Atrial fibrillation: When your heart doesn’t beat in the right rhythm

Your heartbeat is the first sign that you are alive. According to the doctors, the normal heart rate for adults should range between 60 to 100 beats per minute. However, if it is as fast as 300 times per minute, you are suffering from a condition called atrial fibrillation (AF) which means your heart’s electrical impulses have lost coordination. Atrial fibrillation or irregular heartbeat (arrhythmia) can be the cause behind heart failure, blood clots, stroke, and other cardiovascular complications. For all those suffering from this condition, a new study has come with significant findings. So far, the surgical procedure to treat atrial fibrillation, known as catheter ablation, was considered to be superior to the available drug therapies. But the new study states that both these options are equally effective. However, the quality of life is better and the need for hospitalization is lower after a surgical procedure compared to the drug therapy.

NEW RAYS OF HOPE FOR ATRIAL FIBRILLATION

Apart from this new research, there have been a few other significant developments in terms of  the AF diagnosis and treatment. Researchers identified two biomarkers known as brain natriuretic peptide (BNP) and fibroblast growth factor-23 (FGF-23) that can help in better diagnosis of irregular heartbeat. BNP is a hormone that is secreted by the heart and FGF-23 is a protein that helps in the regulation of phosphate (an ion).  Elevated levels of these blood markers reveal that a person has irregular heartbeat which needs urgent and targeted treatment.

Also, an updated study has revealed that a new type of blood-thinning medication known as non-vitamin K oral anticoagulants (NOACs) can potentially reduce the risk of stroke due to AF. During atrial fibrillation, irregular heartbeat results in blood clot in the atria (heart chamber). This clot may reach your brain through blood, causing blockage in the blood vessels of your brain, which may result in stroke. The new medications are anticoagulants that can prevent blood clot.

HOW DOES YOUR HEART BEAT, ACTUALLY?

The upper right chamber of your heart, known as the right atrium, hosts a natural pacemaker (sinus node), which produces the electrical impulses responsible for your heartbeat. The electrical impulses pass through the atrioventricular (AV) node, the connecting pathway between the upper and lower chambers of heart. As the signal is produced from the sinus node, it reaches the two upper chambers, known as the atria, which contract to pump blood into your ventricles, the two lower chambers of your heart. Similarly, the ventricles contract to pump blood to your body. This is  when the electrical impulses pass through the AV node to the ventricles (lower chambers of the heart).

DECODING ATRIAL FIBRILLATION

Atrial fibrillation is a condition where your heart beats at an irregular pace. When you suffer from this cardiac ailment, the upper two chambers of your heart experience chaotic electrical impulses and start beating rapidly which is not in sync with the lower two chambers. As a result, the AV node is bombarded with impulses which, it tries to pass on to the ventricles. However, all of them cannot get through. Due to this rapid movement of impulses, the ventricles also start beating fast but not as fast as atria. This results in an irregular heart rhythm, ranging from 100 to 175 beats per minute.

CAUSES AND RISK FACTORS

There are various probable reasons behind atrial fibrillation including high blood pressure, abnormal heart valves, heart attack, coronary artery disease, an overactive thyroid gland, metabolic imbalance, exposure to stimulants like caffeine, tobacco or alcohol, lung diseases, etc. In some cases, however, the causes are unknown where the patients haven’t been diagnosed with any heart damage. But experts have identified a few factors that increase your chance of suffering from irregular heartbeat. They include sleep apnoea, obesity, family history, high blood pressure, and any other chronic condition. According to experts in the field, older people are at a greater risk of developing AF. Additionally, a study has revealed that working for long hours can potentially increase your risk of developing a heart rhythm disorder. Also, another research has found that too much job pressure is linked with 48 per cent higher risk of atrial fibrillation. If you are suffering from this condition, you are likely to experience symptoms like racing heart, fatigue, dizziness, chest pain and shortness of breath.

PREVENTIVE MEASURES

You need to make sure your heart is healthy in order to reduce the risk of atrial. Here are few tips for a healthy heart.

Make healthy food choices: Eat a balanced diet that includes fruits, green vegetables, whole grains, and limited saturated fats. Also, minimize your caffeine and salt intake and avoid processed foods. Opt for salmon, nuts and other foods rich in omega-3 fatty acids. Healthy fats from dark chocolates and olive oil can also potentially protect you from AF.

Quit smoking: According to a study  smoking may boost your risk of developing heart rhythm disorder.

Indulge in daily exercise: Daily workout can make your muscles strong and help in proper blood flow. It is advised to do light exercises like walking and jogging to prevent AF.

Keep your weight in check: Obesity is a potential risk factor for various heart conditions including AF. Therefore, prevent obesity by cutting back on sugar, processed food, simple carbohydrates and unhealthy fats.  Working out regularly is also equally important.

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Deep Vein Thrombosis (DVT)

What is deep vein thrombosis?

Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a vein located deep inside your body. A blood clot is a clump of blood that is in a gelatinous, solid state. Deep vein blood clots typically form in your thigh or lower leg, but they can also develop in other areas of your body. Other names associated with this condition include thromboembolism, post-thrombotic syndrome, and post-phlebitic syndrome.

Who is at risk for deep vein thrombosis?

DVT occurs most commonly in people who are over 50 years in age. Certain conditions that alter how your blood moves through your veins can raise your risk of developing clots. These include:

having an injury that damages your veins such as a bone fracture
being overweight, which puts more pressure on the veins in your legs and pelvis
having a family history of DVT
having a catheter placed in a vein
taking birth control pills or undergoing hormone therapy
heavy smokers
staying seated for a long time while you’re in a car or on a plane, especially if you already have at least one other risk factor

Some diseases and disorders can increase your risk of having blood clots. These include hereditary blood clotting disorders, especially when you have at least one other risk factor. Cancer and inflammatory bowel disease can also increase the risk of developing a blood clot. Heart failure, a condition that makes it more difficult for your heart to pump blood, also occurs with an increased risk of clots.

Surgery

DVT is a major risk associated with surgery. This is especially true if you’re having a surgery in the lower extremities, such as joint replacement surgery. Your doctor will discuss the risk of DVT if you need joint replacement surgery.

Pregnancy

Being pregnant increases your risk of DVT. Increased hormone levels, and a slower blood flow as your uterus expands and restricts blood flowing back from your lower extremities, contribute to this risk. This elevated risk continues until about six weeks after giving birth. Being on bed rest or having a cesarean delivery also increases your risk of having DVT.

What are the symptoms of deep vein thrombosis?

According to the doctors, symptoms of DVT only occur in about half of the people who have this condition. Common symptoms include:

swelling in your foot, ankle, or leg, usually on one side
cramping pain in your affected leg that usually begins in your calf
severe, unexplained pain in your foot and ankle
an area of skin that feels warmer than the skin on the surrounding areas
skin over the affected area turning pale or a reddish or bluish color

People may not find out that they have deep vein thrombosis until they’ve gone through emergency treatment for a pulmonary embolism. A pulmonary embolism is a life-threatening complication of DVT in which an artery in the lung becomes blocked.

When to see a doctor

When should you see a doctor if you’re concerned about deep vein thrombosis?
DVT is a serious medical condition. You should call your doctor right away if you think you’re experiencing symptoms of DVT, or go to the closest emergency room. A healthcare provider can check out your symptoms, review your medical history, and then let you know the best course of action.
If you don’t think you have DVT but are concerned that you may be at risk, you can schedule a regular appointment with your doctor. Your physician can let you know if preventive treatment may be an option for you.

What are the treatment options for deep vein thrombosis?

DVT treatments focus on keeping the clot from growing. In addition, treatment will attempt to prevent a pulmonary embolism and lower your risk of having more clots.

Medication

Your doctor might prescribe medications that thin your blood, such as heparin, warfarin, enoxaparin, or fondaparinux. This makes it harder for your blood to clot. It also keeps existing clots as small as possible and decreases the chance that you’ll develop more clots.

If blood thinners don’t work or if you have a severe case of DVT, your doctor might use thrombolytic drugs. Thrombolytic drugs work by breaking up clots. You’ll receive these intravenously.

Compression stockings

Wearing compression stockings can prevent swelling and may lower your chance of developing clots. They don’t demonstrate a reduction in recurrent DVT.
Compression stockings reach just below your knee or right above it. Your doctor may recommend you wear these every day.

Filters

You might need to have a filter put inside the large abdominal vein called the vena cava if you aren’t able to take blood thinners. This form of treatment helps prevent pulmonary embolisms by stopping clots from entering your lungs.

However, there is a risk to filters being placed. If left long term, they can actually cause DVT. They should be used short term until the risk of thromboembolism is reduced and anticoagulation can be used.

What are the complications associated with deep vein thrombosis?

A major complication of DVT is a pulmonary embolism. You can develop a pulmonary embolism if a blood clot moves to your lungs and blocks a blood vessel. This can cause serious damage to your lungs and other parts of your body. You should get immediate medical help if you have signs of a pulmonary embolism. These signs include: 
dizziness
sweating 
chest pain that gets worse with coughing or inhaling deeply
rapid breathing 
coughing up blood 
rapid heart rate

How do I prevent deep vein thrombosis?

You can lower your risk of having DVT by making a few lifestyle changes. These include keeping your blood pressure under control, giving up smoking, and losing weight if you’re overweight.
Moving your legs around when you’ve been sitting for a while also helps keep your blood flowing. Walking around after being on bed rest can prevent clots from forming.

Take any blood thinners your doctor prescribes if you’re having surgery, as this can lower your chance of developing clots afterward.

Your risk of developing DVT during travel is low, but it becomes higher if you’re sitting for more than four hours at a time while driving or flying. You can lower risk by moving around every so often — get out of your car and move around at intervals during long drives. Walk in the aisles if you’re flying, taking a train, or riding a bus. Stretch your legs and feet while you’re sitting — this keeps your blood moving steadily in your calves. Don’t wear tight clothes that can restrict blood flow.

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Stroke prevention drugs may help reduce dementia risk for atrial fibrillation patients

Patients with atrial fibrillation could reduce the risk of dementia by taking stroke prevention medications, according to recommendations published online today.
 
Heart rhythm disorders (arrhythmias), as well as some procedures undertaken to treat them, can increase the risk of cognitive decline and dementia. The international consensus document was written for doctors specialising in arrhythmias and aims to raise awareness of the risks of cognitive impairment and dementia and how to reduce them.

The document states that atrial fibrillation is associated with a higher risk for cognitive impairment and dementia, even in the absence of apparent stroke. This may be because atrial fibrillation is linked with a more than two-fold risk of silent strokes. The accumulation of silent strokes and the associated brain injuries over time may contribute to cognitive impairment.

Stroke prevention with oral anticoagulant drugs is the main priority in the management of patients with atrial fibrillation. The consensus document says that oral anticoagulation may reduce the risk of dementia.

Adopting a healthy lifestyle may also reduce the risk of cognitive decline in patients with atrial fibrillation. This includes not smoking and preventing or controlling hypertension, obesity, diabetes, and sleep apnoea.

"Patients with atrial fibrillation may be able to reduce their risk of cognitive impairment and dementia by taking their oral anticoagulation medication and having a healthy lifestyle," said the  lead author and consultant.

The document also reviews the association between other arrhythmias and cognitive dysfunction, including post-cardiac arrest, in patients with cardiac implantable devices such as implantable cardioverter defibrillators (ICDs) and pacemakers, and ablation procedures.

Treatment of atrial fibrillation with catheter ablation can itself lead to silent strokes and cognitive impairment. To reduce the risk, physicians should follow recommendations for performing ablation and for the management of patients before and after the procedure.

The consensus document notes that physicians may suspect cognitive impairment if a patient's appearance or behaviour changes—for example, if appointments are missed. Family members should be asked for collateral information. If suspicions are confirmed, the consensus document recommends tools to conduct an objective assessment of cognitive function.

The paper highlights gaps in knowledge and areas for further research. These include, for instance, how to identify atrial fibrillation patients at increased risk of cognitive impairment and dementia, the effect of rhythm control on cognitive function, and the impact of cardiac resynchronisation therapy (CRT) on cognitive function.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                                                                                                                                                                                                         PS- THOSE INTERESTED IN RECIPES ARE FREE TO VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/   

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Advanced treatment for brain aneurysm conducted at AIMS

Amrita Institute of Medical Sciences (AIMS) here has performed the most advanced treatment for brain aneurysm, the 'flow diverter pipeline stent', the First of its kind in a private hospital in Kerala.

The treatment was performed by a team of doctors Endovascular Division, Neurosurgery Department of AIMS, on a woman patient who had developed disturbances in vision due to a large aneurysm of the brain. The patient was discharged from the hospital within three days after 'the flow diverter pipeline stent' procedure, a press release said.

Aneurysms of the brain's blood vessels are abnormal balloon-like projections that form on the wall of an artery. When these rupture, they can cause disasters. Some patients have complex aneurysms that are large and involve multiple branches of the blood vessel. Traditionally treated with major open skull base surgery and clipping, but the surgery is very complex and required longer hospital stay, the release said.

In the flow diverter Pipeline Embolization Device (PED) which is American FDA approved, is a new alternative that allows for a more natural healing of the aneurysm avoiding a major open surgery.
The device is attached to the end of a catheter that is inserted through the Femoral artery in the right leg. The catheter is threaded into the carotid artery of the brain and into its final position where it is then expanded against the walls of the artery to block off the mouth of the aneurysm, thus cutting off the blood flow into the aneurysm which later shrinks and heals over the next few months. The device also reduces the risk of the aneurysm rupture.

The procedure considerably reduces the hospital stay of the patient to two or three days and the recovery is fast in comparison with similar open surgeries.

Amrita Hospital is one of the only six centers in India that is performing this specialized procedure. The Neurovascular center at Amrita Institute is also providing facilities to tackle the most difficult disease conditions involving the brain's blood vessels - including complex neurosurgical procedures, aneurysm coiling/stenting and stereotactic radiosurgery for vascular malformations of the brain.

The division also offers regular disease-specific screening programmes for carotid disease and stroke prevention, early detection of diseases of the brain's blood vessels.

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