Attitude of the Icelandic population towards performing cardiopulmonary resuscitation on strangers in the pre-hospital setting

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Initiation of bystander cardiopulmonary resuscitation (CPR) is directly linked to the outcome of cardiac arrest in the community. Recent reports have indicated a reluctance among witnesses to perform CPR on strangers especially mouth to mouth ventilation. The status of this in Iceland is unknown. The objective of this study was to assess the attitude of Icelanders towards bystander CPR. Material and methods: A telephone survey was conducted on 1200 randomly selected Icelanders, aged 16-75 years, with regard to their attitude towards pre-hospital CPR on strangers. A total of 804 (70.1%) chose to participate. Results: A large number had received some kind of training in CPR (73%), wheras only 6% had actually participated in CPR. In accordance, 50% thought they would be able to perform chest compressions adequately and 55% mouth to mouth ventilation. A total of 491 (65%) would likely volunteer to perform chest compressions on a stranger, while 178 (24%) would not and 84 (11%) were undecided. Similarly, 473 (64%) would likely volunteer to perform mouth to mouth ventilation on a stranger. One hundred seventy seven (24%) would not and 93 (12%) were unsure. An overwhelming majority, 620 (81%) said it would not make any difference regarding their participation in CPR if the procedure was simplified and included only chest compressions but not mouth to mouth ventilation. Conclusions: Icelanders have a very positive attitude towards bystander CPR, over two thirds have had some kind of CPR instruction and a large majority has no aversion towards performing mouth to mouth ventilation on strangers. These results are in contrast to similar data from the United States.Inngangur: Skyndidauði er í meirihluta tilfella vegna sleglahraðtakts (ventricular tachycardia) eða sleglaflökts (ventricular fibrillation). Grunnendurlífgun með öndunaraðstoð og hjartahnoði ásamt raflostsmeðferð geta verið lífsbjörg undir slíkum kringumstæðum. Undanfarin ár hefur gætt tregðu meðal almennings erlendis við að taka þátt í endurlífgun hjá ókunnugum utan sjúkrahúss. Á það sérstaklega við munn við munn öndunaraðstoðina og er mikilvægasta ástæðan ótti við smitsjúkdóma. Viðhorf Íslendinga til endurlífgunar hjá ókunnugum utan sjúkrahúss er ekki þekkt. Tilgangur: Markmið þessarar rannsóknar var að kanna viðhorf almennings á Íslandi til endurlífgunar utan sjúkrahúss með áherslu á viðhorf til munn við munn öndunaraðstoðar. Jafnframt vildum við kanna hvort það myndi breyta einhverju um þátttöku almennings í endurlífgun á ókunnugum ef slíkt fæli eingöngu í sér hjartahnoð en ekki munn við munn öndun. Efniviður og aðferðir: Gerð var símakönnun þar sem átta spurningar voru lagðar fyrir slembiúrtak einstaklinga í þjóðskrá á aldrinum 16-75 ára. Upphaflegt úrtak var 1200 manns, 804 svöruðu og svarshlutfall var því 70,1%. Niðurstöður: Stór hluti aðspurðra hafði hlotið tilsögn í framkvæmd hjartahnoðs (69%) og munn við munn öndunar (73%). Hins vegar höfðu fáir (6%) tekið þátt í tilraun til endurlífgunar. Af þeim sem tóku afstöðu treystu 394 (50%) sér til að framkvæma hjartahnoð hjá ókunnugum úti á götu og 491 (65%) myndi líklega gefa sig fram til að framkvæma hjartahnoð. Hvað varðar munn við munn öndunaraðstoð, treystu 417 (55%) sér vel til að framkvæma slíkt og 473 (63%) myndu líklega gefa sig fram til að framkvæma munn við munn öndun. Mest kom á óvart að það skipti ekki máli fyrir þátttöku 81% aðspurðra í endurlífgun hvort framkvæmdin fæli eingöngu í sér hjartahnoð eða bæði hnoð og munn við munn öndun. Ályktun: Íslendingar virðast almennt mjög jákvæðir gagnvart því að taka þátt í endurlífgun hjá ókunnugum utan sjúkrahúss. Margir hafa hlotið tilsögn í grunnendurlífgun og það skiptir ekki máli fyrir þátttöku þeirra hvort ferlið sé einfaldað á þann hátt að það feli eingöngu í sér hjartahnoð en ekki munn við munn öndunaraðstoð

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)

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Metabolic aspects of cardiac arrhythmias

Cardiac arrhythmias are an important cause of mortality and morbidity in patients with cardiac diseases. Sudden death due to ventricular tachycardia and fibrillation (VT/VF) in the setting of acute myocardial infarction (AMI) and heart failure (HF) is a frequent cause of premature death. Another recognized cause for sudden cardiac death is acquired complete heart block (CHB), a condition where the heart must quickly adapt to volume overload and increased wall stress to maintain normal hemodynamics. In the pre-pacemaker era this was a condition with a very high mortality mostly due to sudden death and progressive HF. The most common sustained arrhythmia, atrial fibrillation causes significant morbidity and is associated with stroke, heart failure and risk of premature death. The heart is an electro-mechanic pump that metabolizes mostly fatty acids for energy generation. Most of the energy is fuelling contractile work but approximately one-third is designated for ion pumps that maintain the electrochemical homeostasis of the cardiomyocyte, and give rise to the cell depolarization and repolarization. As the ATP pool is completely turned over every 10s, effective metabolism is imperative for the maintenance of electrical stability in the cell. In different pathophysiological states, i.e. obesity and diabetes, there is a mismatch between uptake and utilization of fatty acids leading to intracellular lipid accumulation. This may lead to the production of toxic lipid metabolites (e.g. lysophosphatidylcholine (LPC), diacylglycerol (DAG) and ceramides) and is referred to as lipotoxicity. LPC is also generated during myocardial ischemia and has been proposed as a contributor to the generation of ventricular arrhythmias during AMI. An import metabolic regulatory hormone, growth hormone (GH), has been shown to exert various positive effects in post-infarction HF. Aims I. To evaluate the short- and long-term effects of CHB on cardiac function, morphology and energy metabolism in the rat II. To investigate the effects of GH on ischemic and non-ischemic arrhythmogenesis in the rat III. To set up and validate an in vitro experimental system for studies of the effects of LPC on electrophysiological parameters in beating cardiomyocytes. IV. To evaluate associated risk factors for having AF in patients admitted to cardiac care units and to evaluate the role of lipid metabolism in the pathophysiology of AF. Results and conclusions I. Rats with CHB compensate for the reduction in heart rate by doubling the stroke volume and thereby maintaining cardiac output. Increases in wall tension leads to eccentric left ventricular hypertrophy. After long-term CHB there were no hemodynamic or metabolic signs of HF. II. GH reduced the occurrence of spontaneous VT/VF in rats with induced AMI as well as reducing induced VT/VF in anesthetized rats. This adds to previously described beneficial effects of GH in HF and AMI, and we suggest that the effect is partly mediated via decreased sympathetic stimulation. III. LPC induced prompt and pronounced electrophysiological alterations that may underlie its observed pro-arrhythmic properties. Our model may be a useful tool for preclinical studies of electrophysiological effects of various pathophysiological concepts. IV. In a multivariate analysis we found that obesity was associated with AF, but diabetes was not. AF was associated with quantitative and qualitative alterations in atrial lipid content but not with signs of lipotoxicity. Polyunsaturated DAG may play a role in pathophysiology of AF

Attitude of the Icelandic population towards performing cardiopulmonary resuscitation on strangers in the pre-hospital setting

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Initiation of bystander cardiopulmonary resuscitation (CPR) is directly linked to the outcome of cardiac arrest in the community. Recent reports have indicated a reluctance among witnesses to perform CPR on strangers especially mouth to mouth ventilation. The status of this in Iceland is unknown. The objective of this study was to assess the attitude of Icelanders towards bystander CPR. Material and methods: A telephone survey was conducted on 1200 randomly selected Icelanders, aged 16-75 years, with regard to their attitude towards pre-hospital CPR on strangers. A total of 804 (70.1%) chose to participate. Results: A large number had received some kind of training in CPR (73%), wheras only 6% had actually participated in CPR. In accordance, 50% thought they would be able to perform chest compressions adequately and 55% mouth to mouth ventilation. A total of 491 (65%) would likely volunteer to perform chest compressions on a stranger, while 178 (24%) would not and 84 (11%) were undecided. Similarly, 473 (64%) would likely volunteer to perform mouth to mouth ventilation on a stranger. One hundred seventy seven (24%) would not and 93 (12%) were unsure. An overwhelming majority, 620 (81%) said it would not make any difference regarding their participation in CPR if the procedure was simplified and included only chest compressions but not mouth to mouth ventilation. Conclusions: Icelanders have a very positive attitude towards bystander CPR, over two thirds have had some kind of CPR instruction and a large majority has no aversion towards performing mouth to mouth ventilation on strangers. These results are in contrast to similar data from the United States.Inngangur: Skyndidauði er í meirihluta tilfella vegna sleglahraðtakts (ventricular tachycardia) eða sleglaflökts (ventricular fibrillation). Grunnendurlífgun með öndunaraðstoð og hjartahnoði ásamt raflostsmeðferð geta verið lífsbjörg undir slíkum kringumstæðum. Undanfarin ár hefur gætt tregðu meðal almennings erlendis við að taka þátt í endurlífgun hjá ókunnugum utan sjúkrahúss. Á það sérstaklega við munn við munn öndunaraðstoðina og er mikilvægasta ástæðan ótti við smitsjúkdóma. Viðhorf Íslendinga til endurlífgunar hjá ókunnugum utan sjúkrahúss er ekki þekkt. Tilgangur: Markmið þessarar rannsóknar var að kanna viðhorf almennings á Íslandi til endurlífgunar utan sjúkrahúss með áherslu á viðhorf til munn við munn öndunaraðstoðar. Jafnframt vildum við kanna hvort það myndi breyta einhverju um þátttöku almennings í endurlífgun á ókunnugum ef slíkt fæli eingöngu í sér hjartahnoð en ekki munn við munn öndun. Efniviður og aðferðir: Gerð var símakönnun þar sem átta spurningar voru lagðar fyrir slembiúrtak einstaklinga í þjóðskrá á aldrinum 16-75 ára. Upphaflegt úrtak var 1200 manns, 804 svöruðu og svarshlutfall var því 70,1%. Niðurstöður: Stór hluti aðspurðra hafði hlotið tilsögn í framkvæmd hjartahnoðs (69%) og munn við munn öndunar (73%). Hins vegar höfðu fáir (6%) tekið þátt í tilraun til endurlífgunar. Af þeim sem tóku afstöðu treystu 394 (50%) sér til að framkvæma hjartahnoð hjá ókunnugum úti á götu og 491 (65%) myndi líklega gefa sig fram til að framkvæma hjartahnoð. Hvað varðar munn við munn öndunaraðstoð, treystu 417 (55%) sér vel til að framkvæma slíkt og 473 (63%) myndu líklega gefa sig fram til að framkvæma munn við munn öndun. Mest kom á óvart að það skipti ekki máli fyrir þátttöku 81% aðspurðra í endurlífgun hvort framkvæmdin fæli eingöngu í sér hjartahnoð eða bæði hnoð og munn við munn öndun. Ályktun: Íslendingar virðast almennt mjög jákvæðir gagnvart því að taka þátt í endurlífgun hjá ókunnugum utan sjúkrahúss. Margir hafa hlotið tilsögn í grunnendurlífgun og það skiptir ekki máli fyrir þátttöku þeirra hvort ferlið sé einfaldað á þann hátt að það feli eingöngu í sér hjartahnoð en ekki munn við munn öndunaraðstoð

Ablation of ganglionated plexi to treat symptomatic parasympathetic induced atrioventricular block

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadSamkvæmt klínískum leiðbeiningum er einkennagefandi gáttasleglarof meðhöndlað með gangráðsmeðferð. Í ungum einstaklingum getur sú meðferð reynst erfið til langframa vegna hættu á fylgikvillum, til að mynda sýkingum, leiðsluvandamálum og hjartabilun af völdum gangráðsörvunar. Hér er lýst tvítugum manni sem upplifði endurtekin yfirlið þar sem uppvinnsla sýndi fyrstu gráðu gáttasleglarof ásamt breytilegu gáttasleglarofi af gráðu 2, Mobitz 1. Sjúklingurinn var meðhöndlaður með brennsluaðgerð á parasympatísk taugahnoð í hægri gátt. Við það varð PRbil eðlilegt. Meðferðinni hefur aldrei verið beitt áður á Íslandi og einungis er fáum tilfellum lýst á heimsvísu.According to clinical guidelines a symptomatic atrioventricular block (AV block) is treated with a pacemaker. For young individuals such a therapy can be difficult due to possible long term complications such as infections, lead disruptions and pacemaker induced cardiomyopathy. We describe a twenty year old man with recurrent syncopes due to intermittent parasympathetic caused AV block of grade 2. The patient underwent cardioneuroablation where parasympathetic ganglia in the right atrium were ablated. After the procedure the PR interval normalized. This procedure has never been performed in Iceland before and there is a limited amount of case reports in the literature