0
What else can I help you with?
Intracardiac electrophysiology study (EPS)?
DefinitionIntracardiac electrophysiology study (EPS) is an invasive test that allows doctors to determine the details of abnormal heartbeats, or arrhythmias.See also: Cardiac ablation proceduresAlternative NamesElectrophysiology study - intracardiac; EPS - intracardiacHow the test is performedThe study involves placing wire electrodes in the heart to measure electrical activity along the heart's conduction system and in heart muscle cells themselves.The procedure is done in a hospital laboratory by a trained staff that includes cardiologists, technicians, and nurses. The environment is safe and controlled to minimize any danger or risk to the patient.A health care provider will clean your groin area and apply a numbing medication (anesthetic). The cardiologist will then place several IVs into the groin area. Once these IVs are in place, tubes (catheters) can be passed through the IVs into the body.The doctor uses moving x-ray images to carefully guide the catheter up into the heart and place the electrodes into the proper areas.The electrodes detect the heart's electrical activity and map out any abnormal heartbeats. This helps the doctor see the type of arrhythmia you have and where the problem starts in your heart.Abnormal electrical activity can occur anywhere along this heart's conduction system ("the heart's wiring"). Normally, the heart's electrical signals move through the the two chambers on the top of the heart (the atria), to the atrioventricular (AV) node, and then to the lower chambers of the heart (the ventricles).How to prepare for the testTest preparations are similar to those for a cardiac catheterization. Food and fluid will be restricted for 6 - 8 hours before the test. The procedure will take place in a hospital, and you will wear hospital clothing. You must sign a consent form for the procedure.Your health care provider will give you instructions regarding any changes to your normal medications. Do not stop taking or change any medications without consulting your health care provider.A mild sedative is usually given 30 minutes before the procedure. You may not be able to drive home yourself if you are discharged the same day.How the test will feelDuring the test, you will be awake and able to follow instructions.A simple EPS generally lasts from 20 minutes to 1 hour. It may take longer if other procedures are involved.Why the test is performedYour doctor may order this test if you have signs of an abnormal heart rhythm (arrhythmia). Information from this study helps your doctor determine the severity of the arrhythmia as well as the best treatment. Before this test is done, your cardiologist may have tried other, less invasive tests such as ambulatory cardiac monitoring.An EPS may be done to:Pinpoint a known arrhythmia that is beginning in the heart and help decide the best therapyDetermine whether you are at risk for future heart events, especially sudden cardiac deathSee if medicine is controlling an abnormal heart rhythmEvaluate the need for a pacemaker or implantable cardioverter-defibrillator (ICD)What abnormal results meanAbnormal results may be related to slow or fast abnormal heart rhythms. Some examples are:Sick sinus syndromeAtrial fibrillationHeart blockWolff-Parkinson-White syndromeSupraventricular tachycardiaVentricular fibrillation and ventricular tachycardiaThis list may not be all-inclusive.The health care provider must determine the exact location and type of the arrhythmia so that specific treatment can be given. The arrhythmia may start from any area of the heart's electrical conduction system.What the risks areThe procedure is generally very safe. Possible risks include:ArrhythmiasBleedingBlood clots that lead to embolismCardiac tamponadeHeart attackInfectionInjury to the veinLow blood pressureSpecial considerationsA catheter ablation may be done during EPS to treat the arrhythmia.ReferencesMiller JM. Diagnosis of cardiac arrhythmias. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 32.
Lactose intolerance?
DefinitionLactose intolerance is the inability to digest lactose (a type of sugar found in milk and other dairy products).Alternative NamesLactase deficiency; Milk intolerance; Disaccharidase deficiency; Dairy product intoleranceCauses, incidence, and risk factorsLactose intolerance happens when the small intestine does not make enough of the enzyme lactase. Babies' bodies make this enzyme so they can digest milk, including breast milk. Before humans became dairy farmers, most people did not continue to drink milk, so their bodies did not make lactase after early childhood.Lactose intolerance is more common in Asian, African, African-American, Native American, and Mediterranean populations than it is among northern and western Europeans.Lactose intolerance can begin at different times in life. In Caucasians, it usually starts to affect children older than age 5. In African-Americans, lactose intolerance often occurs as early as age 2.Lactose intolerance is very common in adults and is not dangerous. Approximately 30 million American adults have some amount of lactose intolerance by age 20.Lactose intolerance is sometimes seen in premature babies. Children who were born at full term generally do not show signs of lactose intolerance until they are at least 3 years old.Not having enough lactase (lactase deficiency) may also occur as a result of intestinal diseases such as celiac sprue and gastroenteritis, or after bowel surgery. Temporary lactase deficiency can result from viral and bacterial infections, especially in children, when the cells lining the intestine are injured.SymptomsAbdominal bloatingAbdominal crampsDiarrheaFloating stoolsFoul-smelling stoolsGas (flatulence)MalnutritionNauseaSlow growthWeight lossSymptoms often occur after you eat or drink milk products, and are often relieved by not eating or drinking milk products. Large doses of milk products may cause worse symptoms.Signs and testsEnteroscopyLactose-hydrogen breath testLactose tolerance testTest for stool-reducing substancesTreatmentRemoving milk products from the diet usually improves the symptoms. However, not having milk in the diet can lead to a shortage of calcium, vitamin D, riboflavin, and protein. Add other sources of calcium to the diet if you remove milk products.Most people with low lactase levels can tolerate 2 - 4 ounces of milk at one time (up to one-half cup). Larger (8 oz.) servings may cause problems for people with some amount of milk intolerance.These milk products may be easier to digest:Buttermilk and cheeses (they have less lactose than milk)Fermented milk products, such as yogurtGoat's milk (but drink it with meals, and make sure it is supplemented with essential amino acids and vitamins if you give it to children)Ice cream, milkshakes, and aged or hard cheesesLactose-free milk and milk productsLactase-treated cow's milk for older children and adultsSoy formulas for infants younger than 2 yearsSoy or rice milk for toddlersYou can add lactase enzymes to regular milk or take them in capsule or chewable tablet form.You may need to find new ways to get calcium into your diet (you need 1,200 - 1,500 mg of calcium each day):Take calcium supplementsEat foods that have more calcium (leafy greens, oysters, sardines, canned salmon, shrimp, and broccoli)Drink orange juice that contains added calciumRead food labels. Lactose is also found in some non-milk products -- including some beers.Expectations (prognosis)Symptoms usually go away when milk products are removed from the diet.ComplicationsWeight loss and malnutrition are possible complications.Calling your health care providerCall your health care provider if:You or your child has symptoms of lactose intolerance and you need information on food substitutes.Your symptoms get worse or do not improve with treatment, or you develop new symptoms.PreventionThere is no known way to prevent lactose intolerance.If you have the condition, avoiding or restricting the amount of milk products in your diet can reduce or prevent symptoms.ReferencesInformation from your family doctor. Lactose intolerance: what you should know. Am Fam Physician. 2006;74:1927-1928.Hogenauer C, Hammer HF. Maldigestion and Malabsorption. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006: chap98.
Atrial fibrillation/flutter?
DefinitionAtrial fibrillation/flutter is a heart rhythm disorder (arrhythmia). It usually involves a rapid heart rate that is not regular.Alternative NamesAuricular fibrillation; A-fibCauses, incidence, and risk factorsArrhythmias are caused by problems with the heart's normal electrical conduction system.Normally, the four chambers of the heart (two atria and two ventricles) contract (squeeze) in an orderly way. When this happens, your heart is able to pump the blood your body needs without working any harder than it needs to.The electrial impulse that signals your heart to contract begins in the sinoatrial node (also called the sinus node or SA node). This node is your heart's natural pacemaker.The signal leaves the SA node and travels through the two upper chambers (atria).Then the signal passes through another node (the AV node), and finally, through the lower chambers (ventricles).In atrial fibrillation, the electrical impulse of the heart is not regular. The atria are contracting very quickly and not in a regular pattern. This makes the ventricles beat abnormally, leading to an irregular (and usually fast) pulse. As a result, the heart may be working harder and may no longer be able to pump enough blood.In atrial flutter, the ventricles may beat very fast, but in a regular pattern.If the atrial fibrillation/flutter is part of a condition called sick sinus syndrome, the sinus node may not work properly. The heart rate may alternate between slow and fast. As a result, there may not be enough blood to meet the needs of the body.Atrial fibrillation can affect both men and women. It becomes more common with increasing age.Causes of atrial fibrillation include:Alcohol use (especially binge drinking)Congestive heart failureCoronary artery disease (especially after a heart attack or coronary artery bypasssurgery)Heart surgeryHigh blood pressure (hypertension)Hypertrophic cardiomyopathyMedicationsOveractive thyroid gland (hyperthyroidism)PericarditisValvular heart disease (especially mitral stenosis and mitral regurgitation)SymptomsYou may not be aware that your heart is not beating in a normal pattern, especially if it has been occurring for some time.Symptoms may include:Pulse that feels rapid, racing, pounding, fluttering, or too slowPulse that feels regular or irregularSensation of feeling the heart beat (palpitations)Shortness of breathConfusionDizziness, light-headednessFaintingFatigueNote: Symptoms may begin or stop suddenly. This is because atrial fibrillation may stop or start on its own.Signs and testsThe health care provider may hear a fast heartbeat while listening to the heart with a stethoscope. The pulse may feel rapid, irregular, or both. The normal heart rate is 60 - 100, but in atrial fibrillation/flutter the heart rate may be 100 - 175. Blood pressure may be normal or low.An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring -- Holter monitor (24 hour test) -- may be necessary because the condition often occurs at some times but not others (sporadic).Tests to find underlying heart diseases may include:Coronary angiographyEchocardiogramElectrophysiologic study (EPS)Exercise treadmill ECGNuclear imaging testsTreatmentIn certain cases, atrial fibrillation may need emergency treatment to get the heart back into normal rhythm. This treatment may involve electrical cardioversion or intravenous (IV) drugs such as dofetilide, amiodarone, or ibutilide. Drugs are typically needed to keep the pulse from being too fast.Daily medications taken by mouth are used in two different ways:To slow the irregular heartbeat. These medications may include beta-blockers, calcium channel blockers, and digitalis.To keep atrial fibrillation from coming back. These medications may work well in many people, but they can have serious side effects. Many patients may go back to atrial fibrillation even while taking these medications.Blood thinners, such as heparin and warfarin (Coumadin) reduce the risk of a blood clot traveling in the body (such as a stroke). Because these drugs increase the chance of bleeding, not everyone will use them. Antiplatelet drugs such as aspirin or clopidogrel may also be prescribed. Your doctor will consider your age and other medical problems to decide which drug is best.A procedure called radiofrequency ablation can be used to destroy areas in your heart that may be causing your heart rhythm problems. Cardiac ablation procedures are done in a hospital laboratory by specially trained staff. Reasons why ablation may be done include:When medicines are not controlling the symptoms, or are causing side effectsWhen the condition will become dangerous if not treatedAs a possible cure for some patients with atrial flutterSome patients may need the radiofrequency ablation done directly on an area of the heart called the AV junction. Ablation of the AV junction leads to complete heart block. This condition needs to be treated with a permanent pacemaker.Expectations (prognosis)The disorder is usually controllable with treatment. Many people with atrial fibrillation do very well.Atrial fibrillation tends to become a chronic condition, however. It may come back even wtih treatment.ComplicationsFainting (syncope), if atrial fibrillation and atrial flutter cause the pulse to be too quick or slowHeart failureStroke, if clots break off and travel to the brain (drugs that thin the blood such as heparin and warfarin can reduce the risk)Calling your health care providerCall your health care provider if you have symptoms of atrial fibrillation or flutter.PreventionFollow the health care provider's recommendations for treating underlying disorders. Avoid binge drinking.ReferencesLafuente-Lafuente C, Mahe I, Extramiana F. Management of atrial fibrillation. BMJ. 2009;b5216.Dobrev D, Nattel S. New antiarrhythmic drugs for treatment of atrial fibrillation. Lancet. 2010;375:1212-1223.Crandall MA, Bradley DJ, Packer DL, Asirvatham SJ. Contemporary management of atrial fibrillation: update on anticoagulation and invasive management strategies. Mayo Clin Proc. 2009;84:643-662.Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. Circulation. 2006;114:e257-e354.Noheria A, Kumar A, Wylie JV Jr., Josephson ME. Catheter ablation vs. antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Arch Intern Med. 2008;168:581-586.
