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Challenges and Opportunities in Arrhythmia​

Challenges and Opportunities in Arrhythmia

Siddhartha Mani, Sujata Sen, Kaushik Nag, and Prof. Sobhan Biswas

NH-Rabindranath Tagore International Institute of Cardiac Science, Emergency Medicine Department, Tripura Medical College

Abstract

Background: The occurrence of arrhythmias among acute coronary syndrome patients is very common. However, their diagnosis is not considered in contemporary acute coronary syndrome patients. This study investigates the incidence and types of arrhythmias among acute coronary syndrome patients presenting to the emergency department, as well as their association with various factors and patient outcomes.

Methods: The current prospective observational study was conducted at a tertiary care center in Kolkata, India. Data were collected from 76 acute coronary syndrome patients admitted between October 2020 and May 2021 to the emergency department. Information was gathered through semi-structured interviews and relevant investigations.

Results: The majority of the patients were aged 61–70 years, with three-fourths of the study population being male. The incidence of arrhythmia was diagnosed in 77.6% of the patients. The most common arrhythmias were sinus tachycardia, ventricular premature complex, atrial fibrillation, sinus bradycardia, and complete heart block. Arrhythmias were more prevalent among ST-elevation myocardial infarction (62.7%) and unstable angina (8.5%) patients. Patients with a left Ventricular Ejection Fraction ≤ 40% had a higher incidence of arrhythmias (93.5%). The mortality rate during hospital stays was 11.9% among acute coronary syndrome patients with arrhythmias, while all acute coronary syndrome patients without arrhythmias had a 100% survival rate.

Conclusion: This study highlights the incidence and types of arrhythmias in acute coronary syndrome patients presenting to the emergency department. It reveals a higher prevalence of arrhythmias in specific subgroups, such as patients with ST-elevation myocardial infarction and those with a reduction in left ventricular function. These findings contribute to our understanding of arrhythmias in acute coronary syndrome and their association with patient outcomes, emphasizing the importance of appropriate management and monitoring in this population.

Motoharu Shibusawa and Erika Imamine

IMS group IMS Tokyo Katsushika General Hospital, Department of Cardiology, Tokyo, Japan

Abstract

Cardiovascular issues are important concerns in malignant lymphoma treatment. These issues can be broadly categorized into two groups: the invasion of malignant lymphoma into the heart and cardiovascular disease related to malignant lymphoma treatment. In terms of malignant lymphoma invasion of the heart, the presence of a heart lesion of malignant lymphoma often presents with heart-related symptoms and findings such as chest pain, heart failure, and arrhythmias. Notably, heart failure and arrhythmias can be fatal. The identification of heart lesions in malignant lymphoma will result in appropriate management and survival improvement. As for cardiovascular disease associated with malignant lymphoma treatment, the incidence and types of cardiovascular disease, management, and follow-up planning should be identified before starting treatment. This identification and plan will allow an understanding of the risk of developing cardiovascular disease and appropriate management and follow-up. In clinical practice, it is important to keep in mind that cardiac issues in patients with malignant lymphoma should be identified, assessed, and managed before initiating treatment.

Soumya Patnaik and Amar N Patnaik

Star Hospitals

Abstract

The wide array of clinical manifestations of the ongoing COVID-19 pandemic due to the SARS-CoV-2 infection continues to be a big puzzle to healthcare professionals. The picture is becoming complex with the appearance of new strains and widespread vaccination against the viral infection. The acute cardiovascular manifestations are diverse but have been fairly well documented. But the mechanism behind the persistent symptoms like dyspnea, fatigue, chest pain, and other symptoms in some of the survivors weeks and months after the onset of the initial infection is poorly understood. The post-acute and long-term cardiovascular impact of COVID-19 affection on the heart and other systems is not fully clear. As the number of survivors after an acute episode is fast growing, managing them is emerging as a new public health concern.

A recent study on cardiovascular outcomes of COVID-19 in the post-acute phase by Xie et al. in a cohort of 153,760 survivors of COVID showed that these individuals are at substantial risk of CV disorders like thromboembolic problems, arrhythmias, ischemic and non-ischemic myocardial injury, pericarditis, myocarditis, and heart failure, irrespective of the intensity of the initial infection. Currently, defining cardiovascular risk and predicting the long-term consequences for COVID survivors are issues of priority for researchers and clinicians alike. The cardiac MRI is emerging as a useful tool to evaluate the myocardial damage in the post-acute phase of COVID infection. This review is an attempt to analyze the existing knowledge and bring out the potential gaps in the understanding of these challenging issues after the acute phase of COVID is over.

Andrea M.P. Romani

Abstract

The effect of alcohol consumption on cardiac and cardiovascular functions remains a point of contention in the medical field. The consumption of low or moderate amounts of alcohol has been largely associated with having a beneficial effect on cardiac contractility and the cardiovascular system as a whole, owing to the detected vasodilatory effect exerted by the alcohol and the reduction in mortality documented by several studies. In contrast, excessive alcohol consumption results in negative outcomes in both men and women, with cardiac arrhythmias and atrial fibrillation, abnormalities in cardiac contraction leading to heart failure, dilated cardiomyopathy, and overall cardiovascular dysfunctions, including hypertension. The main points of contention are twofold: the dose of alcohol at which its perceived beneficial effects disappear and proper cardiac and cardiovascular functions become progressively impaired, and how to clinically and therapeutically address cardiac and cardiovascular pathologies in chronic alcoholics to ameliorate their general conditions and their prognosis. The present review aims at providing the reader with a general understanding of the effects of alcohol on the cardiovascular system and the pathophysiological mechanisms that lead to the most common cases of cardiac dysfunction, as well as highlighting the current guidelines for treatment of alcoholic cardiomyopathy to ameliorate clinical presentation and prognosis in alcoholic patients.

Stefan Farsky, M.D, FESC

Abstract

Cardiologists play a key role in the identification and subsequent management of patients with cardiovascular disease and comorbid obesity. In addition to the overall cardiovascular risk profile, one must also consider the residual cardiovascular risk in patients in whom, despite properly treated comorbidities (dyslipidemia and hypertension), in connection with ongoing obesity, the chronic inflammatory process of the vascular wall continues, and myocardial fibrosis and the HFpEF phenotype develop. Since last year, it has also been able to indicate modern pharmacotherapy such as GLP-1 receptor agonists (RA) and SGLT2 inhibitors for indications other than DM2T. GLP-1 receptor agonists, specifically liraglutide, regulate appetite by increasing the feeling of satiety while simultaneously reducing the feeling of hunger and the desire to consume more food. This leads to significant weight loss and a subsequent reduction in the risk of hypertension, arrhythmias (including atrial fibrillation), ischemic heart disease, and heart failure. It can be expected that this type of treatment for patients with the HFpEF phenotype and obesity will gain significant traction in the near future. In this case, the liraglutide application led to significant weight reduction. This enabled a reduction in the extent of pharmacotherapy, especially the extreme reduction of daily insulin burden dosage, together with a dramatic decrease in blood glucose levels near normal values. The most probable explanation for this impressive improvement is the insulin resistance reduction combined with weight reduction. This was accompanied by an improvement in the patient’s quality of life, especially in terms of dyspnea reduction and renal function improvement.