Infark Serebri Tipe Kardioemboli pada Pasien dengan Fibrilasi Atrium

2020 ◽  
Vol 17 (2) ◽  
pp. 202
Author(s):  
ERIC HARTONO TEDYANTO ◽  
KEN CHRISTIAN KAWILARANG ◽  
FEISAL TANJUNG
Keyword(s):  
Atrial Fibrillation ◽  
Ct Scan ◽  
Blood Clot ◽  
Heart Rhythm ◽  
Embolic Stroke ◽  
Temporal Part ◽  
Heart Rhythm Disorders ◽  
Increased Risk ◽  
Close Supervision ◽  
Chief Complaints

<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Stroke is the leading cause of disability and the second most common cause of death in the world. Atrial fibrillation (AF) is the major risk factor for embolic stroke. Patients with atrial fibrillation have a 5 times much more risk of stroke to those who do not have atrial fibrillation.</p><p><strong>Case Report: </strong>A 40-year-old woman came to the Emergency Unit with chief complaints the left-sided limbs suddenly weakened while cooking. On ECG examination there is an irregular rhythm (irregular P-P), leading to an atrial fibrillation. CT scan revealed hypodense lesions on the temporal part of the left side, leading to a cerebral infarction.</p><p><strong>Discussion:</strong> AF puts patients at an increased risk for stroke because blood can ot be properly pumped, which caused stagnation and formed a blood clot. This clot can released from ventricle, then travel to the other organ via artery, including brain and block the blood flow which can result a infarct stroke.<strong> </strong></p><p><strong>Conclusion: </strong>Close supervision and routine control are needed for patients with heart rhythm disorders, especially atrial fibrillation to prevent embolic stroke.</p><p><strong>Keywords: </strong>embolic stroke, atrial fibrilation.</p><p><strong>ABSTRAK</strong></p><p><strong>Latar Belakang:</strong> Stroke adalah penyebab utama kecacatan dan penyebab kematian paling umum kedua di dunia. Fibrilasi atrium (AF) secara numerik merupakan faktor risiko paling penting untuk stroke. Sudah dipastikan bahwa pasien dengan AF memiliki risiko stroke 5 kali lipat relatif terhadap mereka yang tidak.</p><p><strong>Laporan Kasus: </strong>Seorang perempuan 40 tahun datang ke IGD dengan keluhan anggota gerak sisi kiri secara tiba-tiba melemah saat sedang memasak. Pada pemeriksaan EKG didapatkan adanya irama ireguler (P-P ireguler), mengarah ke suatu fibrilasi atrium. Pada pemeriksaan CT Scan didapatkan adanya lesi hipodense di bagian temporal sisi kiri, mengarah ke suatu infark serebri.</p><p><strong>Diskusi:</strong> AF merupakan faktor resiko tinggi untuk stroke karena darah mungkin tidak dipompa dengan baik dari jantung, yang dapat menyebabkannya mengumpul dan membentuk gumpalan di dalam ventrikel. Gumpalan ini kemudian dapat lepas dan mengalir ke otak dan memblokir aliran darah ke bagian otak yang dapat menyebabkan stroke.</p><p><strong>Kesimpulan:</strong> Pengawasan ketat dan kontrol yang rutin sangat diperlukan bagi pasien penderita gangguan irama jantung khususnya fibrilasi atrium untuk mencegah terjadinya stroke emboli.</p><p><strong>Kata Kunci</strong>: stroke emboli, fibrilasi atrium</p>

scholarly journals HAS-BLED scor system for the assessment of risk of breathing of patients on oral anticoagulant therapy // HAS-BLED skor sistem bodovanja za procjenu rizika od krvarenja pacijenata na oralnoj antikoagulantnoj terapiji

2018 ◽  
Vol 5 (1) ◽  
pp. 11
Author(s):  
Daniela Dobrovoljski
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Heart Rhythm ◽  
Clinical Problem ◽  
Coagulation Factors ◽  
Heart Rhythm Disorders ◽  
Anticoagulant Drugs

Oral anticoagulant drugs (OALs) are effective agents in the prevention and treatment of thromboembolic complications. However, despite standardization and application progression, OALs represent a significant clinical problem because they are small-therapeutic medicines that easily interact with food and medicine, which can substantially affect the increased or weakened therapeutic effect. Oral anticoagulants are 4-hydroxycoumarin derivatives and vitamin K antagonists, and their pharmacological activity is based on inhibition of the synthesis of coagulation factors in the liver. These drugs are effective in the prevention of venous thromboembolism, acute myocardial infarction (AIM), heart rhythm disorders by type of atrial fibrillation, stroke prevention, and the like. The most important and clinically commonly undesirable effect of OAL is bleeding. The risk of bleeding is greatest during the introduction of the drug in therapy and for the first few months of the onset of therapy. HAS-BLED scor is a skoring system developed to estimate the 1-year risk of major bleeding in patients with atrial fibrillation and is also used for other indications.

scholarly journals Problem of prescribing anticoagulant therapy in patients with atrial fibrillation on the regional level

2020 ◽  
pp. 19-25
Author(s):  
M. G. Nazarkina ◽  
V. V. Stolyarova ◽  
D. A. Karpova
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Significant Proportion ◽  
Heart Rhythm ◽  
Regional Level ◽  
Thromboembolic Complications ◽  
Constant Form ◽  
Heart Rhythm Disorders ◽  
The Republic

Introduction. Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, with heart rhythm disorders accounting for a significant proportion of them. Atrial fibrillation (AF) is an arrhythmia that poses a risk of thromboembolic complications and is difficult to treat with ongoing preventive anticoagulant therapy. Aim of the study. To analyze the prescription of anticoagulant therapy to patients with AF on the regional level. Methods and results. The study included 72 patients with the nonvalvular form of AF (from 41 to 82 years old) of the Department of Rhythm and Conductivity Abnormalities of the State Budgetary Institution of the Republic of Mordovia RCH № 4 for 2019. Three groups were singled out depending on the AF form: the first one – patients with the constant form (n = 22), the second one (n = 24) – with the persistent form, the third one (n = 24) – with the paroxysmal form. The risk of thromboembolic complications was assessed using the CHA2DS2-VASc scale and hemorrhagic complications using the HAS-BLED scale. All patients had a high risk of thromboembolism (index above 2 points), which reflects multiple risk factors and indicates the need for oral anticoagulants (OAC). According to HAS-BLED scale calculations, the risk of haemorrhagic complications was low in most patients (2 or less points) – there was no significant increase in the risk of bleeding, but careful monitoring is required. Analysis of the results revealed that only 54% of patients took OAC, despite the fact that all patients were shown anticoagulant therapy. When analyzing the cases of patients who did not take anticoagulants, it was found that 23% of patients, despite the doctor’s recommendations, refused to take the drugs, 47% of patients justified the inability to control IHR and 30% were unable to purchase expensive new OAC. Conclusion. Despite the recommendations for the management of patients with atrial fibrillation, only 54% were prescribed oral anticoagulants.

Abstract WP232: Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Continuous Outpatient Telemetry After Cryptogenic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denise Sebasigari ◽  
Alexander Merkler ◽  
Guo Yang ◽  
Benjamin Kummer ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Heart Rhythm ◽  
Population Based ◽  
Embolic Stroke ◽  
P Wave ◽  
Left Atrial Diameter ◽  
New Diagnosis ◽  
Rhythm Monitoring

Background: In population-based studies, biomarkers of atrial dysfunction or “cardiopathy” have been shown to be associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict atrial fibrillation on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods: This was a single-center retrospective study including all patients who met consensus criteria for ESUS and who underwent 30 days of ambulatory heart-rhythm monitoring looking for AF between Jan 1 st , 2013 and Dec 31 st , 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in ECG lead V1 , and PR interval on ECG. Multiple logistic regression was used to assess the relationship between atrial biomarkers and AF detection. Results: Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 vs. 61.4 years, p < 0.001) and had larger left atrial diameter (39.2 vs. 35.7 mm, p = 0.03). In a multivariable model including variables significant on univariate analyses, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; p = 0.04). Atrial biomarkers were not associated with AF detection. Conclusion: Atrial biomarkers were not associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms and study anticoagulation versus antiplatelet treatment for secondary stroke prevention in patients with ESUS and atrial cardiopathy.

scholarly journals Genetics of Atrial Fibrillation in 2020

2020 ◽  
Vol 127 (1) ◽  
pp. 21-33 ◽  
Author(s):  
Carolina Roselli ◽  
Michiel Rienstra ◽  
Patrick T. Ellinor
Keyword(s):  
Atrial Fibrillation ◽  
Complex Disease ◽  
Association Studies ◽  
Heart Rhythm ◽  
Genome Wide Association Studies ◽  
Future Directions ◽  
Genetics Research ◽  
Genome Wide ◽  
Increased Risk ◽  
Rhythm Disorder

Atrial fibrillation is a common heart rhythm disorder that leads to an increased risk for stroke and heart failure. Atrial fibrillation is a complex disease with both environmental and genetic risk factors that contribute to the arrhythmia. Over the last decade, rapid progress has been made in identifying the genetic basis for this common condition. In this review, we provide an overview of the primary types of genetic analyses performed for atrial fibrillation, including linkage studies, genome-wide association studies, and studies of rare coding variation. With these results in mind, we aim to highlighting the existing knowledge gaps and future directions for atrial fibrillation genetics research.

scholarly journals Acute Device-Related Thrombus after Watchman Device Implant

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Muhammad Ajmal ◽  
Vijendra Swarup
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Blood Clot ◽  
Heart Rhythm ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Acute Thrombosis ◽  
Increased Risk ◽  
Watchman Device ◽  
Laa Closure

Atrial fibrillation is characterized by irregularly irregular heart rhythm with an increased morbidity and mortality. It is associated with an increased risk of thromboembolism due to formation of blood clot in the left atrium. Most of these blood clots are formed in the left atrial appendage. The risk of blood clot formation is reduced with the use of anticoagulants. The patients who cannot take anticoagulants due to an increased bleeding risk can undergo percutaneous left atrial appendage (LAA) closure. A Watchman device is used for this purpose. LAA closure with the Watchman device is associated with some adverse effects, and one of them is device-related thrombus. Currently, there are no specific guidelines for the management of device-related thrombus. We present a case of Watchman device-related thrombus which developed 16 hours after the device placement. We will also discuss various options for the management of acute thrombosis.

scholarly journals Risk Factors for Cardiovascular Events in Patients on Antidementia Medications

2020 ◽  
Vol 35 ◽  
pp. 153331752092238
Author(s):  
Meiqi He ◽  
James M. Stevenson ◽  
Yuting Zhang ◽  
Inmaculada Hernandez
Keyword(s):  
Cardiovascular Events ◽  
Heart Rhythm ◽  
Combined Model ◽  
Factors Associated ◽  
C Statistic ◽  
Five Factors ◽  
Heart Rhythm Disorders ◽  
Increased Risk ◽  
History Of ◽  
Β Blockers

Objective: To identify characteristics associated with an increased risk of cardiovascular events in patients diagnosed with Alzheimer disease (AD) and treated with antidementia medications. Methods: Demographics, diagnoses, and medication usage of 30 433 Medicare patients were analyzed using 2006 to 2013 claims data and a combined model of screening, ranking and stepwise logistic regressions to evaluate factors associated with composite outcomes of 6 cardiovascular events. Results: Incidence rate of at least 1 cardiovascular event was 25.1%. Fifty-five factors were identified from the 10 381 candidate variables by the combined model with a c-statistic of 67% and an accuracy of 75%. Factors associated with increased risk of cardiovascular events include history of heart rhythm disorders, alteration of consciousness (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.14-1.36), and usage of β-blockers (OR: 1.19; 95% CI: 1.13-1.27). Conclusions: Clinicians should consider the increased risk of cardiovascular events in patients with AD with heart rhythm disorders and on β-blockers.

scholarly journals Apelin and Atrial Fibrillation: The Role in the Arrhythmia Recurrence Prognosis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Agata Salska ◽  
Michał Dziuba ◽  
Witold Salski ◽  
Krzysztof Chizynski ◽  
Marzenna Zielinska
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Persistent Atrial Fibrillation ◽  
Enzyme Linked Immunosorbent Assay ◽  
Direct Current Cardioversion ◽  
Heart Rhythm Disorders ◽  
Cardiology Clinic ◽  
Clinic Medical ◽  
Medical University

Apelin is a novel peptide of wide expression and multiple biological functions including the crucial role in cardiovascular homeostasis. The apelin role in the pathophysiology of heart rhythm disorders is considered, although the reports are scarce so far. The purpose of this study is to investigate the potential utility of apelin as a marker of arrhythmia recurrence after direct-current cardioversion (DC). The prospective, observational study included 60 patients (aged 41–86; 30% female) with nonvalvular, persistent atrial fibrillation from the group of 204 consecutive patients scheduled for DC during the 12-month period (from May 2010 to May 2011) in the Cardiology Clinic Medical University of Lodz, Poland. The study group was divided into SCD (successful DC), 45 (75%) patients, and NDC (nonsuccessful DC), 15 (25%) patients. Within the SCD group, the subgroups were distinguished depending on the time sinus rhythm maintenance after DC: up to 7 days (SDC-7), 11 patients; 7 to 30 days (SDC-30), 12 patients; over 90 days (SDC-90), 22 patients. Patients were evaluated during the hospitalization and within the 3-month follow-up period. The apelin level was determined within the plasma samples collected at the admission, using the commercially available enzyme-linked immunosorbent assay (ELISA) Kit for apelin-36. It was found that the median value of initial apelin in the subset of patients from groups NDC + SDC-7 + SDC-30 is significantly higher than from group SDC-90 (p=0.0463); there was no relationship between NDC and SCD overall. Neither of the compared subgroup pairs revealed statistically significant correlation between the proBNP concentration and the DC effectiveness in our population. In conclusion, in our study, proBNP was not a marker of arrhythmia recurrence whereas higher apelin concentration at the admission indicated patients in whom DC was not effective or they had an arrhythmia recurrence within a month-period observation.

scholarly journals Peripheral blood leukocyte telomere length as a possible prognostic marker for the development of atrial fibrillation

2020 ◽  
Vol 11 (2) ◽  
pp. 50-54
Author(s):  
Svetlana Yu. Nikulina ◽  
Ksenya Yu. Shihkova ◽  
Vladimir A. Shulman ◽  
Anna A. Chernova ◽  
Vladimir N. Maksimov
Keyword(s):  
Atrial Fibrillation ◽  
Telomere Length ◽  
Heart Rhythm ◽  
Peripheral Blood Leukocyte ◽  
Response To Therapy ◽  
Leukocyte Telomere Length ◽  
Risk Markers ◽  
Heart Rhythm Disorders ◽  
Blood Leukocyte

Atrial fibrillation is one of the most common heart rhythm disorders. The most prominent risk factor for atrial fibrillation is advanced age. Population ageing contributes to an increase in both the prevalence of this pathology and socio-economic burden of the disease for society in general and the patient in particular. Adequate therapy and prevention of atrial fibrillation requires the search for novel prognostic risk markers for disease development, progression, and patients response to therapy. One of these markers is the length of telomeres structures at the ends of chromosomes that protect them from degradation during cell division. The article provides an overview of world studies, both confirming and disproving the role of leukocyte telomere length in atrial fibrillation development.

scholarly journals Direct oral anticoagulants in atrial fibrillation patients aged 75 years or older: Efficacy and safety balance

2017 ◽  
Vol 89 (4) ◽  
pp. 4-7 ◽  
Author(s):  
V V Fomin ◽  
A A Svistunov ◽  
D A Napalkov ◽  
A A Sokolova ◽  
M A Gabitova
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Research Programme ◽  
Heart Rhythm ◽  
Scientific Data ◽  
Treatment And Prevention ◽  
Heart Rhythm Disorders ◽  
Prevention Of Thromboembolic Events

Atrial fibrillation (AF) is one of the most common heart rhythm disorders in the population. Researchers revealed a direct relationship between their incidence and a patient’s age long ago. One of the most challenging issues of clinical practice in patients with AF is anticoagulant therapy used in the so-called very elderly patients aged 75 years and older when age itself is a risk factor for developing both thromboembolic and hemorrhagic events due to anticoagulants, regardless of the mechanism of action of the latter. However, scientific data regarding the treatment and prevention of thromboembolic events in elderly and senile patients with AF are very scarce and often uninformative. The data from the EURObservational Research Programme-Atrial Fibrillation Registry Pilot Phase (EORP-AF Pilot) and the randomized clinical studies RELY, ROCKET AF, ARISTOTLE, and AVERROES were analyzed to identify the most safe and most effective anticoagulant for elderly patients (over 75 years). Relying on the analyses of literature data, the authors propose an algorithm based on clinical characteristics for choosing the anticoagulant for patients older than 75 years.

scholarly journals The impact of the acceptance of illness on the quality of life of patients with atrial fibrillation

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
B Jankowska-Polanska ◽  
D Kasperczak ◽  
N Swiatoniowska-Lonc ◽  
J Polanski
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Well Being ◽  
Supraventricular Arrhythmia ◽  
Heart Rhythm Disorders ◽  
The Mean ◽  
Acceptance Of Illness ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background. Atrial fibrillation (AF) is the most common supraventricular arrhythmia. AF and the complications associated with it interfere with the physical, mental and social well-being of a person, thus affecting the quality of life. An important factor affecting the quality of life of patients with AF is the acceptance of illness (AI). In spite of the large problem related to this subject, the analysis of the relation between the acceptance of illness and the quality of life of patients with AF is insufficient. The aim of the study was to assess the impact of the acceptance of illness on the quality of life of patients with AF. Material and methods. 84 patients (including 51 men) aged 57.86 ± 17.72 years hospitalized in the cardiology department due to heart rhythm disorders. Standardized tools were used in the study: Acceptance of Illness Scale (AIS) to assess the acceptance of illness and Arrhythmia-Specific questionnaire In Tachycardia and Arrhythmia (ASTA) to assess quality of life. Results. The majority of patients were secondary educated (64.27%), lived in a city (78.58%), were inactive (57.15%), were hospitalized 3-5 times (42.85%), had a cardiostimulator (23.80%) or underwent ablation (22.62%) during the last year. The average result of the acceptance of illness was 27.67 ± 7.70. 48.8% of patients had a high level of the acceptance of illness, 38.09% average, and 13.11% did not accept their illness. The mean result of quality of life for the whole studied group was (ASTA III) 25.64 ± 8.64. As regards the severity of symptoms (ASTA II) the mean result was 17.15 ± 5.89. Correlation analysis showed that the higher the level of the acceptance of illness the higher the quality of life (r = 0.640; p = 0.002) and lower the severity of AF symptoms (r=-0.51, p &lt; 0.001). Conclusions. Patients with AF present a moderate level of disease acceptance and quality of life. The acceptance of illnessis the independent predictor and significantly increases quality of life of patients with AF.

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