45 research outputs found

    Diagnosis and Treatment of Inappropriate Sinus Tachycardia

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    Inappropriate sinus tachycardia (IST) is a syndrome of cardiac and extracardiac symptoms characterized by rapid sinus heart rate at rest (>100 bpm) or with minimal activity and disproportionate to the physiologic demands. Patients with this unique and puzzling arrhythmia may require restriction from physical activity. The responsible mechanisms for IST are not completely understood. IST and postural orthostatic tachycardia syndrome (POTS) are the 2 sides of the same coin. It is important to distinguish IST from so-called appropriate sinus tachycardia and from POTS, with which an overlap may occur. As the long-term outcome seems to be benign, treatment may be unnecessary, or may be as simple as physical training. However, for patients with intolerable symptoms, therapeutic measures are warranted. Beta-adrenergic blockers, considered a first-line therapy, are usually ineffective even at high doses; the same applies for most other medical therapies. Ivabradine seems to be more effective than beta-blockers especially in the non- hypertensive patients. In rare instances, catheter- or surgically- based right atrial or sinus node modification may be helpful, but even this is fraught with limited efficacy and potential complications. Overtreatment, in an attempt to reduce symptoms, can be difficult to avoid, but is discouraged. In this report, we will be review IST, explore its mechanisms and evaluate possible management strategies

    Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

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    Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%
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