Elevated Heart Rate Over Time Significant Risk Of Death

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Yvonne
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Elevated Heart Rate Over Time Significant Risk Of Death

Post by Yvonne » Sun 15 Aug 2010 16:11

http://www.medicalnewstoday.com/articles/197628.php

Elevated Heart Rate Over Time Linked To Significant Risk Of Death
An elevated resting heart rate that develops or persists during follow-up is associated with a significantly increased risk of death, whether from heart disease or other causes, researchers from the Ronald O. Perelman Heart Institute at NewYork-Presbyterian Hospital/Weill Cornell Medical Center found studying outcomes in more than 9,000 patients.

The findings, published July 2 online in the European Heart Journal, suggest that tracking heart rate over time can provide a profoundly simple and important marker of health issues that could become lethal but which also might be prevented with diagnosis and treatment

"It is easy and inexpensive to determine heart rate, and in fact is done routinely in a doctor's office. But this study suggests that physicians need to track the pattern over a number of years, not just consider single readings," says the study's lead investigator, Dr. Peter Okin, a noted cardiologist at the Ronald O. Perelman Heart Institute of NewYork-Presbyterian/Weill Cornell and professor of medicine in the Division of Cardiology at Weill Cornell Medical College.

"Based on this study, we believe that an elevated heart rate seen over a number of years is worrisome, signifying that these patients need further evaluation to see what might be causing the high heart rate," he says.

In their study, researchers discovered that development of a heart rate of 84 beats per minute or greater that either developed or persisted in patients during the study's average five-year time span was linked to a 55 percent greater risk of cardiovascular death and a 79 percent greater risk of death from all causes. Although the participants had hypertension, the scientists adjusted for this fact as well as for other cardiovascular risk factors. A healthy heart rate is between 60 and 80 beats per minute.

Even incremental increases in heart rate were associated with increased risk of death. For example, every extra 10 beats per minute higher than a normal resting pulse was associated with a 16 percent increased risk of death from cardiovascular disease and a 25 percent greater risk of all-cause death

This is one of the few studies that has looked at changes in heart rate over time, says Dr. Okin. The notion is that because heart rates may increase or decrease over time in response to changes in a person's condition or response to a treatment, the predictive value of a single heart rate measurement is less valuable than measurements over time.

"Heart rates can change day to day and year to year," he says. "It's like having a higher body temperature one day that goes away the next. Something caused the fever, but it has resolved, perhaps with treatment. Heart rate is the same over a longer time span. If it goes up and remains elevated, some disorder is likely to blame

For example, high heart rate, among other things, is a marker of increased sympathetic nervous system activity, which itself is linked to increased heart ischemia, and is also associated with promoting atherosclerosis and susceptibility to arrhythmia.

This study is a sub-analysis of the LIFE (Losartan Intervention For Endpoint) study, which has been completed. It enrolled 9,193 patients from Scandinavia and the United States to test two different treatments (losartan versus atenolol) for hypertension. Among other variables, heart rate was routinely measured in these patients.

In this study, researchers divided 9,190 patients into two groups those that had a persistent heartbeat rate of 84 or greater per minute, and those that had less. That figure was selected because other studies had suggested it was linked to mortality risk.

After a mean of almost five years, 814 patients (8.9%) died 438 (4.8%) of which from cardiovascular disease. After adjusting for possible effects of randomized treatment, and for every other risk factor (such as age, gender, race, diabetes, history of heart disease, and so on), the researchers found a strong association between persistent elevated heart rate and risk of death.

The patients died from a variety of causes, but considering all factors, "heart rate remains a significant predictor of increased mortality," Dr. Okin says. "In addition to high blood pressure, this study demonstrated that changing heart rate over time is a highly significant predictor of mortality."

To date, no medication has been approved in the United States that can reduce heart rate without side effects, although a drug (ivabradine) is being tested, he says. Exercise and diet have also been shown to lower heart rate.
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Spanky
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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by Spanky » Sun 15 Aug 2010 19:20

"Yvonne":

After adjusting for possible effects of randomized treatment, and for every other risk factor (such as age, gender, race, diabetes, history of heart disease, and so on), the researchers found a strong association between persistent elevated heart rate and risk of death.
OH, GEE, THANKS, Yvonne. Now, I feel much better... :lol:

That probably explains why the insurance company rejected me so quickly, too. (And I probably should take back what I said about the tachycardia thing not being particularly dangerous in another thread, too).

http://www.lymeneteurope.org/forum/view ... ?f=5&t=244

Guess the only thing for me now is to sell everything and live out my few remaining years in some warm, tranquil, non-stressful setting...where only the sight of scantily-clad Polynesian women will raise my heartrate. "Here today, gone to Maui".

And see, that business about not getting the proper initial treatment...just keeps getting funnier and funnier...I sure can see how some think that is so damned funny... :roll:

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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by X-member » Sun 15 Aug 2010 19:39

Spanky, you wrote:
And see, that business about not getting the proper initial treatment...just keeps getting funnier and funnier...I sure can see how some thing that is so damned funny...
I am sure it would have been better if you have had "a proper initial treatment" before your Lyme became harder to cure.

According to what Brorson (the Norwegean "cyst-man" :D ) said in Norwegean TV, it is when you have had Lyme for 6 - 12 month, that it become harder to treat.

But, if you get a bit longer treatment (maybe like the one you already have had) you can be cured (=come into remission) if you haven't had Lyme for more than 1 - 2 years before treatment! It depends on if you had a good immune defence before you got Lyme!

It is not where the infection is located in the body that is most important to know how long treatment you need, it is how long you have had Lyme before treatment!

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Spanky
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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by Spanky » Sun 15 Aug 2010 20:05

"Carina":

I am sure it would have been better if you have had "a proper initial treatment" before your Lyme became harder to cure.

What I am referring to there is the failure, in my case, to have an iv, because there was a diagnosis of Lyme carditis. (It's in my records). And, as I have indicated in another thread, here, I had briefly lost consciousness a few times, around that time, that's how bad it had gotten, which I suspected was being caused by the heart troubles. Yvonne actually found a very similar description of that and posted it here:

http://www.lymeneteurope.org/forum/view ... ?f=5&t=244

Even the IDSA says that is what should be done in that instance. And, according to another post of Yvonne's...maybe even in a hospital setting.

Whether or not that would have made a difference?

No one will ever know.

But look...since the insurance company didn't have to pay for the iv or the hospital stay...I figure they owe me for the reasonable costs of both.

Plus accumulated interest, compounded daily, for ten years.

Offer: settle out of court...two weeks on Maui. Win-win.

Call me. :D

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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by X-member » Sun 15 Aug 2010 21:52

Hello again Spanky! :D

Let's see, so if you have had "a proper initial treatment" after 2 years from the start of the disease, then you think it would have been enough with only one month treatment?

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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by Spanky » Sun 15 Aug 2010 22:35

"Carina":Hello again Spanky! :D

Hey, 'how ya doin?", Carina... (that's how we say "hi" in Chicago)... :D
Let's see, so if you have had "a proper initial treatment" after 2 years from the start of the disease, then you think it would have been enough with only one month treatment?
Gee, I don't know. The point, though, of the iv is to get the level of antibiotics up quickly, as I have tried to explain earlier in another thread. The iv is only a delivery mechanism. In a case of Lyme carditis, I guess there is a need for speed.

Here's what the current IDSA Guidelines say:

http://www.journals.uchicago.edu/doi/pdf/10.1086/508667
Lyme carditis.

Patients with atrioventricular heart block
and/or myopericarditis associated with early Lyme disease may
be treated with either oral or parenteral antibiotic therapy for
14 days (range, 14–21 days). Hospitalization and continuous
monitoring are advisable for symptomatic patients, such as
those with syncope, dyspnea, or chest pain. It is also recommended
for patients with second- or third-degree atrioventricular
block, as well as for those with first-degree heart block
when the PR interval is prolonged to 30 milliseconds, because
the degree of block may fluctuate and worsen.
"Syncope" means passing out, fainting, losing it...exactly what I was doing. Had the chest pain, too.

So, it looks like I should have not only been administered an iv...immediately...but should have also been in the hospital.

Under today's guidelines...a repeat treatment is recommended if there is treatment failure:
NOTE. Regardless of the clinical manifestation of Lyme disease, complete response to treatment may be delayed beyond the treatment duration. Relapse
may occur with any of these regimens; patients with objective signs of relapse may need a second course of treatment.
And, as the following paragraph, below, reads, it is important to note that the Guidelines really are not substitutes for individual judgment.

I guess, based upon my own experiences, I would certainly suggest that the physician not arbitrarily cut-off treatment based upon Guideline recommendations...but base treatment length decisions, instead, on how the patient responds, with particular care to cases where diagnosis was delayed.
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to the guidelines listed below to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.
-----------------------------------------------------------------------------------------------------------

Blue man insurance group : I am thinking that I forgot about pain and suffering and emotional distress. Now, the offer is three weeks, with Mai-Tai drip. Don't wait too long. Hiring lawyers is expensive.

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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by X-member » Sun 15 Aug 2010 22:54

Hi, again Spanky!

I think I know and understand a lot of American or English expressions, since I have had an English boyfriend, and since my eldest sons father live in Ohio! :D

But, I am spoiled, because both of them understand Swedish, so my own written English is not improving! :D

I think that the members of IDSA have a lot to learn!

And, what ever you do, do not have repeted too short or too poor treatments (with only one type of abx), because this could make the bacteria to change into a form or forms that are very resistant to abx (source: Lida Mattman and other educated persons).

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Spanky
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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by Spanky » Mon 16 Aug 2010 1:22

"Carina":
I think I know and understand a lot of American or English expressions, since I have had an English boyfriend, and since my eldest sons father live in Ohio! :D
Yes, and I am understanding you quite well! This is a difficult and technical subject, though. And sometimes shades of meaning, I suspect, are missed or misinterpreted because of language.

When I said, "how ya doin" (how are you doing) is a Chicago way of saying, "hello"...it really is sort of unique to Chicago neighborhoods...and Chicago has its own, distinctive accent. (Not everyone. I don't. But people who were raised here, especially on the South and Southwest sides of town).

To do it properly, you kind of have to hold your nose and talk out of the side of your mouth, while hitting the other person lightly on the arm. Sort of smack them and say, "hey, howyadoin, dere, (there) Spanky"? :lol:

(My brother-in-law is of Swedish ancestry. I will post some Swedish-American things for you on the off-topic board). The upper Midwest was settled by many people from Scandinavia...and many Swedes came to live in Chicago.
I think that the members of IDSA have a lot to learn!
Well, okay...but I would rather that YOU tell them.

I have had the experience of talking to infectious disease doctors about Lyme disease.

I would rather go to the dentist. Or the opera, even...and I'm not too worried about the longterm tachycardia stuff.

Compared to the risk of getting run over in the parking lot by a soccer mom on her cell phone in her SUV/monster truck?

Piece of cake.

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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by Cobwebby » Mon 16 Aug 2010 3:49

Since I have lived to tell about it I do have a funny story about my heart arrythmias.
Also having a history of these episodes in the year prior to my being officialy diagnosed with Lyme Disease makes me think that I was effected by LD long before it brought me to my knees.

Anyway- From time to time I would feel this very unnatural heart beat . I don't know if it was the arrythmia or my fear of impending heart attack that made me faint of heart. But they seemed to subside on their own which brought such relief I never mentioned them to anyone. It's called denial. :)

One day picking the kids up from school I hopped out of the car and was talking to another Mom when my heart flipped into this unnatural rythym. I stopped mid conversation and went back to sit in my car-but the episode did not subside. By this time the kids are in the car, and I'm thinking maybe I can take my mind off of this and lower my anxiety if I concentrate on driving.

But I felt like I was on the verge of passing out-which isn't the best condition to be driving, especially with kids in the car. So, still without saying anything to the kids, I turned the car around at the end of the parking lot and drove back to the school office and parked. Still I'm waiting for it to subside.

I finally told the kids "Mommy's heart feels funny so let's go in the office" Which we did. I sank into a chair and asked someone to call my husband to come pick us up. The secretary asked me if i wanted to call 911, but I said no . We were in the county and i would be taken to an unfamiliar hospital.

They called my husband, who advised me to at least call my doctor. A nurse at his office said I needed to go to the nearest hospital. I said "Fine, but i want my husband to come pick me up and take me". Which he did.
I think the office staff was quite relieved to have me out of there because I was scaring them with my stubborness and inability to move. :o

We drove twenty minutes to a hospital close to our home. My husband kept asking me to take my pulse and I kept trying to explain to him that I couldn't because it was too fast. We were doing this silly "go' and 'stop' business with one of the kids looking at the clock. It was futile.

Once at the hospital, Jim dropped my off at the emergency entrance. I thought he was going to park the car. What I didn't know was that he decided to take the kids to McDonald's and then home for grandma to watch.

I walk up to the triage desk and simply say my heart is acting funny. Of course I was quickly ushered back and hooked up for an EKG. The reading meant nothing to me-but it sure made an impression on the nurse because she immediately said she was getting the doctor and they were going to have to do a cardioversion.

An IV was placed in the upper part of my right arm(for faster delivery they told me) of a drug called Adenosine
which was going to stop my heart for 15 seconds and hopefully a normal rythym would follow.

I wanted to call my husband. Here I was in a hospital, nobody knew I was there, and they were about to stop my heart. But time was a wastin' , there was no cell phone service AND the room phone was not connected.

My life was in their hands. I lay on the table. I could not see the monitor, but I could see the expressions on their faces- the doctor and several nurses with a crash cart in the room.

In went the drug, all eyes would flit from my face to the monitor and back to my face. Seemed like everybody was holding their breath. When my heart did stop-what I felt was hot molten lava pooling in my chest, up the back of my neck and down my arms. I couldn't move. I didn't dare move.

After what seemed like an eternity-but was really only 15 seconds or so-there was a collective sigh of relief. I took that as a good sign. My heart rythym was back to normal. :-P

By the time my dear husband did make it back to the hospital I was ready for discharge with a prescription for a beta blocker in hand and a strong admonition not to wait if it should happen again. Call 911.

I must tell you- I felt euphoric. To have cheated death once again. They stopped my heart and I lived to tell about it while my husband was at McDonald's playing in the ball pit with the kids. :o

I asked if i had had a heart attack-"no" they said-"but an arrythymia like I had often leads to heart failure."
Of course I had extensive follow up-but no body mentioned Lyme Disease. It was just one more piece of the puzzle.

Nobody connected the dots until I made it to an LLMD.

Following my infection induced heart attack last Spring when I had sepsis I am now followed more closely by a cardiologist and very greatful to have her on board-especially since she takes insurance.

http://www.bellaonline.com/articles/​art3037.asp
Cardioversion

The cardiovascular system is one of the key players in the health and wellness of our patients. When the heart is not functioning properly, every other system is affected adversely. One of the ways in which the heart can malfunction involves the electrical conduction system. Some of the more commonly seen arrhythmias are ventricular fibrillation with a pulse, rapid atrial fibrillation/flutter, and supraventricular tachycardias. This last rhythm is really a catch-all for any narrow, rapid rhythm originating outside of the sinus node and above the ventricles.

The danger in all of these rhythms is insufficient perfusion of the brain and other vital organs, as well as stroke resulting from micro-clots due to the choppy blood flow. The nurses responsibility is to recognize the rhythm and be able to run the algorithm for treatment dependent on the patient’s presentation, rhythm, and standing orders. Cardioversion is one of the treatment options and comes in several forms that “convert” the heart rhythm to one that is more optimal for health.

Chemical cardioversion is routinely achieved with diltiazem (Cardizem) IV bolus and gtt, as well as adenosine (Adenocard) IV rapid push. Diltiazem works by blocking entry of calcium into the cardiac muscle cell, thus slowing the ability of the cell to contract. Adenosine can be a scary drug to administer as it blocks the atrial-ventricular communication, causing the heart to stop briefly. Due to this chemical interruption, the re-entry arrhythmias are disrupted. It is important for the nurse to remain calm and supportive of the patient. Be sure to position your cardiac monitor away from the patient and family’s line of sight! Rarely, a patient will present with ventricular fibrillation and appear fine. While you attempt to chemically cardiovert this patient with amiodarone (Cordarone), be sure to have the defibrillator ready to go!

A second way to cardiovert is with electricity. This can be achieved with an implantable device, an external device that a patient wears, or done manually by trained staff. Cardioversion is always done in sync with the patient’s rhythm. Otherwise, you would be defibrillating, which is another thing altogether! The cardiac monitor senses the ventricular contraction and times the electrical impulse to prevent triggering ventricular fibrillation. It is critical to reset the sync button with each delivered charge, as most monitors automatically remove this feature after shock delivery. It is equally important to have adequate sedation for the patient, as it is a painful procedure. Follow the ACLS recommended guidelines for joules delivered and know if your machine is biphasic or monophasic.

Both forms of cardioversion require the same procedural tools. Know your rhythms and your equipment, have IV access, and administer oxygen and sedation. These are formulated actions that your institution should train you to perform comfortably and proficiently. Above all else, observe the patient. The monitor is only a tool to assist you in “seeing” the patient. After cardioversion, your patient will require monitoring and some form of antiarryhthmic drug either IV or PO, as ordered by the physician. Spend time teaching the patient about the rhythm they had, the dangers it posed, and the importance of medication compliance.
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Spanky
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Re: Elevated Heart Rate Over Time Significant Risk Of Death

Post by Spanky » Mon 16 Aug 2010 5:37

"Cobwebby":
Since I have lived to tell about it I do have a funny story about my heart arrythmias.
Well, all I can say, then, in response to this very colorful tale is that you should be the very last person to be online mocking someone else's misfortune, then.

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