Abnormal Heart Rhythm (Arrhythmia)

Abnormal Heart Rhythm (Arrhythmia)
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An irregular heartbeat is an arrhythmia (also called dysrhythmia). Heart rates can also be irregular. A normal heart rate is 50 to 100 beats per minute. Arrhythmias and abnormal heart rates don't necessarily occur together. Arrhythmias can occur with a normal heart rate, or with heart rates that are slow (called bradyarrhythmias -- less than 60 beats per minute). Arrhythmias can also occur with rapid heart rates (called tachyarrhythmias -- faster than 100 beats per minute). In the United States more than 850,000 people are hospitalized for an arrhythmia each year.
What Causes an Arrhythmia?

Arrhythmias may be caused by many different factors, including:

* Coronary artery disease.
* Electrolyte imbalances in your blood (such as sodium or potassium).
* Changes in your heart muscle.
* Injury from a heart attack.
* Healing process after heart surgery.

Irregular heart rhythms can also occur in "normal, healthy" hearts.
What Are the Types of Arrhythmias?

The types of arrhythmias include:

* Premature atrial contractions. These are early extra beats that originate in the atria (upper chambers of the heart). They are harmless and do not require treatment.
* Premature ventricular contractions (PVCs). These are among the most common arrhythmias and occur in people with and without heart disease. This is the skipped heartbeat we all occasionally experience. In some people, it can be related to stress, too much caffeine or nicotine, or too much exercise. But sometimes, PVCs can be caused by heart disease or electrolyte imbalance. People who have a lot of PVCs, and/or symptoms associated with them, should be evaluated by a heart doctor. However, in most people, PVCs are usually harmless and rarely need treatment.
* Atrial fibrillation. AF is a very common irregular heart rhythm that causes the atria, the upper chambers of the heart to contract abnormally.
* Atrial flutter. This is an arrhythmia caused by one or more rapid circuits in the atrium. Atrial flutter is usually more organized and regular than atrial fibrillation. This arrhythmia occurs most often in people with heart disease, and in the first week after heart surgery. It often converts to atrial fibrillation.
* Paroxysmal supraventricular tachycardia (PSVT). A rapid heart rate, usually with a regular rhythm, originating from above the ventricles. PSVT begins and ends suddenly. There are two main types: accessory path tachycardias and AV nodal reentrant tachycardias (see below).
* Accessory pathway tachycardias. A rapid heart rate due to an extra abnormal pathway or connection between the atria and the ventricles. The impulses travel through the extra pathways as well as through the usual route. This allows the impulses to travel around the heart very quickly, causing the heart to beat unusually fast.
* AV nodal reentrant tachycardia. A rapid heart rate due to more than one pathway through the AV node. It can cause heart palpitations, fainting or heart failure. In many cases, it can be terminated using a simple maneuver performed by a trained HeartCare-Info professional, medications or a pacemaker.
* Ventricular tachycardia (V-tach). A rapid heart rhythm originating from the lower chambers (or ventricles) of the heart. The rapid rate prevents the heart from filling adequately with blood; therefore, less blood is able to pump through the body. This can be a serious arrhythmia, especially in people with heart disease, and may be associated with more symptoms. A heart doctor should evaluate this arrhythmia.
* Ventricular fibrillation. An erratic, disorganized firing of impulses from the ventricles. The ventricles quiver and are unable to contract or pump blood to the body. This is a HeartCare-Info emergency that must be treated with cardiopulmonary resuscitation (CPR) and defibrillation as soon as possible.
* Long QT syndrome. The QT interval is the area on the electrocardiogram (ECG) that represents the time it takes for the heart muscle to contract and then recover, or for the electrical impulse to fire impulses and then recharge. When the QT interval is longer than normal, it increases the risk for "torsade de pointes," a life-threatening form of ventricular tachycardia. Long QT syndrome is an inherited condition that can cause sudden death in young people. It can be treated with antiarrhythmic drugs, pacemaker, electrical cardioversion, defibrillation, implanted cardioverter/defibrillator or ablation therapy.
* Bradyarrhythmias. These are slow heart rhythms, which may arise from disease in the heart's electrical conduction system. Examples include sinus node dysfunction and heart block.
* Sinus node dysfunction. A slow heart rhythm due to an abnormal SA (sinus) node. Sinus node dysfunction is treated with a pacemaker.
* Heart block. A delay or complete block of the electrical impulse as it travels from the sinus node to the ventricles. The level of the block or delay may occur in the AV node or HIS-Purkinje system. The heart may beat irregularly and, often, more slowly. If serious, heart block is treated with a pacemaker.

What Are the Symptoms of Arrhythmias?

An arrhythmia can be silent and not cause any symptoms. A doctor can detect an irregular heartbeat during a physical exam by taking your pulse or through an electrocardiogram (ECG).

When symptoms occur, they may include:

* Palpitations (a feeling of skipped heart beats, fluttering or "flip-flops," or feeling that your heart is "running away").
* Pounding in your chest.
* Dizziness or feeling light-headed.
* Fainting.
* Shortness of breath.
* Chest discomfort.
* Weakness or fatigue (feeling very tired).

How Are Arrhythmias Diagnosed?

Tests used to diagnose an arrhythmia or determine its cause include:

* Electrocardiogram
* Holter monitor
* Event monitor
* Stress test
* Echocardiogram
* Cardiac catheterization
* Electrophysiology study (EPS)
* Head-up tilt table test

How Are Arrhythmias Treated?

Treatment depends on the type and seriousness of your arrhythmia. Some people with arrhythmias require no treatment. For others, treatments can include medication, making lifestyle changes and undergoing surgical procedures.
What Medications Are Used to Treat Arrhythmias?

A variety of drugs are available to treat arrhythmias. These include:

* Antiarrhythmic drugs. These drugs control heart-rate, and include beta-blockers.
* Anticoagulant or antiplatelet therapy. These drugs reduce the risk of blood clots and stroke. These include warfarin (a "blood thinner") or aspirin.

Because everyone is different, it may take trials of several medications and doses to find the one that works best for you.
What Lifestyle Changes Should Be Made?

* If you notice that your irregular heart rhythm occurs more often with certain activities, you should avoid them.
* If you smoke, stop.
* Limit your intake of alcohol.
* Limit or stop using caffeine. Some people are sensitive to caffeine and may notice more symptoms when using caffeine products (such as tea, coffee, colas and some over-the-counter medications).
* Stay away from stimulants used in cough and cold medications. Some such medications contain ingredients that promote irregular heart rhythms. Read the label and ask your doctor or pharmacist what medication would be best for you.

What Is Electrical Cardioversion?

If drugs are not able to control a persistent irregular heart rhythm (such as atrial fibrillation), cardioversion may be required. After administration of a short-acting anesthesia, an electrical shock is delivered to your chest wall that synchronizes the heart and allows the normal rhythm to restart.
What Is a Pacemaker?

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate. Pacemakers primarily prevent the heart from beating too slowly. The pacemaker has a pulse generator (which houses the battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to the heart muscle. Newer pacemakers have many sophisticated features that are designed to help manage arrhythmias and optimize heart-rate-related function as much as possible.
What Is an Implantable Cardioverter-Defibrillator (ICD)?

An ICD is a sophisticated device used primarily to treat ventricular tachycardia and ventricular fibrillation, two life-threatening heart rhythms. The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again. There are several ways the ICD can be used to restore normal heart rhythm. They include:

* Anti-tachycardia pacing (ATP). When the heart beats too fast, a series of small electrical impulses may be delivered to the heart muscle to restore a normal heart rate and rhythm.
* Cardioversion. A low energy shock may be delivered at the same time as the heart beats to restore normal heart rhythm.
* Defibrillation. When the heart is beating dangerously fast or irregularly, a higher energy shock may be delivered to the heart muscle to restore a normal rhythm.
* Anti-bradycardia pacing. Many ICDs provide back-up pacing to prevent too slow of a heart rhythm.
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Heart Attack & Heart Failure at Heart Care Info

Heart Attack & Heart Failure at Heart Care Info

There are numerous distinct disorders that relate to heart. These include arteriosclerosis and atherosclerosis, angina, heart attack, and heart failure, arrhythmias, myocarditis, cardiomyopathy, heart murmurs, rheumatic heart disease, valvular disease, mitral valve prolapse and high blood pressure or hypertension.

Like any muscle, the heart needs a constant supply of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged and cannot supply enough blood to the heart, the result is coronary heart disease.



Coronary Heart Disease:
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The most common type of heart disease is coronary heart disease (CHD), also called coronary artery disease. It is the No. 1 killer in America, affecting more than 12 million Americans. Coronary heart disease develops when one or more of the coronary arteries that supply the blood to the heart become narrower than they used to be. This happens because of a buildup of cholesterol and other substances in the wall of the blood vessel, affecting the blood flow to the heart muscle.


Symptoms: The most common symptom is angina or "angina pectoris." Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling. Other sypmtoms are shortness of breath, faster heartbeat, sweating.
Angina Pectoris:

Angina is chest pain caused by coronary heart disease, a partial blockage of the coronary arteries. It occurs when the heart muscle doesn't get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked. Insufficient blood supply is called ischemia.

Symptoms: Some risk factors for developing angina are male sex, family history of angina, diabetes, smoking, high cholesterol, high blood pressure, obesity, sedentary lifestyle, and stress.
Heart Attack:

A heart attack (myocardial infarction) occurs when a coronary artery abruptly fails to deliver blood to a part of your heart. Coronary arteries are the blood vessels on the surface of your heart. They bring oxygen and nutrients to your heart muscle (myocardium). The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. This is usually caused by the buildup of plaque (deposits of fat-like substances), a process called atherosclerosis

Symptoms: Symptoms of a heart attack include: Discomfort, pressure, heaviness, or pain in the chest, arm or below the breastbone, Rapid or irregular heartbeats, Difficulty breathing, Nausea, vomiting, Dizziness, weakness.

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Hair Removal

Hair removal

Every single human being has to face the hair removal process from time to time. While it's just simple routine for some, others have to cope with a number of problems while dealing with it. No matter to which of the above you belong, you can always improve your skills in hair removal.

Hair removal may be classified by different criterions, for example, location (facial, body, bikini), removal type (waxing, shaving, plucking) or by type of hair (vellum or terminal). Knowing what type of hair you will be removing will help you choose the way of performing the procedure.

Vellum hair is soft, fine and short. This type of hair usually appears on women back, chest or face and they are so small that the removal is only optional, unless you have a darker complexion, which can make them more visible. Terminal hair is coarser, darker and longer. It's the hair that grows on your head, legs, armpits and bikini zone.

Laser hair removal, plucking or waxing is the most recommended methods for vellum hair removal. It might be more painful, but the effect will last longer and hair won't get thicker (the effect shaving causes).

Terminal hair can be removed by using such methods as shaving, plucking, depilatories, waxing, electrolysis, laser and prescription treatment. The choice of methods depends on your ability to deal with pain, area you want to clean and your financial capabilities.

Shaving is cheap and won't cause you any pain. Yet the effect won't last so long (1 to 3 days) and you'll have to do it again and again. It is very comfortable in a way that you do not have to make any appointments with anybody. The major drawback is that you can't shave them until they reach a certain length.

Plucking lasts long (from 3 to 8 weeks), yet it's really painful and takes time. As far as you can pluck only one hair at a time removing hair from your legs would probably take a whole day. Plucking is recommended on small areas such as eyebrows, upper lip and chin.

Depilatories are inexpensive and won't cause you any pain. The effect lasts from several days to two weeks. They can be used on any area, yet you have to be very careful when purchasing one, because it usually has a lot of chemical components. It's not recommended for people who have sensitive skin.

Waxing is probably the most painful method of hair removal, however, the effect is long lasting (from 3 to 6 weeks). For some people it may cause skin redness, inflammation and bumps, yet these effects will not take long to disappear, leaving smooth skin.

Electrolysis is permanent, yet it takes time for you to see the actual effect and you have to make appointments for that. It's usually used only for small areas such as upper lip, eyebrows and underarms. The procedure is painful and may cause dry skin, scabs, scarring and inflammation. Also, electrolysis is expensive, being the only permanent hair removal method. l

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Small bowel perforation after blunt injury abdomen and causes of delay in diagnosis

Friday, August 28, 2009
Small bowel perforation after blunt injury abdomen and causes of delay in diagnosis

INTRODUCTION

The diseases of the small bowel are very rare in occurrence. In contrast, there are various kinds of contributory causes to perforation of the small bowel. These are classified as follows, traumatic, foreign body, ulcerative, tumorous, ileus, vessel originated-disease and idiopathic. Needless to say, the death of perforation is closely associated with the time interval from onset to operation.
The small intestine occupies a relatively large surface area within the peritoneal cavity and thus is frequently injured in patients with penetrating abdominal trauma. Because the small bowel is relatively mobile, has a lower bacterial flora, and has fewer anaerobes than the colon, peritoneal contamination secondary to small bowel injuries is better tolerated than that associated with colon injuries.
The Penetrating Abdominal Trauma Index (PATI), which quantitates the severity of abdominal injury based on risk factors associated with specific organs, employs a multiplier of 3 for small bowel injuries (compared with 4 for colon and liver, and 5 for pancreas and duodenum).

* The management of penetrating small bowel injuries for these reasons is generally straightforward, with simple repair being the rule.

INCIDENCE

* Estimates of the incidence of small bowel rupture associated with blunt abdominal injury range from 3 to 18%.
* The death related to perforation of the small bowel 17.1% which is between those of the colon (27.3%) and the stomach and duodenum (1 1.1%), respectively.

DELAY IN DIAGNOSIS

* It is generally accepted that delay in diagnosis in common because definite clinical signs is prone to being concealed. It is due to a low incidence of the appearance of free gas in the peritoneal cavity on abdominal X-ray film. To salvage the patients in early stage, surgeons should be alert to a latent interval in this stage.
* The diagnosis of SBI is now more frequently made on the basis of clinical signs or an abnormal CT scan, than as an associated injury during a trauma laparotomy. As a result, delays in the diagnosis of SBI may occur and contribute significantly to morbidity and mortality.
* Small-bowel perforations are often minute and may seal temporarily before free air is noted." Associated spasm of the circular muscle above and below the level of the perforation, results in a localised ileus which further prevents leakage. After 5 or 6 hours the spasm passes off and contamination of the peritoneal cavity occurs as the isolated segment takes part in the peristaltic activity again.
* ' Klinger" described 50 patients of all ages, in only 10 of whom he noted free air; in one of them the perforation only became evident on delayed films. Delay in diagnosis may occur as a result of late rupture of an intramural haematoma'" or after serosal and tunica muscularis tears, or after interference with the blood supply, as occurs in avulsion injuries." Delayed diagnosis may also be the result of lack of careful examination in patients with multiple injuries."
* In the digestive organ with the lumen, it is necessary that traumatic perforation should be quickly detected and treated. It is without saying that a presence of free gas is a confirmable finding.
* In contrast, abdominal free gas is unlikely to appear and often fails to detect in the early stage.

Pathogenesis of perforation of the gut is much different from each other. It is well known that perforation of lower part of the gut more frequently provokes endotoxic shock.

Summary of Amount and Location of Free Air according to Perforation Sites
Perforation Site Amount Location
Stomach/duodenum Abundant Around liver and stomach
Post-bulbar duodenum Right anterior pararenal space
Small bowel Small Mesenteric folds, around liver
Appendix Small/absent Around appendix
Large bowel Variable Pelvis, mesenteric folds, retroperitoneal space

Classification of Small Bowel Damage After Trauma
Grade Injury Description
I Hematoma Contusion or hematoma without devascularization
Laceration Partial thickness, no perforation
II Laceration Laceration <50%>

* Motor vehicle accidents are the main cause of blunt SBI. The increase in seat belt use has resulted in lower fatality rates and injury severity, but has been accompanied by a concomitant increase in rates of intestinal injuries.
* Blunt trauma commonly occurs as a result of motor vehicle crashes, falls from heights, and interpersonal assaults with blunt objects.

Intestinal injuries can occur secondary to blunt trauma by two major mechanisms:

1. Horizontal deceleration or shearing can occur in patients involved in collisions. The regions that are affected most commonly are near junctions between fixed and nonfixed points of bowel (i.e., proximal jejunum, terminal ileum).

2. Direct blow with a linear object (seat belt) across loop of bowel, with a subsequent "blowout" injury, can occur at any point of the intestine or the mesentery.

* Serial clinical evaluations of the abdomen are extremely useful in the diagnosis of SBI, particularly in patients with additional associated intra-abdominal injuries.
* A bruise across the abdomen inflicted by a seat belt ("seat belt sign") and ongoing abdominal pain are known associated risk factors of SBI.
* Fakhry et al. observed that 67.7% of 198 patients with blunt SBI initially presented with signs or symptoms highly suggestive of this lesion, and 84.3% were taken to the operating room without delay. In this study, of the patients involved in motor vehicle crashes, only 30% had the abdominal seat belt sign, which is less than that commonly reported in the literature (nearly 50%). Consistent with prior reports, the most frequent clinical signs were abdominal pain upon admission (75.6%) and abdominal tenderness upon physical examination (46.7%).
* Diagnosis of these injuries remains problematic. Early recognition of SBI is important in the prevention of morbidity. DPL is more sensitive than CT imaging for diagnosis of SBI; however, in many cases, it results in nontherapeutic laparotomy. CT imaging is newer than DPL, and it has become popular in recent years. The major advantages of CT include noninvasiveness, capacity to quantify free fluid, the ability to select patients with solid organ injury for non-operative management, and the ability to view retroperitoneal organs.
* Saku et al. analyzed the CT findings of 12 patients with SBI perforation due to blunt trauma, all patients underwent radiography and CT, and five underwent presurgical follow-up CT. Radiography demonstrated free air in only 8% (1/12) and 25% (3/12) at the initial and follow-up examinations, respectively. In contrast, the initial and followup CT scans detected extraluminal air in 58% (7/12) and 92% (11/12), respectively, suggesting that the incidence of extraluminal air increases as time elapses, prompting the authors to recommend a repeat CT, particularly after 8 h, in suspect cases to increase sensibility. Mesenteric fat obliteration was seen in 58% (7/12) and 75% (9/12) at initial and follow-up CT, respectively.

Posted by jitendraagrawal2000 at 3:10 PM
Dr. Jitendra Agrawal

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