Welcome To www.LupusMCTD.com
July 06, 2022, 10:15:58 pm *
Welcome, Guest. Please login or register.

Login with username, password and session length
 
   Home   Forum Help Search Calendar Login Register  
Pages: 1   Go Down
  Print  
Author Topic: Ventricular Tachycardia  (Read 19231 times)
0 Members and 1 Guest are viewing this topic.
hpyrch
Living with MCTD
Seeker of Support
*
Offline Offline

Gender: Female
Posts: 8



« on: October 24, 2007, 10:26:07 am »

Hello everyone, please help?I was just told on Monday that I have ventricular tachycardia..
After a year of tests, and an implantable heart monitor that I've had in me for 8 months,this is the answer i got. I also have mitral valve prolapse with regurgitaion and a torn valve. Now I have to go through more tests and have heart surgery or sugery and a defribilator implanted for the rest of my life. I'm young, only 30. The Dr. can't say if it is from the MCTD or not. Does anyone else have this problem? how did it tutn out?
« Last Edit: April 13, 2009, 05:29:55 pm by Adminஐﻬ » Logged

hpyrch
 http://apps.facebook.com/causes/133356
Mixed Connective Tissue Disease (MCTD) Awareness
Adminஐﻬ
"Pay It Forward" ஐﻬ
Site Owner
******
Offline Offline

Gender: Female
Posts: 10407


LupusMCTD Founder ஐﻬ


WWW
« Reply #1 on: October 24, 2007, 11:16:31 am »

Hello everyone, please help?I was just told on Monday that I have ventricular tachycardia..
After a year of tests, and an implantable heart monitor that I've had in me for 8 months,this is the answer i got. I also have mitral valve prolapse with regurgitaion and a torn valve. Now I have to go through more tests and have heart surgery or sugery and a defribilator implanted for the rest of my life. I'm young, only 30. The Dr. can't say if it is from the MCTD or not. Does anyone else have this problem? how did it tutn out?
Hello hpyrch,
I personally do not have this problem, but I had a nephew born with something like this and had his first open heart surgery at 3 days old. (His blood was flowing the opposite way)
THen a patch blew and he had a second patch put in and he's now 21years old, healthy as a horse.

I Googled a few of your key words "mitral valve prolapse with regurgition" and found this info.
(it's on excercising and MVP)
Keep us posted on what your Cardiologist says and how you are feeling. Hang in there,
Kathy


Exercise and Mitral Valve Prolapse


 Mitral valve prolapse occurs in four to seven percent of the population. Very fit people may have the condition and still be able to exercise.

The mitral valve is one of four valves that helps pump blood through the heart. It is located between the upper and lower chambers of the left side of the heart. The mitral valve allows blood to flow from the top to the bottom chamber only. When there is a prolapse, the valve is "floppy" and appears as a sail billowing in the wind. If excessive, this can cause blood to flow back into the top chamber. There are different degrees of mitral valve prolapse. If one of the two leaves of the valve fail to close all the way, it is called mitral regurgitation.

Some people with a mitral valve prolapse can live their whole lives without symptoms. People with symptoms may have heart palpitations, chest pain, fainting, reduced stamina, or fatigue with periods of weakness. If you have symptoms such as these, seek medical help.

Mitral valve prolapse is a common, not progressive, condition. It is rarely serious. People bothered by chest pains or palpitations are sometimes given beta blockers. These drugs slow the heart rate during exercise. Active lifestyles can still be continued and aerobic exercise is recommended.

The heart is a muscle, and like any muscle, it gets stronger with exercise. Aerobic exercise strengthens the heart and makes it more efficient. Examples are walking, jogging, swimming, cycling, or aerobic dance. A good aerobic exercise program doesn't have to be strenuous. Keeping a moderate aerobic pace for just 30 minutes a day provides the same benefits with fewer risks as strenuous activity. Do the "talk test" to set the pace. If the pace is too fast to talk comfortably to a companion, slow down.

Seek medical advice for the exercise guidelines that are right for your heart's condition.
Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
www.LupusMCTD.com Represents:
1) We are patients helping researchers build a future for the lives of others...
2) Where HOPE is a WORK In Progress
3) Pay It Forward~Giving Back To The Future Lupus/MCTD Patients
3sisters
Lupus patient with overlapping accessories
Newsletter Editor
******
Offline Offline

Gender: Female
Posts: 1034



« Reply #2 on: October 25, 2007, 12:41:53 am »



Welcome Hyprch~

  I'm glad that you are here. I'm sorry that you are going thru all of this, and I want you to know that you're not alone    litbflys

I have  ventricular tachycardia.. I have tried lots of different meds, aahhhhh!!!!  I am currently on Verapamil  and that seems to be holding me really well. >I call my heart med, my "3 in 1" medicine because it treats: my tachycardia, high blood pressure   and raynauds.

If this medicine doesn't hold me I will try an ablation, before having a device implanted in me. I also cringe at the thought of taking heavy duty blood thinners for the rest of my life, which to the best of my knowledge would be part of my daily plan if I have the device implanted.

Also, MVP, is very common in MCTD patients.

> I'm not a doctor, just a detective patient who needs to know  the "Why's" and what treatments are available to me.  girlwink

Back to the MVP and MCTD. I encourage you do to a google search on MVP and MCTD.  In my little dectective work, I came across many links to this. Also, of interest, is that lesions can occur on the heart valves, as a direct result of antiCardiolipin antibodies.
Also MVP runs in families.
Is the torn valve the mitral valve? I'm really sorry to hear this. It sucks!
I'm all for trying medications before going for surgery. actually, the mere thought of surgery makes me turn into chicken @hit!  I hope that you have excellent specialists on your health team!

I love my cardiologist. He's very sharp and I trust him.
You have a heck of a lot on your plate, and I hope that our community offers you the support  you need and deserve. Look forward to getting to know you and please keep us posted!
Please feel free to PM me anytime.   Take care, Kim
Logged

Living with NP-SLE/ MCTD and MS. Powered by the Indigenous 7th Sense and lots of meds... Living with an invisible illness sucks. But living with an UN-diagnosed and UN-treated illness REALLY sucks.
"Where HOPE is a Work in Progress™"
Adminஐﻬ
"Pay It Forward" ஐﻬ
Site Owner
******
Offline Offline

Gender: Female
Posts: 10407


LupusMCTD Founder ஐﻬ


WWW
« Reply #3 on: October 28, 2007, 01:10:30 pm »

Hello everyone, please help?I was just told on Monday that I have ventricular tachycardia..
After a year of tests, and an implantable heart monitor that I've had in me for 8 months,this is the answer i got. I also have mitral valve prolapse with regurgitaion and a torn valve. Now I have to go through more tests and have heart surgery or sugery and a defribilator implanted for the rest of my life. I'm young, only 30. The Dr. can't say if it is from the MCTD or not. Does anyone else have this problem? how did it tutn out?
BUMP! hpyrch I sent you personal message regarding new post from 3 sisters.Please read her post, very informative.
How are you doing?
Wishing you well
Kathy
Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
www.LupusMCTD.com Represents:
1) We are patients helping researchers build a future for the lives of others...
2) Where HOPE is a WORK In Progress
3) Pay It Forward~Giving Back To The Future Lupus/MCTD Patients
hpyrch
Living with MCTD
Seeker of Support
*
Offline Offline

Gender: Female
Posts: 8



« Reply #4 on: October 30, 2007, 06:54:27 am »

Thank you so much for your support. I haven't heard yet that MCTD was connected to MVP untill now. Although I pretty much think all of my heart probs come from it. I never had a problem in child hood, nor does it run in my family...but autoimmune does. It has affected almost all women on my mothers side of my family. My grandmother had RA and sjorgens(who died from heart comp. which is the main reason why I am so scared. I also love my Dr. I totally trust him, which I can't say that for all the other 8 or so Dr.'s I see. thank you again for your support, I greatly appreciate it. I hope today is a well day for you.  girlbiggrin
hpych
Logged

hpyrch
 http://apps.facebook.com/causes/133356
Mixed Connective Tissue Disease (MCTD) Awareness
Adminஐﻬ
"Pay It Forward" ஐﻬ
Site Owner
******
Offline Offline

Gender: Female
Posts: 10407


LupusMCTD Founder ஐﻬ


WWW
« Reply #5 on: October 30, 2007, 08:48:52 am »

Hey hpych,  blkcat
Glad to see you checked in and let us know you are OK. I am sorry to hear that auto immune runs in your family (it runs in mine)

If you have questions about the ventricular tachycardia Kim (3 sisters) is the one to ask questions to.

Keep us updated, you are very lucky to have a Dr. that you trust.Not too many I trust personally, as I've been jacked around so much through the years.

Hang in there!
Kathy
 pkin 
 trotrt 
Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
www.LupusMCTD.com Represents:
1) We are patients helping researchers build a future for the lives of others...
2) Where HOPE is a WORK In Progress
3) Pay It Forward~Giving Back To The Future Lupus/MCTD Patients
sunnipearl
Guest
« Reply #6 on: October 30, 2007, 10:25:37 am »

 CandleSmilie
                           Hi Hpych,
                                              I am also very sorry to hear that this all runs in your family mine to..Just like kathy I have had no peace when it has come to doctors for me..I have seen them all...The one I did love has retired...That was sad for me,B/C the next doctor that took his place is very mean to me..Oh well I have to bite the bullet..My gram died for the same reasons as your did...I am sorry to hear that. My sister and mom both have Lupus....But reciently i saw a new doctor and he looks at me no tests or anything and says who told you have Lupus? I told him my primary doctor is the one who found it and then the rhumy's I had went to all said the same thing...He disagrees and saids and I quote: You don't have Lupus all you have is Fibromyalgia! ALL? thats bad enough..But he never did any tests at that point yet....My blood work wqas all messed up and he still said to throw away my meds go and celebrate i don't have Lupus and get into the real world..Bacially thats what he told me...HELLO? JERK! well thats my story I have another appointment with the doctor today we will she what this one has to say? Oh God I hate going back and forth to the doctors alll the time it's so tiring........You have painfree days ahead and keep us posted and get better okay.Love Gail halwen
Logged
3sisters
Lupus patient with overlapping accessories
Newsletter Editor
******
Offline Offline

Gender: Female
Posts: 1034



« Reply #7 on: November 16, 2007, 01:53:20 am »

Hi Hyprch~

Glad you touched base with us. Unfortunatley, like Gail and Kathy both said, connective tissue diseases do run in family's.

 I am really glad that you trust and love that one doc! Wicked cool! Keep us posted, OK?

Hells bells, Girls, do you think it is possible that all the mean, arrogant doctors graduated from the same school?
                The Lack of Tact  University?                            2funny 
Logged

Living with NP-SLE/ MCTD and MS. Powered by the Indigenous 7th Sense and lots of meds... Living with an invisible illness sucks. But living with an UN-diagnosed and UN-treated illness REALLY sucks.
"Where HOPE is a Work in Progress™"
hpyrch
Living with MCTD
Seeker of Support
*
Offline Offline

Gender: Female
Posts: 8



« Reply #8 on: January 15, 2008, 08:09:17 am »

Thank you everyone for all of your comforting support and kind words...
It's been a few months since I really checked in last. I have had tests up the  tooot on my heart...Finally the doc says I will have another electrophysiology study done, an angiogram and then have a defibralator implanted. This was in the begining of Dec. I get there @ 6 am. I waited untill 12 pm. to finally go into the OR. I was so scared, I thought my life was going to be different from now on; I had revved my self up for this...Then, they awoke me around 4:30, only to tell me they didn't implant the defib. because they still didn't know the cause and didn't want to do something to harm me more than necessary. I began to cry and yell and swing! The next thing I know, the nurses are coming to inject me with more sedatives...I was out again. When I woke up around 6, I still cried, I couldn't stop. Then of course I started throwing up and got the worst migraine I've ever had (and I've had alot).I finally went home, tore up like I was in a car accident, at 9:30. I had about 3 weeks recovery because of course with MCTD it seems we all take longer to heal? Also there were burns all over my skin from the shocks they gave me. It was very painful. And for what? I feel I haven't gotten anywhere! I thought I would have this burden off my chest! Again, I feel like a ticking time bomb...
So I requested a copy of all my records...It's funny how the dr.s leave out little details from the test results...Maybe they think they are insignificant? For instance, I had an MRI done on my heart. In the report the radiologist gives me a diagnosis of THORACIC OUTLET SYNDROME! The dr. says it was negative. There was also narrowing in one of my arteries!
What the hell is that I say? So I look it up! Nothing major I guess (Compressed artery and vein)but why wasn't this told to me? I've had symptoms of this for a long time now....You would think one of these 100 dr.s would have picked up on it?  Angry  I think maybe some of these dr.s play god. And if we don't be the police of our own bodies and proactively protect ourselves, we are the ones who will pay the price... It's horrible! I know now why mother gave up on dr.s. But I can't give up! I've got 2 kids and a husband! And a life somewhere in there. I won't go down without a fight!
Logged

hpyrch
 http://apps.facebook.com/causes/133356
Mixed Connective Tissue Disease (MCTD) Awareness
Sweet Jasmine
Jr. Seeker of Support
**
Offline Offline

Posts: 465



« Reply #9 on: January 15, 2008, 09:42:05 am »

 rockingbaby  you fight these docters like you haven't fought befour.  CandleSmilie 
Logged
Adminஐﻬ
"Pay It Forward" ஐﻬ
Site Owner
******
Offline Offline

Gender: Female
Posts: 10407


LupusMCTD Founder ஐﻬ


WWW
« Reply #10 on: January 15, 2008, 10:19:38 am »

Quote
.It's funny how the dr.s leave out little details from the test results...Maybe they think they are insignificant? For instance, I had an MRI done on my heart. In the report the radiologist gives me a diagnosis of THORACIC OUTLET SYNDROME! The dr. says it was negative. There was also narrowing in one of my arteries!

  litbflys   hpyrch ,
I am sorry you are going to hell and back with this group of Drs. Yes they do play God sometimes I guess they assume they are the closet thing to it why not play it.
I agree with you on the "little things" they leave out or don't tell us in their reports.
Just this week my Dr told me my bone desity scan "was not good at all" yet the Radiologist who took it, told me it was great, rattled off some numbers where I was at, discuss my calcium intake, etc.

Why didn't the Drs go ahead an put the implant in you, I don't understand. Do you have those records yet?

What are the  chances of you changing Drs now or fincially do you need to stay where your'e at? If so, all I can suggest is do what your'e doing now. Get pissed, and fight. Fight for you and your loved ones. Do't them them jack you around.
If you need help with information ro anything I can provide you with just give me a hallor I'm always online every morning/afternoon (Pacific time)
Or you can email me at LupusWebsite@aol.com

Hang in there, you have to be your own advocate. Learn as much as you can about each illness thay say you might have. Education/knowledge is the key.
And Drs. don't like it when the patient knows just as much as what they are talking about (well mine doesn't ).
You have to be a detective in your paperwork, look at everything, and make notes.

Hang in there,
Kathy
« Last Edit: January 15, 2008, 10:22:25 am by Admin » Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
www.LupusMCTD.com Represents:
1) We are patients helping researchers build a future for the lives of others...
2) Where HOPE is a WORK In Progress
3) Pay It Forward~Giving Back To The Future Lupus/MCTD Patients
hpyrch
Living with MCTD
Seeker of Support
*
Offline Offline

Gender: Female
Posts: 8



« Reply #11 on: January 17, 2008, 05:53:36 am »

Thank you...
It feels really good to have a place to vent where people know where I'm coming from smiley
I got all of my records and am going to go to another dr. for a second opinion. Unfortunately I still have the recorder still implanted in me so I have to continue going to this office every month untill the batteried die (maybe another year?). But that doesn't mean I can't get another one or two opinions.
The Dr. said because there are so many things going on with my heart that it may be more detrimental than good. ( I see it as "I'm covering my own ass, mam").

I am sorry to hear of your misshap with the radiologist. In the state I live in it is illegal for the radiologist or any other person other than the dr. or nurse to give results. It reminds me that I need to have my bi annual dexa scan done. A couple years ago,they said I was appraoching ostiopenia. What kind of things are they having you do?

Have a good day!
Heidi
Logged

hpyrch
 http://apps.facebook.com/causes/133356
Mixed Connective Tissue Disease (MCTD) Awareness
Adminஐﻬ
"Pay It Forward" ஐﻬ
Site Owner
******
Offline Offline

Gender: Female
Posts: 10407


LupusMCTD Founder ஐﻬ


WWW
« Reply #12 on: January 17, 2008, 07:18:58 am »

Thank you...
It feels really good to have a place to vent where people know where I'm coming from smiley
I got all of my records and am going to go to another dr. for a second opinion. Unfortunately I still have the recorder still implanted in me so I have to continue going to this office every month untill the batteried die (maybe another year?). But that doesn't mean I can't get another one or two opinions.
The Dr. said because there are so many things going on with my heart that it may be more detrimental than good. ( I see it as "I'm covering my own ass, mam").

I am sorry to hear of your misshap with the radiologist. In the state I live in it is illegal for the radiologist or any other person other than the dr. or nurse to give results. It reminds me that I need to have my bi annual dexa scan done. A couple years ago,they said I was appraoching ostiopenia. What kind of things are they having you do?

Have a good day!
Heidi
Good Morning Heidi, bb
It's early , 5;10 AM. COULDN'T SLEEP SO WHERE SO i COME TOO? lol

iT'S GOOD TO KNOW YOU ARE GETTING ANOTHER ooops sorry about the caps I'm half ass awake. Keep going to as many Drs. to talk with them over what previous Drs have said and done to you. Tell them you want what is best for your health for right now and the future . It's obvious your'e young with any, many years ahead of you. But it's up to them to see to it, they are doing what is best for you.
I'm sure they are covering their own asses, but they neeed to make good and take care of you and see to it your'e taken care of.

I'm doing OK.Yeah California the radiologist isn't suppose to tell us jack on MRI's, scans, xrays, etc. But it was my first bone density scan I just thought this was normal for her to have me sit there with her paperwork and go over everything about my calcium intaake, etc.
According to my Dr. she was wrong and my bones are not that great. I have to get on 800 mg of Vitamin D as well as Calcium supplements.
So that needs to be done today, while I'm thinking about it.


Please keep us posted after your visits to each of these upcoming Dr. visits. I'm curious to hear what they have to say.

Hang in there Heidi,
We're always here for you.
Kathy smke 

Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
www.LupusMCTD.com Represents:
1) We are patients helping researchers build a future for the lives of others...
2) Where HOPE is a WORK In Progress
3) Pay It Forward~Giving Back To The Future Lupus/MCTD Patients
3sisters
Lupus patient with overlapping accessories
Newsletter Editor
******
Offline Offline

Gender: Female
Posts: 1034



« Reply #13 on: January 20, 2008, 03:19:08 pm »


Hi Heidi~

     I'm truly sorry that you are having to battle for answers and  are in the state of frustration because of the professionals lacking along the line of a definite diagnosis with your cardiovascular health.

Yes, it is frightening to live in the territory of the unknown, while glancing back at your children and husband, wondering where you'll be at over time. As a mother I relate to the state of many feelings and thoughts that this uncertain heart-vascular problem may impose on you as a mother and wife. Not to mention the limitations that the condition/s are placing on your ability to get around,: Example: like walk and talk at the same time!   tongue  Not to mention getting winded before foreplay with your husband! I used to have to sit at the counter to slice veggies.... before I got diagnosed and the right medication.

So many Lupies live with the never ending array of health issue's. It sux, but thank God for places like this, where we aren't alone, and among other's who are walking the same road...

Please know that we are here for you. Many of us have had to advocate for ourselves, and still do.

> On the note about bone density tests, I go for my first scan tomorrow. Thanks to you and Kathy for pointing out that the technician  isn't supposed to discuss what you all just mentioned. I'll leave that for my doctor.  wink

Heidi, please take care of yourself and keep us posted. I'll be praying for you!  Gentle Hugs, Kim
Logged

Living with NP-SLE/ MCTD and MS. Powered by the Indigenous 7th Sense and lots of meds... Living with an invisible illness sucks. But living with an UN-diagnosed and UN-treated illness REALLY sucks.
"Where HOPE is a Work in Progress™"
Adminஐﻬ
"Pay It Forward" ஐﻬ
Site Owner
******
Offline Offline

Gender: Female
Posts: 10407


LupusMCTD Founder ஐﻬ


WWW
« Reply #14 on: March 17, 2009, 10:59:43 am »

Commentary
Effective and efficient use of implantable defibrillators:
Sometimes it's over when it's over
Paul Dorian, MD

Paul Dorian is Professor and Director, Division of Cardiology, University of Toronto, Toronto, Ont.

Patients with substantial left ventricular scarring are prone to sudden death, presumably from ventricular tachyarrhythmias (sustained ventricular tachycardia and ventricular fibrillation). Rates of death, especially sudden cardiac death, increase as left ventricular function worsens. At first glance, implantable cardioverter defibrillators seem to offer a simple solution to this complex problem. It appears self-evident that the implantation of a device that has a greater than 98% probability of successfully terminating lethal ventricular arrhythmias would be life-prolonging in most if not all such patients. Indeed, randomized clinical trials of defibrillators implanted in patients at risk of sudden death because of severe left ventricular dysfunction (usually defined as an ejection fraction < 30%) have shown a 20%–30% decrease in all-cause mortality and a 50%–75% decrease in the rate of sudden death.1 Hence, on the premise that "it ain't over 'til it's over," defibrillators are often implanted prophylactically in patients with severe left ventricular dysfunction.

However, not all patients benefit equally from implantable defibrillators. The devices cannot effectively prevent deaths from causes other than arrhythmia. Also, the number of patients needed to treat to reduce all-cause mortality by a meaningful amount is directly related to the risk of death from arrhythmia, as opposed to the risk of overall death.2 Thus, to ensure that the use of implantable defibrillators is cost-effective and efficient (i.e., to avoid the morbidity and complications of defibrillator placement in patients destined never to receive therapy from the device), it is important to understand the clinical characteristics of patients who will be most (or least) likely to benefit from an implantable defibrillator.

In this issue of CMAJ, Setoguchi and colleagues provide an example, among others previously observed, of a patient population in which implantable defibrillators are unlikely to provide a meaningful survival benefit.3 In their cohort of a largely elderly population with at least 1 previous hospital admission related to heart failure, they found that 13.7% of the deaths occurred outside a hospital setting. This finding suggests that only a small proportion of deaths are likely to be sudden and due to arrhythmia. In their appropriately conservative analysis, the authors assumed that all out-of-hospital deaths were potentially preventable with the use of an implantable defibrillator, which is most unlikely.

However, the authors' expression of the measure of potential benefit from implantable defibrillators as the prolongation of a hypothetical median survival is not clinically useful. The absolute survival benefit will be realized in only a small proportion of patients, who as individuals are likely to derive substantial benefit if they survive long enough after a successful defibrillator shock. Other limitations of the study include uncertainty about cause of death, and thus its preventability, the implicit assumption that no in-hospital deaths would be preventable with the use of an implantable defibrillator, the absence of data on left ventricular function, and the collection of data at a time when currently indicated drug therapies such as β-blockers, angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers, and statins (in patients with coronary artery disease) were used less often.

Nevertheless, the study by Setoguchi and colleagues reminds us that, in some patient populations, the decision to implant a defibrillator for primary prophylaxis should be made very carefully. For some patients with left ventricular dysfunction, defibrillators simply do not prolong survival, as evidenced by the results of large multicentre randomized controlled trials.4 In the Defibrillator in Acute Myocardial Infarction Trial (DINAMIT), patients were randomly assigned to receive an implantable defibrillator or no defibrillator shortly after an acute myocardial infarction associated with an ejection fraction of less than 35% and decreased heart rate variability (an indicator of increased risk of death).5,6 Patients who received a defibrillator did not live longer than those given standard pharmacotherapy alone. The benefit of the defibrillators in reducing sudden cardiac death was offset by an increased risk of other causes of death, presumably from myocardial ischemic events or heart failure.

In the Coronary Artery Bypass Graft (CABG) Patch Trial, patients with an ejection fraction of less than 35% and a positive signal-averaged electrocardiogram (another marker of poor outcome) were randomly assigned to receive an implantable defibrillator or no defibrillator immediately after bypass surgery.7,8 Defibrillators did not prolong survival. Despite a substantial proportion of patients receiving "appropriate defibrillator therapy," the presumed reduction in sudden death was offset by an increase in other kinds of cardiovascular-related death.

These randomized controlled trials lend credence to the "conversion hypothesis," which suggests that, in some patient populations, a successful defibrillator shock will prevent sudden cardiac death but that the "saved" patient will be at high risk of dying from another cardiovascular cause within a short period. The benefit of the defibrillator is thus negated.

In other patient populations, use of an implantable defibrillator may be relatively ineffective because the underlying risk of sudden death is very low, or because the risk of death from other causes is so high that the probability of a meaningful prolongation of life for the majority of patients is small. Although information is sparse, patients with an ejection fraction of more than 30%, particularly those with a QRS interval of less than 120 ms, appear to be at low risk of cardiovascular-related death; therefore, these patients will likely not experience a major long-term benefit from implantable defibrillators.9,10 At the other end of the spectrum, as Setoguchi and colleagues point out, patients with heart failure at high risk of death, including those with prior (especially multiple) hospital admissions related to heart failure and those with chronic kidney disease, are probably at too high a risk of death from non-arrhythmia causes to benefit from defibrillator implantation. Even if all of the 13.7% of potentially treatable sudden deaths were prevented with an implantable defibrillator, the overall risk of death would remain prohibitively high. These hypotheses are supported by the seemingly counterintuitive observation in the largest trial of prophylactic use of implantable defibrillators, the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT): patients with more severe heart failure (New York Heart Association class III) received less benefit from an implantable defibrillator than patients with class II symptoms of heart failure.11

These concepts lead one to believe that a "one size fits all" approach to the use of implantable defibrillators may represent neither the most effective use of resources nor the best balance between risk and benefit. There is likely a U-shaped relation between the number needed to treat with an implantable defibrillator to prolong life and a patient's overall burden of cardiovascular illness (Figure 1). Some patients have a sufficiently low risk of sudden death that defibrillators may not be warranted. As the burden of illness increases, use of implantable defibrillators may become increasingly effective in terms of an absolute reduction of mortality, until morbidity and the risk of death from causes other than sudden death become sufficiently high to make defibrillators again less useful.


Figure 15
View larger version (35K):
[in this window]
[in a new window]

     Figure 1: U-shaped relation between number needed to treat with an implantable defibrillator and overall burden of cardiovascular disease. *The cost-efficacy threshold can be arbitrarily set to any value, depending on resources and consensus.

 

As in all areas in medicine, appropriate decision-making regarding the use of implantable defibrillators requires thoughtful consideration of both the clinical trial evidence and the clinical context.

@@ See related research paper by Setoguchi and colleagues, page 611

    * Key pointsAlthough implantable defibrillators are highly effective in preventing sudden cardiac death, not all patients benefit from them.
    * The study by Setoguchi and colleagues suggests that patients with heart failure who have prior hospital admissions related to heart failure and those who have chronic kidney disease are at too high a risk of death from non-arrhythmia causes to benefit from the device.
    * Use of implantable defibrillators will likely also not benefit patients with heart failure at low risk of death, such as those with an ejection fraction of more than 30% and a short QRS interval.
    * Clinical decisions regarding defibrillator implantation should consider effective use of resources and whether a reasonable balance exists between benefit and risk.

Footnotes

Acknowledgement: I am grateful to Dr. Arnold Pinter for his helpful comments and suggestions.

Competing interests: Paul Dorian has received speaker fees and educational grants from Boston Scientific Inc., Medtronic Inc. and St. Jude Inc.


REFERENCES

   1. Nanthakumar K, Epstein AE, Kay GN, et al. Prophylactic implantable cardioverter-defibrillator therapy in patients with left ventricular systolic dysfunction: a pooled analysis of 10 primary prevention trials. J Am Coll Cardiol 2004;44: 2166-72.[Abstract/Free Full Text]
   2. Jolly S, Dorian P, Alter DA. The impact of implantable cardiac defibrillators for primary prophylaxis in the community: baseline risk and clinically meaningful benefits. J Eval Clin Pract 2006;12:190-5.[CrossRef][Medline]
   3. Setoguchi S, Nohria A, Rassen JA, et al. Maximum potential benefit of implantable defibrillators in preventing sudden death after hospital admission because of heart failure. CMAJ 2009;180:611-6.[Abstract/Free Full Text]
   4. Myerburg RJ. Implantable cardioverter-defibrillators after myocardial infarction. N Engl J Med 2008;359:2245-53.[Free Full Text]
   5. Hohnloser SH, Kuck KH, Dorian P, et al.; DINAMIT Investigators. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 2004;351:2481-8.[Abstract/Free Full Text]
   6. Dorian P, Connolly S, Hohnloser SH; DINAMIT Investigators. Why don't ICD's decrease all-cause mortality after MI? Insights from the DINAMIT Study [abstract]. Circulation 2004;110:III-502.
   7. Bigger JT Jr; Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. N Engl J Med 1997;337:1569-75.[Abstract/Free Full Text]
   8. Bigger JT Jr, Whang W, Rottman JN, et al. Mechanisms of death in the CABG Patch Trial: a randomized trial of implantable cardiac defibrillator prophylaxis in patients at high risk of death after coronary artery bypass graft surgery. Circulation 1999;99:1416-21.[Abstract/Free Full Text]
   9. Tang AS, Ross H, Simpson CS, et al.; Canadian Heart Rhythm Society, Canadian Cardiovascular Society. Canadian Cardiovascular Society/Canadian Heart Rhythm Society position paper on implantable cardioverter defibrillator use in Canada. Can J Cardiol 2005;21(Suppl A):11A-8A.[Medline]
  10. Dorian P, Talajic M, Levesque S, et al.; AF-CHF Investigators. Prolonged QRS duration is associated with a marked increase in mortality in the AF-CHF Study. Circulation 2008;118:S795.[CrossRef]
  11. Bardy GH, Lee KL, Mark DB, et al.; Sudden Cardiac Death in Heart Failure Trial. (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225-37
\

SOURCE: CMAJ
Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
www.LupusMCTD.com Represents:
1) We are patients helping researchers build a future for the lives of others...
2) Where HOPE is a WORK In Progress
3) Pay It Forward~Giving Back To The Future Lupus/MCTD Patients
Adminஐﻬ
"Pay It Forward" ஐﻬ
Site Owner
******
Offline Offline

Gender: Female
Posts: 10407


LupusMCTD Founder ஐﻬ


WWW
« Reply #15 on: April 03, 2009, 01:36:33 pm »

Old drug treats heart disorder

03 April 2009

New research has found that the answer to treating a rare inherited heart disorder could lie with a drug already on the market.

Associate Professor Derek Laver from the University of Newcastle and international colleagues have found that Flecainide - a drug used to treat heart arrhythmias - could also be used to treat Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT).

CVPT is a heart arrhythmia induced by emotional stress or exercise. It is estimated to cause 15 per cent of all unexplained sudden cardiac deaths in people under the age of 30.

Associate Professor Laver said CPVT was caused by too much calcium being released from calcium stores within the heart cells.

"Correct calcium flow within the heart cells is essential for the heart to function properly," he explained.

"Calcium is released from the stores into the heart cells through specific channels and we have found that Flecainide reduces the ability of these channels to release calcium, thereby directly counteracting the cause of CPVT."

Currently, beta-blockers are used to treat CPVT but 37 per cent of patients are unresponsive and 24 per cent suffer sudden cardiac death within 10 years of beginning treatment.

Implantable defibrillators are used to prevent sudden death but these cause painful electric shocks that can trigger further stress-induced arrhythmias.

"Current treatments are largely ineffective and we need new and more effective anti-arrhythmic drugs," Associate Professor Laver said.

"We have now discovered something close to an ideal drug for this rare arrhythmia disorder."

SOURCE:Nature Medicine journal.
Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
www.LupusMCTD.com Represents:
1) We are patients helping researchers build a future for the lives of others...
2) Where HOPE is a WORK In Progress
3) Pay It Forward~Giving Back To The Future Lupus/MCTD Patients
Pages: 1   Go Up
  Print  
 
Jump to:  


© Page Contents, Layout, Graphics and Design All Copyrighted by Credited Artists and are Not Public Domain.



LupusMCTD Founder & Patient
Former Domestic Violence SURVIVOR
Kathy A. Patterson

Author of the Upcoming Memoir Book:
"Fighting From The Inside Out"..
A lupus patient fights the beast within her immune system and the beast at home....

e-Booklet filled with photos and videos of what abuse was, signs to look for,
where to turn to for help, and much more to help others like me...


For more information
Call the National Domestic Violence Hotline at 1−800−799−SAFE(7233)



"The Meaning of the Words in the Second Amendment .... "That the people have a right to freedom of speech, and of writing, and publishing their sentiments;"

PRIVACY NOTICE: Warning--any person and/or institution and/or Agent and/or Agency of any governmental structure including but not limited to the United States Federal Government also using or monitoring/using this website or any of its associated websites, you do NOT have my permission to utilize any of my profile information nor any of the content contained herein including, but not limited to my photos, and/ or the comments made about my photo's or any other "picture" art posted on my profile. You are hereby notified that you are strictly prohibited from disclosing, copying, distributing, disseminating, or taking any other action against me with regard to this profile and the contents herein. The foregoing prohibitions also apply to your employee(s), agent(s), student(s) or any personnel under your direction or control. The contents of this profile are private and legally privileged and confidential information, and the violation of my personal privacy is punishable by law
Photobucket
© 2008 LupusMCTD Foundation of America - All Rights Reserved
Est.November 11, 2005
"We Understand What You Are Going Through"™
Powered by EzPortal

Powered by MySQL Powered by PHP Powered by SMF 1.1.21 | SMF © 2015, Simple Machines
Twitter Mod created by 2by2host.com - a web hosting company