The Indian Practitioner

Biswaranjan Mishra ¹

Affiliations
1 Max Diagnostics, Ranihat, Cuttack, Odisha, IN

Abstract

With increasing longevity and decreased mortality of cardiovascular diseases, atrial fibrillation (AF) has emerged as one of the important public health problems. AF is the most common sustained cardiac arrhythmia, prevalence of which increases with age. Prevalence of AF is approximately 3% in adults aged 20 years or older. It complicates almost all cardiac diseases sooner or later producing not only symptomatic deterioration but sharply increasing morbidity and mortality. Although a simple bedside ECG has remained the gold standard in the diagnosis of this arrhythmia for more than a century, advances in Echocardiography, advanced imaging techniques and electrophysiology has greatly facilitated the assessment of the underlying cardiac pathophysiologic state. Presentation of AF may vary from palpitation to a disabling embolism, the prevention of which is of paramount importance. Management approaches of AF are broadly based on heart rate control, restoration to sinus rhythm and anti-coagulation to prevent a thrombus formation. Oral anti-coagulation (OAC) with vitamin K antagonists significantly reduce stroke rate. Recent availability of newer oral anti-coagulants (NOACs) has increased the safety and efficacy of OAC. Development of clinical scoring systems for assessing risk of thrombosis and bleeding, such as CHA2DS2VASC and HAS-BLED scores, has greatly aided in decision making for giving or withholding OAC. Similarly therapeutic advances like catheter ablation and left atrial appendage occlusion have immensely improved the outcome of patients suffering from AF which otherwise have a poor prognosis.

Keywords

Arrhythmia, Stroke, Oral Anticoagulants, Vitamin K Antagonist, NOAC.

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Biswaranjan Mishra ¹, Chinmay Divyad ²

Affiliations
1 Senior consultant cardiologist, Max Diagnostic, IN
2 PG resident 1st Year, Dept of Anaesthesiology, D.Y. Patil Hospital, IN

Abstract

Exercise or stress ECG referred to as treadmill test (TMT) has been used for the last several decades for the diagnosis of obstructive coronary artery disease (CAD) but is limited by its low sensitivity and specificity. The advent of other modalities which combines imaging such as echocardiography, nuclear perfusion imaging, computed tomography (CT), and magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of myocardial ischemia. Anatomic imaging of coronary arterial obstruction by CT angiography has also emerged as a highly sensitive and specific test to rule out CAD. TMT now moved from diagnosis of myocardial ischemia to assessment of valvular heart disease, congenital heart disease, pulmonary hypertension, arrhythmia, diastolic dysfunction, genetic CV disease, and peripheral arterial disease. It remains an important test for assessing exercise-induced symptoms, functional capacity, exercise duration, heart rate, and blood pressure during exercise and during recovery after exercise. Of its low sensitivity and specificity TMT should be avoided as a routine test in asymptomatic individuals and in persons with a low probability of CAD. However, due to its wide availability, low-cost and easy interpretation, when used judiciously in cases of moderate to a high probability of CAD, it remains invaluable.

Keywords

Exercise ECG, Stress ECG, TMT, myocardial ischemia, stable coronary artery disease.

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