Atrial fibrillation in elderly patients with heart failure: Convergence of two cardiovascular epidemics in the 21st Century
Northwestern University Feinberg School of Medicine, 676 N. St Clair Street, Suite 600, Chicago, IL 60611, USA.Expert Review of Cardiovascular Therapy 07/2011; 9(7):903-12. DOI: 10.1586/erc.11.89
Atrial fibrillation and heart failure have been called the twin cardiovascular epidemics of the 21st Century. The prevalence of both conditions is increasing in the elderly and often the two conditions coexist in the same patients, leading to worse outcomes. Current data show that rate control and rhythm control are both reasonable strategies for the treatment of atrial fibrillation in heart failure patients. Emerging data suggest the beneficial effects of novel therapeutic approaches such as cardiac resynchronization therapy, and pulmonary vein isolation on left ventricular remodeling and functional outcomes. Anticoagulation remains a mainstay of therapy for stroke prevention in this high-risk population.
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ABSTRACT: The indications for digoxin are currently limited to rare cases of heart failure and/or atrial fibrillation. Its use should be even more rare in geriatrics its pharmacological characteristics, associated with age-related changes and comorbidities, particularly increase the risk of digoxin poisoning in the elderly. However, at least a third of aged patients suffering from heart failure and/or atrial fibrillation is treated by digitalis. Digoxin intoxication can provoke gastrointestinal troubles, neurological disturbances and, above all, cardiac conduction impairment and dysrythmias, which explain its severity and high mortality rate. Presently, first-line therapy is the administration of digoxin specific antibodies. Poor prognosis factors, frequently found in digoxin intoxications in the elderly, have been established for guiding the prescription of antibodies and their dosage. It is important for geriatricians to be able to recognize poisoning signs and the conditions in which an antidote treatment is necessary. This will permit a more effective management of the case, with the support of a poison control center and possible referral of the patient to an intensive care unit.
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ABSTRACT: Objectives: Chronic subdural hematoma (CSDH) is a common neurosurgical problem. Most studies of pathogenesis and treatment involve humans. Advances in understanding of human diseases may be made using animal models. We reviewed all animal models of CSDH and report here their results, conclusions and limitations in order to set a baseline upon which further advanced experimental work related to this disease can be made. Methods: PubMed, Medline, Embase and ISI Web of Knowledge were searched with no time limits using the keyword 'chronic subdural hematoma' and MeSH term 'hematoma, subdural, chronic'. The authors reviewed all papers written related to this disease and selected all publications involving animals. There were no other restrictions. The findings and conclusions of the papers are summarized here. No formal analysis was done because of the variation in species used, methods for induction of CSDH, times of assessment and reporting of results. Results: Attempts to create CSDH have been made in mice, rats, cats, dogs and monkeys. Methods include injection or surgical implantation of clotted blood or various other blood products and mixtures into the potential subdural space or the subcutaneous space. No intracranial model produced a progressively expanding CSDH. Transient hematoma expansion with liquification could be produced by subcutaneous injections in some models. Spontaneous subdural blood collections were found after creation of hydrocephalus in mice by systemic injection of the neurotoxin, 6-aminonicotinamide. The histology of the hematoma membranes in several models resembles the appearance in humans. None of the models has been replicated since its first description. Discussion: We did not find a report of a reproducible, well-described animal model of human CSDH.
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