Summary:The prevalence of elderly individuals in the populations of developed countries is increasing rapidly, and atrial tibrillation (AF) is quite common in these elderly patients: currently, 11 % of the U.S. population is between the ages of 65 and 85 years; 70% of people with AF are between the ages of 65 and 8.5 years. AF causes symptoms secondary to hemodynamic derangements that are the result of increased ventricular response and loss of atrial booster function. AF can lead to reversible impairment of left ventricular function, cardiac chamber dilatation, clinical heart failure, and thromboembolic events. AF requires treatment in order to prevent these potential complications. Type la, Ic, and 111 antiarrhythmics are capable of converting AF to normal sinus rhythm (NSR). Amiodarone has the greatest efficacy and safety for converting AF and maintaining NSR while digoxin and verapamil are ineffective in restoring NSR. Quinidine, flecainide, disopyramide, and sotalol have also been shown to maintain NSR after conversion of AE Proarrhythmia is a definite concern with the latter four agents. Alternative therapy for AFindudes anticoagulation with warfarin or aspirin for the prevention of thromboembolic events, and a variety of agents to control the ventricularresponse. All medications used to treat AF carry significant risks in the elderly, whether from proarrhythmia, overdosing because of compliance errors, or hemorrhage secondary to anticoagulation. Treatment of AF must be based on a careful risk-benefit evaluation. The physician must know the capability of the particular patient as well as
Spindle-cell sarcomas are a group of aggressive malignant soft-tissue tumors with diverse clinical presentations. While some of these tumors may represent de novo malignant transformation of benign entities, others may present with a long indolent course before their invasive nature is apparent. We report the case of a previously healthy 73-year-old female with spindle-cell sarcoma of the left popliteal fossa who initially presented with a painless mass of several months' duration. Magnetic resonance imaging (MRI) suggested a benign vascular lesion/venous angioma, but after the patient’s clinical course changed, repeat MRI 18 months later was consistent with an infiltrative soft-tissue malignancy/sarcoma. Excisional biopsy revealed a stage II spindle-cell sarcoma. The patient then underwent radiotherapy and subsequent above-the-knee amputation. Three years following the amputation, the patient is free of local tumor recurrence or metastatic disease.
The Class IC antiarrhythmic drugs, propafenone and flecainide, may slow the atrial rate during atrial flutter permitting 1:1 AV conduction. This effect is well known to occur soon after starting treatment for atrial fibrillation or atrial flutter with these Class IC drugs. We report two patients who had adverse effects after prolonged treatment with either propaienone or flecainide. In addition, we illustrate that this adverse effect can occur despite concomitant treatment with drugs that act on the AV node to prevent rapid AV conduction. A.N.E. 2000;5(1):101–104
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.