2008 November 21

Treatment of atrial fibrillation and atrial flutter: Part II.

Nov 212008

Treatment of atrial fibrillation and atrial flutter: Part II.

Cardiol Rev. 2008 Sep-Oct;16(5):230-9

Authors: Aronow WS

Atrial fibrillation (AF) is often complicated by a life-threatening ventricular response, and emergency electrocardioversion and/or drug therapy to reduce the rapid ventricular rate may be necessary. However, patients with AF and Wolff-Parkinson-White syndrome should not be given digoxin or calcium channel blockers. Elective direct current (DC) cardioversion has a higher success rate and a lower incidence of cardiac adverse effects than does medical cardioversion in converting AF to sinus rhythm. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective direct current or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer, especially in older patients, ventricular rate control plus warfarin rather than maintaining sinus rhythm with antiarrhythmic drugs. Patients with chronic or paroxysmal AF at high risk for stroke should be treated with long-term warfarin to achieve an international normalized ratio of 2.0-3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should be treated with aspirin 325 mg daily. Management of atrial flutter is similar to management of AF.

PMID: 18708824 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Beta-blockers for primary prevention of heart failure in patients with hypertension insights from a meta-analysis.

J Am Coll Cardiol Start a Discussion »

Nov 212008

Beta-blockers for primary prevention of heart failure in patients with hypertension insights from a meta-analysis.

J Am Coll Cardiol. 2008 Sep 23;52(13):1062-72

Authors: Bangalore S, Wild D, Parkar S, Kukin M, Messerli FH

OBJECTIVES: This study sought to evaluate the efficacy of beta-blockers (BBs) for primary prevention of heart failure (HF) in patients with hypertension. BACKGROUND: The American College of Cardiology/American Heart Association staging for HF classifies patients with hypertension as stage A HF, for which BBs are a treatment option. However, the evidence to support this is unknown. METHODS: We conducted a MEDLINE/EMBASE/CENTRAL search of randomized controlled trials that evaluated BB as first-line therapy for hypertension with follow-up for at least 1 year and with data on new-onset HF. The primary outcome was new-onset HF. Secondary outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. RESULTS: Among the 12 randomized controlled trials, which evaluated 112,177 patients with hypertension, BBs reduced blood pressure by 12.6/6.1 mm Hg when compared with placebo, resulting in a 23% (trend) reduction in HF risk (p = 0.055). When compared with other agents, the antihypertensive efficacy of BBs was comparable, which resulted in similar but no incremental benefit for HF risk reduction in the overall cohort (risk ratio: 1.00; 95% confidence interval: 0.92 to 1.08), in the elderly (> or =60 years) or in the young (<60 years). Analyses of secondary outcomes showed that BBs confirmed similar but no incremental benefit for the outcomes of all-cause mortality, cardiovascular mortality, and myocardial infarction but increased stroke risk by 19% in the elderly. CONCLUSIONS: In hypertensive patients, primary prevention of HF is strongly dependent on blood pressure reduction. When compared with other antihypertensive agents, there was similar but no incremental benefit of BBs for the prevention of HF. However, given the increased risk of stroke in the elderly, BBs should not be considered as first-line agents for prevention of HF.

PMID: 18848139 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Austrian syndrome (pneumococcal pneumonia, meningitis, and endocarditis): a case report.

Am J Med Sci Start a Discussion »

Nov 212008

Austrian syndrome (pneumococcal pneumonia, meningitis, and endocarditis): a case report.

Am J Med Sci. 2008 Oct;336(4):354-5

Authors: Dalal A, Ahmad H

This report describes a case of Austrian syndrome (pneumonia, meningitis, and endocarditis, as a result of Streptococcus pneumoniae infection). A computerized medline search was performed for review of literature. In the review of literature, 54 cases including our case were found. Complete clinical and microbiological information was available only for 20 cases. Most invasive pneumococcal infections occurred in debilitated middle aged men with chronic alcoholism. Native aortic valve insufficiency was the commonest cause of cardiac failure among these patients, requiring valve replacement. Austrian syndrome is seen infrequently in this antibiotic era but is still associated with a poor outcome. Hence early recognition and appropriate medical or combined medical-surgical treatment needs to be considered promptly.

PMID: 18854681 [PubMed - indexed for MEDLINE]

Link to Article at PubMed