Cancellations and Transfers Related to New-Onset Atrial Fibrillation: An Analysis of Survey and Patient Safety Reporting Data From Ambulatory Surgical Facilities

Atrial fibrillation (AF) is a cardiac arrhythmia characterized by an irregular rhythm and often rapid heart rate. People with AF can be symptomatic or asymptomatic and are at increased risk for stroke. In this study, we used two data sources—a survey and Pennsylvania Patient Safety Reporting System (PA-PSRS) reports—to examine new-onset AF in Pennsylvania ambulatory surgical facilities (ASFs). The survey was developed and conducted to learn more about new-onset AF– related cancellations and transfers in Pennsylvania ASFs and to update the Patient Safety Authority ASF Cancellation and Transfer Tracking Tool. The survey response rate was 53.1%, with 50.9% of respondents indicating new-onset AF–related cancellations in the last year. A five-year review of PA-PSRS data revealed an increase in the number of new-onset AF–related cancellation and transfer events that occurred in the last two years. In 70.9% of the reports, patients were 65 years of age and older. A paucity of research on this patient safety issue led us to identify areas for future research.

Coronavirus disease 2019 (COVID-19) and Pregnancy: A narrative review

: A novel viral respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-C0V-2), is responsible for a pandemic situation in the world. Pregnant women are susceptible against this virus due to physiologic changes of immunologic system. Some adverse pregnancy outcome such as; death, still birth, preeclampsia, intra uterine fetal distress may increase in infected pregnant women. Infected women should be isolated and investigated and they should admit in a designated hospital with adequate facilities and multi-disciplinary expertise to manage them. Some adverse neonatal complication such as; Small for Gestational Age, Large for Gestational Age, shortness of breath, thrombocytopenia with abnormal liver function, rapid heart rate, vomiting and pneumothorax may increase in affected neonate. This study reviews the problems and guidelines of covid-19 in pregnancy. The limitation of this study was; we didn’t conduct systematic review among studies were done in pregnancy and COVID 19.

A Case of Recurrent Palpitations in an Elderly Woman with Breast Cancer: Management of Recalcitrant Svt in the Emergency Department

Supraventricular tachycardia encompasses a group of cardiac rhythm disturbances characterised by a rapid heart rate, which arise from impulses originating above the bundle of His. This condition affects patients across all age groups and is a common occurrence in the emergency setting. We present the case of a 69-year-old woman with a history of breast carcinoma, hypertension and hyperlipidaemia, who presented to the emergency department with recurrent palpitations which were confirmed on electrocardiogram to be the result of supraventricular tachycardia. The management of recalcitrant supraventricular tachycardia in the emergency setting, including techniques described in recent literature, as well as special considerations for the elderly and oncological patients in the acute setting will be discussed.

Fetal Tachycardia in the Delivery Room: Fetal Distress, Supraventricular Tachycardia, or Both?

Background Supraventricular tachycardia (SVT) is seldom considered a cause for fetal tachycardia; commoner etiologies including maternal fever and fetal distress are usually envisaged. Fetal arrhythmia can be missed as a diagnosis, potentially leading to suboptimal management. Cases Three cases are described where detection of fetal tachycardia >200 beats per minute (bpm) at 36, 40, and 38 weeks gestation resulted in emergency cesarean section for presumed fetal distress. Retrospective review of the cardiotocograph in two cases revealed baseline heart rates 120 to 160 bpm, with loss of trace associated with auscultated rates over 200 bpm. The diagnosis of SVT was not initially considered and made later when the infants required cardioversion at the age of 3 weeks, 2 days, and 8 days, respectively. The 36-week infant required noninvasive ventilation for prematurity. Conclusion SVT should be actively considered in the differential diagnosis of fetal tachycardia. Unrecognized fetal SVT may result in avoidable caesarean for suspected fetal distress, with potential prematurity-related problems. The cardiotocograph can be helpful if showing contact loss associated with rapid heart rate auscultation. The antenatal detection of fetal SVT is important as it can allow anticipation and prevention of neonatal SVT, which is potentially life-threatening if not detected and treated promptly.

Effects of 12-Week Supplementation of a Polyherbal Formulation in Old Adults with Prehypertension/Hypertension: A Randomized, Double-Blind, Placebo-Controlled Trial

Background. Uncontrolled blood pressure is the leading cause of mortality and disability due to associated cerebral and cardiovascular diseases and kidney failure. More than one-third of the old adult population have hypertension or prehypertension and many of their blood pressure are poorly controlled. Objective. We hypothesized that plant extracts-based antioxidants may benefit those with prehypertension/hypertension. Method. One hundred age- and gender-matched healthy older adults were randomly assigned to receive HyperBalance capsules (n=50) or placebo (n=50) at Tang-Qiao Community Health Service Center, Shanghai. Blood pressure and severity scores of hypertension treatment-related symptoms (dizziness, headache, ringing/buzzing in ears, rapid heart rate, and chest tightness) were evaluated before and after the 12-week intervention. Results. Ninety-eight people completed the study, with 2 dropouts in the placebo group before the end of the study. Forty-one subjects (82%) of the HyperBalance group and 40 subjects (83.3%) of the placebo group had prehypertension (systolic blood pressures (SBP) between 130-139 and diastolic blood pressure (DBP) between 85-89mmHg), and 9 subjects (18%) in the HyperBalance group and 8 subjects (16.7%) in the placebo group had hypertension (≥140/90mmHg) before the intervention. HyperBalance significantly (P<0.01) reduced SBP from 136.18±4.38 to 124.14±3.96 mmHg and reduced DBP from 82.45±2.91 to 80.24±2.41mmHg, respectively, and reversed all 9 hypertension people to normotension or prehypertension state, whereas the placebo moderately reduced SBP from 135.79±4.22 to 132.35±4.656mmHg and reduced DBP from 82.90±3.07 to 82.27±3.01mmHg. All symptom severity scores became significantly lower in the HyperBalance group than in the placebo group after HyperBalance intervention: dizziness (0.82±0.44; vs 2.02±0.64, P<0.01); headache (0.46±0.50; vs 1.81±0.61, P<0.01); ringing/buzzing in ears (0.44±0.50; vs 1.04±0.29, P<0.01); and rapid heart rate and chest tightness (0.30±0.46; vs 0.92±0.28, P<0.01). Conclusion. Polyherbal supplementation such as HyperBalance could benefit old adults with prehypertension/hypertension and improve treatment-related symptoms. Further studies are needed to validate the current findings.

Forecasting Ventricular Deviation in Monitoring of Live ECG Signal

Number of coronary artery disease cases and ventricular arrhythmias has been increasing in India. One of the common forms of cardiac disorder is Ventricular Tachycardia(VT). Due to improper electrical activities in the ventricles, consistent and rapid heart rate occurs, which produces Ventricular Tachycardia disorder. Short time period may not lead to severe heart problem, but the longer duration increases it may be a severe heart issue. In this disorder,for short durations it is possible that there may not be any symptoms or few symptoms with palpitations(increase / decrease in heart beats), dizziness or pain in chest. This disorder may result in cardiac arrest. This may also results into ventricular fibrillation. initially it was found that near about 7% of people in cardiac arrest are caused by Ventricular Tachycardia. In this work, a novel platform for real time diagnosis of Ventricular Tachyarrhythmia with the help of a portable Single lead ECG device is proposed. The gateway for signal analysis and combined edge and cloud based processing for the diagnosis is used. The biosignal captured by the device in LEAD II configuration is pushed to a cloud based diagnosis API through a mobile gateway. An algorithm in the cloud analyses this signal and finds out P, Q, R, S, T, their amplitude positions, onset and offset. From the onset and offset ST segment slope, elevation, depression, S morphology and ST segment variation statistics is captured and classified using rule based classifier. The work evaluates the performance of the classifier with Physionet dataset. The accuracy of the system was found to be 90% with accuracy of detecting normal ECG being 100% where as the accuracy of detection of VT being 80%. Results shows that the system is extremely efficient in detecting Ventricular Tachyarrhythmia and many related cardio vascular diseases.

Co-morbidity (HFrEF and HFpEF): valvular heart disease

Heart failure may complicate primary valvular disease as the result of late diagnosis, too late intervention, or absence of intervention because of severe co-morbidities. The objective of the management of primary valve disease is to prevent heart failure through close follow-up, preferably in a specialized heart valve clinic. Reduction in too late intervention and the availability of catheter-based valve implantation in high- and moderate-risk patients can reduce the development of heart failure. This leads to increased expectancy of life but the patients may have redo-interventions and a risk of recurrent heart failure. Symptoms and signs of heart failure can relate to the valve disease or complications such as atrial fibrillation, ventricular systolic dysfunction, and/or diastolic dysfunction. Atrial fibrillation is frequent. The occurrence of atrial fibrillation can produce acute heart failure as a consequence of rapid heart rate and a decrease in diastolic time. This is particularly severe in patients with mitral stenosis who can develop acute pulmonary oedema. In patients with severe aortic stenosis, the left ventricle has prolonged relaxation and reduced compliance; a fast heart rate is usually not tolerated.