriate dose targets in heart failure are discussed. Advice regarding the initiation, titration, and discontinuation of beta blockers is presented, providing practical guidance for healthcare professionals who manage patients with heart failure. Finally, the chapter explores the evidence underlying the use of beta blockers in specific populations, such as elderly patients, black patients, and those with atrial fibrillation, obstructive airways disease, or asymptomatic left ventricular systolic dysfunction.

scholarly journals Prevalence and prognosis of severe tricuspid regurgitation in patients with atrial fibrillation with normal left ventricular systolic function

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Prapan ◽  
N Ratanasit
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Tricuspid Regurgitation ◽  
Systolic Function ◽  
Systolic Pressure ◽  
Female Gender ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Normal Left Ventricular ◽  
Significant Difference

Abstract Background Significant functional tricuspid regurgitation (FTR) can be found in some patients with atrial fibrillation (AF). The results of the previous studies are still controversial whether significant FTR in patients with AF can cause worse outcomes such as heart failure or death. Purpose To study the prevalence, predictors and prognosis of significant FTR in patients with AF with normal left ventricular (LV) systolic function. Methods We conducted a retrospective cohort study in patients with AF and normal LV ejection fraction (LVEF) from May 2013 through January 2018. Significant FTR was defined as moderate to severe FTR. Pulmonary hypertension (PH) was defined as right ventricular systolic pressure &gt;50 mmHg or mean pulmonary artery pressure &gt;25 mmHg. We evaluated the prevalence of significant FTR and evaluated the adverse outcomes between significant and insignificant FTR groups. The adverse outcomes were defined as heart failure visit or hospitalization and all cause death within 2 years of follow up. We also evaluated the factors associated with significant FTR in AF patients. Results There were 498 patients with AF and 300 (mean age 68.8±10.8 years, 50% female) were included in the study. Paroxysmal, persistent and permanent AF were found in 34.7%, 44.7% and 20.6% respectively. Mean LVEF was 65.3±6.3%. PH and significant FTR were reported in 30.7% and 21.7%, respectively. All cause death and heart failure (visit and hospitalization) were found in 26 (8.7%) and 39 (13%) patients, respectively. There was no statistically significant difference in death between patients with significant and insignificant FTR (12.3% vs. 7.7%; 95% confidence interval (CI) 0.70–4.08, p=0.24). Patients with significant FTR had heart failure more often than those with insignificant FTR (61.5% vs. 38.5%; 95% CI 4.15 - 17.75, OR 8.58, p&lt;0.001). The multivariate analysis showed that the predictors of significant FTR were female gender, permanent AF and presence of PH (OR 2.5, 3.6 and 6.1, respectively). The predictors of the adverse outcomes in patients with AF were high CHA2DS2-VASc score (95% CI 1.09 - 1.92, p=0.01) and significant FTR (95% CI 9.61 - 698.17, p&lt;0.01). Conclusions Significant FTR was common in patients with AF and associated with heart failure outcomes. Female gender, permanent AF and presence of PH were independent predictors of significant FTR, while high CHA2DS2-VASc score and significant FTR were independent predictors of the adverse outcomes in patients with AF and normal LVEF. Funding Acknowledgement Type of funding source: None

Diastolic Dysfunction- Anaesthesiologist’s Dilemma!

2021 ◽  
Vol 7 (1) ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricle ◽  
Diastolic Dysfunction ◽  
Independent Predictor ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Compliance

Left ventricular systolic dysfunction is well recognized and ably managed by anesthesiologists. Left ventricular diastolic function needs to be reckoned as well, every single time anaesthesia is planned in a patient with cardiac disease. This article emphasizes why one should take cognizance of diastolic dysfunction during perioperative anaesthesia management. Diastolic dysfunction(DD) is the inefficiency of the left ventricle to allow filling at lower atrial pressures.[1] In other words, it is the abnormal relaxation during diastole along with the reduction in left ventricular compliance which culminates into higher filling pressures of the left ventricle.[2] It is associated with comorbid conditions such as hypertension, diabetes and atrial fibrillation. Oftentimes it is asymptomatic at rest but can manifest in stress-induced circumstances such as acute severe hypertension, tachycardia, overzealous fluid administration or arrhythmias especially atrial fibrillation.[3] Various reciprocal changes occur over time within the systolic function due to long-standing diastolic dysfunction. Also, mild to moderate diastolic dysfunction forms an independent predictor for the risk of mortality in addition to the established risk of hypertension, diabetes, coronary artery disease and advanced age.[4] It is also an independent predictor of major adverse cardiac events (MACE). (5) Most of the patients in whom anaesthesia is given for various surgical procedures have comorbidities like hypertension, diabetes, dyslipidemia, atrial fibrillation and ischemic heart disease which endure high risk for DD. They may have associated heart failure with preserved ejection fraction (HFpEF).DD can contribute to postoperative heart failure [6] and is associated with various complications in the postoperative period.[2] The act of administration of anaesthesia, mechanical ventilation and intraoperative events like tachycardia, hypertension, inordinate fluid therapy along with the overall surgic

Cardiovascular

2018 ◽  
Author(s):  
Lesley K. Bowker ◽  
James D. Price ◽  
Ku Shah ◽  
Sarah C. Smith
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Left Ventricular ◽  
Peripheral Vascular ◽  
Conduction Disorders ◽  
Failure Assessment ◽  
Treatment Of Hypertension ◽  
Coronary Syndromes

This chapter provides information on the ageing cardiovascular system, chest pain, stable angina, acute coronary syndromes, myocardial infarction, hypertension, treatment of hypertension, presentation of arrhythmias, management of arrhythmias, atrial fibrillation, rate/rhythm control in atrial fibrillation, stroke prevention in atrial fibrillation, bradycardia and conduction disorders, common arrhythmias and conduction abnormalities, heart failure assessment, acute heart failure, chronic heart failure, dilemmas in heart failure, heart failure with preserved left ventricular function, valvular heart disease, peripheral oedema, preventing venous thromboembolism in an older person, peripheral vascular disease, gangrene in peripheral vascular disease, and vascular secondary prevention.

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