Cardiovascular diseases in elderly are major cause of expiry

Cardiovascular disease in elderly

Cardiovascular diseases as hypertension and cerebrovascular diseases and heart diseases as coronary artery disease, arrhythmias and heart failure, increased incidence with increasing age.The aging process itself also affects the cardiovascular system. It is difficult to differentiate “;normal “; aging is inevitable, once the age-related disease, which is potentially preventable or treatable. Age-related changes are more likely to be in the  “ old old “  who have escaped cardio-vascular disease early in life. This group reflects the dual process, often interacting biological aging of the cardiovascular system and age-related pathology.




Otherwise healthy people, the decline is probably not very important, but when the second condition, such as coronary artery or valvular disease, affects the heart, these age-related changes may exacerbate the problem or its treatment. management system also has experience gradual changes over the decades.



The walls of the arteries tend to lose elasticity and harden, even in the absence of internal blockade by fatty deposits (atherosclerosis). In general, this class can lead to high blood pressure called isolated systolic blood pressure greater (see below). Heart disease, including coronary heart disease, hypertension, cardiac arrhythmias and valve, increasingly common with age. At the age of 80 years, for example, 20 percent of Americans have symptomatic coronary artery disease. The change of role in several risk factors for the subject of this chapter because there is no reason to make changes in lifestyle, supposedly to prevent or slow the progression of coronary disease in the elderly. uncomfortable old heart can affect the quality of life, longevity, or both.



While heart disease is the largest cause of expiry among older Americans, and other problems, such as arrhythmias  and valve dysfunction are important because they show some  symptoms such as pain in the chest and fatigue, difficulty breathing ( dyspnea ) and fainting.



Practitioners whether decades of exposure to factors of cardiovascular risk may be compromised in the future. They also wonder if there is sufficient time for appropriate prevention measures for their effectiveness and applicability. But it is important to recognize that the life expectancy, even after the age of 80 years, about eight years.



Interpretation of information epidemics in the elderly is difficult because we must consider the prevalence of heart in this age, comorbidity, higher mortality and natural selection. concurrent disease is common in life can alter the association between risk factors and incidence of coronary heart disease.



Because hidden, serious disease of coronary artery disease, half of elderly patients from rich countries the distinction between primary and secondary prevention is blurred. In this age of sediments causes the development of proven or clinical events may be particularly important. All prospective studies of coronary heart disease, it is not possible to take account of competing causes of death.



The decrease in the strength of coronary risk factors with age may be due to the phasing out of the vulnerable population. Moreover, risk factors measured in the elderly may not reflect lifetime exposure to those observed to mitigate its impact on coronary heart disease.


The prevailing view that the power to reduce coronary risk factors in elderly because of reluctance to intervene.



However, to reduce the hazard ratio is offset by a significantly increased risk, so that makes the risk management more cost-effective compared to older age in between. Elderly patients at high risk of one or more risk factors for coronary heart disease can be effectively targeted to address the overall risk assessment for unnecessary overtreatment can be avoided.

Common heart disease in elderly are responsible for morbidity and high burden of disability

Common heart disease in elderly

In older age, many body systems will experience normal wear  and tear and may not work as they used to. This also applies to one of the major muscles of the body, the heart. Because of genetics, heredity and poor lifestyle choices, heart problems can occur at any age. However, they tend more and more generally in the elderly. The good news is that when people become aware of the common cardiovascular diseases in the elderly may be, are steps they can take to mitigate many of these conditions. It takes place in older increased risk of heart problems, reducing the pumping capacity of the blood. There are several problems to humans due to a deterioration of cardiac function.

We are an aging population. 


An estimated 20% of the population in Europe will be over 65 in 2000. The proportion of the population over 80 years, the  “ old “  “ old  “ is increasing most rapidly. Life expectancy at all ages is also increasing. A 65-year life expectancy ranges from 14.9 to 18.9 years of age and 80 years from 6.9 to 9.1 years for men and women, respectively. Cardiovascular diseases are the leading cause of death in people over 65 age and especially it is responsible for significant morbidity and a high burden of disability, particularly in the community.

The heart of the person through subtle physiological changes, even if he is sick. aged heart muscle can not relax completely to win less, as a result of pumping Chambers (room) must be rigid and may work less effectively, especially if certain heart diseases are present. Old age, heart pump is not strong or powerful than ever. the hearts of parents also less sensitive to adrenaline and can increase the strength or the number of contractions during the same extent that young people can.

We all know that even though 50 - or 100-yard dash was easy when we were 20, it is very difficult because we are old, the heart does not get enough blood to the muscles to give them enough oxygen. 


The percentage changes of cardiac function and reduces varies greatly among individuals.

Recent decline in mortality from coronary heart disease was one of the elders, showing that coronary disease is not an inevitable consequence of aging or immutable. Epidemiological studies of cardiovascular disease for the elderly shows that the risk factors that apply to the importance of the environment for the elderly.

Symptoms of heart (cardiovascular ) diseases - Fainting , Fatigue ,Pain in the limbs

SYMPTOMS OF HEART (CARDIOVASCULAR ) DISEASE .

 

PAIN IN THE LIMBS .

 

 

The pain can occur when tissues are not getting enough blood (a condition known as ischemia). The pain occurs because the tissues do not receive enough oxygen, which is carried by the blood to tissues, and because the waste products, which are made out of tissues by the blood that accumulates. If blood flow is completely blocked, as a blood clot in a large artery, a constant pain occurs suddenly, and the affected arm or leg becomes pale and cold. If blood flow is partially blocked, as can happen with atherosclerosis (typically a problem in the legs), the person usually feels a tightening, fatigue, pain in the calf muscle, during physical activity. This pain, called claudication, is quickly relieved by rest and similar returns during the activity. 

 

The pain of the limbs can also be caused by tense muscles, nerve damage near certain spinal cord, blood clots in the veins (venous thrombosis) or a skin infection or muscle. If the doctor suspects that the pain is due to a malfunction of vascular ultrasound to assess blood flow in the affected area can be done.

 

FATIGUE .

 

When the heart pumps inefficiently because heart failure, blood flow to muscles may be inadequate during exercise, which causes weakness and fatigue. The symptoms are often subtle. People tend to compensate by gradually reducing their activity, or they may blame the symptoms of age.

 

 

 FAINTING .

 

Turbidity (near-syncope) is the feeling that you are  about to faint. Fainting (syncope) is a sudden and brief loss of consciousness followed by spontaneous return of consciousness. The causes of confusion and fainting tend to be the same. A person can lose consciousness, unless the brain is generally disrupted. This disorder usually occurs because the blood flow to the brain is reduced. cerebral blood flow may be reduced by a heart disorder or, more often, without disturbing the normal return of blood to the heart and reduces blood flow to the brain. The elderly are particularly vulnerable because the blood flow to the brain decreases with age. Brain disorders in themselves rarely cause fainting, unless they also affect blood vessels. Seizures, a brain disease that can cause loss of consciousness, but is not considered defective.

 

Cardiac abnormalities, blood flow to the brain can be reduced if the heart rate or rhythm is abnormal (or too slow, too fast) or if the heart does not pump blood adequately, because blood flow is blocked. Blood flow can prevent a defective heart valve (in most cases, the aortic valve), or blood clots in the lungs, sometimes the heart, and, rarely, cardiac tumors, such as atrial myxoma.

 

Many factors can interfere with the return of blood flow. Coughing or straining bowel can increase the return of the chest to relieve blood pressure. healthy soldiers may feel weak or faint could stay in a long time (a phenomenon called parade ground unconscious) because the leg muscles must be active to return blood flow. Strong sense (in particular, has generated examining bloody or gruesome scene) or the pain may activate the vagus nerve. As a result, the blood vessels to expand (extension), will reduce the return of blood flow and sometimes the cause of fainting (called vasovagal syncope). Some diseases of the brain and spinal cord and drugs (particularly blood pressure) may also expand the blood vessels and cause fainting.

 

Sitting or standing too quickly can cause discomfort or fainting, as the change in position causes the blood in the legs, causing a drop in blood pressure. Normally, the body adapts quickly to maintain blood pressure. The inability to adjust quickly called orthostatic hypotension. This condition is especially common among the elderly. People are more likely to feel weak or faint when standing. When you lie or a drop in cerebral blood flow increases, usually recover consciousness.

 

 

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Symptoms of heart ( cardiovascular ) disease - Chest pain stress ,edema

SYMPTOMS OF HEART ( CARDIOVASCULAR )  DISEASE .

 

 

 None of the symptoms of a heart defect is conclusive proof, but certain symptoms suggest the possibility, and several symptoms together may make the diagnosis almost certain. Doctors identify symptoms of interviewing for medical history and physical examination. Diagnostic procedures are often performed to confirm the diagnosis. However, sometimes a heart defect, although serious, does not produce symptoms until late. routine health inspections or visit a doctor for some other reason can not reveal a heart defect, which did not cause any symptoms. Sometimes doctors perform procedures screen heart defect, although there is no evidence.

 

The symptoms of heart problems, including some types of pain, dyspnea, fatigue, palpitations (slow, fast or irregular heartbeat), dizziness, fainting and swelling of the legs, ankles and feet. However, these symptoms does not necessarily mean a heart problem. For example, pain may be due to respiratory or digestive system instead of a heart condition. Symptoms of disorders of the peripheral blood vessels vary depending on where blood vessels are involved. Symptoms may include pain, difficulty breathing, muscle cramps, muscle fatigue, dizziness, swelling, numbness and discoloration of the skin of the affected body part.

 

 

CHEST PAIN OR DISCOMFORT  

 Some more alarming symptoms of chest pain. In the minds of many people, the chest pain is equal to the pain of heart. And whilethere are many other conditions can cause chest pain, heart failure is very common - and dangerous - the symptom of chest pain should not be ignored out of hand as being insignificant.Chest pain is a vague term. It is often used to describe any pain, pressure, squeezing, choking, numbness or other discomfort in the chest, neck or upper abdomen, and often associated with jaw pain , head or arms. It may last less than a second to several days or weeks, can occur frequently or rarely and can occur sporadically or predictably. This description of chest pain is obviously very vague, and as was expect, many medical conditions, apart from these diseases can produce similar symptoms.

EDEMA

The swelling due to fluid accumulation (edema) in tissues. Occurs when blood pools in the leg veins, increasing pressure on leg veins and forcing the fluid from the veins into tissues. Blood may accumulate because the heart can not pump all the blood it receives from the body (heart failure) or due to a deep vein in the leg is blocked (deep vein thrombosis). swelling of the legs, ankles and feet, or abdomen may indicate a heart failure or a venous disorder, such as deep vein thrombosis. However, this inflammation is usually caused by standing or sitting in one position too long or age-related changes in the veins of the leg. Leg swelling is common during pregnancy. Inflammation may also be due to liver or kidney problems.

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Symptoms of heart ( cardiovascular ) disease -Shortness of breath ,cheyne-stokes breathing ,limitations in physical activity

Symptoms of heart  ( cardiovascular ) disease

CHEYNE-STOKES BREATHING .

Very severe heart failure, and alternatehyperventilation apnea or Cheyne-Stokes breathing may occur.This can also develop in elderly people without obvious heart failure.It associated with depression of the respiratory center, due to poor cardiac and cerebrovascular diseaes. Such ventilation can also be seen after morphine.

 
SHORTNESS OF BREATH OR DYSPNOEA .

Shortness of breath (dyspnea) is the sensation of difficult or labored breathing. Any disorder, disturb the normal, the delicate balance between oxygen supply and the body need oxygen can cause shortness of breath. It is a common symptom of lung disease, including infection, asthma and allergies. Shortness of breath may also occur in individuals who have a disorder of the respiratory muscles, a nervous system disorder that interferes with breathing, or too few red blood cells carry oxygen to the tissues (anemia). Shortness of breath is also a frequent symptom of heart disease, mainly heart failure (heart failure) and coronary heart disease (CHD).

In heart failure, respiratory distress and escape of fluid into the air spaces of the lungs, a condition known as pulmonary congestion or pulmonary edema. Ultimately, this process is similar to drowning. In the early stages of heart failure, shortness of breath may occur only during physical activity. The worsening heart failure, breathlessness occurs with less activity and, finally, occurs at rest. Shortness of breath at rest occurs mostly when people are lying because they filter the fluid in the lung tissue. This symptom often occurs at night and then called nocturnal dyspnea. When people stand up and turn the legs, gravity causes fluid to accumulate at the base of the lungs, reducing symptoms. Therefore, people with nocturnal dyspnea usually sleep with the support of pillows to keep flat.

In heart disease, shortness of breath usually occurs during physical activity, but people with serious illnesses, which may occur during minimal activity or at rest. Sometimes symptoms suggestive of a cause to the doctor. nocturnal dyspnea that is relieved when sitting with legs dangling and suggests heart failure. Shortness of breath that occurs during physical activity and is accompanied by chest pain to coronary artery disease. Shortness of breath with cough and fever suggests a lung infection. Shortness of breath that seem to be triggered by exposure to something in the environment, such as smoke or animal hair, suggests allergic disease or asthma.



LIMITATION OF PHYSICAL ACTIVITY .


Heart disease can reduce the ability of a person to perform an activity. One way to assess the degree of heart disease is to determine how this capacity is limited. Physicians can use the New York Heart Association (NYHA) functional class system to conduct this assessment. In a mild disease (class I), regular physical activity may be limited. In moderate disease (class II), the ordinary activity causes symptoms, and in moderately severe disease (class III), less the results of ordinary activities of symptoms. In severe disease (class IV), symptoms occur at rest, and any other physical activity that makes them worse. But this system is not foolproof, because even serious heart disease may produce no symptoms, if people reduce their activity to compensate for the disorder. 

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Symptoms of heart ( cardiovascular disease ) Heart palpitations

PALPITATIONS .

 

Palpitation is a sensation in the chest, which has been described in different ways. These are known as the heart beat faster in his chest, fluttering of the heart, the knowledge of the heart, or emotional to win or lose heart. Palpitations can be a symptom of a variety of symptoms from mild to severe diseases or disorders. Palpitations may arise in drug use, infection, cardiac arrhythmia, myocardial infarction, trauma, and other abnormal processes. Palpitations can occur at any age group or population. Palpitations are often linked to heart disease, but may also occur in many other diseases, disorders and conditions. For example, palpitations, usually because of some street drugs like methamphetamine and ecstasy.

 

Palpitations may result from relatively mild to moderate disease, which is relatively easy to solve, such as drinking too much coffee or an anxiety attack. Palpitations can also be a symptom of serious illness or death as cardiac arrhythmia. Palpitations are often associated with heart disease, but any condition or disease that causes rapid heartbeats (tachycardia) may cause palpitations. There may be disorders of the respiratory system, circulatory system and digestive system.

 

Depending on the cause, palpitations can be short and disappear quickly, as when palpitations occur during an anxiety attack. Palpitations can also occur in sudden, severe episodes, such as palpitations what is happening with a cardiac arrhythmia called supraventricular tachycardia. Palpitations may be chronic and continuous over a long period of time as when due to a cardiac arrhythmia chronic atrial fibrillation. Palpitations occur frequently in combination with other symptoms, which vary according to underlying disease or disorder. Other common symptoms include irregular heartbeat, chest pain, chest tightness, shortness of breath, cough, fever, abnormal vital signs, rapid breathing (tachypnea), shortness of breath (dyspnea). Dizziness, anxiety, agitation, and paranoia may also occur.

 

Complications about the causes of palpitations situation can be life-threatening, oxygen and carbon and high carbon dioxide in the body, sepsis, shock, life-threatening cardiac arrhythmias, respiratory arrest, cardiac arrest and death. The diagnosis of the cause of palpitations and begins to take a complete medical history and family, like symptoms, and the end of a medical examination. According to the suspicion September palpitations, blood tests can be complete blood counts, which can reveal the process of infectious diseases, and the configuration of the heart, which can detect heart. Blood and urine drug screens to determine if the drug agency, which may be the cause of palpitations.

 

The diagnosis of heart palpitations and their causes may be delayed or lost, because in some cases, palpitations may not be severe enough or last long enough for a person to seek medical attention. Palpitations may be a sign of serious illness and even potentially fatal and should be evaluated immediately.

Life saving procedures for heart conditions ( diseases ) advanced life support ACLS

ADVANCED CARDIAC LIFE SUPPORT .

Supports advanced cardiac life Support (ACLS) refers to a range of clinical interventions for the emergency treatment of cardiac arrest and other life-threatening medical emergencies and the knowledge and skills to use these interventions. Extensive medical knowledge and rigorous practical training and practice required to master ACLS. Only trained health professionals (doctors, paramedics, nurses, respiratory therapists, clinical pharmacists, physician assistants, nurses and other health workers trained) to provide ACLS, as it requires the ability to manage the airway of the patient , initiate IV access, read and interpret ECG emergency pharmacology, and understand. Some health professionals, or even put the rescuers can be trained in our basic life support (BLS), Cardiopulmonary resuscitation or CPR in particular.

When you experience a sudden cardiac arrest, immediate CPR an important link in survival. Another important link is early defibrillation, which has greatly improved the widespread availability of anti-epileptic drugs. ACL is to extend the BLS. It often begins with an analysis of the patient's heart rhythm manual defibrillator. Contrary to AED in BLS, the machine to decide when and how a shock to the patient, leading ACL will make these decisions based on the rhythms are controlled and the patient's vital signs. The following steps are the ACL has been added to intravenous (IV) lines and positioning of different airway devices. ACL commonly used drugs like adrenaline, atropine and amiodarone was then adopted. Currently, ACL staff to quickly search the possible causes of cardiac arrest (eg heart attack, drug overdose or trauma). Based on their diagnosis, more specific treatments.

These treatments may be medical, such as intravenous injection of an antidote to an overdose of drugs or surgery, such as the insertion of a chest tube for those who hemothorax or tension pneumothorax. While the above steps are carried out in ACLS, is crucial to continue chest compression with minimal interruptions. This point is repeatedly emphasized in the new ACLS guidelines.

The current  guidelines of advanced cardiac life support are set into different groups. ,with set of different instructions that are followed to uniform approach for treatment, and increase efficiency. These algorithms are generally  in the form of a flowchart, incorporating yes/no  type  of decision, which can make  the algorithm easy to remember
.
Notes for the use of  ACLS algorithm

• The most common issue of  defibrillation is not successful is the failure of suppliers to identify and correct the root causes of the arrhythmia.
• identify and treat potentially reversible cause of  cardiac arrest, bradycardia / tachycardia.
• Be careful before using epinephrine in  cardiac arrests linked with cocaine or some other sympathomimetic medicines.
• Give atropine 1 mg  (IV) for( heart block )asystole or slow PEA (heart rate <60 per minute ) (No longer recommended.
• In arrest ( PEA ) related with hyperkalemia, hypocalcemia. or  overdose Calcium channel antagonist  , give  dose of 10mL of  calcium chloride (IV)  10% (6.8 mmol/L)
• Give  amiodarone for ventricular fibrillation/pulseless ventricular tachycardia after three defibrillation attempts.
• For torsades de pointes, refractory Ventricular fibrillation  in digoxin toxicity  patients or in condition of hypomagnesemia, give magnesium sulfate  ( IV ) 8 mmol (4mL of 50% ).

Life saving procedures for heart conditions ( diseases ) Cardiopulmonary resuscitation CPR

THERAPEUTIC PROCEDURES FOR HEART DISEASE .

CARDIAC RESUSCITATION ( CPR ) .

Recovery Equipment (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone breathing or heartbeat has stopped. Ideally, CPR involving two elements: chest compression with rescue breathing mouth to mouth. But what a viewer needs to do in an emergency really depends on your data and level of comfort. Its clear that it is much better to do something rather than doing nothing, if you're afraid of that knowledge or skills are not 100 percent complete. Remember, the difference between doing something and doing nothing could be one of life.

cardiopulmonary resuscitation (CPR) is a combination of rescue breathing and chest compressions delivered to victims thought to be in cardiac arrest. Upon the occurrence of cardiac arrest, the heart stops pumping blood. CPR can support a small amount of blood flow to the heart and brain to buy time "for normal heart function is restored. Cardiac arrest is often caused by an abnormal heart rhythm called ventricular fibrillation (VF). When VF develops, makes the heart quiver rather than blood contamination of the pump. The victim in VF cardiac arrest needs CPR and delivering a shock to the heart, called defibrillation. Defibrillation eliminates the abnormal heart rhythm and allows the rhythm VF normal again. defibrillation is not effective for all forms of cardiac arrest, but it is effective to treat VF, the most common cause of sudden cardiac arrest.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. When the heart stops, the lack of oxygenated blood can cause irreversible brain damage within minutes. A person can die within eight to 10 minutes. To learn CPR properly, take an accredited first aid, including CPR and how to use an automated external defibrillator (AED).

Before start the CPR See :

The person is conscious or unconscious?

If the person appearing unconscious, or shake his shoulders and ask loudly, Are you alright ? 

If the person does not respond and two people are available, call  or your local emergency number and begin CPR. If you are alone and have immediate access to a telephone, call your emergency no before beginning CPR - unless you think the person does not respond due to choking (like drowning). In this particular case, begin CPR for one minute, then consult a doctor urgently. 

If an AED is immediately available, deliver a shock if the instructions for the machine, then begin CPR.

Remember the ABC:

Think ABC - airway, breathing and circulation - to remember the steps below. Move quickly through the airways and breathing begin chest compressions. 

Airways: clear the airways of the person 

1.Put back on a firm surface. 

2.Kneel left side of the person's neck and shoulders.

3.Open person using the head tilt airway maneuver chin lift. Place the palms on the front of the person and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

Check for normal breathing, when more than five or 10 seconds. Search the chest, listening to the normal breath sounds, and feel for the person your breath on my cheek and ear. Gasping is not considered normal breathing. If a person is not breathing normally and were trained in CPR, begin CPR. If you believe that the person is unconscious from a heart attack and you have no training in emergency procedures, rescue skip mouth-to-mouth breathing and proceed directly to chest pack.


Breathing: breathing of the person's breathing can be mouth to mouth or mouth to nose breathing if the mouth is seriously injured or can not be opened. With the airway open (with the tilt of the head, chin-lift maneuver) Pinch the nostrils shut for mouth-to mouth, and cover the person's mouth to hers, making a seal. Prepare to give two rescue breaths. Give the first rescue breath - lasting for a second - and see if the chest rises. If he gets up, gives the wind seconds. If the chest does not rise, the inclination of the head maneuver chin lift and then give the second breath.Start chest compressions to restore circulation.


Circulation :Restore blood circulation with chest compressions 1.Place the heel of one hand on the center of the person's chest between the nipples. Place your other hand on the first hand. Keep elbows straight and position your shoulders over your hands. 2.Use higher body weight (and not just the arms) as they push down (compression) on the chest 2 inches (5 centimeters). Push hard at a rate of 100 compressions per minute.3.After 30 compressions, tilt the head back and lift the chin to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe in the mouth for a second. If the chest rises, give a second rescue breath. If the chest does not rise, the inclination of the head maneuver chin lift and then give rescue breathing seconds. Its a cycle. If someone is available, ask that person to give two breaths after 30 cuts. If you are not CPR trained and at ease on the stage only chest compressions, continue artificial respiration and continue chest compressions at a rate of 100 compressions per minute until medical personnel arrived.4.If a person has not begun moving after five cycles (approximately two minutes) and Automated External Defibrillator (AED) is available, apply and follow the instructions. Deploy a single shot, continue CPR - chest from the pack - two minutes before the second administration of a shock. If you are not trained to use AED, 911 operator may be able to guide you in its use. Use pillows for children, if available, for children aged 1-8. Do not use the AED for infants under age 1 If the DAE is not available, skip to Step 5.

5.Continue CPR until signs of movement or until emergency medical personnel to take charge.

Therapeutic procedures for heart conditions (diseases) Cardioversion and its types

CARDIOVERSION
Cardioversion is a medical procedure by which an abnormally fast heartbeat or cardiac arrhythmia is converted into a normal rhythm using electrical or drugs. Synchronized electrical cardioversion using a therapeutic dose of electrical current to the heart at one point in the cardiac cycle. pharmacological cardioversion, also known as chemical conversion, medicine antiarrhythmia user instead of a shock.

Each normal heartbeat begins in a region of the heart known as the sinus node is located in the upper right chamber (right atrium) . The sinus node contains specialized cells that send an electrical signal through the heart of organized crime in a timely heartbeat rhythm. In patients with atrial fibrillation, however, atrial fibrillation (or trembling) due to the chaotic electrical signals that circulate in the two atria. This results in a rapid and irregular heartbeat. While some patients have no symptoms, others may experience shortness of breath, dizziness and fatigue. Depending on your medical history and symptoms, your doctor may recommend a cardioversion to return his heart to a normal rhythm.



DIFFERENT TYPES OF CARDIOVERSION .

Rhythm of the shipment may be chemical or electrical. chemical rate refers to the transfer of antiarrhythmia taking drugs to restore normal heart rhythm. These drugs work by changing the electrical properties of the heart to suppress cardiac arrhythmias and restore normal rhythm. The doctor can choose to manage antiarrhythmia drug outpatient clinic or hospital may agree to give oral or intravenous drug antiarrhythmia when the heart rhythm is continuously monitored. In deciding whether you need to be hospitalized on the basis of symptoms, the doctor chooses a specific drug, and your underlying heart disease.

electrical cardioversion (also known as current or a DC) is a procedure whereby a synchronized electric current (shock) is delivered through the chest wall to the heart through special electrodes or paddles applied to the skin on the chest and back . The purpose of cardioversion to cut the abnormal electrical circuit (s) in the heart and restore a normal heart rhythm. The supply shock causes all the heart cells to contract simultaneously, thereby interrupting and terminating the abnormal electrical rhythm (usually atrial fibrillation in) without affecting heart. Heart's electrical system then restores a normal heart rhythm.


Electrical conversion performed in hospital as a intensive care unit, recovery room or special procedure room. A cardiologist, a nurse and / or an anesthesiologist present to monitor your breathing, blood pressure and heart rate. Special cardioversion pads are placed on your chest and back (or, alternatively, both pads are placed on the front of the chest). The pads are connected to an external defibrillator by a cable. The defibrillator allows the medical team to monitor your heart rate and apply the energy needed to restore heart rhythm to normal.

Since the shock can be uncomfortable, sedation is administered intravenously or nurse anesthetist trained. When You're Sober, your doctor will give you a shock. Other illnesses have a higher level of energy can be delivered, if the first shock does not restore the rhythm to normal. Rarely, a small skin irritation may occur on the pages moves rhythm cushions. Patients usually wake up quickly and without any recollection of the amnesic effects of interference due to tranquilizers. Patients are advised to avoid driving or making important decisions on the final day, because the potential for a mild, lingering effects of anesthesia. Patients must be accompanied by a family member or friend, and usually can not go home hours after the operation.
A normal heart rhythm may be restored to about 90% of the time, although abnormal rhythms again around 50% of the time in the year. Cardioversion can be repeated for patients who relapse to an abnormal rhythm.


Because the upper chambers of the heart are atrial fibrillation (tremor) and do not tighten evenly in patients with atrial fibrillation, there is a potential risk of blood clots can form. The process of restoring normal rhythm could dislodge a clot of blood from the heart causing a heart attack or stroke. Fortunately, blood thinners before the cardioversion can prevent more blood clots. This is a process called anticoagulation. Anticoagulants such as aspirin, heparin and warfarin (Coumadin ). Warfarin is a pill taken daily and doses according to blood tests. This test called the INR or International Normalized Ratio the monitors for thinness or thick blood and, in general, should be around 2.0 to 3.0 (normal INR for someone who is not Warfarin is usually around 1.0).

If the INR is too high, there may be an increased risk of bleeding. Heparin is an anticoagulant that can be administered as an intravenous solution or a bullet in the skin. It acts faster and its effects are reversed as soon as Coumadin . Often, patients are placed on heparin to Coumadin will enter into force because it can take several days.

Before making the transfer of rhythm, the doctor determine the risk of blood clotting (and thus your risk of stroke or heart attack), and then blocking drugs. Patients with atrial fibrillation or flutter, which is present in an instant, the blood must be thin enough for at least 3-4 weeks before the pace moves to reduce the risk of stroke. Since it takes several hours to form blood clots, the pace of movement can be performed safely without blood thinning drug in patients who have had their problem of arrhythmia within 48 hours. Sometimes, your doctor may recommend that in particular, cardiac ultrasound (called a transesophageal echocardiography, or TEE). During transesophageal echocardiography, a special sensor placed in the esophagus.

It allows your doctor to directly visualize the atria to detect potential blood clots. Typically, anticoagulation is continued after cardioversion for four weeks to six months, the success of cardioversion well.

Therapeutic procedures for heart conditions ( diseases ) Defibrillation( defibrillator),temporary pacing ( pacemaker)

Therapeutic procedures for heart conditions ( diseases )

Defibrillation

Defibrillation is the definitive treatment of potentially fatal cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy in the affected heart with a device called a defibrillator. This depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows normal sinus rhythm is restored the body's natural pacemaker, the sinus node of the heart. Defibrillators can be external, transvenous, or implanted, depending on the type of device or as needed. Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that it was the answer or bystanders are able to use successfully with little or, in some cases, no training.

It is not effective for termination asystole (complete cardiac activity, better known as Flatline) and pulse less electrical activity (PEA). The purpose of defibrillation of ventricular arrhythmia, is to apply a controlled electric shock to the heart, leading to depolarization of the entire electrical wiring system in the heart. Once the heart repolarise normal electrical impulses can occur, in which case a ventricular arrhythmia over. But if it is not enough energy used for defibrillation, the heart can not be completely depolarized, in which ventricular tachycardia or fibrillation case can not be stopped. In addition, if the heart is not enough oxygen or there is instability of electrolytes in cardiac cells, ventricular arrhythmias may again ..

TEMPORARY PACING.

Transvenous temporary pacing is much less painful than the transthoracic approach is required for many directions as a bridge to permanent stimulation especially in patients who are unable to comply immediately or permanent implantation in patients with bradycardia is severe and hemodynamic (blood pressure, pulse rate) is unstable. It is necessary, often patients with bricks infranodal severe and less frequent with AV nodal block and sick sinus syndrome. It can be bound to consider a significant bradycardia due to drugs, as a surplus of digitalis. Planned or actual bradyarrthythmia during acute myocardial infarction may also require temporary pacing. The appearance of a right bundle branch block (RBBB) on the cardiac conduction system may precede block infranodal. A sudden change can occur from 1:01 abnormal conduction block Mobitz II second degree or complete asystole.

The lack of an escape rate is above the potential dangerous and warrants temporary pacing even with only the beginning of the BBD in the presence of acute myocardial infarction earlier. temporary pacing of an atrium or ventricle is often useful after cardiac surgery when transient bradyarrhythmias and atrial flutter are common. It can also be used in recurrent tachyarrhythmias as torsade de pointes and incessant ventricular tachycardia.

HEART PROBLEMS IN ELDERLY - LEV'S DISEASE , CAROTID SINUS HYPERSENSITIVITY , ATRIAL FIBRILLATION

SPECIFIC HEART PROBLEMS IN THE ELDERLY . 

LEV'S DISEASE IN ELDERLY .

Lev disease, or illness Lenegre Lev, is a branch block with normal heart and normal coronary arteries due to fibrosis or calcification in the heart conduction system. It affects the membranous septum, the apex of the diaphragm and, often, mitral valve disease and aortic rings.1 Lev is most commonly seen in older people, and is often described as the conduct of senile degeneration système .

Disruption of His - Purkinje conduction fibrosis and calcification is more frequent in the former given that Lev disease.It with Stokes - Adams attacks and must be treated after a pacemaker inserted. Age is not an indication for the cons-rate, even when the most advanced equipment used physiologically. Pacemakers should be prescribed at similar criteria in young and old.

CAROTID SINUS HYPERSENSITIVITY ..
Carotid sinus hypersensitivity (CSH) is an overreaction to stimulation of carotid sinus baroreceptors. This results in dizziness or fainting transient cerebral perfusion decreased. While the role of baroreceptors generally decreases with age, some people feel a carotid baroreflex sensitivity. For these people, even a slight stimulation of the neck results in a marked bradycardia and a fall in blood pressure. CSH affects mainly older men. It is a powerful contributing factor and a potentially treatable cause of unexplained falls and episodes of neurocardiogenic syncope in the elderly people.However, CSH is often overlooked in the differential diagnosis of syncope. CSH, orthostatic hypotension, vasovagal syncope are common conditions that may coexist in patients with syncope and falls.

Carotid sinus reflex plays a central role in the homeostasis of blood pressure. Changes in transmural pressure baroreceptors and stretch out the heart, carotid sinus, aortic and other large vessels. afferent impulses to provide the carotid sinus, glossopharyngeal, vagus nerve and nucleus tractus solitarius and para median is the nucleus of the brainstem. efferent limbs through the vagus and sympathetic nerves in the heart and blood vessels, control of heart rate and vasomotor tone.

Management of carotid sinus hypersensitivity (CSH) is based on the frequency, severity and consequences of the symptoms of each patient. Most patients can be treated with education, lifestyle changes, waiting, and routine monitoring. One of the few people who have recurrent disabling symptoms and may need the following ways: it is used to treat recurrent pharmacotherapy, symptomatic conditions. However, none of the agents was found to create long-term efficacy of large randomized controlled trial. Permanent pacemaker implantation in general, an effective treatment for cardioinhibitory CSH and mixed forms of CSH. maintaining the volume can be monitored in the form of CSH vasodilator prevention of syncopal episodes, maintaining an adequate number of stations. Individuals without a second heart would be to increase salt intake and drink more fluids containing electrolytes.

Surgical and radiological denervation denervation of the carotid sinus nerve were the techniques used previously, but have been largely abandoned due to high rate of complications. Surgery is an option for a patient with a neck tumor is compressing the carotid sinus. 

Although a variety of pharmacological agents were used empirically to treat recurrent CSH, symptomatic, no agent has been unequivocally shown to provide effective long-term large-scale randomized controlled trials. Some observers have been successfully used serotonin reuptake inhibitors sertraline and fluoxetine in patients who have not responded to stimulation room.

ATRIAL FIBRILLATION IN ELDERLY .

Atrial fibrillation (AF) is the most frequently diagnosed arrhythmia, affecting 2.3 million people in the United States. Its circulation increases with age, and up to 9% of persons aged 80 years is affected.1 Atrial fibrillation is characterized by a lack of coordinated atrial activity and the loss of organized atrial slowdown could lead to a multitude of clinical scenarios, including decompensated heart failure (CHF), embolic stroke (CVA), ischemia, dizziness / weakness, and even in asymptomatic patients with tachycardia.

Management of atrial fibrillation includes many methods: pharmacological treatment to keep patients in sinus rhythm and control of speed, DC electric catheter ablation and anticoagulation to prevent thromboembolic disease.

Atrial fibrillation (AF) resulted in codeshare different waveforms within the Atria, which bombard the atrioventricular (AV) node, commonly leading to tachycardia, which is irregularly irregular. The speed with which atrial fibrillation causing ventricular contraction depend on the state of the AV node refractory. It is the loss of atrial contraction and its effect on ventricular filling, also called ventricular calcium loss. Moreover, this contraction can lead to loss of blood stagnation atrium and can contribute to the formation of thrombi. Patients may be at risk of embolization when atrial fibrillation converted to sinus rhythm organized atrial contraction may now lead to loosening or fragmentation of atrial thrombus in the systemic circulation.

The autonomic nervous system may play a role in triggering atrial fibrillation. Increased sympathetic innervation in patients with atrial fibrillation may be responsible for the conversion of atrial fibrillation substrate and can lead to development of persistent atrial fibrillation. More recently, lung tissue and the vein left atrium pulmonary vein (LA) junction has been shown to play an important role in activating and maintaining atrial reentrant atrial activity. It is an atrial muscle that extends into the thoracic veins, and this tissue is innervated vagal. These anatomical findings are important in a technique that pulmonary vein isolation for atrial fibrillation ablation catheter.

Risk factors for atrial fibrillation (AF) are age, male gender, hypertension longstanding valvular heart disease, left ventricular hypertrophy, coronary heart disease (with or without depression of left ventricular function), diabetes, smoking, and any form of carditis. Take care of hemodynamically unstable patients are guided by ACLS protocols, including the direct current (DC) DC. Symptomatic patients may benefit from intravenous (IV) agents control rates, or calcium channel blockers or beta-blockers.

In most cases, the patient is stable, but they have a high ventricular response and need drugs that control the speed, with a target heart rate during the 80th This target heart rate recommended was challenged in the study RACE II examined cons of HR 110 less than 80 years. The gentle arm was no difference in the control arm Strict composite endpoint of death from heart failure, CHF, stroke, systemic bleeding, and fatal arrhythmia events.

If there is another clinical condition to drive the tachycardia, such as fever, infection or dehydration, then efforts to control the temperature and the restoration of aid normovolemic control tachycardia. Consideration of anticoagulation based on patient risk factors may also begin the emergency.