Stroke is a common problem, affecting nearly 800,000 people annually in the United States and serving as a leading cause of significant long-term disability. This article begins with a brief discussion of stroke epidemiology and then provides an overview of the various stroke mechanisms, setting a framework for which to consider etiology-specific stroke management.
In a retrospective analysis of electronic health record data matched with remote pacemaker and implantable cardioverter-defibrillator recordings of atrial fibrillation episodes, a threshold daily arrhythmia burden portending higher stroke risk was determined over a range of CHA2DS2-VASc scores.
The Apple Heart Study participants were people without atrial fibrillation who purchased a smart phone app and consented to monitoring using a smartwatch-based irregular pulse notification algorithm, which identified possible atrial fibrillation. If notification occurred, the person was mailed an electrocardiography (ECG) patch to be worn for seven days to confirm the findings first identified by the smartwatch. The age distribution of this group is different than the usual cohort at risk for atrial fibrillation: 52% were between the ages of 22 and 39 years of age, and only 5.9% were 65 years or older. A much more useful study would have included an older cohort that carries a higher risk of atrial fibrillation.
Medications are frequently used in the emergency department to help restore conduction of normal cardiac electrophysiology. This article will briefly review arrhythmias and discuss commonly used and new medications with their indications, side effect profile, and contraindications to use.
This two-part series presents a review of the current evidence on atrial fibrillation. The first part includes its definition, classification, risk factors, comorbidities, evaluation, and acute management of newly diagnosed patients. The second part will focus on long-term management, including risk factor modification, rate and rhythm control measures, stroke risk stratification, and anticoagulation management.
In a large, population-based, prospective cohort study of Danish people aged 50-64 years, researchers found that chocolate intake was inversely related to incidental rates of atrial fibrillation and atrial flutter.
This article provides an overview of atrial fibrillation (AF) and evidence-based guidance on controversial aspects of AF workup and management in the emergency department. The evidence is provided to help safely reduce unnecessary testing and expand the emergency provider’s management armamentarium to include electrical and pharmacologic conversion in recent-onset AF patients.
The recognition, diagnosis, and treatment of tachycardia is a cornerstone of emergency medicine practice. This article will cover the most commonly seen supraventricular and ventricular tachycardias encountered in the ED, with a focus on their electrocardiographic diagnoses and treatment options.
In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was not inferior to perioperative bridging with low molecular weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding.
Rate control and rhythm control strategies for cardiac surgery patients with postoperative atrial fibrillation lead to similar hospital durations, similar complication rates, and similar very low rates of atrial fibrillation at 60-day follow-up.