Ngaire has Palpitations

Transcription

1 Ngaire has Palpitations David Heaven Cardiac Electrophysiologist/Heart Rhythm Specialist Middlemore, Auckland City and Mercy Hospitals Auckland Heart Group

2 MCQ Ms A is 45, and a healthy marathon runner. She was recently found to have a first episode of paroxysmal atrial fibrillation She has a normal echocardiogram, normal BP, no history of stroke She has a sinus bradycardia of 45 bpm She should be prescribed: A ) Aspirin B) Metoprolol C) Nothing D) Dabigatran E) Flecainide

3 Case Ms ST, 46 year old woman Morbid Obesity Sister died from a myocardial rhabdomyosarcoma Laparoscopic gastric sleeve surgery 17/6/14 Post-op intolerant of fluids Admitted, acute renal failure, mild hypokalaemia Stricture on gastroscopy, dilated Discharged on 11/7 omeprazole, domperidone and cyclizine

4 -Case K+ 2.5, Mg

5 QT Women have longer QT intervals than men In genetic long QT syndrome, after the age of 15 women have 3 x higher cardiac events compared with men Women with long QT syndrome have a higher risk of events post-partum 70% of cases of drug induced torsades de pointes occurs in women

6 Case Ms SW 39 yo Elite Triathlete Palpitations since teenager, had been infrequent Came back to NZ because things were out of hand Interfering with training and competition Event monitoring

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10 SVT AVNRT is twice as common in women WPW related arrhythmias are more common in men Increased prevalence of SVT in the pre-menstrual period Increased incidence of SVT and ectopic arrhythmia in pregnancy (new presentation and worsening of existing) Strongly consider SVT ablation before planning a family Women have faster and more symptomatic SVT In a US study, women were referred for ablation 28 months later than men

11 Case Mrs CE, 78 year old woman Longstanding paroxysmal atrial fibrillation Hypertension Rapidly conducted atrial fibrillation-highly symptomatic Intolerant of flecainide, diltiazem, digoxin On sotalol, frequent breakthrough, does not want to take amiodarone On warfarin Just had a dual chamber pacemaker, planned AV node ablation

12 Atrial Fibrillation Prevalence of atrial fibrillation is 1-2% Age adjusted incidence of atrial fibrillation is higher in men Atrial fibrillation is much more common in the elderly About 55% of patients with atrial fibrillation are women Women have more symptoms, faster v rate, less QOL Women have a higher risk of stroke (x2), especially in the elderly Women have been prescribed less warfarin and more aspirin (Canadian Registry) Afib management is generally more conservative Less DCCV, later referral for ablation

13 Atrial Fibrillation Mrs CE CHADS score 2 CHA2DS2VASc 4 Clinical trial stroke risk 4% Real life stroke risk 5%+

14 Tools for Investigating Suspected Arrhythmia Resting sinus rhythm ECG ECG in tachycardia Exercise stress test Ambulatory ECG Holter External loop recorder/event monitor Implantable loop recorder Pacemaker/ICD electrograms Tilt table test Electrophysiology study

15 Tools for Investigating Structural Heart Disease Therapies Echocardiography Coronary angiography Cardiac MRI Cardiac CT Vagal manoeuvres Medications (AVB, AARx, anticoagulation) Devices Ablation (radiofrequency, cryo) Surgery/PCI

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20 MCQ Ms A is 45, and a healthy marathon runner. She was recently found to have a first episode of paroxysmal atrial fibrillation She has a normal echocardiogram, normal BP, no history of stroke She has a sinus bradycardia of 45 bpm She should be prescribed: A ) Aspirin B) Metoprolol C) Nothing D) Dabigatran E) Flecainide