Self – Assessment MCQ Questions for Vol.1 No.3

2002 ◽  
Vol 1 (3) ◽  
Author(s):  
D Phil ◽  
DK Satchithananda ◽  
David McNamara ◽  
Joanna C Girling ◽  
Marguerite E Hill ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Pulmonary Embolism ◽  
Sinus Thrombosis ◽  
Accessory Pathway ◽  
Foot Drop ◽  
Ventricular Rate ◽  
Repeat Endoscopy ◽  
Increased Risk ◽  
Bleeding Gastric Ulcer

(DK Satchithananda, A Macnab & AJF Page) · The following are true of atrial fibrillation: 1. An irregularly irregular pulse is pathognomonic of atrial fibrillation. 2. Co-ordinated atrial activity at around 300 beats per minute is usually apparent on the 12 lead ECG. 3. Ventricular rate is usually between 100-160 beats per minute in untreated AF. 4. Bradycardia usually implies the presence of an accessory pathway. 5. P-waves may be visible on the baseline of a 12-lead ECG. · The following are true of cardioversion for AF: 6. Following successful electrical cardioversion, more than 90% of patients remain in sinus rhythm at 1 year. 7. Anticoagulation prior to cardioversion is not mandatory if the duration of AF is less than 48 hours. 8. Biphasic energy defibrillation is associated with a higher success rate. 9. Sotalol is contraindicated for patients with ischaemic heart disease. 10. Flecainide is the pharmacological treatment of choice for patients with structurally normal hearts. (P Bhandari & P Patel) · The following are associated with a higher mortality following upper GI haemorrhage: 11. Older age. 12. Co-existent liver disease. 13. Reflux oesophagitis on endoscopy. 14. Systolic blood pressure >100mmHg on admission. 15. Pulse rate · Following the diagnosis of bleeding gastric ulcer: 16. Oral proton pump inhibitors reduce likelihood of rebleeding. 17. Intravenous ranitidine should be administered if peptic ulcer disease is identified on endoscopy. 18. Helicobacter pylori eradication may be beneficial. 19. Repeat endoscopy is not required. 20. Aspirin is less likely to cause recurrence if enteric-coated. (A J Lindahl, M E Hill & D Phil) · Which of the following are common clinical features of Myasthenia Gravis? 21. Unilateral foot drop. 22. Nasal regurgitation when swallowing liquids. 23. Fluctuating hemiparesis. 24. Headache. 25. Unilateral dilated unreactive pupil. · Which of the following statements about MG are true? 26. It is predominantly a disease of young women. 27. Removal of a thymoma may result in disease remission. 28. It is rare before puberty. 29. The elderly are less likely to respond to medication. 30. A negative anti-acetylcholine receptor antibody test does not rule out the diagnosis. · When treating MG: 31. It is generally safe to start steroid treatment as an outpatient. 32. Steroids should be introduced slowly. 33. Most myasthenics manage well on anticholinesterases and do not require immunosuppression. 34. Gastrointestinal side effects are common with anticholinerases. (J C Girling) · During pregnancy: 35. The ECG finding of an S wave in lead I, Q-wave in lead III and inverted T-wave in lead III usually implies pulmonary embolism. 36. PO2 is usually lower with the patient supine. 37. Increased risk of pulmonary embolism is confined to the 3rd trimester. 38. Low molecular weight heparin should be avoided. 39. D-dimer is usually positive. · Following a first fit during pregnancy: 40. The absence of proteinuria and normal blood pressure excludes the diagnosis of eclampsia. 41. Treatment with magnesium sulphate is recommended for eclampsia. 42. Cortical sinus thrombosis should be considered. 43. Sodium valproate is the drug of choice for non-eclamptic fits. 44. Amniotic fluid embolism should be considered. (D McNamara) · Neuroleptic Malignant Syndrome (N.M.S.) and Serotonin Syndrome (S.S.) have the following differences: 45. S.S. has a higher mortality. 46. N.M.S. has a quicker onset. 47. S.S. has a slower course. 48. S.S. has a higher recurrence rate following drug rechallenge. 49. Laboratory findings are more supportive diagnostically of N.M.S. · Strategies with proven efficacy include: 50. ECT for S.S. 51. Cyproheptadine for N.M.S. 52. Dantrolene for S.S. 53. Benzodiazepines for both. 54. Artificial ventilation for both. · Risk factors for N.M.S. include: 55. agitation. 56. rapid neuroleptisation. 57. previous ECT. 58. brain injury. 59. females.

scholarly journals Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1514
Author(s):  
Hilde Espnes ◽  
Jocasta Ball ◽  
Maja-Lisa Løchen ◽  
Tom Wilsgaard ◽  
Inger Njølstad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Pressure Management ◽  
Reference Models ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

P6578Development of the novel program to diagnose atrial fibrillation using automated blood pressure monitor

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ishizawa ◽  
T Noma ◽  
S Ishikawa ◽  
K Matsunaga ◽  
R Kawakami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Sensitivity And Specificity ◽  
Pressure Pulse ◽  
High Sensitivity ◽  
Cardiac Patients ◽  
The Novel ◽  
Waveform Data ◽  
Medical Needs ◽  
Increased Risk

Abstract Background Atrial fibrillation (AF) is often asymptomatic and contributes to an increased risk of strokes. The development of proper screening device of AF is unmet medical needs worldwide. Recently, we had reported that multiple measurements using Omron automated blood pressure (BP) monitor with irregular heartbeat detection showed high sensitivity and specificity for AF detection in general cardiac patients, however, this method had limitations in discriminating between AF and other arrhythmias. Purpose The aim of this study is to develop a novel program that can accurately diagnose AF by discriminating it from other arrhythmias using the pressure pulse waveform data outputted from Omron automated BP monitor. Methods In our previous clinical research, BP measurements were performed 3 times each for 303 general cardiac patients (mean age: 72.2 years, 69.8% male) with recording the real-time single lead ECG, and a total of 909 pressure pulse waveforms were obtained. Among them, 840 pressure pulse waveforms from 280 patients (include 40 AF patients) used for further analysis. We developed a program to analyze and visualize uniquely the characteristics of AF waveform through the autocorrelation-based waveform processing system produced by Melody International Ltd, Kagawa, Japan. All visualized results were judged and classified into Sinus, Non-AF and AF by two individuals blinded to the results. For each patient who obtained 3 results, a two by two contingency table was created and sensitivity, specificity, and accuracy for diagnosing AF were calculated. Results Among 840 pressure pulse waveforms, only 21 (2 Sinus and 19 Non-AF) out of 720 Sinus and Non-AF waveforms were judged as AF, and 7 out of 120 AF waveforms were judged as Non-AF. None of AF waveforms was absolutely misjudged as Sinus. In analysis for each patient, when one or more AF judgements were found in 3 waveforms, the diagnosis of AF has sensitivity and specificity of 100% and 95.8%, respectively. When two or more AF judgements were found in 3 waveforms, the diagnosis of AF has sensitivity and specificity of 100% and 97.9%, respectively. In this rule, the diagnostic accuracy of AF reached up to 98.8%, and no sinus patients were misjudged as AF. Conclusion The novel program, which applied autocorrelation methods uniquely to analysis of the pressure pulse waveforms recorded by automated BP monitor, showed high sensitivity and high specificity for AF diagnosis in general cardiac patients. This program is expected to be useful for early diagnosis for asymptomatic AF patients. Acknowledgement/Funding The present research is supported by a grant through the SCOPE from the Ministry of Internal Affairs and Communications, Japan.

scholarly journals Hypertension burden and the risk of new-onset atrial fibrillation: a nationwide population-based study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
SR Lee ◽  
CS Park ◽  
EK Choi ◽  
HJ Ahn ◽  
KD Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Population Based ◽  
Total Study Population ◽  
Funding Sources ◽  
Increased Risk ◽  
Burden Scale ◽  
History Of ◽  
Study Population ◽  
Stage 1

Abstract Funding Acknowledgements Type of funding sources: None. Background The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. Purpose We aimed to investigate the relationship between hypertension burden and the development of incident AF. Methods and Results: Using the Korean National Health Insurance Service database, we identified 3,726,172 subjects who underwent four consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22,012 patients (0.59% of the total study population, 1.168 per 1,000 person-years). Using the BP values at each health checkup, we determined the burden of hypertension (systolic blood pressure [SBP] ≥130 mmHg or diastolic blood pressure [DBP] ≥80 mmHg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n = 742,806), 19% (n = 704,623), 19% (n = 713,258), 21% (n = 766,204), and 21% (n = 799,281). Compared to normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semi-quantitative analyses with further stratification of stage 1 (SBP 130-139 mmHg or DBP 80-89 mmHg) and stage 2 (SBP ≥140 mmHg or DBP ≥90 mmHg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. Conclusions Both a sustained exposure and the degree of increased blood pressure were associated with an increased risk of incident AF. Tailored blood pressure management should be emphasized to reduce the risk of AF. Abstract Figure.

scholarly journals Ambulatory blood pressure and long-term risk for atrial fibrillation

Heart ◽  
2018 ◽  
Vol 104 (15) ◽  
pp. 1263-1270 ◽  
Author(s):  
Valérie Tikhonoff ◽  
Tatiana Kuznetsova ◽  
Lutgarde Thijs ◽  
Nicholas Cauwenberghs ◽  
Katarzyna Stolarz-Skrzypek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Population Based ◽  
European Population ◽  
Night Time ◽  
Cox Models ◽  
Increased Risk ◽  
Daytime Blood Pressure

ObjectiveData on the contribution of ambulatory blood pressure (ABP) components to the risk of developing atrial fibrillation (AF) are limited. We prospectively tested the hypothesis that ABP may represent a potentially modifiable risk factor for the development of AF in a European population study.MethodsWe recorded daytime blood pressure (BP) in 3956 subjects randomly recruited from the general population in five European countries. Of these participants, 2776 (70.2%) underwent complete 24-hour ABP monitoring. Median follow-up was 14 years. We defined daytime systolic BP load as the percentage BP readings above 135 mm Hg. The incidence of AF was assessed from ECGs obtained at baseline and follow-up and from records held by general practitioners and/or hospitals.ResultsOverall, during 58 810 person-years of follow-up, 143 participants experienced new-onset AF. In adjusted Cox models, each SD increase in baseline 24 hours, daytime and night-time systolic BP was associated with a 27% (P=0.0056), 22% (P=0.023) and 20% (P=0.029) increase in the risk for incident AF, respectively. Conventional systolic BP was borderline associated with the risk of AF (18%; P=0.06). As compared with the average population risk, participants in the lower quartile of daytime systolic BP load (<3%) had a 51% (P=0.0038) lower hazard for incident AF, whereas in the upper quartile (>38%), the risk was 46% higher (P=0.0094).ConclusionsSystolic ABP is a significant predictor of incident AF in a population-based cohort. We also observed that participants with a daytime systolic BP load >38% had significantly increased risk of incident AF.

The association between atrial fibrillation and pulmonary embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Svennberg ◽  
L Friberg
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Risk Factor ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Funding Source ◽  
Anticoagulant Treatment ◽  
Oral Anticoagulant Treatment ◽  
Increased Risk

Abstract Background and objectives Previous studies have suggested that atrial fibrillation is a risk factor for pulmonary embolism. Oral anticoagulant therapy is the mainstay of treatment for atrial fibrillation and pulmonary embolism. We wanted to investigate if atrial fibrillation remained associated with the development of pulmonary embolism if oral anticoagulant treatment was accounted for. Method In this retrospective registry study a random sample of 20% of the adult Swedish population comprising approximately 1.5 million individuals were included during 2010–2017 in a cohort analysis. The endpoint was acute pulmonary embolism. In the cohort study, patients were analysed according to oral anticoagulant treatment and presence of atrial fibrillation at baseline. Results The group with atrial fibrillation was &gt;25 years older than the group without and had almost three times higher incidence of pulmonary embolism (2.91 vs 1.09 /1000 year at risk, p&lt;0.001). Individuals with atrial fibrillation on oral anticoagulant therapy had a lower risk of pulmonary embolism in multi-variable analysis (HR 0.59, CI 0.45–0.77). In the unadjusted analysis participants with atrial fibrillation without oral anticoagulant therapy showed an increased risk of pulmonary embolism (HR 3.33, CI 3.05–3.63). However, after multi-variable adjustment this association disappeared (HR 0.98, CI 0.89–1.07). In the entire atrial fibrillation cohort, no association was seen with the development of pulmonary embolism after multi-variable adjustment (HR 0.92, CI 0.84–1.01). The higher rate of pulmonary embolism among patients with atrial fibrillation can be fully explained by differences in age and co-morbidity. Conclusion Atrial fibrillation does not appear to be a clinically relevant risk factor for pulmonary embolism. Oral anticoagulant therapy protects against the development of pulmonary embolism in patients with atrial fibrillation. Associations with pulmonary embolism Funding Acknowledgement Type of funding source: Other. Main funding source(s): The main author has received funding from Stockholm County Council (Clinical postdoctorial appointment)

scholarly journals Blood Pressure Variability and Incidence of New-Onset Atrial Fibrillation

Hypertension ◽  
2020 ◽  
Vol 75 (2) ◽  
pp. 309-315 ◽  
Author(s):  
So-Ryoung Lee ◽  
You-Jung Choi ◽  
Eue-Keun Choi ◽  
Kyung-Do Han ◽  
Euijae Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Blood Pressure Measurement ◽  
Population Based ◽  
Increased Risk ◽  
Complete Set ◽  
The Impact ◽  
Fourth Quartile

Blood pressure variability is a well-known risk factor for cardiovascular disease, but its association with atrial fibrillation (AF) is uncertain. We aimed to evaluate the association between visit-to-visit blood pressure variability and incident AF. This population-based cohort study used database from the Health Screening Cohort, which contained a complete set of medical claims and a biannual health checkup information of the Koran population. A total of 8 063 922 individuals who had at least 3 health checkups with blood pressure measurement between 2004 and 2010 were collected after excluding subjects with preexisting AF. Blood pressure variability was defined as variability independence of the mean and was divided into 4 quartiles. During a mean follow-up of 6.8 years, 140 086 subjects were newly diagnosed with AF. The highest blood pressure variability (fourth quartile) was associated with an increased risk of AF (hazard ratio, 95% CI; systolic blood pressure: 1.06, 1.05–1.08; diastolic blood pressure: 1.07, 1.05–1.08) compared with the lowest (first quartile). Among subjects in the fourth quartile in both systolic and diastolic blood pressure variability, the risk of AF was 7.6% higher than those in the first quartile. Moreover, this result was consistent in both patients with or without prevalent hypertension. In subgroup analysis, the impact of high blood pressure variability on AF development was stronger in high-risk subjects, who were older (≥65 years), with diabetes mellitus or chronic kidney disease. Our findings demonstrated that higher blood pressure variability was associated with a modestly increased risk of AF.

P683Cardiovascular adverse events associated with BRAF and MEK inhibitors

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R I Mincu ◽  
A A Mahabadi ◽  
L Michel ◽  
S M Mrotzek ◽  
D Schadendorf ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Adverse Events ◽  
Arterial Hypertension ◽  
Mek Inhibitor ◽  
High Grade ◽  
Mek Inhibitors ◽  
Increased Risk ◽  
Melanoma Patients ◽  
Infarction Heart

Abstract Background Cardiovascular adverse events (CVAE) following treatment with B-Raf proto-oncogene serine/threonine kinase inhibitors and mitogen-activated protein kinase (BRAF/MEK) inhibitors in patients with melanoma remain incompletely characterized. We conducted the first detailed meta-analysis focused on BRAF/MEK inhibitor-associated CVAE. Purpose To determine the type and risk of BRAF/MEK inhibitor-associated CVAE. Methods We systematically searched Pubmed, Cochrane, and Web of Science for keywords “vemurafenib”, “dabrafenib”, “encorafenib”, “trametinib”, “binimetinib”, “cobinimetinib” through November 30, 2018. We selected randomized controlled trails (RCT) reporting on CVAE in melanoma patients under BRAF/MEK inhibitors. The selected endpoints were: decrease in left ventricular ejection fraction (LVEF), pulmonary embolism, atrial fibrillation, arterial hypertension, myocardial infarction, heart failure, pericarditis, and QTc interval prolongation. All-grade and high-grade (grade 3 or higher) CVAE were recorded. Results 9 RCTs including 4,616 patients with melanoma were selected. The treatment with BRAF/MEK inhibitors was associated with an increased risk in a decrease in LVEF, pulmonary embolism, atrial fibrillation, and arterial hypertension. The relative risks (RR) of myocardial infarction, heart failure, pericarditis, and QTc prolongation were similar between the BRAF/MEK inhibitors group and control group (Figure). These results were consistent for high-grade CVAE. The subgroup analysis showed that the combination therapy with BRAF/MEK inhibitors resulted in a higher risk of a decrease in LVEF, pulmonary embolism, and arterial hypertension, while the risk for atrial fibrillation was increased in BRAF inhibitors monotherapy group compared to controls. There was no significant difference between melanoma patients with mean age below and above 55 years old, except for the increased risk of atrial fibrillation in the older population group. The endpoints were similar between studies with mean follow-up times under and over 24 months. RR of cardiovascular adverse events Conclusions The therapy with BRAF and MEK inhibitors is associated with a higher risk of CVAE. This study increases the awareness on CVAE under these therapies and help to balance between beneficial melanoma treatment options and increased cardiovascular morbidity and mortality.

Atrial fibrillation and hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 2227-2229
Author(s):  
Hung-Fat Tse ◽  
Jo-Jo Hai
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Pressure Control ◽  
Hypertensive Patients ◽  
Good Blood Pressure Control ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Stress Activation

Hypertension is one of the most important independent risk factors for atrial fibrillation (AF). Conversely, AF is associated with an increased risk of stroke in hypertensive patients. While the pathophysiology linking the two conditions is not completely understood, it is likely attributed to interplay between mechanical stress, activation of the renin–angiotensin–aldosterone system, oxidative stress, and inflammatory response in hypertension to cause atrial electroanatomical remodelling, and thus AF. Management of hypertensive patients with AF encompasses lenient rate control, thromboprophylaxis, and good blood pressure control.

Asymptomatic pre-excitation

ESC CardioMed ◽  
2018 ◽  
pp. 2100-2105
Author(s):  
Jonathan Chrispin ◽  
Hugh Calkins
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Symptoms ◽  
Accessory Pathway ◽  
Clinical Signs ◽  
Epidemiological Data ◽  
Population Based ◽  
Increased Risk ◽  
Pr Interval ◽  
Life Threatening ◽  
Electrocardiogram Ecg

Manifest pre-excitation on the surface electrocardiogram (ECG) with a short PR interval and delta wave occurs in a very small percentage of the population based on epidemiological data. For the vast majority, this ECG finding will have no clinical manifestation and over time the ECG manifestation of pre-excitation may even go away. A small minority of individuals, however, develop clinical signs related to ventricular pre-excitation, most notably atrioventricular reentrant (reciprocating) tachycardia. This non-life-threatening arrhythmia is associated with clinical symptoms of palpitations, dyspnoea, and presyncope. Those with ventricular pre-excitation are at increased risk for atrial fibrillation. Multiple invasive electrophysiological and longitudinal studies have shown that those with atrial fibrillation and robust conduction down the atrioventricular accessory pathway are at an increased risk of sudden cardiac death from ventricular fibrillation. This chapter reviews the available and recommended strategies for assessing the patient with asymptomatic pre-excitation.

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