CON. Nově vzniklá fibrilace síní na JIP časná resinuzace je prospěšná. Harazim M.

CON Nově vzniklá fibrilace síní na JIP časná resinuzace je prospěšná Harazim M.

výhody časné kardioverze u kriticky nemocných? nižší mortalita nižší riziko kardioembolizace síňový příspěvek (zisk 10-40% plnění LK) bezpečná léčba

Patogeneze přístup k nemocnému s akutně vzniklou fibrilací síní na ICU Boos, Christopher J., Richard A. Anderson, and Gregory YH Lip. "Is atrial fibrillation an inflammatory disorder?." European heart journal 27.2 (2006): 136-149.

Etiologie přístup k nemocnému s akutně vzniklou fibrilací síní na ICU 46% Hypotenze 40% Vazopresor nebo inotropikum 27% 18% > 5L/48h 17% katetr 12% 11% < 3,5 mmol/l 11% < 0.7 mmol/l 8% Hemoglobin < 80g/l 8% Arter ph < 7.25 6% AIM Kanji, Salmaan, et al. "Epidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients." Journal of critical care 27.3 (2012): 326-e1.

Atrial stunning přístup k nemocnému s akutně vzniklou fibrilací síní na ICU 40-90% kardioverzi i kardioverze 24h riziko trombotizace Harjai, Kishore J., et al. "Clinical variables affecting recovery of left atrial mechanical function after cardioversion from atrial fibrillation." Journal of the American College of Cardiology 30.2 (1997): 481-486. Khan, Ijaz A. "Transient atrial mechanical dysfunction (stunning) after cardioversion of atrial fibrillation and flutter." American heart journal 144.1 (2002): 11-22. Airaksinen, KE Juhani, et al. "Thromboembolic complications after cardioversion of acute atrial fibrillation." Journal of the American College of Cardiology 62.13 (2013): 1187-1192.

Atrial stunning 3D modely vedení signálu v levé síni SR po kardioverzi Adeniran, Ismail, et al. "Effects of persistent atrial fibrillation-induced electrical remodeling on atrial electro-mechanics insights from a 3D model of the human atria." PloS one 10.11 (2015): e0142397.

Amiodaron přístup k nemocnému s akutně vzniklou fibrilací síní na ICU Arytmie na ICU = amiodaron 1 tbl (200mg) - - - - 50

Amiodaron přístup k nemocnému s akutně vzniklou fibrilací síní na ICU Common side effects of amiodarone: Abnormal Liver Function Tests Abnormally Low Blood Pressure Inflammation of the Alveoli of the Lungs Interstitial Pneumonitis Lung Fibrosis Sun-Sensitive Skin Feel Like Throwing Up Incomplete or Infrequent Bowel Movements Involuntary Quivering Loss of Appetite Low Energy Not Feeling Well Throwing Up Uncoordinated Infrequent side effects of amiodarone: Abnormal Heart Rhythm Blurred Vision Chronic Heart Failure Deposits on the Eye Disease of the Optic Nerve hypothyroidism overactive thyroid gland Prolonged Q-T Interval on EKG Sinus Bradycardia Skin Discoloration Sudden Blindness and Pain Sudden Rapid Heartbeat-Paroxysmal VT Ventricular Fibrillation Very Rapid Heartbeat - Torsades de Pointes Visual Halos Around Lights Altered Interest in Having Sexual Intercourse Chronic Trouble Sleeping Dizzy Dry Eye Head Pain Hemorrhage of Blood Under the Skin Intense Abdominal Pain Numbness and Tingling Sensitive to Light Sexual Problems Taste Problems Temporary Redness of Face and Neck Rare side effects of amiodarone: Acquired Decrease of All Cells in the Blood Acute Inflammation of the Pancreas Acute Respiratory Distress Syndrome Atrial Fibrillation Atrioventricular Heart Block Bleeding from the Lungs Blind Spot in the Eye Blockage of Normal Bile Flow Blood Clotting Disorder Bronchiolitis Obliterans Bronchospasm Coughing Up Blood Decreased Blood Platelets Decreased Neutrophils a Type of WBC Decreased Oxygen In The Tissues Or Blood Deficiency of Granulocytes a Type of WBC Demyelinating Disease Deterioration of the Cornea of the Eye DRESS syndrome 100% 1% 5-20% Epididymitis Erythema Multiforme Escape of Fluid into the Lungs Fluid in the Lungs Giant Hives Hallucination Heart Block Heart Failure - Sinoatrial Arrest Hepatitis Inflammation of Skin caused by an Allergy Inflammation of the Skin with Blisters Kidney Disease Kidney Failure Life Threatening Allergic Reaction Lung Failure causing Loss of Breath Muscle Problems Numbness, Tingling or Pain of Hands or Feet Optic Disk Edema Parkinson Symptoms Peripheral Demyelinating Neuropathy Pleurisy Pneumonia with Eosinophil WBC Pseudotumor Cerebri Rash Serious Muscle Damage that may Lead to KF Shock Signs and Symptoms at Injection Site Skin Cancer Skin Rash with Sloughing Slow Heartbeat Stevens-Johnson Syndrome Swollen Lymph Nodes SIADH thyroid carcinoma cancer Tissue Death Toxic Epidermal Necrolysis Trouble Breathing Vasculitis Visible Water Retention Abnormal Manner of Walking Backache Cough Diarrhea Dry Mouth Eczema Fever Hair Loss Hives Inability to have an Erection Increased Eosinophils in the Blood Increased Production of Saliva Involuntary Muscle Movements Muscle Spasm Muscle Weakness Puffy Face from Water Retention Sleep Disorder

Digoxin přístup k nemocnému s akutně vzniklou fibrilací síní na ICU With digoxin treatment, no rate control or rhythm control can be reached in a mixed ICU population Especially in seriously ill patients, digoxin fails to achieve an adequate reduction of the ventricular rate 90min average onset time Clemo, Henry F., et al. "Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias." The American journal of cardiology 81.5 (1998): 594-598. Sleeswijk, Mengalvio E., et al. "Clinical review: treatment of new-onset atrial fibrillation in medical intensive care patients: a clinical framework." Critical Care 11.6 (2007): 233.

Propafenon přístup k nemocnému s akutně vzniklou fibrilací síní na ICU < 35% - SSSy, SA blok, AVB II.-III nebo blok Myasthenia gravis ritonavirem

Verapamil Nondihydropyridinový Ca-blokátor efekt antiarytmiky ( )

Algoritmus přístup k nemocnému s akutně vzniklou fibrilací síní na ICU Korekce MAP assess for reversible trigger Korekce iontogramu? rhytm control Korekce teploty? clinical assessment rate control

Hear your heart. Heart your health.