Libri: "Bradycardia"

1

Lennon, Krystal. Euphoric Bradycardia. PublishAmerica, 2006.

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2

PILBERY. Standby Cpd: Symptomatic Bradycardia. Class Publishing, 2015.

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3

Jr, Joseph C. Kunz, e Michele G. Kunz. Zombie Notes Bradycardia/Heartblocks. Dickson Keanaghan, LLC, 2011.

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4

Swain, Una Gabriele. Heart rates and diving bradycardia in beaver. 1985.

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5

Burnett, Catherine. Effects of choline and exercise on resting bradycardia in rats. 1988.

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6

Burnett, Catherine. Effects of choline and exercise on resting bradycardia in rats. 1988.

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7

Publications, ICON Health. Bradycardia - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. ICON Health Publications, 2004.

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8

Katritsis, Demosthenes G., Bernard J. Gersh e A. John Camm. Sinus nodal disease. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199685288.003.1459_update_003.

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9

Ramrakha, Punit, e Jonathan Hill, a cura di. Arrhythmias. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199643219.003.0010.

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The cardiac conduction system 478Bradycardia: general approach 480Sinus bradycardia 482Sinus pause 482Sick sinus syndrome 482Atrioventricular block 483Bundle branch block 484Tachycardia: general approach 486Tachycardia: emergency management 488Tachyarrhythmias: classification 490ECG diagnosis of tachyarrhythmias 492Supraventricular tachycardia 494...

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10

Gill, Harminder S., e Jaswinder S. Gill. Causes, diagnosis, and therapeutic strategy in bradyarrhythmias. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0157.

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Bradyarrhythmias (defined as a heart rate <60 beat/min) occur frequently in the critical care setting. Most are related to underlying disease processes and the multidrug therapies administered. Because of the intense monitoring of these patients, recognition is generally easy. Examination of the ECG will allow diagnosis of the type of bradycardia based on the sinus node, atrioventricular node and the infra-Hissian conducting system. The extent of conduction system disease can be estimated and this has an influence on the prognosis. Bradycardias causing haemodynamic collapse require treatment of underlying causes, resuscitation, and administration of atropine and epinephrine. If there is no response to these then either transcutaneous pacing, or temporary transvenous pacing is necessary. This can be followed by implantation of a permanent pacing system. The outcome of correctly diagnosing and treating a bradyarrhythmia is excellent as long as the causative pathology can be stabilized.

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11

Brady, Peter A. Specific Arrhythmias and Syncope. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0044.

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Bradycardia is defined as a heart rate less than 60 beats per minute at rest or a decreased heart rate response to exercise. Causes of bradycardia include high vagal tone (most cases occur in asymptomatic and often fit and healthy persons), sinus node dysfunction, drug therapy, heart block, and myocardial infarction. A conduction system disorder is present when there is a delay in impulses from the sinus node reaching the ventricles or when some impulses do not reach the ventricles because of block within the AV node or distal conduction system (His-Purkinje system). Conduction system disorders can be divided into first-degree, second-degree, and third-degree (complete) heart block. The tachycardias (atrial fibrillation and atrial flutter) and syncope (as a transient loss of consciousness with spontaneous recovery) are also reviewed.

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12

Mosca, Nancy Walsh. HOLDING PREMATURE INFANTS DURING GAVAGE FEEDING: EFFECT ON APNEA, BRADYCARDIA, OXYGENATION, GASTRIC RESIDUAL, GASTRIN, AND BEHAVIORAL STATE. 1995.

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13

Goldschneider, Kenneth R., e Eric P. Wittkugel. Laryngospasm. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0014.

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Laryngospasm is one of the most common complications of anesthesia in children. If not recognized immediately and treated promptly, laryngospasm may progress to complete airway obstruction with subsequent hypoxia, hypercarbia, bradycardia, and cardiac arrest. All anesthesiologists who anesthetize children must have a good understanding of when it can occur and how it is managed.

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14

Thorne, Sara, e Sarah Bowater. Device therapy in ACHD. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198759959.003.0020.

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This chapter discusses device therapy in ACHD. Insertion of devices in these patients requires special consideration. Knowledge of underlying anatomy, previous surgical procedures, and vascular access routes; an understanding of problems likely to be encountered with lead placement in complex hearts; and obtaining a stable position are all crucial. This chapter discusses bradycardia pacing, implantable cardiac defibrillators (ICD), cardiac resynchronization therapy (CRT), and technical considerations for device therapy in ACHD.

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15

Jolly, Elaine, Andrew Fry e Afzal Chaudhry, a cura di. Acute medical emergencies and practical procedures. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199230457.003.0001.

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Chapter 1 covers the basic science and clinical topics relating to acute medical emergencies and practical procedures which trainees are required to learn as part of their basic training and demonstrate in the MRCP. It covers cardiorespiratory arrest, shock, acute coronary syndromes, tachycardia, bradycardia, hypertensive emergencies, pulmonary oedema, acute asthma, massive pulmonary embolism, acute upper gastrointestinal haemorrhage, acute kidney injury, coma, traumatic brain injury, status epilepticus, adrenal crisis, thyroid emergencies, acute poisoning, and burns.

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16

Bowker, Lesley K., James D. Price, Ku Shah e Sarah C. Smith. Cardiovascular. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198738381.003.0010.

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This chapter provides information on the ageing cardiovascular system, chest pain, stable angina, acute coronary syndromes, myocardial infarction, hypertension, treatment of hypertension, presentation of arrhythmias, management of arrhythmias, atrial fibrillation, rate/rhythm control in atrial fibrillation, stroke prevention in atrial fibrillation, bradycardia and conduction disorders, common arrhythmias and conduction abnormalities, heart failure assessment, acute heart failure, chronic heart failure, dilemmas in heart failure, heart failure with preserved left ventricular function, valvular heart disease, peripheral oedema, preventing venous thromboembolism in an older person, peripheral vascular disease, gangrene in peripheral vascular disease, and vascular secondary prevention.

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17

Furse, Cory M., e Matthew D. McEvoy. Laryngospasm. A cura di Matthew D. McEvoy e Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0015.

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Laryngospasm is one of the most vexing problems in anesthesia and perioperative care. The onset of which carries the risk of oxygen desaturation, bradycardia, aspiration, and cardiac arrest. In this chapter, the mechanisms involved in producing laryngospasm are covered in detail, and an anatomical review of both sensory and motor innervation is included. Risk factors associated with the development of laryngospasm, including those specific to the patient, the type of surgery, and/or the anesthesia techniques are discussed. Proper patient assessment and prompt treatment for this life-threatening emergency are essential skills needed for safe patient care in the peri-operative arena.

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18

Lin, Erica P., James P. Spaeth e Melanie Handley. Down Syndrome. A cura di Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel e Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0057.

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The majority of children with Down syndrome are friendly and separate from parents easily. The presence of comorbidities should be the area of focus for the anesthesiologist. Cardiac anomalies are commonly present, and the most common of these is common atrioventricular canal. Not all patients present with cardiac disease though, and some may present with gastrointestinal anomalies. These children also exhibit sensitivity to inhalational anesthetics resulting in bradycardia during inhalation induction. They tend to have very narrow auditory canals, making myringotomy challenging and resulting in relatively longer anesthetics for ear tube placement. Careful attention should be paid to positioning of the neck during instrumentation of the airway as well due to possible instability of the cervical spine.

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19

Abcejo, Arnoley S., e Jeffrey J. Pasternak. Neurogenic Shock. A cura di Matthew D. McEvoy e Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0072.

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Neurogenic shock is a pathophysiologic state of systemic hypoperfusion characterized by a significant decrease in systemic vascular resistance secondary to loss of sympathetic tone. Neurogenic shock is most commonly seen in the setting of acute spinal cord injury (SCI) but can also occur following significant brain injury. Interruption of sympathetic fibers causes loss of basal vascular sympathetic tone, commonly allowing unopposed parasympathetic tone. As a result, severe hypotension and bradycardia can further exacerbate neurologic injury and organ perfusion. Understanding the physiologic and anatomic changes of neurogenic shock can help direct appropriate resuscitation efforts. Physiologic goals should focus on reversing hypotension, preventing hypoxia, and optimizing perfusion of the injured central nervous system and other critical organs.

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20

Cropsey, Christopher L., e Patrick B. Knight. Beta Blocker/Calcium Channel Blocker Overdose. A cura di Matthew D. McEvoy e Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0088.

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Beta blocker and calcium channel blocker overdose is a rare perioperative complication that manifests with symptoms of altered mental status, hypotension, bradycardia, and cardiovascular collapse. Although the clinical presentation is often similar, the underlying pathophysiology can differ between either cardiogenic or vasodilatory shock. Standard therapies such as calcium administration or beta-adrenergic agonists may be effective but often require much higher doses than normal. The evidence for targeted therapies, such as high-dose insulin infusion and glucagon, is mixed, but these should be considered. Refractory toxicity may require advanced lifesaving measures such as intra-arterial balloon counterpulsation or extracorporeal membrane oxygenation. If prompt cardiovascular support can be achieved, patient outcomes are generally very positive.

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21

Rajappan, Kim. Bradyarrhythmias. A cura di Patrick Davey e David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0119.

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A bradyarrhythmia is defined as a rhythm disturbance that results in a heart rate of less than 60 bpm. It is important to note that many healthy people have a resting heart rate that is less than 60 bpm, most commonly due to sinus bradycardia (i.e. a rhythm arising from the sinus node but with a ventricular rate less than 60 bpm). Other forms of bradyarrhythmia are sinus node disease, sick sinus syndrome, first-degree atrioventricular (AV) block, second-degree AV block (which can be characterized as Möbitz type I (Wenckebach phenomenon) or Möbitz type II), and third-degree AV block (also known as complete heart block). This chapter discusses the bradyarrhythmias, focusing on their etiology, symptoms, demographics, diagnosis, prognosis, and treatment.

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22

Hurwitz, Barry. Apnea and Bradycardia Elicited by Facial Airstream Stimulation in Healthy Infants in the First Year of Life: Implications for Detection of Infants at Risk for Sudden Infant Death Syndrome. Dissertation Discovery Company, 2019.

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23

Hurwitz, Barry. Apnea and Bradycardia Elicited by Facial Airstream Stimulation in Healthy Infants in the First Year of Life: Implications for Detection of Infants at Risk for Sudden Infant Death Syndrome. Creative Media Partners, LLC, 2019.

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24

Uffman, Joshua C. Neuronal Ceroid Lipofuscinoses (Batten Disease). A cura di Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi e Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0042.

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Neuronal ceroid lipofuscinoses (NCL) are a group of autosomal recessive genetic disorders which represent the most common form of childhood neurodegenerative disease. Classically the disease was described according to the age of diagnosis resulting in four common phenotypes: (i) infantile or Santavuori-Haltia, (ii) late infantile or Jansky-Bielschowsky, (iii) juvenile or Spielmeyer-Vogt, and (iv) adult or Kufs. With advances in genetic mutational analysis techniques and improved understanding of NCL disease as a whole, disease classification now focuses on which of the known genetic defects is responsible for the disease. Regardless of genetic defect or age of onset, patients typically present with language delay, seizures, blindness, and ataxia. The term “Batten disease” is used to refer to the group as a whole in addition to specifically referring to the juvenile form. Anesthetic implications focus on disease symptoms at presentation, with special attention to maintaining normorthermia and the possibility of bradycardia.

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25

Brady, Peter A. Evaluation and Treatment of Arrhythmias. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0043.

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Abnormal cardiac arrhythmias may be due to reentry, abnormal automaticity, or triggered activity. Reentrant rhythms may be microreentrant or macroreentrant. Ambulatory (Holter) monitoring is useful for the evaluation of both symptomatic and asymptomatic rhythm disturbances and their relationship to daily activity. Treadmill exercise testing is very useful in the evaluation of patients who present with bradycardia and symptoms of palpitations because it allows both documentation of the adequacy of heart rate response to exercise and the recording of the cardiac rhythm during exercise in a controlled setting with ECG monitoring. An electrophysiologic study is useful for assessing sinus node function and the cardiac conduction system and for attempting to induce atrial or ventricular arrhythmias that could explain the clinical presentation. Electrophysiologic study requires placement of electrode catheters in the heart to record and to stimulate heart rhythm. Several therapeutic options are available for heart rhythm disorders, including drug therapy, radiofrequency ablation, and device therapy.

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26

Dyer, Robert A., Michelle J. Arcache e Eldrid Langesaeter. The aetiology and management of hypotension during spinal anaesthesia for caesarean delivery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0023.

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The management of hypotension during spinal anaesthesia for caesarean delivery remains a challenge for anaesthesiologists. Close control of maternal haemodynamics is of great importance for maternal and fetal safety, as well as maternal comfort. Haemodynamic responses to spinal anaesthesia are influenced by aortocaval compression, the baricity and dose of local anaesthetic and opioid employed, the rational use of fluids, and the goal-directed use of vasopressors. The most common response to spinal anaesthesia is hypotension and an increased heart rate, which reflects a decreased systemic vascular resistance and a partial compensatory increase in cardiac output. Phenylephrine is therefore the vasopressor of choice in this scenario. Less commonly, hypotension and bradycardia may occur, possibly due to the activation of cardiac reflexes. This requires anticholinergics and/or ephedrine. The rarest occurrences are persistent refractory hypotension, or high spinal block with respiratory failure. Special considerations include patients with severe pre-eclampsia, in whom spinal anaesthesia is associated with haemodynamic stability, and less hypotension than in the healthy patient. Careful use of neuraxial anaesthesia in specialized centres has an important role to play in the management of patients with cardiac disease, in conjunction with careful monitoring. Prevention is better than cure, but should hypotension occur, rapid intervention is essential, based upon the exact clinical scenario and individual haemodynamic response.

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27

Ferguson, Colin. Pathophysiology and management of hypothermia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0354.

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Accidental hypothermia is defined as a core temperature of <35°C and is uncommon. It may present in any age group at any time of the year. Hypothermia may be primary, where the cold injury is the major pathology, or secondary where patients develop hypothermia incidental to another illness. Since the severely cold patient may be in cardiac arrest, areflexic, and in coma, decision making regarding treatment, its initiation, and continuation, may be difficult. Hypothermia is classified into mild (33–35°C), moderate (28–33°C) and severe (<28°C), but these are not distinct clinical syndromes. A more recent classification into stages has emerged from alpine medicine along with a treatment algorithm based on it. Many pathophysiogical changes are due to reduced enzyme action. Clinical features include changes in higher cerebral functions with bizarre behaviour progressing to coma. In the circulation initial tachycardia and hypertension (‘cold stress’) are replaced, as the patient cools, with worsening hypotension and bradycardia and, eventually, ventricular fibrillation and asystole. Rewarming methods are classified as passive or active and the latter subdivided into external, core, and extracorporeal. Active warming should be considered for patients with a temperature of 32°C or lower. Peritoneal lavage has the advantage of warming the liver directly and also the heart through the diaphragm. Cardiopulmonary bypass is the extracorporeal method with most experience, but the advent of extracorporeal membrane oxygenation has the advantage of portability.

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28

Palomäki, Outi, e Petri Volmanen. Alternative neural blocks for labour analgesia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0018.

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Although neuraxial analgesia is available to the majority of parturients in developed countries, alternative neural blocks for labour analgesia are needed for medical, individual, and institutional reasons. Paracervical and pudendal blocks are usually administered transvaginally by an obstetrician. An injection of 0.25% bupivacaine using a superficial technique into the lateral fornixes gives rapid pain relief and has been found to have no negative effect on either fetal oxygenation, or maternal and neonatal outcomes. Low rates of post-analgesic bradycardia and high rates of spontaneous vaginal delivery have been described in low-risk populations. The analgesic effect of a paracervical block is moderate and is limited to the first stage of labour. A pudendal block, administered transvaginally, can be used for pain relief in the late first stage, the second stage, in cases of vacuum extraction, or for episiotomy repair. In clinical use, 1% lidocaine gives rapid pain relief but the success rate is variable. The complications of pudendal block are rare and localized. The sympathetic and paravertebral blocks are currently mainly of historic interest. However, they may benefit parturients in exceptional conditions if the anaesthesiologist is experienced in the techniques. Lumbar sympathetic block provides fast pain relief during the first stage of labour when a combination of 0.5% bupivacaine with fentanyl and epinephrine is employed. With the currently available data, no conclusion on the analgesic effects of thoracic paravertebral block can be drawn when it is used for labour pain relief. Potential maternal risks limit the use of these methods in modern obstetrics.

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29

Lambert, David G. Mechanisms and determinants of anaesthetic drug action. A cura di Michel M. R. F. Struys. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0013.

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This chapter is broken into two main sections: a general description of the principles of ligand receptor interaction and a discussion of the main groups of ‘targets’; and explanation of some common pharmacological interactions in anaesthesia, critical care, and pain management. Agonists bind to and activate receptors while antagonists bind to receptors and block the effects of agonists. Antagonists can be competitive (most common) or non-competitive/irreversible. The main classes of drug target are enzymes, carriers, ion channels, and receptors with examples of anaesthetic relevance interacting with all classes. There are many examples in anaesthesia where multiple interacting drugs are co-administered—polypharmacology. To give an example: neuromuscular blockade. Rocuronium is a non-depolarizing neuromuscular blocker acting as a competitive antagonist at the nicotinic acetylcholine receptor. Rocuronium competes with endogenous acetylcholine to shift the concentration–response curve for contraction to the right. The degree of contractility is less for a given concentration of acetylcholine (agonist) in the presence of rocuronium. Using the same principle, the rightward shift can be compensated by increasing the amount of acetylcholine (as long as the amount of rocuronium presented to the receptor as an antagonist remains unchanged, its action can be overcome by increased agonist). Acetylcholine at the effect site is increased by acetylcholinesterase inhibition with neostigmine. One of the side-effects of neostigmine is that it acts as an indirect parasympathomimetic. In the cardiovascular system this would lead to muscarinic receptor-mediated bradycardia; these effects are routinely reversed by the competitive muscarinic antagonist glycopyrrolate.

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30

Stacey, Victoria. Resuscitation. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199592777.003.0002.

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Advanced Life Support (ALS) - Cardiac arrest in special circumstances - Anaphylaxis - Post-resuscitation care - Peri-arrest arrhythmia management - Peri-arrest tachycardias - Peri-arrest bradycardias - Shock - SAQs

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31

Schneider, Antoine, e Rinaldo Bellomo. Atrial Fibrillation and Other Cardiac Arrhythmias (DRAFT). A cura di Raghavan Murugan e Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0005.

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Cardiac arrhythmias are common in hospitalized patients, with their incidence increasing in older patients and those with comorbidities. Cardiac arrhythmias represent a trigger for approximately 10% of rapid response team (RRT) activations. Of those, atrial fibrillation (AF) is the most commonly observed. Other common cardiac arrhythmias in the in-hospital setting include supraventricular tachycardia, atrial flutter, ventricular tachycardia, and bradycardias. Members of the RRT should be skilled in the diagnosis and management of these common arrhythmias. This chapter presents an overview of cardiac arrhythmias that RRT members are likely to encounter, discussing their incidence and significance, as well as their immediate management.

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32

Gorenek, Bulent. Temporary pacing. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0026.

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Temporary cardiac pacing by electrical stimulation of the heart is indicated as a short-term treatment of life-threatening bradyarrhythmias or tachyarrhythmias. It can be used temporarily until the arrhythmias resolve or as a bridge to permanent pacing. Symptomatic bradycardias needing temporary pacing may occur in acute myocardial infarction, during percutaneous coronary intervention, and in patients with sinus node dysfunction. Temporary pacing can also be useful for terminating or suppressing some types of supraventricular and ventricular arrhythmias. Single-chamber, dual-chamber, or biventricular pacing modes can be used. In haemodynamically compromised patients, dual-chamber pacing is preferred. Ideally, this procedure is performed under fluoroscopy, but electrode catheters can also be inserted without fluoroscopy, with ECG and/or pressure monitoring. Several methods of temporary pacing are available: transvenous, external, and transoesophageal pacing. Transvenous pacing is the most commonly used technique. Although this method is safe and easy, some complications related to venous access or caused by the inserted electrode catheters or by an electrical dysfunction of the pacing device may occur, either during or after the implantation.

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Gorenek, Bulent. Temporary pacing. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0026_update_001.

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Temporary cardiac pacing by electrical stimulation of the heart is indicated as a short-term treatment of life-threatening bradyarrhythmias or tachyarrhythmias. It can be used temporarily until the arrhythmias resolve or as a bridge to permanent pacing. Symptomatic bradycardias needing temporary pacing may occur in acute myocardial infarction, during percutaneous coronary intervention, and in patients with sinus node dysfunction. Temporary pacing can also be useful for terminating or suppressing some types of supraventricular and ventricular arrhythmias. Single-chamber, dual-chamber, or biventricular pacing modes can be used. In haemodynamically compromised patients, dual-chamber pacing is preferred. Ideally, this procedure is performed under fluoroscopy, but electrode catheters can also be inserted without fluoroscopy, with ECG and/or pressure monitoring. Several methods of temporary pacing are available: transvenous, external, and transoesophageal pacing. Transvenous pacing is the most commonly used technique. Although this method is safe and easy, some complications related to venous access or caused by the inserted electrode catheters or by an electrical dysfunction of the pacing device may occur, either during or after the implantation.

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Libri sul tema "Bradycardia"

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