Pneumonia With Cardiac Event In Hospital Predicts Poor Outcome
ROME, ITALY In a small Italian study of patients hospitalized with community-acquired pneumonia, those who had an in-hospital cardiac eventMI or atrial fibrillationwere more likely to die from any cause or have another cardiac eventcardiac death, nonfatal MI, or strokeduring a median 17.4-month follow-up.
These findings highlight the importance of identifying these higher-risk patients among those hospitalized with community-acquired pneumonia, coauthor Prof Francesco Violi told heartwire from Medscape. “The take-away message is to check troponin and in the early phase of pneumonia,” he said.
But another researcher who was not involved with this study feels that the high rate of adverse outcomes in the patients who did not have a CV event in the hospital is especially notable. “Is it novel to tell me that somebody who has a heart attack is going to have a heart attack again? Frankly, I don’t think so,” Dr Jacob A Udell told heartwire. However, it is “fascinating” that “patients who didn’t have a cardiac complication in the hospital had a 10% risk of dying in the next 2 years and a one in five, or 20%, risk of having a cardiac complication in the next 2 years,” he said.
The study, by Dr Roberto Cangemi and colleagues from the Thrombosis-Related Extra-Pulmonary Outcomes In Pneumonia study group, was published online May 22, 2015 in the American Journal of Cardiology.
Long-term Effect of Cardiac Complications in Pneumonia
References
Can You Have Atrial Fibrillation With Low Blood Pressure
Atrial fibrillation can cause blood pressure to drop at dangerously low levels. In medical terminology it is called hemodynamic instability or hemodynamic compromise, sometimes also called Unstable Afib. It is a medical emergency that requires immediate management or else it can have deleterious consequences.
The cut-off blood pressure for labeling a patient as unstable afib is < 90/60 mmHg or mean blood pressure of < 65mmHg.
The European Society of Cardiology 2020 guidelines for Atrial Fibrillation define acute hemodynamic compromise as the presence of the following features:
- Syncope
- Symptomatic hypotension
- Cardiogenic shock
Hypertension or raised bp may be the cause of AF whereas low blood pressure is the effect.
Can Strenuous Exercise Trigger Afib
The next thing that can trigger episodes of atrial fibrillation is exercise. There may be patients out there who clearly see that a certain type of exercise triggers atrial fibrillation. The tricky part about exercise induced atrial fibrillation is that exercise is actually healthy for you. In general, it is recommended that if you have atrial fibrillation that you should exercise, you should try to lose weight if overweight, and so exercise is always good. But exercise should be carefully monitored if you have atrial fibrillation. People with atrial fibrillation need to be careful when exercising to try to figure out where your own individual tolerances are. Usually I recommend to my patients to start off slow with things that are low-impact, and build up, as you are able to.
Also, heart rate monitors, whether that’s a Fitbit or Apple watch, have been very useful for patients to monitor their exercise. They can be used to monitor your heart rate to help try to prevent episodes of atrial fibrillation while exercising. Of course while exercising staying hydrated is an important tip as well.
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Reducing Atrial Fibrillation Symptoms Through Diet And Exercise
We recommend a consistent healthy diet by eating the right foods and tracking calories regularly, plus getting 30 minutes of aerobic exercise five days per week for healthy weight loss. Considering the link between obesity and AFib, patients who lose greater than 10% of their body weight could see a 60% reduction in the need for stronger treatments, such as heart rhythm medications or ablation procedures.
Extreme weight loss or the use of stimulants to lose weight can be harmful to your overall health and actually cause or worsen symptoms of atrial fibrillation. In some rare cases, surgery may be needed for a patient to lose weight and improve these modifiable health conditions.
Know When To See A Doctor
Dealing with breathing discomforts at home is important, but its also important to know when your breathlessness requires medical attention. If you feel chest pain or a heaviness thats preventing you from taking in a full breath, dont wait for it to pass: breathing problems can be a medical emergency, so speak with your doctor now about warning signs to watch for, and when to call an ambulance.
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How Does Afib Lead To Stroke
- The heartbeat seems to quiver in an erratic way. The upper chambers of the heart do not produce an effective, regular contraction, but contract irregularly.
- The contraction fails. Imagine wringing out a sponge. Without a good squeeze, water will still be left in the sponge. In the same way, when a heart contraction is either too fast or too uneven, it doesnt completely squeeze the blood from the atria into the next chamber.
- Blood pools in the atria. Blood not completely pumped out of the atria can remain and may pool there.
- Risks of clotting go up. When blood has the opportunity to pool, it also has the opportunity to clot.
- Clots can travel and cause blockages. If a blood clot forms in the atria, it can be pumped out of the heart to the brain, blocking off the blood supply to an artery in the brain, causing a stroke. This type of stroke is called an embolic stroke or some doctors call it a cardioembolic stroke.
Disturbances Of Fluids Electrolytes And Acid
Hypokalemia is prevailing in patients with COVID-19 and occurs in up to 61% of hospitalized patients . This is assumed to be due to increased urinary and/or gastrointestinal loss of potassium. SARS-CoV-2 binds ACE2 and enhances the degradation of ACE2, and thus decreases the countering effects of ACE2 on the renin-AngII system. The final effect is to increase reabsorption of sodium and water, and thereafter increase blood pressure and excretion of potassium. Besides, patients with COVID-19 often have gastrointestinal symptoms such as diarrhea and vomiting, lowering potassium resources in the human body. , Subsequently, hypokalemia results in cellular hyperpolarity, increases resting membrane potential and hastens depolarization in cardiac cells that predispose to AF .
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Can Stress Trigger Afib
Another thing that can trigger episodes of atrial fibrillation is just stress by itself. Stress by itself, whether that is stress at home, or stress at work, can lead to episodes of atrial fibrillation. How does stress increase episodes of atrial fibrillation? First, when people are in periods of stress, they may also have these stress-related hormones released that can trigger episodes of atrial fibrillation. Also, the habits that people have when they’re stressed also can lead to episodes of atrial fibrillation. Those habits may include sleep deprivation. Perhaps you’re not sleeping as much when you’re stressed but other stress habits can include more caffeine intake because you’re tired or more alcohol intake because you’re stressed, and so all of those habits together can lead to episodes of atrial fibrillation.
Mechanisms Of Cardiac Damage During Cap
The heart is a very peculiar organ that is composed of several types of cells such as cardiomyocytes , fibroblasts, myofibroblasts, macrophages and other inflammatory cells. Importantly, adults have a regeneration rate of 3% of the total population of cardiomyocytes per year, which severely limits its capacity of healing.- When cardiomyocytes are killed, myofibroblasts proliferate and synthesize extracellular matrix, rich in collagen, to replace dead cardiomyocytes . This process allows the heart to continue working effectively when the number of dead cells is low, but when the injury is bigger, heart scars are formed and are a potential aetiology of arrhythmias and heart failure. Consequently, identifying the mechanisms underlying cell death and cardiac damage during CAP is of vital importance to understand and prevent CC in patients with CAP. In the following sections, we attempt to describe the translational research available that could potentially describe the hostâpathogen interactions and mechanisms underlying CC during CAP .
| Pathogen |
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Streptococcus pneumoniae.
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How Do You Stop An Afib Episode
There are many ways that people manage their atrial fibrillation at home including many of my own patients. There are up to 4 methods that I frequently discuss with my patients, which can include vagal maneuvers and biofeedback just to name a few. but it is also important to know when is the right time to seek emergency treatment for AFib. Check out my article for tips for managing atrial fibrillation attacks at home here.
Stroke And Atrial Fibrillation
Stroke is one of the most feared complications of afib that contributes to both morbidity and mortality.
According to European Society of Cardiology 2020 guidelines for atrial fibrillation, 20-30% of all ischemic strokes are due to afib.
The brain has specific centers that regulate the respiratory system and maintain the oxygen levels in the blood. These primarily include the brainstem, the upper two-thirds of the medulla, and the pons.
Whenever a stroke involves these specific areas, the normal process of respiration is affected and a patient can develop respiratory failure which might be severe enough to necessitate mechanical ventilation.
This is how afib can cause low oxygen saturation with stroke.
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Echocardiography And La Strain Analysis
TTE was performed by trained operators in supine position, within 48 h of ICU admission. Standard echocardiography protocol were used in accordance with the American Society of Echocardiography guidelines and the European Society of Cardiology . Echocardiographic images were obtained by a high-quality commercially available ultrasound system . All operators had a level III competence of general adult TTE .
Enhancing Healthcare Team Outcomes
Managing hospital-acquired pneumonia and ventilator-associated pneumonia requires an interprofessional team of specialists in infectious diseases, pulmonary diseases, critical care, anesthesiologists, and any clinicians and healthcare providers including nurses and pharmacists caring for hospitalized patients with nosocomial pneumonia. Without proper management the morbidity and mortality from HAP and VAP are high.
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How Does Afib Lead To Heart Failure
Heart failure means the heart isnt pumping enough blood to meet the body’s needs. AFib can lead to heart failure because the heart is beating so fast that it never properly fills up with blood to pump out to the body.
As a result, when the heart doesn’t efficiently pump the blood forward with strong contractions, symptoms develop because:
- Blood can back up” in the pulmonary veins which can cause fluid to back up into the lungs.
- When AFib causes heart failure, fluid in the lungs can cause fatigue and shortness of breath. Oxygen-rich blood is not being delivered to the body and brain, causing physical and mental fatigue and reduced stamina. Fluid also can build up in the feet, ankles, and legs, causing heart-failure related weight gain.
Can Atrial Fibrillation Resolve Itself
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Are There Reversible Causes Of Atrial Fibrillation
Atrial fibrillation is the most common heart rhythm disorder in the United States and affects approximately 5.5 million people. Symptoms include heart palpitations, shortness of breath, fatigue, light-headedness, dizziness, and sometimes passing out.
On its own, atrial fibrillation is not generally a life threatening condition, but it can cause stroke or congestive heart failure if left untreated. It can also be extremely limiting to a persons lifestyle due to fatigue, shortness of breath, and palpitations.
Atrial fibrillation can be caused by many things, and some of those causes are reversible, which means a patients symptoms can improve or stop entirely without additional heart rhythm medications or a surgical procedure.
Outcomes Of Atrial Fibrillation In Patients With Covid
- 1 Ming-yue Chen and Fang-ping Xiao have contributed equally to this workMing-yue Chen1 Ming-yue Chen and Fang-ping Xiao have contributed equally to this workAffiliations
- 1 Ming-yue Chen and Fang-ping Xiao have contributed equally to this workFang-ping Xiao1 Ming-yue Chen and Fang-ping Xiao have contributed equally to this workAffiliations
- Department of Geriatrics, Second Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- 1 Ming-yue Chen and Fang-ping Xiao have contributed equally to this work
- Preexisting AF was associated with increased mortality and ventilator use in COVID-19.
- New-onset AF during COVID-19 was significantly correlated with increased mortality.
- Patients with AF tend to present worse outcomes, which deserve managed appropriately.
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How Is Electrical Cardioversion Done
It is performed in the hospital setting by the experts like doctors & paramedics.
During the procedure, the patientsâ vital signs like heart rate, rhythm, blood pressure, & oxygen saturation are monitored.
Several ECG electrodes are placed on the chest wall. The electrodes are connected to a cardioverter. This helps monitor heart rate and rhythm.
Usually, a sedative drug is given before the procedure as giving shock is painful.
An injection of a blood thinner like heparin is also given to decrease the risk of stroke.
Stroke can occur with electrical cardioversion in patients with afib because if there is a clot in the left atrium or left atrial appendage, it can get dislodged and move to the cerebral circulation.
The next step is the application of defibrillation pads on the chest wall.
One pad is placed on the right side of the sternum underneath the clavicle and the other one at the 5th or 6th intercostal space at the left anterior axillary line i.e. apex of the heart.
The defibrillator is turned on.
Synchronize mode is then activated by pressing the synchronize button.
The charge button is then pressed.
Before delivering the shock, the person holding the paddles shouts loudly âall clearâ. At this time it is ensured that no one is touching the bed or the equipment.
Finally, the button on the paddle is pressed and shock is delivered.
Can Afib Simply Go Away
Yes, rarely spontaneous remission does happen it simply goes away. However, it is still something you and your healthcare provider will want to monitor for because some people live with AFib and do not feel the symptoms. However, the risks are still present.
Overall, most of the risks, symptoms and consequences of AFib are related to how fast the heart is beating and how often rhythm disturbances occur.
AFib may be brief, with symptoms that come and go. It is possible to have an atrial fibrillation episode that resolves on its own. Or, the condition may be persistent and require treatment. Sometimes AFib is permanent, and medicines or other treatments can’t restore a normal heart rhythm.
But for all the reasons listed above, it is important to work with your healthcare provider to determine your treatment needs, and to understand your treatment options. It is also important to maintain a heart-healthy lifestyle and reduce your overall risks as much as possible.
Watch this short video explaining stroke risk:
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Funding Support And Author Disclosures
The PARADIGM-HF and PARAGON-HF trials were funded by Novartis. Dr. McMurray is supported by a British Heart Foundation Centre of Research Excellence Grant . Drs Jhund, Anand, Bhatt, Desai, Maggioni, Martinez, Pfeffer, Rizkala, Rouleau, Swedberg, Vaduganathan, Vardeny, van Veldhuisen, Zannad, Zile, Packer, Solomon, and McMurray or their institutions have received funding from Novartis.
Electrical Problems In Atrial Fibrillation:
- In AFib, the SA node may not start the contraction. Instead, the contraction might start randomly in other areas of the atria or even in the pulmonary veins.
- In AFib, the electrical current doesnt flow in an organized top-to-bottom fashion. Instead, contractions are rapid and disorganized.
- In AFib, the AV node often cant regulate the chaotic current. It does its best to protect the ventricle from extra electrical impulses, but it cant stop all of them. As a consequence, the ventricle beats more often than it should giving rise to the noticeable symptoms of breathlessness and fatigue.
- When the beat is off, the blood supply can be unpredictable. So, even though the ventricles may be beating faster than normal, they aren’t beating as fast as the atria. Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AFib, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute.
The amount of blood pumped out of the ventricles to the body is based on the randomness of the atrial beats.
The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat.
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Cardiovascular Complication After Cap
Involvement of the cardiovascular system after developing CAP is as an important short- and long-term co-morbidity., Corrales-Medina et al. performed a systematic review and meta-analysis of observational studies, and found that CC occurred in 18% of CAP patients. Most of the studies showed that the rate of CC is higher among hospitalized patients than outpatients.
Several risk factors are associated with the development of CC in patients with pneumonia. The strongest associated risk factor is preexistent CVD preceding the pneumonia event. Patients with CAP older than 65âyears tend to have higher rates of co-morbidities. The most common co-morbidities include chronic obstructive pulmonary disease , ischaemic heart disease, congestive heart failure, diabetes and stroke. However, all these conditions seem to be overrepresented among hosts with compromised immunological status, potentially leading to poor clinical outcomes. In addition, many of these co-morbidities are associated with poor functional and disability status, usually requiring admission to long-term care facilities.,