Anticoagulants & Dementia

Here's some good news for anyone who's worried about developing dementia later on in life. A breakthrough study from the European Society of Cardiology has found that blood-thinning medication (also known as anticoagulants) used to decrease the risk of heart attacks and strokes for patients suffering from atrial fibrillation (AF) may also be able to significantly lower the risk of getting dementia.

This fantastic discovery, which was recently published in the European Heart Journal, could provide hope to many people who are at risk of developing dementia all around the world. The researchers reached this conclusion by collecting and studying the health data of 444,000 Swedish sufferers of AF, who were diagnosed between 2006 and 2014, paying particular attention to the drugs that each patient was prescribed. 

 

According to the study's co-author, Dr. Leif Friberg from Stockholm's Karolinska Institute, "there are AF patients who have a fatalistic view on stroke. Either it happens or it does not. Few patients are fatalistic about dementia, which gradually makes you lose your mind.” He also said that "no brain can withstand a constant bombardment of microscopic clots in the long run. Patients probably want to hang on to as many of their little grey cells for as long as they can.” 

 

Despite establishing concrete links between AF, dementia, and anticoagulants, the team still hasn't discovered what causes their relationship. However, they "strongly suggested" that commonly prescribed anticoagulants, such as apixaban, warfarin, rivaroxaban, edoxaban, and dabigatran, protected patients by not allowing dementia-causing blood clots to ever develop.

In spite of the uncertainty, Dr. Friberg still believes that AF patients would be wise to keep taking anticoagulants regularly. He says that "doctors should not tell their patients to stop using oral anticoagulants without a really good reason. To patients, I would say don’t stop unless your doctor says so." Just because they haven't found the underlying reason for their effectiveness, it doesn't mean that they don't work. 

 

According to Dr. Carol Routledge, the Head of Science at Alzheimer’s Research UK, "the findings highlight a need to investigate this link further, but the nature of the study prevents us from firmly concluding that anticoagulants reduce the risk of dementia." She also said that "it will be important to see the results of other ongoing studies in this area, as well as teasing apart the exact relationship between anticoagulants and the risk of different types of dementia.”

 

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What is tachycardia, and when a high heart rate is dangerous

  Tachycardia is when your heart rate is faster than normal. 

    Sinus tachycardia is a normal increase in heart rate, like when you're exercising, and it is not generally considered dangerous. 

    Other types of tachycardia, like atrial fibrillation, cause a prolonged or recurring high resting heart rate — these types are considered dangerous and doctors will recommend treatment.
    
Tachycardia is a type of arrhythmia when your heart rate is faster than normal. A healthy resting heart rate for most adults is between 60 and 90 beats per minute (bpm), but adults with tachycardia usually have a resting heart rate greater than 100 bpm.

Here's what you need to know about what causes the different types of tachycardia and when the condition is considered dangerous. 

What is tachycardia

There are multiple types of tachycardia, which are categorized by where they originate in the heart. Some are not considered a danger to your health while others should be monitored closely. These include:

    Sinus tachycardia is a normal increase in heart rate, which can happen when you're exercising, scared, or anxious. It originates from the heart's sinoatrial node, commonly known as the heart's natural pacemaker. Sinus tachycardia is not usually considered dangerous because your heart is still beating properly.

    Supraventricular tachycardia occurs in the upper chambers of the heart. It's the most common type of tachycardia in children and also more common in women than in men. Some people experience no symptoms, but in extreme cases, you may lose consciousness and, very rarely, have cardiac arrest.

    Atrial fibrillation is the most common type of tachycardia. It happens when chaotic electrical impulses in the upper chambers of the heart (the atria) lead to rapid, uncoordinated contractions. Researchers estimate that 2.7 million to 6.1 million US adults have AFib. It's associated with 1 in every 7 strokes, tends to cause more severe disability from stroke, and contributes to more than 150,000 deaths annually.

    Ventricular tachycardia occurs in the lower chambers of the heart. It is dangerous: the National Library of Medicine classifies it as a "major cause of sudden cardiac death." Some 300,000 deaths a year in the US are attributed to this type of tachycardia.

    Ventricular fibrillation is a similar process in the lower chambers, where the ventricles quiver instead of pumping necessary blood to the body. The most serious form of tachycardia, v-fib is a medical emergency and leads to sudden cardiac arrest.

Who's at risk of tachycardia

Many types of tachycardia can lead to emergency medical events, like sudden cardiac arrest, a heart attack, heart failure, and stroke. But according to Solomon Sager, MD, a cardiologist and electrophysiologist at the Chicago Cardiology Institute, you might not even know you have it.

While those with tachycardia won't always notice, there are a few common symptoms. The first indicator is a heartbeat that feels too fast, which you can check by taking your pulse. Other symptoms may include heart palpitations, chest pain, shortness of breath, or lightheadedness.

You're more likely to develop some form of tachycardia as you age. That's because structural changes in the heart may cause these abnormal heart rhythms over time, Sager says.

Patients who have a family history of tachycardia or congenital conditions at birth are at a higher risk. Certain health conditions are also associated with an increased risk, such as heart disease, high blood pressure, diabetes, obesity, sleep apnea, and anxiety disorders.

With the help of wearable health trackers like the Apple Watch, more people are discovering they have tachycardia, even when they don't experience symptoms. Sager says you should take this kind of data seriously and follow up with your physician if anything is out of the ordinary.
How to treat tachycardia

Physicians treat tachycardia in a variety of ways, often involving critical lifestyle changes. Sager says people diagnosed with AFib are encouraged to exercise, eat a healthy diet, and treat underlying health issues, such as sleep apnea or diabetes. They should also cut down on alcohol and quit tobacco.

People with ventricular tachycardia more often require medication, surgery, or ablation. Doctors may prescribe antiarrhythmic medications to prevent arrhythmias from coming on, beta blockers to slow heart rate, and blood thinners to reduce the risk of blood clots.

Patients who still have tachycardia despite medication may undergo catheter ablations. During this two- to four-hour procedure, a cardiologist guides a flexible wire into the heart that burns affected heart tissue using radiofrequency energy. This stops abnormal electrical signals with a 90% success rate in some types of tachycardia.

If you experience a prolonged or recurring high resting heart rate, along with other symptoms of tachycardia, you should go to the emergency room or call 911.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
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Cardiovascular diseases associated with increased risk of developing kidney failure

New research indicates that cardiovascular diseases- including heart failure, atrial fibrillation, coronary heart disease, and stroke- are each linked with a higher risk of developing kidney failure. The findings, which appear in an upcoming issue of JASN, highlight the importance of protecting the kidney health of individuals diagnosed with cardiovascular disease.

The heart and the kidneys have a bi-directional relationship, whereby dysfunction in either may compromise the function of the other. Many studies have investigated the risks of kidney disease on heart health, but few have examined the reciprocal relationship.

To investigate, a team led by Kunihiro Matsushita, MD, PhD and Junichi Ishigami, MD, PhD (Johns Hopkins Bloomberg School of Public Health) examined information on 9,047 US adults who did not have signs of heart disease when they enrolled in a community-based study.

"Many physicians probably recognize that patients with cardiovascular disease are at risk of kidney disease progression, but to my knowledge, this is the first study quantifying the contribution of different cardiovascular diseases to the development of kidney failure," said Dr. Matsushita.

During a median follow-up of 17.5 years, 2,598 participants were hospitalized with cardiovascular disease-;1,269 with heart failure, 1,337 with atrial fibrillation, 696 with coronary heart disease, and 559 with stroke-;and 210 patients developed kidney failure.

The incidence of major cardiovascular disease was associated with a higher risk of kidney failure, with the highest risk for heart failure. Participants hospitalized with heart failure had an 11.4-times higher risk of developing kidney failure than participants without cardiovascular disease.

 Individuals with a history of cardiovascular disease should be recognized as a high risk population for kidney failure. In this context, physicians should be aware of cardiovascular disease as an important risk condition, and thereby minimize treatments that are toxic to the kidneys in such individuals. Additionally, our findings may have implications for monitoring kidney function, although current cardiovascular disease guidelines do not necessarily specify the frequency of evaluating kidney function following the incidence of cardiovascular disease."     Dr. Junichi Ishigami, Johns Hopkins Bloomberg School of Public Health

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Burnout linked with irregular heartbeat

Feeling excessively tired, devoid of energy, demoralised, and irritable? You may have burnout, a syndrome associated with a potentially deadly heart rhythm disturbance. That's the conclusion of a large study published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

"Vital exhaustion, commonly referred to as burnout syndrome, is typically caused by prolonged and profound stress at work or home," said study author Dr. Parveen K. Garg of the University of Southern California in Los Angeles. "It differs from depression, which is characterised by low mood, guilt, and poor self-esteem. The results of our study further establish the harm that can be caused in people who suffer from exhaustion that goes unchecked."

Atrial fibrillation is the most common form of heart arrhythmia. It is estimated that 17 million people in Europe and 10 million people in the US will have this condition by next year, increasing their risk for heart attack, stroke, and death. Yet, what causes atrial fibrillation is not fully understood.

Psychological distress has been suggested as a risk factor for atrial fibrillation, but previous studies showed mixed results. In addition, until now, the specific association between vital exhaustion and atrial fibrillation had not been evaluated.

The researchers in this study surveyed more than 11,000 individuals for the presence of vital exhaustion, anger, antidepressant use, and poor social support. They then followed them over a period of nearly 25 years for the development of atrial fibrillation.

Participants with the highest levels of vital exhaustion were at a 20% higher risk of developing atrial fibrillation over the course of follow-up compared to those with little to no evidence of vital exhaustion.

While further study is needed to better understand the observed relationship, Dr. Garg noted that two mechanisms are likely at play. "Vital exhaustion is associated with increased inflammation and heightened activation of the body's physiologic stress response," he said. "When these two things are chronically triggered that can have serious and damaging effects on the heart tissue, which could then eventually lead to the development of this arrhythmia."

No connections were found between anger, antidepressant use, or poor social support and development of atrial fibrillation. "The findings for anger and social support are consistent with prior research but two previous studies did find a significant association between antidepressant use and an increased risk of atrial fibrillation. Clearly, more work still needs to be done," said Dr. Garg.

Further research is also needed to identify concrete actions for doctors to help patients with exhaustion, said Dr. Garg.

He concluded: "It is already known that exhaustion increases one's risk for cardiovascular disease, including heart attack and stroke. We now report that it may also increase one's risk for developing atrial fibrillation, a potentially serious cardiac arrhythmia. The importance of avoiding exhaustion through careful attention to -- and management of -- personal stress levels as a way to help preserve overall cardiovascular health cannot be overstated."

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Dos and Don'ts for cardiac patients during winter

With the cold conditions continue to grip the northern states, peaople with heart diseases are more prone to complications of precautions are not taken by them says a cardiologist.

The Dr. said, definitely the winter and low-temperature are not good for the patients who are having underlying coronary artery diseases. They've  a high incidence of an acute coronary syndrome, that means heart attack and unstable angina, which are common in the winter season.

A higher dise of medication during winter is suggested by the Dr. for the patients who are hypertensive and who are taking BP-lowering medications.

patients having arrhythmia problems like rhythm disorder, atrial fibrillation also have a higher incidence of the problems, feels the Dr.

The caring measures suggested by the doctor for the patients with slow heart-pumping include avoid smoking and consumption of alcohol, control the intake of fat-rick food items, which is more of a tendency during winter. Keeping a count on your blood pressure is a must.

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AI can predict if you will die within next year

After looking at standard ECG tests, Artificial Intelligence (AI) can help identify patients most likely to die of any medical cause within a year, claim researchers.

To reach this conclusion, researchers from Geisinger Health System in Pennsylvania analyzed the results of 1.77 million ECGs and other records from almost 400,000 patients. 

The team used this data to compare machine learning-based models that either directly analyzed the raw ECG signals or relied on aggregated human-derived measures (standard ECG features typically recorded by a cardiologist) and commonly diagnosed disease patterns.

The neural network model that directly analyzed the ECG signals was found to be superior for predicting one-year risk of death. Surprisingly, the neural network was able to accurately predict risk of death even in patients deemed by a physician to have a normal ECG. 

Three cardiologists separately reviewed the ECGs that had first been read as normal, and they were generally unable to recognize the risk patterns that the neural network detected, researchers said. 

"This is the most important finding of this study. This could completely alter the way we interpret ECGs in the future," said Brandon Fornwalt, chair of the Department of Imaging Science and Innovation at Geisinger in Danville, Pennsylvania.

Another study by the same group of researchers found that AI-based models can analyse ECG test results and pinpoint patients at higher risk of developing a potentially dangerous irregular heartbeat (arrhythmia).

The team used more than two million ECG results from more than three decades of archived medical records in Pennsylvania/New Jersey's Geisinger Health System to train deep neural networks.

They found that Artificial intelligence can examine ECG test results, to predict irregular heartbeat and the death risk, according to the two preliminary studies to be presented at the American Heart Association's Scientific Sessions 2019 in Philadelphia from November 16-18.

While the vast Geisinger database is a key strength of both studies, the findings should be tested at sites outside of Geisinger, the researchers noted. 

"Incorporating these models into routine ECG analysis would be simple. However, developing appropriate care plans for patients based on computer predictions would be a bigger challenge," said lead author Sushravya Raghunath.

Both studies are among the first to use AI to predict future events from an ECG rather than to detect current health problems.

"This is exciting and provides more evidence that we are on the verge of a revolution in medicine where computers will be working alongside physicians to improve patient care," said Fornwalt.

Atrial fibrillation is associated with higher risk of stroke and heart attack. Jennifer Hall, the American Heart Association Chief of the Institute for Precision Cardiovascular Medicine, said that deep learning is "terrific as another way for us in our field of cardiovascular medicine to be able to help patients and help those understand the risk of stroke."

"Having these techniques at our fingertips and having more precise techniques to uncover potential atrial fibrillation now or in the future, is absolutely tremendous," Hall noted.

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