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CARDIOLOGY

CARDIOLOGY

1-3 cups of coffee a day can reduce the risk of atrial fibrillation.

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Are you the “coffee family” who must drink coffee every day?Coffee has become one of the essential drinks in daily life. Some people rely on it to refresh and resist fatigue at work; some people regard it as the only source of energy; and some people just raise their hands to live a habit.Recently, related research published in the Journal of the American Heart Association (JAHA) has shown that drinking coffee can help reduce the risk of AF.1 Study Interpretation The data of this prospective cohort study are from the American Physicians’ Health Study. A total of 18,960 physicians were selected, all males, with an average age of 66.1 years.The frequency of coffee citations was reported by the doctors themselves in the form of questionnaires, while the occurrence of AF was derived from the annual questionnaire and the subject’s medical records.The COX proportional hazard model was used to calculate the Hazard ratio (HR) of AF in different subjects.So, how much coffee can reduce the risk of AF?What is the mechanism of coffee to reduce the risk of AF?Below we reveal the answers one by one.2 How much do American doctors like coffee?Coffee drinking is very common among doctors in the United States. One reason is that hospitals in the United States have a very complete infrastructure, including cafes.American doctors enjoy more leisure time at work than Chinese doctors are at war.In well-known American dramas such as Grey’s Anatomy, Early Morning Monday, and Dr. House, we can see that coffee is a necessity for many doctors before going to work, during lunch breaks, and after surgery.From this study, of the 18,960 participants who participated in the study, 3,946 reported that they seldom drank coffee, and a total of 1419 people who drank 1 cup or less a week, and a total of 2-4 cups a week.1036 people, a total of 766 people who drink 5-6 cups a week, the above subjects did not drink much coffee and had not reached the daily level of coffee.The number of daily cups was 3453; the number of people drinking 2-3 cups daily reached 6432, the highest proportion; moreover, the daily coffee consumption reached 4 cups or more, totaling 1,908 people.It can be seen that more than half of the subjects drink at least one cup of coffee daily.3 How much coffee is most suitable?The study was followed up for an average of 9 years. Of the 18960 subjects, a total of 2098 patients had new AF.The study adjusted the age, smoking history, drinking history, and exercise of the subjects. The risk of atrial fibrillation was defined as 1 in subjects who had never taken coffee, and the risk ratios in the remaining groups were 0.85 and 1.07., 0.93, 0.85, 0.86, and 0.96.The results suggest that drinking 1-3 cups of coffee daily has the lowest risk (HR) of AF.4 Why does coffee reduce the risk of AF?According to previous views, drinking coffee is one of the causes of atrial fibrillation, because caffeine may cause sympathetic nerve excitement, cause a rapid heart rate, and then cause atrial fibrillation.So how do the results of this study be interpreted?According to the literature, caffeine can reduce the occurrence of atrial fibrillation based on the following mechanisms of action: The main active component of coffee is caffeine. Caffeine is a non-selective inhibitor of adenosine A1 and A2A receptors, thereby inhibiting adenosine-inducedAtrial action potential is shortened to reduce the occurrence of atrial fibrillation.Both caffeine and polyphenols in coffee have antioxidant effects, effectively prevent atrial remodeling, and are protective factors for the occurrence of AF.The disadvantage is that the study did not include female subjects.According to the author’s observation, in daily life, female compatriots love coffee more than men.How does drinking coffee benefit women’s AF?How many cups of coffee is appropriate for women daily?Let’s expect more research to reveal the answer.Finally, focus on the points: male compatriots, 1-3 cups of coffee a day, are you drinking right?The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party.

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CARDIOLOGY

Atrial Fibrillation Anticoagulation: Warfarin Four Questions and Four Answers

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Warfarin is an effective drug for the prevention and treatment of atrial fibrillation stroke.Warfarin has become the standard treatment for valvular atrial fibrillation, rheumatic mitral valve stenosis, mechanical valve replacement, biological valve replacement within 3 months or mitral valve repair with AFFor antithrombotic therapy, warfarin should be selected.Warfarin can also be used in patients with nonvalvular atrial fibrillation with anticoagulant indications.How to determine the dose of warfarin?The best anticoagulant strength of warfarin is INR 2.0 ~ 3.0, at this time the risk of bleeding and thromboembolism is the lowest.The best results were achieved when INR was within 60% of the treatment time (TTR).During the treatment with warfarin, the INR should be monitored regularly and the warfarin dose adjusted accordingly.1. Initial dosage It is recommended that the initial dosage for Chinese is 1 ~ 3 mg, which can reach the target range in 2 ~ 4 weeks.In some patients, such as the elderly, patients with impaired liver function, patients at high risk of congestive heart failure, and bleeding, the initial dose can be appropriately reduced.If rapid anticoagulation is required, give unfractionated heparin or low-molecular-weight heparin and warfarin for more than 5 days. Warfarin will be given on the first or second day of heparin administration. When the INR reaches the target range, the generalHeparin or low molecular weight heparin.In the Chinese Atrial Fibrillation Antithrombotic Study, the mean maintenance dose of warfarin was 3 mg.To reduce excessive anticoagulation, loading doses are generally not recommended.Depending on the dose of warfarin, anticoagulation began to appear 2 to 7 days after oral administration.2. When the initial dose of the dose adjustment is not within 1 week, the dose can be adjusted according to the original dose of 5% ~ 20% and the INR can be monitored continuously (every 3 ~ 5 d) until it reaches the target value (INR 2.0 ~ 3.0)..If the INR has been stable, occasionally fluctuates, and the amplitude does not exceed 0.5 above and below the target range of the INR, you do not need to adjust the dose, and review the INR as appropriate and pay attention to the cause.If the two INRs are outside the target range, the dose should be adjusted.Can increase or decrease the original dose of 5% to 20%, pay attention to strengthen monitoring after adjusting the dose.When the dose adjustment of warfarin is small, the method of calculating the weekly dose can be adopted, which is more accurate than adjusting the daily dose.How to monitor when using warfarin?Due to the metabolic characteristics and pharmacological effects of warfarin itself, its application is more complicated, and many factors also affect the anticoagulant effect of warfarin. Therefore, it is necessary to closely monitor the coagulation index and repeatedly adjust the dose.1. Monitoring indicators Prothrombin time (PT) is the most commonly used indicator for monitoring the anticoagulant strength of warfarin.PT reflects the degree of inhibition of prothrombin, factor VII, and factor X.INR is calculated from the PT measured by different laboratories after being adjusted by the international sensitivity index (ISI) of thromboplastin.INR can make coagulation indicators measured in different laboratories comparable.2. Frequency of monitoring Inpatients take warfarin for 2 to 3 days and start monitoring INR daily or every other day until the INR reaches the treatment target and is maintained for at least 2 days.Thereafter, the stability of the INR results is monitored once a few days to one week, which can be extended according to the situation, and stable patients can be monitored once every 4 weeks after discharge.Outpatients should be monitored from a few days to once a week before the dose is stable. Once the INR is stable, they can be monitored every 4 weeks.If dose adjustment is required, the monitoring frequency described above should be repeated until the INR stabilizes again.The frequency of treatment monitoring should be based on the patient’s bleeding risk and medical conditions.Warfarin clearance is reduced in elderly patients, and other diseases or medications are frequently used. Monitoring should be strengthened.In combination with drugs or other diseases that may affect the effect of warfarin, the frequency of surveillance should be increased and the warfarin dose adjusted as appropriate.The frequency of INR monitoring in patients taking long-term warfarin is affected by patient compliance, co-morbidity, co-administration, diet adjustment, and stability of anticoagulant response.What should I do about abnormally elevated INR and / or bleeding?The following factors affect the INR value: accuracy of INR detection methods, changes in vitamin K intake, absorption and metabolism changes of warfarin, changes in vitamin K-dependent coagulation factor synthesis and metabolism, changes in other drug treatments, warfarinThe compliance of Lin taking medicine.When the INR is beyond the scope of treatment, we should look for the above factors, and take different methods according to the degree of increase and the risk of bleeding.The risk of bleeding in patients taking warfarin is related to anticoagulation intensity, anticoagulation management, and stability of INR; bleeding risk factors related to patients such as previous bleeding history, age, tumors, liver and kidney dysfunction, stroke history, alcoholismConcomitant use, especially antiplatelet drugs and non-steroidal anti-inflammatory drugs.1. INR 3.0 ~ 4.5, no bleeding complications due to lower dose warfarin (5% to 20%) or stop taking 1, 1 ~ 2 d after review INR.When the INR returns to within the target value, adjust the warfarin dose and restart treatment.Or strengthen the monitoring of whether INR can return to the treatment level, while looking for factors that may increase INR.2. INR 4.5 ~ 10.0, no bleeding complications deactivated warfarin, intramuscular injection of vitamin K1 (1.0 ~ 2.5 mg), 6 ~ 12 h after review INR.After INR <3, treatment was restarted with a small dose of warfarin.3. INR≥10.0, no bleeding complications deactivated warfarin, intramuscular injection of vitamin K1 (5 mg), 6 ~ 12 h after review INR.After INR <3, treatment was restarted with a small dose of warfarin.In patients with high risk factors for bleeding, infusion of fresh frozen plasma, prothrombin concentrate, or recombinant factor VIIa may be considered.4. Severe bleeding, regardless of the level to disable INR warfarin, intramuscular injection of vitamin K1 (5 mg), infusion of fresh frozen plasma, prothrombin concentrates or recombinant clotting factor VIIa, INR monitored at any time.The need for warfarin therapy needs to be re-evaluated when the condition is stable.5. For minor bleeding, there is no need to immediately stop or reduce the dose when the INR is within the target range. The cause should be found and monitoring should be strengthened.In addition to bleeding, warfarin has rare adverse reactions.Such as acute thrombosis, including skin necrosis and limb gangrene, usually appear on the 3rd to 8th days of medication, which may be related to protein C and protein S deficiency.Further warfarin also interfere with the synthesis of bone proteins, leading to osteoporosis and vascular calcification.Which drugs or foods affect the pharmacokinetics of warfarin?Warfarin absorption, pharmacokinetics and pharmacodynamics affected by genetic and environmental factors, including drugs and diet.Significantly enhance the anticoagulant effect of warfarin drugs: amiodarone, phenylbutazone, sulfinpyrazone, and metronidazole suladimethoxypyrimidine like.Drugs that slightly enhance the anticoagulant effect of warfarin: cimetidine and omeprazole.Drugs that reduce the anticoagulant effect of warfarin: barbiturate, rifampicin, carbamazepine.Drugs that increase the risk of bleeding: Taken at the same time as non-steroidal anti-inflammatory drugs, certain antibiotics, and antiplatelet drugs, increasing the risk of bleeding.Long-term drinking can increase warfarin clearance, but drinking large amounts of wine has almost no effect on patients' coagulation function.Some traditional Chinese medicines (such as salvia, ginseng, angelica, ginkgo, etc.) or food (such as grape sleeve, mango, garlic, ginger, onion, kelp, cauliflower, kale, carrot, etc.) can also enhance or weaken the anticoagulant effect of warfarin.The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party..

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CARDIOLOGY

Diabetes, or an independent risk factor for heart failure

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A new population-based study suggests that diabetes may be an independent risk factor for heart failure.The study was published online May 2 in Mayo Clinic Proceedings.Researchers tracked 116 diabetic patients and 232 matched control subjects over a 10-year period and found that 1 in 5 diabetic patients had heart failure and had nothing to do with other causes (such as diastolic dysfunction), while non-diabetic patients1/10 suffer from heart failure.Research by Dr. Michael Klajda’s team at the Mayo Clinic has shown that patients with diabetes have a significantly increased risk of heart failure compared to those without diabetes.Even without structural heart disease (diastolic dysfunction), people with diabetes are still at risk of developing heart failure.These findings support the concept of diabetic cardiomyopathy (DCM).Research Summary The researchers used data from the Rochester Epidemiology Project (REP). The final sample included 116 diabetic patients over 45 years of age and 232 matched controls with age, hypertension, gender, coronary artery disease, and diastolic dysfunction.By.During follow-up, participants were regularly monitored for mortality and endpoints for heart failure, myocardial infarction, and stroke.At baseline, patients with diabetes had a higher BMI than those without diabetes, and had higher rates of AF, heart failure, and metabolic syndrome, and higher triglyceride levels.Diabetics do not use newer hypoglycemic drugs, such as SGLT-2 inhibitors and DPP-4 inhibitors.The E / e ′ ratio was higher in diabetic patients, but there was no statistical difference in EF, left atrial size, and diastolic dysfunction between the two groups.During a follow-up of 10.8 years, the risk of heart failure was higher in patients with diabetes than in those without diabetes, with a hazard ratio (HR) of 2.1 (95% CI, 1.2-3.6; P = 0.01).In the 1 year from the initial data collection, 4% of diabetic patients developed heart failure; at 5 years, 14% developed heart failure; and at 10 years, 21% and 12% of the two groups had heart failure.There were no statistical differences between the two groups in terms of cardiogenic death, myocardial infarction, stroke, and all-cause mortality.The researchers compared the subgroup of participants without diastolic dysfunction with their matched control subgroup and found that patients with diabetic dysfunction at baseline also had an increased risk of heart failure at 10 years compared with those without diabetes (HR, 2.595% CI, 1.0-6.3; P = 0.04).At 10 years, although death, cardiac death, myocardial infarction, and stroke were similar, 13% of the diabetic group developed heart failure, compared with only 7% of the non-diabetic group.In this cohort, even without potential diastolic dysfunction, the incidence of heart failure in patients with diabetes increased during 10 years of follow-up.These findings indicate that diabetes is an independent risk factor for heart failure and supports the concept of diabetic cardiomyopathy.The overall size of this study cohort is small, and the results need to be validated in large-scale studies.Future research should focus on whether actively managing risk factors reduces the risk of heart failure in people with diabetes, such as BMI, blood glucose, and cholesterol levels.

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CARDIOLOGY

Hypertension classification: exceeding this value is dangerous!

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Hypertension is the most common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. It is common in the elderly to be common in the elderly, and the disease has a tendency and tendency to age. In this case, we haveEveryone should know this so that they can avoid the occurrence of adverse risk damage.What are the grades of hypertension?What are the symptoms after the onset of hypertension?What are the classifications of hypertension?When it comes to the classification of hypertension, in fact, patients with hypertension should be classified once they are diagnosed. Hypertension patients are divided into 3 levels: (1) systolic blood pressure is 140-159mmHg and / or diastolic blood pressure is 90-99mmHg is called grade 1 hypertension; (2) systolic blood pressure is between 160-179mmHg and / or diastolic blood pressure is between 100-109mmHg is called level 2 hypertension; (3) systolic blood pressure is above 180mmHg and / or diastolic blood pressureAbove 110mmHg is called grade 3 hypertension.The reason why hypertension is divided into these levels is because the classification of blood pressure needs to be paid attention to different degrees.

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CARDIOLOGY

“Bad” is not alone?

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Once suffering from hypertension, it often means that the second half of life can not be separated from the “accompaniment” of antihypertensive drugs.Controlling blood pressure is a “protracted battle”. In the process, laziness will inevitably occur. Some people don’t pay attention and the blood pressure suddenly rises. Then a dose of fierce medicine is given and the blood pressure is low.Repeated blood pressure fluctuations in this way are actually more harmful to the body.Long-term blood pressure fluctuations, beware of the risk of dementia. Blood pressure fluctuations may increase the risk of dementia through autonomic nervous disorders or hemodynamic mechanisms.A recent study conducted a 15-year follow-up of more than 5,000 people without dementia, analyzed their systolic blood pressure changes and the diagnosis of dementia, and adjusted for various interference factors to find that the systolic blood pressure changed significantly.There is a significant correlation with increased risk of dementia.The study found that large fluctuations in systolic blood pressure within 5 years may cause a significant increase in the risk of dementia in the next 15 years.Therefore, don’t think that taking medicine once again is not a big problem!

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CARDIOLOGY

Shoulder pain in the winter to the heart, maybe the heart is asking for help

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Winter joint pain is high, especially shoulder pain.Many people think that it may be caused by cold or cervical strain, so just wear some clothes and rest for a while.Liu Yongxin, deputy chief physician of the Second Department of Cardiovascular Medicine of the Second People’s Hospital of Guangdong Province, reminds everyone that there is a case of shoulder pain that may be caused by heart disease, and you should seek medical treatment in time to avoid missing the best opportunity for treatment.I believe that for most people, shoulder pain usually feels tired, especially for people who often sit in front of a computer and work at a desk for a long time, and shoulder pain is not uncommon.Usually getting up and moving around, or doing a simple massage can quickly relieve.But for Guo Qiang (pseudonym) working in Guangzhou, this “shoulder pain” has become a big trouble.The 43-year-old Guo Qiang is a middle-aged man at the middle of his life. He is usually good, but suddenly he had a panic a few days ago and then fainted.The frightened family quickly dialed 120 and sent him to the hospital. After the medical staff worked hard to rescue him, Guo Qiang finally turned to safety.The attending doctor said that Guo Qiang’s acute myocardial infarction was fortunate to be rescued in time, otherwise he would probably die.When asking the family members, the doctor found a detail: As early as a week ago, Guo Qiang had told his family that his left shoulder was painful.The family thought it was due to fatigue, so they didn’t care.Liu Yongxin, deputy chief physician of the Second Department of Cardiovascular Medicine of the Second People’s Hospital of Guangdong Province, told his family that sometimes shoulder pain is also an atypical symptom before the onset of myocardial infarction, not just muscle soreness that everyone thinks.”Prior to the onset of acute myocardial infarction of coronary heart disease, angina pectoris is often a precursor symptom, and treatment will be delayed if it is not found in time.” Liu Yongxin said that the symptoms of angina pectoris vary from person to person, most of which are chest tightness, chest pain, and atypical symptomsFor abdominal pain, shoulder and arm pain, neck and throat pain, and even toothache.Women show more atypical symptoms.”Angina pectoris is the pain caused by the stimulation of visceral nerves by chemical products. Because the location is not clear, the pain site is often diversified.” Liu Yongxin said that when angina is suspected, an electrocardiogram is the simplest and convenient way to identify it.Factors, accompanied by symptoms, can also be roughly judged as shoulder musculoskeletal pain or angina pectoris.Generally speaking, when angina pectoris is strenuous or emotional, quiet rest can be relieved, which usually lasts for several minutes to ten minutes, and the pain lasts for more than half an hour and must be treated in time.The pain of skeletal muscle is related to a lot of local activities or local cold. The pain is clearly localized and lasts a long time.Liu Yongxin pointed out that cold weather in winter is a season of high incidence of cardiovascular diseases. People with basic diseases such as high blood pressure, diabetes, high blood lipids, and obesity should pay special attention to it. People who usually smoke, drink alcohol, and are stressed should also pay great attention.For people with family history, middle-aged and elderly patients need regular medical examinations.In particular, pay attention to the abnormal symptoms that appear suddenly on the body, especially the atypical symptoms mentioned above.Tips: It is very important to understand the symptoms of heart disease, it is helpful to find the condition in time, and it has a significant effect on the diagnosis and treatment of heart disease.1. Symptoms of indigestive heart disease can also be mistaken for indigestion. Unlike common stomach diseases, stomach pain caused by heart disease rarely causes cramps and severe pain, and tenderness is not common, but there is a kind of dullness and fullness.The feeling of sensation is sometimes accompanied by dull pain, burning sensation, and nausea. There may be some relief after bowel movements, but the discomfort will not completely disappear.2. In addition to the typical symptoms of patients with shortness of breath, heart disease may be accompanied by shortness of breath and breathlessness. This kind of dyspnea is often referred to as “out of breath”.After sitting for a few minutes, breathing seemed to return to normal, but when the patient moved around again, wheezing started again.This sign of wheezing is often overlooked by women and elderly patients with lung disease.3. Extreme fatigue After walking quickly, there will be signs of extreme fatigue, so tired that you have no strength to straighten your body.Fatigue is not limited to one part of the body, but is systemic.If you experience severe fatigue like never before, you should go to the hospital immediately because it is most likely a sign of heart disease.4. Shoulder pain. Arm and shoulder pain are the most common, but have you ever thought that it might be a sign of heart disease?Different from general shoulder pain, this kind of pain is generally dull pain, not severe pain, and often radiates to the front and inner sides of the arms, up to the little finger.Most are tiring, with pain relief after rest.Of course, the signs of this heart disease need to be distinguished from cervical spondylosis.It should be reminded that these may also be the “life-saving signals” of the heart 1. The lower lip on one side and the ring finger are numb, paroxysmal, and sometimes accompanied by heavy sweating; 2. Toothache, which causes problems with the teeth themselvesIn addition, it is best to look at the Department of Cardiology; 3. Headaches, especially with symptoms of chest tightness, intensify during activities, it is better to stop and rest; 4. Stomach pain, it feels like a lot of peppers “spicy””Pain, sometimes accompanied by nausea and vomiting; 5, back pain, from the chest pain to the back, there is radial pain, especially when accompanied by heavy sweating.(Correspondent: Wang Meng).

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CARDIOLOGY

Is fish oil effective?

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The time has unknowingly reached the end of the year, has the wish of 2019 been realized?Has the fund arrived?Have you passed the exam?Has the paper been published?Did the experiment have a positive result?Even if you answered “No” to all the above questions, don’t be sad. In 2019, something quite satisfactory will happen.For example: The first season of a large-scale academic battle series about the effectiveness of fish oil, which has been chasing after all, has finally come to an end in 2019.On December 13, the US Food and Drug Administration (FDA) approved Vascepa (this is a single-molecule prescription drug derived from fish oil, not fish oil itself!) As a target for elevated blood triglycerides (TG≥150 mg / dL)Adult applications for adjuvant statins and treatments that reduce the risk of cardiovascular events.The approval of this indication put an end to the long-lasting fish oil effectiveness battle (previously the drug was approved by the FDA in 2012 as an adjuvant treatment for severely high triglyceride in adults).Vascepa’s active ingredient is an omega-3 unsaturated fatty acid derived from fish oil called EPA. Dr. John Sharretts, Acting Executive Deputy Director of the Metabolic and Endocrine Products Division of the FDA’s Center for Drug Evaluation and Research, said: FDA recognizes Vascepa as a cardiovascular diseaseAs an additional treatment, the approval of this drug will add new adjuvant treatment options to patients with elevated triglyceride levels and those with heart disease, stroke, and diabetes, further reducing the risk of cardiovascular events based on statin medication.As of now, the specific pharmacological mechanism of Vascepa in reducing the risk of cardiovascular events is not clear, but its REDUCE-IT study based on its market confirms its safety and effectiveness: The study recruited a total of 8179 subjects from 11 countries around the world.The subjects included patients over 45 years of age who had a history of cardiovascular and cerebrovascular disease, and carotid and peripheral arterial disease, as well as those who were 50 years of age and over who had diabetes and other cardiovascular risk factors.Studies show that in the intention-to-treat population, the relative risk of first major adverse cardiovascular events (MACE) is further reduced by 25% (HR 0.75; 95% CI: 0.68-0.83; p <.0.001).The key secondary endpoint (complex endpoint of cardiovascular death, nonfatal MI, and nonfatal stroke) had a 26% reduction in relative risk of events (HR 0.74; 95% CI: 0.65-0.83; p <0.001).Other secondary endpoints include: a 20% reduction in the risk of cardiovascular death, a 31% reduction in the risk of fatal or non-fatal MI, a 28% reduction in the risk of fatal or non-fatal stroke, and a reduced risk of acute or emergency coronary revascularization35%, and the risk of hospitalization for unstable angina pectoris decreased by 32%.However, it should be noted that it is absolutely impossible to achieve satisfactory blood lipid control through medication alone, and lifestyle changes such as healthy diet and physical exercise are also indispensable.The FDA also recommends that patients receiving Vascepa must also co-exist with cardiovascular disease / diabetes, and that there are two or more additional risk factors for cardiovascular disease.Koi has something to say and summarize in one sentence: EPA, a fish oil extract, can indeed help reduce lipids, but it must be used in large doses and on the basis of statin therapy. Patients must co-exist with cardiovascular disease / diabetes and have two or moreAdditional risk factors for cardiovascular disease.Fish oil is effective. The first season ends in this way. Are you satisfied with the results?

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CARDIOLOGY

New progress in coronary intervention research in 2019, have you got it?

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Percutaneous coronary intervention (PCI) research focuses on optimizing treatment strategies, developing new devices and drug therapies to improve outcomes, and focusing on the identification of risk stratification and high-risk patients who will be emerging from the emerging atherosclerotic evolutionBenefit from therapy.Recently, Eur Heart J summarized the key findings of PCI published in 2019 and discussed their impact on clinical practice.The COACT study of revascularization in patients with cardiac arrest or acute coronary syndrome is a landmark study that has changed the management of patients with cardiac arrest who successfully resuscitated without ST-elevation myocardial infarction (STEMI).The results of this study suggest that immediate angiography does not improve survival in patients with out-of-hospital cardiac arrest (with cardiopulmonary resuscitation but unconsciousness) without STEMI signs compared with delayed angiography.In contrast, the Complete study confirms the value of active revascularization in patients with STEMI.The results of the study showed that the primary endpoint (cardiovascular death and recurrent myocardial infarction) in patients with complete revascularization had a lower incidence (7.8% vs. 10.5%) compared to patients who only interfered with the offender’s blood vessels.However, the prognostic value of complete revascularization in non-STEMI patients has not been fully studied.Revascularization and Drug Therapy for Chronic Coronary Syndrome Although there is strong evidence to support the prognostic significance of complete revascularization in STEMI patients, the value of PCI in improving the prognosis of patients with chronic coronary syndrome is not relevant.One.A retrospective analysis showed that for patients with ischemic load> 5% to 10%, early surgery or percutaneous revascularization can improve the prognosis.However, post hoc analysis of the clinical results of COURAGE did not confirm these findings.The study after 7.9 years of follow-up found that compared with the best drug treatment, PCI combined with the best drug treatment did not improve the prognosis; more importantly, there was no difference between the degree of ischemia or CAD and the treatment strategy (ie conservative and PCI).interaction.The ISCHEMIA study was designed to compare the efficacy and safety of conventional interventional therapy (based on the best drug therapy) with the best drug therapy alone in patients with stable ischemic heart disease with moderate to severe myocardial ischemia.During a follow-up of 3.3 years, there was no significant difference in the incidence of major composite endpoint events between the two groups (15.5% vs. 13.8%, P = 0.34).Studies have shown that interventional therapy based on this does not benefit patients with stable coronary heart disease with moderate to severe myocardial ischemia compared with the best medication alone.However, an important limitation of the study is the high crossover rate (28%) between conservative and invasive treatments, which may affect the reported results.A recent post hoc analysis of the STICH study failed to demonstrate that the presence or absence of myocardial survival has an impact on the survival benefit of patients undergoing surgical revascularization.The REVIVED trial is currently investigating the safety and effectiveness of PCI in improving the prognosis of patients with heart failure.Patient management in different disease categories 1. Surgical revascularization of the left main trunk with three vascular lesions is currently the recommended treatment strategy for patients with multiple coronary lesions with diabetes. PCI is recommended for patients with SYNTAX score ≤ 22 and SYNTAX score is>22 patients are not recommended.These recommendations are consistent with the results of a follow-up study from FREEDOM, which showed that the PCI group had a higher mortality at 8 years of follow-up compared to the surgical revascularization group (24.3% vs. 18.3%, P = 0.010).In contrast, a non-inferiority study comparing PCI (first-generation paclitaxel-eluting stent) and coronary artery bypass grafting (CABG) of the three branches of the coronary artery and the left main lesion was compared with the SYNTAX study.All-cause mortality showed no significant difference (27% vs. 24%, P = 0.092).CABG has certain advantages in patients with three branches of disease, but left main disease does not.However, both studies have limitations: patients in the PCI group used the first-generation therapeutic drug-eluting stent (DES), which is no longer used, and they only reported all-cause mortality, not patient-specificGuided cardiovascular endpoint.The EXCEL trial overcomes these limitations, selecting a second-generation DES and using all-cause death, myocardial infarction, or stroke as the composite endpoint.At 5-year follow-up, there was no difference in composite endpoints between the PCI and CABG treatment groups.Similar to the situation reported in the SYNTAX study, there were no differences in outcomes between the two treatment strategies for patients with diabetes and non-diabetes at 3- and 5-year follow-up.2. Left main bifurcation lesions. In 2019, the 3-year follow-up results of the DKCRUSH-V trial were announced.The results showed that the failure rate of target lesions in the DK Crush technology group was 8.3%, which was significantly lower than the single stent group’s 16.9%.This is mainly because DK Crush technology reduces target vessel myocardial infarction and target lesion revascularization (TLR).In addition, exact or probable intra-stent thrombosis is also less common in the DK Crush technology group than in the single-stent group.It is worth noting that DK Crush technology is even better for patients with complex lesions or at high risk.However, the 14th consensus document recently released by the European Bifurcation Club advocates the use of temporary T-stent technology for the treatment of bifurcation lesions, and suggests that only when the lesions have an anatomical complex structure that is difficult to enter the collaterals, or where the collateral entrance has> 5 mmTwo stent strategies are used only when the bulge or calcification increases.In the case of the double-stent strategy, the European Forking Club recommends using the culotte technique or the TAP technique, and when considering the squeeze technique, it is recommended to use the DK Crush technique.3. Chronic total occlusive disease According to the ESC myocardial revascularization guidelines, combined with the results of randomized controlled studies, the European CTO Club recommends that despite the best drug treatment, CTO recanalization should be performed in the presence of symptoms; for asymptomatic patientsIt is recommended to perform an ischemic load assessment, and if there is evidence of an increase in ischemic load (≥10% of left ventricular mass), CTO revascularization is recommended.The results of the recently published DECISION-CTO study support this recommendation again.The study followed up for 4 years and found no difference in the composite endpoints and quality of life for death, myocardial infarction, stroke, or revascularization between the CTO-PCI group and the non-CTO-PCI group.Studies have shown that in multivessel disease, it is recommended to consider revascularization of non-CTO lesions and re-evaluation of ischemia and patient symptoms before using CTO.4. Small vessel disease and in-stent restenosis Small vessel disease has a higher incidence of TLR due to major adverse cardiovascular events (MACE) and in-stent restenosis during PCI.The 3-year follow-up data from the BIO-RESORT study showed that, in terms of mortality, incidence of target vascular myocardial infarction, and stent thrombosis, the ultra-thin stent Orsiro and the ultra-thin stent Synergy had no statistical difference compared to the thin-stent RESOLUTE INTEGRITY;In terms of TLR, the ultra-thin stent Orsiro excels.These findings highlight the effect of stent thickness on the prognosis of small vessel disease in the DES era, and are consistent with the results of previously reported studies of bare metal stents.In-stent restenosis is the most common cause of stent treatment failure. The two most effective treatment strategies currently are drug-coated balloon angioplasty or DES implantation.The DAEDALUS study published in 2019 analyzed the differences in anti-restenosis efficacy between DES and drug-coated balloons.The results showed a higher incidence of paclitaxel-coated balloon angioplasty TLR compared to DES implantation.However, the composite endpoint of death, myocardial infarction, or target lesion thrombosis did not differ between the two groups.Existing and emerging interventional devices 1. DES and bioabsorbable stents The ESC Myocardial Revascularization Guidelines recommend the use of second-generation DES in clinical practice.The COMFORTABLE-AMI late follow-up study further demonstrated the superiority of DES in STEMI patients compared to bare metal stents.The BIOSTEMI study found that compared with Xience, patients treated with ultra-thin Orsiro had lower clinically indicated target lesion revascularization rates, leading to differences in TLF.In contrast, the TALENT study concluded that the clinical efficacy of the ultra-thin sirolimus-eluting stent Supraflex is not significantly different from the clinical efficacy of Xience.The introduction of bioabsorbable stents overcomes the limitations of DES and improves long-term efficacy.However, the increased incidence of these devices during short- and medium-term follow-up has raised concerns about their safety and is not currently recommended for routine clinical use.A recent meta-analysis comparing the results of a randomized study of resorbable biostents (BVS) and everolimus-eluting stents found that the incidence of TLF in BVS was higher during a 5-year follow-up (14.9% vs. 11.6%,P = 0.030).Another landmark analysis showed a higher incidence of events in the Absorb BVS group within 0–3 years of follow-up.However, during the follow-up period of 3-5 years, the incidence of cardiogenic death, target vascular myocardial infarction, ischemic TLR and device thrombosis was similar between the two groups in patients who had not experienced an event in the first 3 years.These findings provide the basis for the timing of adverse events in bioabsorbable stents for the first time, and indicate that the incidence of long-term events after complete absorption is low.2. Assisted interventional devices In recent years, intravascular lithotripsy (IVL) has become an effective alternative method for the treatment of calcified lesions.The technology uses sound pressure waves emitted by neatly arranged small lithotripters to break calcified lesions in blood vessels, and the surrounding soft tissues are not affected by them.The DISRUPT CAD study is the first study to systematically evaluate the safety and effectiveness of IVL.The study included 60 patients with severe calcification and a length of 32 mm or less.The results showed that the operation was successful in all lesions, the acute lumen obtained was 1.7 mm, and the residual stenosis was 12.2%.The results of the DISRUPT CAD II study are similar, showing that IVL can significantly increase the lumen area and improve the stent adherence, and no malignant arrhythmia was found.The ongoing DISRUPT CAD III study is expected to provide further evidence for the safety and effectiveness of IVL in the treatment of calcified lesions.The strategy and duration of antiplatelet therapy for adjuvant drugs in patients with PCI has been an area of ​​intensive research by scholars.The results of the TWILIGHT trial announced at the TCT Annual Meeting showed that patients who received PCI and placed DES were switched to ticagrelor monotherapy after 3 months of dual antiplatelet therapy (DAPT). Compared with continuing DAPT, the risk of bleeding was higher.Decreased without an increase in ischemic risk.However, the latest post hoc analysis results of the GLOBAL LEADERS study show that for patients after complex PCI, compared with standard antiplatelet therapy (1 year DAPT + 1 year aspirin), the long-term ticagrelor strategy (1 month DAPT)(Tegrelol alone) may be better.Another study also showed that prolonged DAPT treatment was associated with a lower incidence of ischemic events in patients with a lower risk of bleeding, especially in patients receiving complex PCI.In contrast, long-term use of DAPT in patients with high bleeding risk does not reduce the risk of ischemic events, but increases the risk of bleeding.Patients with AF after PCI have an increased risk of bleeding after receiving antiplatelet and anticoagulant therapy.In recent years, several large-scale randomized controlled studies have investigated the best treatment options for such patients.The results of the much-watched AUGUSTUS trial were announced at this year’s ACC annual meeting.Studies show that for patients with atrial fibrillation who have recently had ACS or received PCI, the risk of bleeding is significantly reduced with the dual antithrombotic regimen of apixaban + P2Y12 inhibitor compared with the triple therapy regimen of warfarin + DAPTThere was no significant difference in the incidence of ischemic events.The results of the ENTRUST-AF PCI study are similar.Studies have confirmed that dual antithrombotic therapy with edosaban + P2Y12 inhibitors is not inferior to VKA triple therapy in terms of primary study endpoints (major bleeding and clinically relevant non-major bleeding).A meta-analysis published this year also confirmed the findings, but patients receiving dual antithrombotic therapy had a higher risk of developing stent thrombosis.Invasive diagnostic tests 1. Coronary physiology tests Recent studies have shown that blood flow reserve fraction (FFR) and resting indicators, including instantaneous no-wave speed ratio (iwFR), can not only guide blood flow reconstruction, but also assessThe final results and predictive prognosis also have some value.However, there are occasional inconsistencies between high blood volume FFR and resting index.A subgroup analysis of the DEFINE-FLAIR study compared the prognosis of patients with left anterior descending branch disease with delayed vascular reconstruction based on FFR or iwFR assessment.The follow-up results showed that the 1-year event rate was lower in the iwFR group.In contrast, a post hoc analysis of a study of patients with diabetes showed no difference in prognosis between the FFR and iwFR groups; however, the iwFR group had a higher incidence of nonfatal myocardial infarction and a significant correlation with diabetes.While introducing resting indicators to assess the severity of intermediate lesion function, researchers are also working to explore computer-assisted coronary angiography or invasive imaging data to obtain FFR.In 2019, two new calculation-derived FFR solutions were proposed: one is to obtain the vessel geometry and estimate the pressure reduction at the lesion by three-dimensional quantitative coronary angiography; the other is to process OCT imaging data.The latter can be combined with morphological and physiological assessments of atherosclerotic lesions and surgical outcomes after PCI.Preliminary validation of these solutions shows good results; however, before they can be widely used in the clinical field, further evaluation of the efficacy on a large number of patients is needed.2. Multiple accumulated evidence for intravascular imaging has demonstrated the value of intravascular ultrasound (IVUS) in guiding PCI.A meta-analysis published this year highlighted IVUS-guided prognostic benefits, with a lower incidence of MACE, cardiac death, TLR, and clear / probable stent thrombosis in the IVUS-guided group compared to the angiographic-guided group.Consistent with the above findings, the 5-year follow-up analysis of the IVUS-XPL study showed that the incidence of MACE and TLR was lower in the IVUS-guided group, which brought benefits from long-term follow-up.These findings underscore the significance of IVUS in guiding the prognosis of revascularization and support its routine use to optimize surgical outcomes and improve short- and long-term outcomes after PCI.FFR is currently recommended to guide vascular reconstruction in patients with chronic coronary syndromes and moderate stenosis.The FORZA study compared the outcome and prognosis of FFR and optical coherence tomography (OCT) guided PCI.After 13 months of follow-up, it was found that the incidence and cost of vascular reconstruction caused by OCT-guided PCI were higher, but there was no difference between the two groups in all-cause death, myocardial infarction, the composite endpoint of target vascular reconstruction, and the incidence of MACE.In 2019, the European Society of Percutaneous Cardiovascular Interventions (EAPCI) published a consensus on clinical applications of intracoronary imaging.This consensus emphasizes the value of intravascular imaging, especially the value of OCT in criminal lesions that cannot be detected by coronary angiography and in the individualized treatment of ACS patients.At the same time, the consensus also emphasized the value of intravascular imaging in assessing ambiguous coronary angiography results, detecting embolism events and intramural hematomas, assessing lesions caused by external organ compression on the blood vessels, and summarizing their support in identifying vulnerableEvidence for a role in plaque and high-risk patients.3. Non-invasive imaging technology Non-invasive imaging technology plays an important role in the diagnosis of symptomatic obstructive CAD patients.MR-INFORM research shows that non-invasive imaging technology, especially cardiac magnetic resonance imaging (CMR), can be used not only for the diagnosis of CAD but also for guiding the revascularization.Similar results were obtained in the CROSS-AMI study, which compared the differences in revascularization between STAMI patients under angiography and echocardiography.A one-year follow-up found no differences in the primary endpoints of cardiogenic death, myocardial infarction, coronary revascularization, or rehospitalization due to heart failure between the two groups.However, one limitation of the CROSS-AMI study is the lack of ability to assess differences between groups.Therefore, it is necessary to further study the value of noninvasive imaging in guiding vascular reconstruction in patients with ACS.Detection of vulnerable plaques In short-term follow-up, the incidence of patients undergoing revascularization, especially in patients with ACS, is high.The emergence of new drug therapies seems to improve atherosclerotic plaques and inhibit disease progression, but its costs and side effects are high.Therefore, accurate risk stratification and identification of high-risk patients are expected to provide personalized active treatment for these patients to improve the prognosis of vulnerable groups.Large-scale prospective intravascular imaging studies have highlighted the value of IVUS in cardiovascular risk in detecting vulnerable plaques that may progress and cause events, as well as more accurate stratification of risks.The Lipid-Rich Plaque (LRP) and CLIMA studies published in 2019 evaluated for the first time the efficacy of near-infrared spectroscopy (NIRS) -IVUS and OCT in detecting vulnerable plaques.During the 2-year follow-up of the LRP study, it was found that the incidence of non-criminal MACE in patients with increased lipid load was higher than that in patients without lipid plaque, and maxLCBI4mm> 400 was an independent predictor of MACE.This study provided evidence for the prognostic impact of plaque components, but due to incomplete IVUS analysis, it was limited to maxLCBI at 4 mm segments and failed to study the synergistic value of NIRS and IVUS in predicting events.The CLIMA study found that the minimum lumen area is <3.5 mm2, the lipid arc is> 180 °, the thickness of the fiber cap is <75 μm, and macrophage accumulation is an independent predictor of end-stage cardiac death and target myocardial infarction.The incidence of events was higher in patients with all plaque-specific lesions than in other patients.In 2019, the combined IVUS-OCT catheter was first applied in the human body.In addition, the application of polarization-sensitive OCT imaging systems in the human body was proposed in 2019, and this method is expected to better describe plaque characteristics and evaluate their composition in more detail.Two more recent reports have examined the efficacy of attenuation compensation techniques.Attenuation compensation is a post-processing method that seems to enhance the depth of OCT imaging and more accurately assess the plaque burden in severely diseased segments.These reports highlight the potential of this approach in assessing the intrinsic vascular plaque area of ​​severe lesions, but also show the significant limitations of this technique.The effect of local hemodynamics on the progression and instability of atherosclerotic diseases cannot be ignored.IBIS-4 analysis shows that the shear stress distribution estimated using computational fluid dynamics analysis has added value in predicting the progression of atherosclerotic disease and changes in plaque morphology, and PROSPECT studies have shown that plaques are estimated by processing virtual histological IVUS imagesBlock stress can more accurately identify lesions that will cause events in the future.Conclusion STEMI patients should be actively treated with the goal of complete vascular reconstruction.In contrast, for patients with out-of-hospital cardiac arrest who have no clinical evidence of acute ischemia, the initial conservative treatment appears to be as effective as early invasive treatment.Strong evidence highlights the short- and long-term efficacy of DES, and advances in coronary physiology and the development of image-based FFR calculation methods are expected to expand its application in guiding revascularization.Cumulative data highlights the prognostic benefits of endovascular imaging in guiding PCI and assessing pathology of lesions, while advances in intravascular imaging and computational models are expected to better predict vulnerable lesions and at-risk patients who will benefit fromNew treatments for plaque evolution.These advances are expected to improve the surgical outcome and long-term prognosis of patients with coronary heart disease through personalized drug invasion strategies..

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CARDIOLOGY

Antiarrhythmic Drug Therapy——Professor Yanyan Yang’s Interpretation of the Latest Chinese Atrial Fibrillation Guide

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Atrial fibrillation (atrial fibrillation) is a high-frequency disease. The guidelines emphasize the overall management of AF, including ventricular rate and rhythm control, anticoagulation therapy, radiofrequency ablation, and lifestyle interventions.Professor Yang Yanmin from the National Cardiovascular Center and Fuwai Hospital of the Chinese Academy of Medical Sciences explained the antiarrhythmic drug treatment section in Atrial Fibrillation: Current Knowledge and Treatment Recommendations (2018).Atrial Fibrillation Rhythm vs Ventricular Rate Control 1. Location of Rhythmic Control Numerous clinical trials have shown that there is no significant difference between ventricular rate control or rhythmic control in terms of cardiovascular endpoint events.The 2016 ESC Atrial Fibrillation Management Guidelines state that to date, all subjects with joint rhythm control have had a neutral outcome in terms of endpoint events.At present, the indication for rhythm control is to improve symptoms in patients who still have symptoms after ventricular rate control.2. Drug maintenance sinus rhythm strategy re-examines randomized clinical trials with patient selection bias, such as including only patients who are willing to treat, including more patients who fail to maintain sinus rhythm.Moreover, the follow-up time of randomized clinical trials was short, and some studies have shown that the rhythm control group did not show clinical benefits until the fifth year.In addition, anti-arrhythmic drugs (AAD) successfully maintained a low percentage of sinus rhythm, and maintaining sinus rhythm to improve clinical outcomes was diluted by the toxic side effects of AAD.If patients can maintain sinus rhythm, clinical outcomes can be improved.Therefore, the reason why the strategy of maintaining sinus rhythm does not show its advantage lies in the lack of a truly safe and effective rhythm control strategy.3. Atrial fibrillation catheter ablation and AAD (CABANA) research. Catheter ablation therapy for AF has made rapid progress. The results of some small-scale clinical trials such as CACAF, RAAFT, APAF, and 4A have shown that catheter ablation has been significantly reduced compared with traditional drug treatment.The possibility of AF recurrence.However, there is a lack of large-scale clinical evidence on the effects of catheter ablation on survival and stroke, quality of life, and medical costs.The CABANA Study is a multicenter, prospective, randomized, open-label clinical study initiated by the National Institutes of Health (NIH) to compare the long-term effects of catheter ablation and AAD treatment on AF mortality, stroke, quality of life, and medical costs.Period influence.From November 2009 to April 2016, 2204 patients with paroxysmal or persistent atrial fibrillation were enrolled. They were randomly divided into groups of 1: 1 for ablation or medication (ventricular rate or rhythm control), with an average follow-up of 48 months.The results showed that the radiofrequency ablation group was not better than drug treatment in reducing the composite endpoint, but the results of ITT analysis showed that catheter ablation was superior to drug treatment.In maintaining sinus rhythm, catheter ablation is more effective than medication.4. Can rhythm control reduce cardiovascular events?The 2018 American Heart Association (AHA) published a scientific statement on AF load stressing that the description of atrial fibrillation with or without atrial fibrillation is too unilateral, and that the impact of AF load on clinical outcomes should be emphasized.Although we do not yet have conclusive evidence that maintaining sinus rhythm reduces stroke risk and mortality, rhythm control is still used for symptomatic atrial fibrillation.However, ongoing research intends to find further evidence.The EAST-AFNET 4 study has enrolled more than 2500 patients to evaluate whether early, comprehensive rhythm control with AAD or catheter ablation can reduce adverse cardiovascular events compared to conventional treatment.Atrial Fibrillation Rhythm Control 1. ESC Guidelines for Atrial Fibrillation 2010 • Symptoms cannot be tolerated through ventricular rate control, EHRA ≥ 2 points (I, B) • Atrial fibrillation-related heart failure, to improve symptoms (IIa, B) • SymptomsYoung patients, do not rule out the possibility of catheter ablation, choose rhythmic control as the initial treatment (IIa, C)? AF is secondary to basic diseases such as ischemia and hyperthyroidism, these factors have been corrected, rhythmic control can be considered (IIa, C) 2. 2014 AHA / ACC / HRS Guidelines for Atrial Fibrillation? Persistent symptoms associated with AF are the strongest indications of rhythm control? Difficulties in heart rate control? Young patients? Tachycardia cardiomyopathy? First episode of atrial fibrillation? Patient willingness 3. AtrialFibrillation: Current Understanding and Recommendations for Treatment-2018 The methods for the conversion of AF to sinus rhythm include autocardia, pharmacological, electrical, and catheter ablation.For hemodynamically stable patients with newly developed atrial fibrillation (usually within 1 week of atrial fibrillation), cardioversion may precede cardioversion.Drugs have a 50% effective rate for renewed atrial fibrillation, but less effective for persistent atrial fibrillation.For atrial fibrillation with severe hemodynamic disorders, cardioversion is the preferred method.Recommendations for pharmacological cardioversion: Class I: ① For patients without a history of ischemic or structural heart disease, flukanib and propafenone are recommended as cardioversion drugs for atrial fibrillation (level of evidence A); ② ischemic and /Or patients with structural heart disease, amiodarone is recommended as a cardioversion agent for AF (evidence level A).Class Ⅱa: ① In patients without a history of ischemic or structural heart disease, iblitide is recommended as a cardioversion drug for atrial fibrillation (level of evidence B); ② selected recent episodes of atrial fibrillation and no obvious structuralPatients with ischemic heart disease or after a safety evaluation may consider a single oral flukanib or propafenone (“pocket” method) for patient self-retroversion (level of evidence B).Class Ⅱb: Wienakaran is used in patients with mild heart failure (cardiac function class Ⅰ or Ⅱ), coronary heart disease, left ventricular hypertrophy and atrial fibrillation (evidence level B).Class III: ① Digoxin and Sotalol are used for cardioversion (level of evidence A); ② Out-of-hospital quinidine, procainamide, and propiramine are used for pharmacology (level of evidence B); ③Dofetilide is used outside the hospital (level of evidence B).Anticoagulant therapy before and after cardioversion is recommended: Category Ⅰ: ① For patients with AF or atrial flutter that last for ≥48 hours or for unknown time, warfarin should be applied at least 3 weeks before cardioversion and 4 weeks after cardioversion (INR 2.0 ~ 3.0)Or NOAC anticoagulation (level of evidence B); ② For patients with atrial fibrillation or atrial flutter for ≥ 48 h or unknown time with hemodynamic instability, immediate cardioversion is required, and anticoagulation should be started as soon as possible. Heparin or lowMolecular Heparin (Level of Evidence C); ③ Whether all patients with AF require long-term anticoagulation after cardioversion depends on the assessment of the risk of thromboembolism (Level of Evidence C); ④ When early reversion is planned, TEE should be performedIf the thrombus in the heart is ruled out, cardioversion can be performed in advance (evidence level B); ⑤ Patients with thrombus detected by TEE should effectively anticoagulate for at least 3 weeks (evidence level C).Class Ⅱa: ① Heparin or NOAC anticoagulation should be started as soon as possible before each atrial fibrillation or atrial fibrillation (evidence level B); ② Patients who have confirmed that AF persists for <48 h can be directly reinstated without TEELaw (level of evidence B).Atrial Fibrillation Ventricular Rate Control Ventricular rate control is currently the main strategy for the management of AF and is one of the basic goals of AF treatment. It can usually significantly improve the symptoms associated with AF.Clinicians should choose a treatment strategy based on the patient's underlying disease, general conditions, and patient wishes.Atrial fibrillation ventricular rate control includes acute ventricular rate control and long-term ventricular rate control.For patients with atrial fibrillation requiring acute ventricular rate control, the cause of the increased ventricular rate should be evaluated, and appropriate drugs should be selected based on the clinical characteristics, symptoms, LVEF and hemodynamic characteristics of the patient.Long-term ventricular rate control methods include long-term oral medication to control ventricular rate and atrioventricular node ablation + permanent pacemaker implantation.Beta blockers can be used as a first-line treatment for all patients with AF.Non-dihydropyridine calcium antagonists have a negative inotropic effect and should be avoided in patients with left ventricular systolic dysfunction and decompensated heart failure.Amiodarone has many potential organ toxicity and drug interactions, which limits its long-term application value in ventricular rate control. It is only used as an alternative drug when other drugs are used to control ventricular rate.In conclusion, Professor Yang Yanmin pointed out: Atrial fibrillation rhythm control and ventricular rate control still need to be individualized; reducing the burden of atrial fibrillation and reducing adverse cardiovascular events have already begun to emerge; although the overall status of antiarrhythmic drugs is not high, it is still impossibleInadequate adjuvant therapy; In addition, some new target drugs are worth looking forward to.The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party..

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CARDIOLOGY

Cough and fever are also related to the heart?

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Myocarditis, which is also a relatively common disease problem in our lives, mainly occurs in young and middle-aged people. After the onset of myocarditis, if there is no timely treatment, it may be life-threatening.And once myocarditis has complications, the consequences are quite serious.What are the symptoms of myocarditis?What are the symptoms of myocarditis?There are 4 major symptoms, and you need to see a doctor as soon as possible!What are the symptoms of myocarditis?(1) Patients with fever and cough myocarditis often have fever, cough, sore throat, diarrhea, muscle soreness and other symptoms 1 to 3 weeks before the onset. Most of the patients are young.When abnormal cough and fever occur, attention must be paid.(2) What are the symptoms of nausea myocarditis?Nausea is often a precursor to vomiting, and it can also occur alone, showing special discomfort in the upper abdomen, often accompanied by symptoms of axillary nerve excitement such as dizziness, salivation, slow pulse, and decreased blood pressure; some patients may have dizziness, nausea, and anorexia.When heart failure occurs in critically ill patients, palpitations, shortness of breath, sitting breathing, and edema may be present.Of course, because vomiting does not have any specific symptoms, it is often ignored, and eventually the disease that causes myocarditis becomes serious.(3) Chest pain Most patients have severe or even intolerable pain, and they are dying. The duration is sometimes not very long, but sometimes the pain is even several days.Patients can’t alleviate pain by taking medicines. It is difficult for people to bear the pain. The feeling of pain is different in patients.(4) What are the symptoms of heart rate change myocarditis?Our temperature and heart rate increase disproportionately, or our heart rate is abnormally slow, are suspicious signs of myocarditis.Don’t underestimate every cold, especially when the symptoms of the cold are accompanied by cardiac discomfort.Obviously, there are many symptoms of myocarditis. I hope everyone can pay more attention to it. Once there is an abnormal situation, you must go to a regular hospital for examination in order to avoid the occurrence of adverse risk damage.

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