Re: Re: Conn's syndrome and SVT

[Guest guest]

You can't really lump SVT and AFIB in the same categories. They both affect the heart, of course, but treatments can differ greatly and the mechanisms that cause them are usually very different. and there is not much crossover between them in terms of treatment. SVT is all about speed and AFIB is all about irregularity and the risks of clots ending in MI, CHF, and/or stroke. Likely they are doing an ablation of an accessory node that is causing the SVT. They do not operate on afib usually and when they do it's often something else they found in the process of working up the afib. But the surgery/ablation in the SVT has a great track record and about a 95% success rate.Subject: Re: Conn's syndrome and SVTTo: hyperaldosteronism Date: Saturday, March 19, 2011, 11:22 AM

For both atrial fibrillation or Supraventricular tachycardia there are other ways to treat them besides surgery? In fact surgery seem a last resort for both.

From Wikipedia. Supraventricular tachycardia (SVT)

TreatmentIn general, SVT is threatening, but episodes can be treated or prevented. While some treatment modalities can be applied to all SVTs with impunity, there are specific therapies available to cure some of the different sub-types. Cure requires intimate knowledge of how and where the arrhythmia is initiated and propagated.

The SVTs can be separated into two groups, based on whether they involve the AV node for impulse maintenance or not. Those that involve the AV node can be terminated by slowing conduction through the AV node. Those that do not involve the AV node will not usually be stopped by AV nodal blocking maneuvers. These maneuvers are still useful however, as transient AV block will often unmask the underlying rhythm abnormality.

AV nodal blocking can be achieved in at least three different ways:

Physical maneuver A number of physical maneuvers cause increased AV nodal block, principally through activation of the parasympathetic nervous system, conducted to the heart by the vagus nerve. These manipulations are therefore collectively referred to as vagal maneuvers.

The Valsalva maneuver should be the first vagal maneuver tried.[4] It works by increasing intra-thoracic pressure and affecting baro-receptors (pressure sensors) within the arch of the aorta. It is carried out by asking the patient to hold their breath and try to exhale forcibly as if straining during a bowel movement, or by getting them to hold their nose and blow out against it.

There are many other vagal maneuvers including: holding ones breath for a few seconds, coughing, plunging the face into cold water, via the diving reflex, drinking a glass of ice cold water, and standing on one's head. Carotid sinus massage, carried out by firmly pressing the bulb at the top of one of the carotid arteries in the neck, is effective but is often not recommended due to risks of stroke in those with plaque in the carotid arteries.

If necessary, the act of defecation can sometimes halt an episode, again through vagal stimulation. Urination has also been found to work especially if there has been a delay in voiding

Medications

Termination of PSVT following adenosineAdenosine, an ultra short acting AV nodal blocking agent, is indicated if vagal maneuvers are not effective. If this works, followup therapy with diltiazem, verapamil or metoprolol may be indicated. SVT that does not involve the AV node may respond to other anti-arrhythmic drugs such as sotalol or amiodarone.

In pregnancy, adenosine is the treatment of choice as recommended by the ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias.

Cardioversion If the patient is unstable or other treatments have not been effective, cardioversion may be used, and is almost always effective.

Atrial fibrillation AF or A-fib

ManagementMain article: Management of atrial fibrillation

The main goals of treatment are to prevent circulatory instability and stroke. Rate or rhythm control are used to achieve the former, while anticoagulation is used to decrease the risk of the latter. If cardiovascularly unstable due to uncontrolled tachycardia, immediate cardioversion is indicated.

AnticoagulationAnticoagulation can be achieved through a number of means including the use of aspirin, heparin, warfarin, and dabigatran. Which method is used depends on a number issues including: cost, risk of stroke, risk of falls, compliance, and speed of desired onset of anticoagulation.

Rate control versus rhythm control using drugsAF can cause disabling and annoying symptoms. Palpitations, angina, lassitude (weariness), and decreased exercise tolerance are related to rapid heart rate and inefficient cardiac output caused by AF. Furthermore, AF with a persistent rapid rate can cause a form of heart failure called tachycardia induced cardiomyopathy. This can significantly increase mortality and morbidity, which can be prevented by early and adequate treatment of the AF.

There are two ways to approach these symptoms using drugs: rate control and rhythm control. Rate control seeks to reduce the heart rate to one that is closer to normal, usually 60 to 100 bpm, without trying to convert to a regular rhythm. Rhythm control seeks to restore with cardioversion the regular heart rhythm and maintain it with drugs. Studies suggest that rhythm control is mainly a concern in newly diagnosed AF, while rate control is more important in the chronic phase. As far as mortality is concerned, the AFFIRM trial showed that there is no statistical difference with rate control treatment versus rhythm control treatment.

The AFFIRM study also showed no difference in risk of stroke in patients who have converted to a normal rhythm with anti-arrhythmic treatment, compared to those who have only rate control. AF is associated with a reduced quality of life, and while some studies indicate that rhythm control leads to a higher quality of life, the AFFIRM study did not find a difference.

A further study focused on rhythm control in patients with AF and simultaneous heart failure, based on the premise that AF confers a higher mortality risk in heart failure. In this setting, too, rhythm control offered no advantage compared to rate control.[28]

In patients with a fast ventricular response, intravenous magnesium significantly increases the chances of successful rate and rhythm control in the urgent setting without significant side-effects.[29] A patient with hemodynamic instability, mental status changes, preexcitation, or angina will require urgent synchronized DC cardioversion.[5] Otherwise the decision of rate control versus rhythm control using drugs is made. This is based on a number of criteria that includes whether or not symptoms persist with rate control.

Rate controlRate control is achieved with medications that work by increasing the degree of block at the level of the AV node, effectively decreasing the number of impulses that conduct down into the ventricles. This can be done with:

Beta blockers (preferably the "cardioselective" beta blockers such as metoprolol, atenolol, bisoprolol, nebivolol)

Non-dihydropyridine calcium channel blockers (i.e. diltiazem or verapamil)

Cardiac glycosides (i.e. digoxin) - have limited use, apart from in the sedentary elderly patient

In addition to these agents, amiodarone has some AV node blocking effects (particularly when administered intravenously), and can be used in individuals when other agents are contraindicated or ineffective (particularly due to hypotension).

Diltiazem has been shown to be more effective than either digoxin or amiodarone.

CardioversionCardioversion is a noninvasive conversion of an irregular heartbeat to a normal heartbeat using electrical or chemical means:

Electrical cardioversion involves the restoration of normal heart rhythm through the application of a DC electrical shock.

Chemical cardioversion is performed with drugs, such as amiodarone, dronedarone, procainamide, ibutilide, propafenone or flecainide.

Vernakalant has been found to safely and rapidly covert new onset atrial fibrillation.

Ablation If rhythm control is desired and cannot be maintained by medication or cardioversion, electrophysiological studies with pathway ablation may be attempted.

> >

> > Hi,

> >

> > My mother was recently diagnosed with SVT (runaway heart) and during the course of setting up the ablation surgery, it was discovered that she also has Conn's Syndrome. I get that Conn's is creating the issues with her blood pressure but at the same time can it be the cause of her extreme heart palpitations at times?

> >

> > SVT has to do with electrical issues in the heart but I was just wondering if anyone had heard of any correlation between the two. I do not want her to have the heart ablation if it is caused by the Conn's.

> >

> > She is taking meds for the Conn's as of a few days ago and her urine smells really awful. We are assuming that its the drug. Her adrenal glad is very swollen today. Her surgery is next week and she will not call and tell the doc that is swollen. She thinks they know that already. (they plan to do the ablation and check out her adrenals at the same time when she is on the table)

> >

> > Please let me know if you have any input.

> > Any help is appreciated.

> >

> > Thanks so much-

> >

>

[Guest guest]

But if the problem is due to low K in PA no need to ablate. And PA hypokalemia is often associated with both as many here will testity. Another thing we need to get into our data base.Have you ever been Dxed with irregular heart beat?No stopYes: what was the diagnosis?How was it treated?What was the result?Indeed we have had one person here (Kim from Cinn as I recall) that had hypokalemic cardiomyopathy so severe and heart failure she was told she would need a heart transplant. Spiro did the job so not transplant.CE Grim MD You can't really lump SVT and AFIB in the same categories. They both affect the heart, of course, but treatments can differ greatly and the mechanisms that cause them are usually very different. and there is not much crossover between them in terms of treatment. SVT is all about speed and AFIB is all about irregularity and the risks of clots ending in MI, CHF, and/or stroke. Likely they are doing an ablation of an accessory node that is causing the SVT. They do not operate on afib usually and when they do it's often something else they found in the process of working up the afib. But the surgery/ablation in the SVT has a great track record and about a 95% success rate.Subject: Re: Conn's syndrome and SVTTo: hyperaldosteronism Date: Saturday, March 19, 2011, 11:22 AM For both atrial fibrillation or Supraventricular tachycardia there are other ways to treat them besides surgery? In fact surgery seem a last resort for both. From Wikipedia. Supraventricular tachycardia (SVT) TreatmentIn general, SVT is threatening, but episodes can be treated or prevented. While some treatment modalities can be applied to all SVTs with impunity, there are specific therapies available to cure some of the different sub-types. Cure requires intimate knowledge of how and where the arrhythmia is initiated and propagated.The SVTs can be separated into two groups, based on whether they involve the AV node for impulse maintenance or not. Those that involve the AV node can be terminated by slowing conduction through the AV node. Those that do not involve the AV node will not usually be stopped by AV nodal blocking maneuvers. These maneuvers are still useful however, as transient AV block will often unmask the underlying rhythm abnormality.AV nodal blocking can be achieved in at least three different ways:Physical maneuver A number of physical maneuvers cause increased AV nodal block, principally through activation of the parasympathetic nervous system, conducted to the heart by the vagus nerve. These manipulations are therefore collectively referred to as vagal maneuvers.The Valsalva maneuver should be the first vagal maneuver tried.[4] It works by increasing intra-thoracic pressure and affecting baro-receptors (pressure sensors) within the arch of the aorta. It is carried out by asking the patient to hold their breath and try to exhale forcibly as if straining during a bowel movement, or by getting them to hold their nose and blow out against it.There are many other vagal maneuvers including: holding ones breath for a few seconds, coughing, plunging the face into cold water, via the diving reflex, drinking a glass of ice cold water, and standing on one's head. Carotid sinus massage, carried out by firmly pressing the bulb at the top of one of the carotid arteries in the neck, is effective but is often not recommended due to risks of stroke in those with plaque in the carotid arteries.If necessary, the act of defecation can sometimes halt an episode, again through vagal stimulation. Urination has also been found to work especially if there has been a delay in voidingMedications Termination of PSVT following adenosineAdenosine, an ultra short acting AV nodal blocking agent, is indicated if vagal maneuvers are not effective. If this works, followup therapy with diltiazem, verapamil or metoprolol may be indicated. SVT that does not involve the AV node may respond to other anti-arrhythmic drugs such as sotalol or amiodarone.In pregnancy, adenosine is the treatment of choice as recommended by the ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias.Cardioversion If the patient is unstable or other treatments have not been effective, cardioversion may be used, and is almost always effective.Atrial fibrillation AF or A-fibManagementMain article: Management of atrial fibrillationThe main goals of treatment are to prevent circulatory instability and stroke. Rate or rhythm control are used to achieve the former, while anticoagulation is used to decrease the risk of the latter. If cardiovascularly unstable due to uncontrolled tachycardia, immediate cardioversion is indicated.AnticoagulationAnticoagulation can be achieved through a number of means including the use of aspirin, heparin, warfarin, and dabigatran. Which method is used depends on a number issues including: cost, risk of stroke, risk of falls, compliance, and speed of desired onset of anticoagulation.Rate control versus rhythm control using drugsAF can cause disabling and annoying symptoms. Palpitations, angina, lassitude (weariness), and decreased exercise tolerance are related to rapid heart rate and inefficient cardiac output caused by AF. Furthermore, AF with a persistent rapid rate can cause a form of heart failure called tachycardia induced cardiomyopathy. This can significantly increase mortality and morbidity, which can be prevented by early and adequate treatment of the AF.There are two ways to approach these symptoms using drugs: rate control and rhythm control. Rate control seeks to reduce the heart rate to one that is closer to normal, usually 60 to 100 bpm, without trying to convert to a regular rhythm. Rhythm control seeks to restore with cardioversion the regular heart rhythm and maintain it with drugs. Studies suggest that rhythm control is mainly a concern in newly diagnosed AF, while rate control is more important in the chronic phase. As far as mortality is concerned, the AFFIRM trial showed that there is no statistical difference with rate control treatment versus rhythm control treatment.The AFFIRM study also showed no difference in risk of stroke in patients who have converted to a normal rhythm with anti-arrhythmic treatment, compared to those who have only rate control. AF is associated with a reduced quality of life, and while some studies indicate that rhythm control leads to a higher quality of life, the AFFIRM study did not find a difference.A further study focused on rhythm control in patients with AF and simultaneous heart failure, based on the premise that AF confers a higher mortality risk in heart failure. In this setting, too, rhythm control offered no advantage compared to rate control.[28]In patients with a fast ventricular response, intravenous magnesium significantly increases the chances of successful rate and rhythm control in the urgent setting without significant side-effects.[29] A patient with hemodynamic instability, mental status changes, preexcitation, or angina will require urgent synchronized DC cardioversion.[5] Otherwise the decision of rate control versus rhythm control using drugs is made. This is based on a number of criteria that includes whether or not symptoms persist with rate control.Rate controlRate control is achieved with medications that work by increasing the degree of block at the level of the AV node, effectively decreasing the number of impulses that conduct down into the ventricles. This can be done with:Beta blockers (preferably the "cardioselective" beta blockers such as metoprolol, atenolol, bisoprolol, nebivolol)Non-dihydropyridine calcium channel blockers (i.e. diltiazem or verapamil)Cardiac glycosides (i.e. digoxin) - have limited use, apart from in the sedentary elderly patientIn addition to these agents, amiodarone has some AV node blocking effects (particularly when administered intravenously), and can be used in individuals when other agents are contraindicated or ineffective (particularly due to hypotension).Diltiazem has been shown to be more effective than either digoxin or amiodarone.CardioversionCardioversion is a noninvasive conversion of an irregular heartbeat to a normal heartbeat using electrical or chemical means:Electrical cardioversion involves the restoration of normal heart rhythm through the application of a DC electrical shock.Chemical cardioversion is performed with drugs, such as amiodarone, dronedarone, procainamide, ibutilide, propafenone or flecainide.Vernakalant has been found to safely and rapidly covert new onset atrial fibrillation.Ablation If rhythm control is desired and cannot be maintained by medication or cardioversion, electrophysiological studies with pathway ablation may be attempted.> >> > Hi,> > > > My mother was recently diagnosed with SVT (runaway heart) and during the course of setting up the ablation surgery, it was discovered that she also has Conn's Syndrome. I get that Conn's is creating the issues with her blood pressure but at the same time can it be the cause of her extreme heart palpitations at times? > > > > SVT has to do with electrical issues in the heart but I was just wondering if anyone had heard of any correlation between the two. I do not want her to have the heart ablation if it is caused by the Conn's. > > > > She is taking meds for the Conn's as of a few days ago and her urine smells really awful. We are assuming that its the drug. Her adrenal glad is very swollen today. Her surgery is next week and she will not call and tell the doc that is swollen. She thinks they know that already. (they plan to do the ablation and check out her adrenals at the same time when she is on the table)> > > > Please let me know if you have any input.> > Any help is appreciated.> > > > Thanks so much-> >>

[Guest guest]

I used to use a lothydrazaline when it was one of the few BP MEDS we had. Never saw it lower K. CE Grim. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Need to find out what your mother's potassium is. Low potassium can be why she had a seizure. Hydralazine lowers potassium and if you have PA it can lower it to be dangerous.

> > > >

> > > > From: Francis Bill SUSPECTED PA <georgewbill@>

> > > > Subject: Re: Conn's syndrome and SVT

> > > > To: hyperaldosteronism

> > > > Date: Saturday, March 19, 2011, 11:22 AM

> > > >

> > > >

> > > > For both atrial fibrillation or Supraventricular tachycardia there

> > > > are other ways to treat them besides surgery? In fact surgery seem a

> > > > last resort for both.

> > > >

> > > > From Wikipedia. Supraventricular tachycardia (SVT)

> > > > TreatmentIn general, SVT is threatening, but episodes can be treated

> > > > or prevented. While some treatment modalities can be applied to all

> > > > SVTs with impunity, there are specific therapies available to cure

> > > > some of the different sub-types. Cure requires intimate knowledge of

> > > > how and where the arrhythmia is initiated and propagated.

> > > >

> > > > The SVTs can be separated into two groups, based on whether they

> > > > involve the AV node for impulse maintenance or not. Those that

> > > > involve the AV node can be terminated by slowing conduction through

> > > > the AV node. Those that do not involve the AV node will not usually

> > > > be stopped by AV nodal blocking maneuvers. These maneuvers are still

> > > > useful however, as transient AV block will often unmask the

> > > > underlying rhythm abnormality.

> > > >

> > > > AV nodal blocking can be achieved in at least three different ways:

> > > >

> > > > Physical maneuver A number of physical maneuvers cause increased AV

> > > > nodal block, principally through activation of the parasympathetic

> > > > nervous system, conducted to the heart by the vagus nerve. These

> > > > manipulations are therefore collectively referred to as vagal

> > > > maneuvers.

> > > >

> > > > The Valsalva maneuver should be the first vagal maneuver tried.[4]

> > > > It works by increasing intra-thoracic pressure and affecting baro-

> > > > receptors (pressure sensors) within the arch of the aorta. It is

> > > > carried out by asking the patient to hold their breath and try to

> > > > exhale forcibly as if straining during a bowel movement, or by

> > > > getting them to hold their nose and blow out against it.

> > > >

> > > > There are many other vagal maneuvers including: holding ones breath

> > > > for a few seconds, coughing, plunging the face into cold water, via

> > > > the diving reflex, drinking a glass of ice cold water, and standing

> > > > on one's head. Carotid sinus massage, carried out by firmly pressing

> > > > the bulb at the top of one of the carotid arteries in the neck, is

> > > > effective but is often not recommended due to risks of stroke in

> > > > those with plaque in the carotid arteries.

> > > >

> > > > If necessary, the act of defecation can sometimes halt an episode,

> > > > again through vagal stimulation. Urination has also been found to

> > > > work especially if there has been a delay in voiding

> > > >

> > > > Medications

> > > > Termination of PSVT following adenosineAdenosine, an ultra short

> > > > acting AV nodal blocking agent, is indicated if vagal maneuvers are

> > > > not effective. If this works, followup therapy with diltiazem,

> > > > verapamil or metoprolol may be indicated. SVT that does not involve

> > > > the AV node may respond to other anti-arrhythmic drugs such as

> > > > sotalol or amiodarone.

> > > >

> > > > In pregnancy, adenosine is the treatment of choice as recommended by

> > > > the ACC/AHA/ESC Guidelines for the Management of Patients With

> > > > Supraventricular Arrhythmias.

> > > >

> > > > Cardioversion If the patient is unstable or other treatments have

> > > > not been effective, cardioversion may be used, and is almost always

> > > > effective.

> > > >

> > > > Atrial fibrillation AF or A-fib

> > > >

> > > > ManagementMain article: Management of atrial fibrillation

> > > > The main goals of treatment are to prevent circulatory instability

> > > > and stroke. Rate or rhythm control are used to achieve the former,

> > > > while anticoagulation is used to decrease the risk of the latter. If

> > > > cardiovascularly unstable due to uncontrolled tachycardia, immediate

> > > > cardioversion is indicated.

> > > >

> > > > AnticoagulationAnticoagulation can be achieved through a number of

> > > > means including the use of aspirin, heparin, warfarin, and

> > > > dabigatran. Which method is used depends on a number issues

> > > > including: cost, risk of stroke, risk of falls, compliance, and

> > > > speed of desired onset of anticoagulation.

> > > >

> > > > Rate control versus rhythm control using drugsAF can cause disabling

> > > > and annoying symptoms. Palpitations, angina, lassitude (weariness),

> > > > and decreased exercise tolerance are related to rapid heart rate and

> > > > inefficient cardiac output caused by AF. Furthermore, AF with a

> > > > persistent rapid rate can cause a form of heart failure called

> > > > tachycardia induced cardiomyopathy. This can significantly increase

> > > > mortality and morbidity, which can be prevented by early and

> > > > adequate treatment of the AF.

> > > >

> > > > There are two ways to approach these symptoms using drugs: rate

> > > > control and rhythm control. Rate control seeks to reduce the heart

> > > > rate to one that is closer to normal, usually 60 to 100 bpm, without

> > > > trying to convert to a regular rhythm. Rhythm control seeks to

> > > > restore with cardioversion the regular heart rhythm and maintain it

> > > > with drugs. Studies suggest that rhythm control is mainly a concern

> > > > in newly diagnosed AF, while rate control is more important in the

> > > > chronic phase. As far as mortality is concerned, the AFFIRM trial

> > > > showed that there is no statistical difference with rate control

> > > > treatment versus rhythm control treatment.

> > > >

> > > > The AFFIRM study also showed no difference in risk of stroke in

> > > > patients who have converted to a normal rhythm with anti-arrhythmic

> > > > treatment, compared to those who have only rate control. AF is

> > > > associated with a reduced quality of life, and while some studies

> > > > indicate that rhythm control leads to a higher quality of life, the

> > > > AFFIRM study did not find a difference.

> > > >

> > > > A further study focused on rhythm control in patients with AF and

> > > > simultaneous heart failure, based on the premise that AF confers a

> > > > higher mortality risk in heart failure. In this setting, too, rhythm

> > > > control offered no advantage compared to rate control.[28]

> > > >

> > > > In patients with a fast ventricular response, intravenous magnesium

> > > > significantly increases the chances of successful rate and rhythm

> > > > control in the urgent setting without significant side-effects.[29]

> > > > A patient with hemodynamic instability, mental status changes,

> > > > preexcitation, or angina will require urgent synchronized DC

> > > > cardioversion.[5] Otherwise the decision of rate control versus

> > > > rhythm control using drugs is made. This is based on a number of

> > > > criteria that includes whether or not symptoms persist with rate

> > > > control.

> > > >

> > > > Rate controlRate control is achieved with medications that work by

> > > > increasing the degree of block at the level of the AV node,

> > > > effectively decreasing the number of impulses that conduct down into

> > > > the ventricles. This can be done with:

> > > >

> > > > Beta blockers (preferably the "cardioselective" beta blockers such

> > > > as metoprolol, atenolol, bisoprolol, nebivolol)

> > > > Non-dihydropyridine calcium channel blockers (i.e. diltiazem or

> > > > verapamil)

[Guest guest]

An arrhythmia IMHO due to low K. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

What is more likely to be the cause of her mother's seizure stopping the metoprolol of low potassium?

> > > > > > >

> > > > > > > From: Francis Bill SUSPECTED PA <georgewbill@>

> > > > > > > Subject: Re: Conn's syndrome and SVT

> > > > > > > To: hyperaldosteronism

> > > > > > > Date: Saturday, March 19, 2011, 11:22 AM

> > > > > > >

> > > > > > >

> > > > > > > For both atrial fibrillation or Supraventricular tachycardia there

> > > > > > > are other ways to treat them besides surgery? In fact surgery seem a

> > > > > > > last resort for both.

> > > > > > >

> > > > > > > From Wikipedia. Supraventricular tachycardia (SVT)

> > > > > > > TreatmentIn general, SVT is threatening, but episodes can be treated

> > > > > > > or prevented. While some treatment modalities can be applied to all

> > > > > > > SVTs with impunity, there are specific therapies available to cure

> > > > > > > some of the different sub-types. Cure requires intimate knowledge of

> > > > > > > how and where the arrhythmia is initiated and propagated.

> > > > > > >

> > > > > > > The SVTs can be separated into two groups, based on whether they

> > > > > > > involve the AV node for impulse maintenance or not. Those that

> > > > > > > involve the AV node can be terminated by slowing conduction through

> > > > > > > the AV node. Those that do not involve the AV node will not usually

> > > > > > > be stopped by AV nodal blocking maneuvers. These maneuvers are still

> > > > > > > useful however, as transient AV block will often unmask the

> > > > > > > underlying rhythm abnormality.

> > > > > > >

> > > > > > > AV nodal blocking can be achieved in at least three different ways:

> > > > > > >

> > > > > > > Physical maneuver A number of physical maneuvers cause increased AV

> > > > > > > nodal block, principally through activation of the parasympathetic

> > > > > > > nervous system, conducted to the heart by the vagus nerve. These

> > > > > > > manipulations are therefore collectively referred to as vagal

> > > > > > > maneuvers.

> > > > > > >

> > > > > > > The Valsalva maneuver should be the first vagal maneuver tried.[4]

> > > > > > > It works by increasing intra-thoracic pressure and affecting baro-

> > > > > > > receptors (pressure sensors) within the arch of the aorta. It is

> > > > > > > carried out by asking the patient to hold their breath and try to

> > > > > > > exhale forcibly as if straining during a bowel movement, or by

> > > > > > > getting them to hold their nose and blow out against it.

> > > > > > >

> > > > > > > There are many other vagal maneuvers including: holding ones breath

> > > > > > > for a few seconds, coughing, plunging the face into cold water, via

> > > > > > > the diving reflex, drinking a glass of ice cold water, and standing

> > > > > > > on one's head. Carotid sinus massage, carried out by firmly pressing

> > > > > > > the bulb at the top of one of the carotid arteries in the neck, is

> > > > > > > effective but is often not recommended due to risks of stroke in

> > > > > > > those with plaque in the carotid arteries.

> > > > > > >

> > > > > > > If necessary, the act of defecation can sometimes halt an episode,

> > > > > > > again through vagal stimulation. Urination has also been found to

> > > > > > > work especially if there has been a delay in voiding

> > > > > > >

> > > > > > > Medications

> > > > > > > Termination of PSVT following adenosineAdenosine, an ultra short

> > > > > > > acting AV nodal blocking agent, is indicated if vagal maneuvers are

> > > > > > > not effective. If this works, followup therapy with diltiazem,

> > > > > > > verapamil or metoprolol may be indicated. SVT that does not involve

> > > > > > > the AV node may respond to other anti-arrhythmic drugs such as

> > > > > > > sotalol or amiodarone.

> > > > > > >

> > > > > > > In pregnancy, adenosine is the treatment of choice as recommended by

> > > > > > > the ACC/AHA/ESC Guidelines for the Management of Patients With

> > > > > > > Supraventricular Arrhythmias.

> > > > > > >

> > > > > > > Cardioversion If the patient is unstable or other treatments have

> > > > > > > not been effective, cardioversion may be used, and is almost always

> > > > > > > effective.

> > > > > > >

> > > > > > > Atrial fibrillation AF or A-fib

> > > > > > >

> > > > > > > ManagementMain article: Management of atrial fibrillation

> > > > > > > The main goals of treatment are to prevent circulatory instability

> > > > > > > and stroke. Rate or rhythm control are used to achieve the former,

> > > > > > > while anticoagulation is used to decrease the risk of the latter. If

> > > > > > > cardiovascularly unstable due to uncontrolled tachycardia, immediate

> > > > > > > cardioversion is indicated.

> > > > > > >

> > > > > > > AnticoagulationAnticoagulation can be achieved through a number of

> > > > > > > means including the use of aspirin, heparin, warfarin, and

> > > > > > > dabigatran. Which method is used depends on a number issues

> > > > > > > including: cost, risk of stroke, risk of falls, compliance, and

> > > > > > > speed of desired onset of anticoagulation.

> > > > > > >

> > > > > > > Rate control versus rhythm control using drugsAF can cause disabling

> > > > > > > and annoying symptoms. Palpitations, angina, lassitude (weariness),

> > > > > > > and decreased exercise tolerance are related to rapid heart rate and

> > > > > > > inefficient cardiac output caused by AF. Furthermore, AF with a

> > > > > > > persistent rapid rate can cause a form of heart failure called

> > > > > > > tachycardia induced cardiomyopathy. This can significantly increase

> > > > > > > mortality and morbidity, which can be prevented by early and

> > > > > > > adequate treatment of the AF.

> > > > > > >

> > > > > > > There are two ways to approach these symptoms using drugs: rate

> > > > > > > control and rhythm control. Rate control seeks to reduce the heart

> > > > > > > rate to one that is closer to normal, usually 60 to 100 bpm, without

> > > > > > > trying to convert to a regular rhythm. Rhythm control seeks to

> > > > > > > restore with cardioversion the regular heart rhythm and maintain it

> > > > > > > with drugs. Studies suggest that rhythm control is mainly a concern

> > > > > > > in newly diagnosed AF, while rate control is more important in the

> > > > > > > chronic phase. As far as mortality is concerned, the AFFIRM trial

> > > > > > > showed that there is no statistical difference with rate control

> > > > > > > treatment versus rhythm control treatment.

> > > > > > >

> > > > > > > The AFFIRM study also showed no difference in risk of stroke in

> > > > > > > patients who have converted to a normal rhythm with anti-arrhythmic

> > > > > > > treatment, compared to those who have only rate control. AF is

> > > > > > > associated with a reduced quality of life, and while some studies

> > > > > > > indicate that rhythm control leads to a higher quality of life, the

> > > > > > > AFFIRM study did not find a difference.

> > > > > > >

> > > > > > > A further study focused on rhythm control in patients with AF and

> > > > > > > simultaneous heart failure, based on the premise that AF confers a

> > > > > > > higher mortality risk in heart failure. In this setting, too, rhythm

> > > > > > > control offered no advantage compared to rate control.[28]

> > > > > > >

> > > > > > > In patients with a fast ventricular response, intravenous magnesium

> > > > > > > significantly increases the chances of successful rate and rhythm

> > > > > > > control in the urgent setting without significant side-effects.[29]

> > > > > > > A patient with hemodynamic instability, mental status changes,

> > > > > > > preexcitation, or angina will require urgent synchronized DC

> > > > > > > cardioversion.[5] Otherwise the decision of rate control versus

> > > > > > > rhythm control using drugs is made. This is based on a number of

> > > > > > > criteria that includes whether or not symptoms persist with rate

> > > > > > > control.

> > > > > > >

> > > > > > > Rate controlRate control is achieved with medications that work by

> > > > > > > increasing the degree of block at the level of the AV node,

> > > > > > > effectively decreasing the number of impulses that conduct down into

> > > > > > > the ventricles. This can be done with:

> > > > > > >

> > > > > > > Beta blockers (preferably the "cardioselective" beta blockers such

> > > > > > > as metoprolol, atenolol, bisoprolol, nebivolol)

> > > > > > > Non-dihydropyridine calcium channel blockers (i.e. diltiazem or

> > > > > > > verapamil)

> >

>

[Guest guest]

Can you postpone the surgery?

To: hyperaldosteronism Sent: Mon, March 21, 2011 10:10:06 AMSubject: Re: Conn's syndrome and SVT

PA dose cause the heart to not beat right. It looks like they have cart before the horse. > > > > > >> > > > > > Hi,> > > > > >> > > > > > My mother was recently diagnosed with SVT (runaway heart) and > > > > during the course of setting up the ablation surgery, it was > > >

> discovered that she also has Conn's Syndrome. I get that Conn's is > > > > creating the issues with her blood pressure but at the same time can > > > > it be the cause of her extreme heart palpitations at times?> > > > > >> > > > > > SVT has to do with electrical issues in the heart but I was just > > > > wondering if anyone had heard of any correlation between the two. I > > > > do not want her to have the heart ablation if it is caused by the > > > > Conn's.> > > > > >> > > > > > She is taking meds for the Conn's as of a few days ago and her > > > > urine smells really awful. We are assuming that its the drug. Her > > > > adrenal glad is very swollen today. Her surgery is next week and she > > > > will not call and tell the doc that

is swollen. She thinks they know > > > > that already. (they plan to do the ablation and check out her > > > > adrenals at the same time when she is on the table)> > > > > >> > > > > > Please let me know if you have any input.> > > > > > Any help is appreciated.> > > > > >> > > > > > Thanks so much-> > > > > >> > > > >> > > >> > > >> > > >> > > >> > >> >>

[Guest guest]

Good keep us posted. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Hi,

No the issues are two separate things.

The ablation (SVT)is over. All went well and I am so thankful.

Now they are going to check out the adrenal situation.

> > > > > > >

> > > > > > > Hi,

> > > > > > >

> > > > > > > My mother was recently diagnosed with SVT (runaway heart) and

> > > > > during the course of setting up the ablation surgery, it was

> > > > > discovered that she also has Conn's Syndrome. I get that Conn's is

> > > > > creating the issues with her blood pressure but at the same time can

> > > > > it be the cause of her extreme heart palpitations at times?

> > > > > > >

> > > > > > > SVT has to do with electrical issues in the heart but I was just

> > > > > wondering if anyone had heard of any correlation between the two. I

> > > > > do not want her to have the heart ablation if it is caused by the

> > > > > Conn's.

> > > > > > >

> > > > > > > She is taking meds for the Conn's as of a few days ago and her

> > > > > urine smells really awful. We are assuming that its the drug. Her

> > > > > adrenal glad is very swollen today. Her surgery is next week and she

> > > > > will not call and tell the doc that is swollen. She thinks they know

> > > > > that already. (they plan to do the ablation and check out her

> > > > > adrenals at the same time when she is on the table)

> > > > > > >

> > > > > > > Please let me know if you have any input.

> > > > > > > Any help is appreciated.

> > > > > > >

> > > > > > > Thanks so much-

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>