Treating Atrial Fibrillation with Vitamin K Antagonist Therapy

Blood to the heart muscles is supplied by the coronary arteries and the entire pumping process is controlled by the heart’s electrical conduction system. Any disruption to the electrical signal transmission affects the blood flow and functioning of the heart. Whenever there is an obstruction in the blood supply, the heart muscles become starved of oxygen and nutrients, which leads to more chest pain or discomfort.  Atrial fibrillation (AF) is one of the common heart conditions characterised with excessively higher or abnormal heart rates. Moreover, it also increases the risk of blood clots causing stroke or life-threatening congestive heart failures. That is why it is highly recommended to seek treatment for AF at the right time.

Atrial fibrillation is categorised into paroxysmal, persistent and permanent depending on the degree and frequency of AF episodes. Diagnostic tests and accurate evaluation of symptoms is essential to devise the right treatment method. Atrial fibrillation has strong associations with other serious cardiovascular diseases such as congestive heart failure, hypertension and coronary artery diseases. Treatment options for AF include medical therapy, catheter ablation and insertion of pacemaker. Drug treatment is often preferred to prevent the risk of stroke or to control the heart rhythm. Patients with permanent AF are at an increased risk of stroke and thromboembolism. Oral anticoagulation common vitamin K antagonist therapy (VKA) is the standard medication prescribed for AF patients with moderate or high risk of stroke.  Also known as blood thinners, this medication demands regular blood tests to monitor its interactions. Some of the common vitamin K antagonist therapy medications include warfarin, apixaban, dabigatran and rivaroxaban.

Catheter ablation is another procedure to treat AF, where the source of erratic signals is destroyed using high-frequency radio waves. Having an artificial atrial fibrillation pacemaker fitted below the skin near the collar bone is another option to maintain the normal heart rhythm. A pacemaker is a small device that consists of a pulse generator and lead wires. Implantation of an artificial atrial fibrillation pacemakeris a minor surgical procedure that is typically done in an electrophysiology lab. Right after the implantation, the device takes over the job of sinoatrial node (SA node) and helps the heart beat regularly. Treatment for atrial fibrillation is decided on the basis of the patient’s symptoms, underlying cause, overall health condition and other factors.

Read More

Percutaneous Coronary Intervention in Managing Acute Coronary Syndromes

Damage of the heart muscles due to inadequate blood flow or oxygenation is known as myocardial ischemia. The condition becomes worse in some cases, resulting in myocardial infarctions (heart attacks) or unstable angina. Atherosclerotic plaque build up in the coronary arteries is the main cause of restriction in the blood supply. Termed as Coronary Artery Disease (CAD) or coronary heart disease, this condition has been a leading cause of mortality and morbidity. CAD can lead to acute coronary syndrome (ACS), a condition characterised by the signs and symptoms compatible with myocardial infarctions (MI) and unstable angina (UA). The spectrum of ACS clinical presentation covers a range from UA to non-ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation myocardial infarction (STEMI). In a nutshell, ACS is associated with the sudden and unexpected rupture of a vulnerable plaque followed by the partial or complete blockage of a stenotic artery. Reperfusion therapy is recommended for ACS patients on an immediate basis. Aggressive medical therapy or non-invasive percutaneous coronary intervention is performed to restore the blood flow to the heart.

Either a combination of anti-ischemic and antithrombotic agents or a non-invasive percutaneous coronary intervention is preferred for treating UA and NSTEMI patients. Accurate diagnosis and prompt revascularization procedures are crucial in devising the management strategy of ACS. Guide-wire based Fractional Flow Reserve (FFR) has become an indispensable tool for the interventional procedures. In-vivo evaluation of the vulnerable plaque and the well-validated cut off value offered by  FFR measurements, guides the ACS treatment. To help choose between drug therapy and revascularization procedure, Guide-wire based fractional flow reserve helps the interventional cardiologist to make a decision.

Although PCI has bbeen considered the safest way to reduce complications related with MI and ACS, some findings reported the occurrence of cardiac arrhythmias among patients undergoing the percutaneous procedure. Irregularity in the heart beat or rhythm leads to twitching of atria and desynchronised contractions of heart chambers, thereby increasing the risk of stroke and heart failure. Insertion of a medical Atrial Fibrillation Pacemaker provides a solution to help prevent adverse clinical conditions and outcomes. Hooked up to the heart with tiny wires, an artificial medical atrial fibrillation pacemaker reduces the risk of complications. Appropriate management of arrhythmia is crucial to improve clinical outcomes.

Read More