My World
Welcome to my world where the reality is here.
Monday, April 4, 2011
My second pregnancy..
Sunday, November 28, 2010
Therapeutic..
Friday, November 26, 2010
So many things.. So little time...
Friday, November 12, 2010
Tachycardia
The upper threshold of a normal human heart rate is usually based upon age:[1]
- 1–2 days: >159 beats per minute (bpm)
- 3–6 days: >166 bpm
- 1–3 weeks: >182 bpm
- 1–2 months: >179 bpm
- 3–5 months: >186 bpm
- 6–11 months: >169 bpm
- 1–2 years: >151 bpm
- 3–4 years: >137 bpm
- 5–7 years: >133 bpm
- 8–11 years: >130 bpm
- 12–15 years: >119 bpm
- >15 years – adult: >100 bpm
When the heart beats rapidly, the heart pumps less efficiently and provides less blood flow to the rest of the body, including the heart itself. The increased heart rate also leads to increased work and oxygen demand for the heart (myocardium), which can lead to rate related Ischemia thus perhaps causing a heart attack (myocardial infarction) if it persists. This occurs because the decreased flow of necessary oxygen to the heart causes myocardial cells to begin to die off. Acutely, this leads to angina; and chronically to ischemic heart disease.[2]
[edit]Differential diagnosis
An electrocardiogram (ECG) can help distinguish between the various types of tachycardias, generally distinguished by their site of pacemaker origin:
- Sinus tachycardia, which originates from the sino-atrial (SA) node, near the base of the superior vena cava.
- Ventricular tachycardia, any tachycardia which originates in the ventricles.
- Supraventricular tachycardia (SVT), which is a tachycardia paced from the atria or the AV node. SVT rhythms include:
Tachycardias may be classified as either narrow complex tachycardias (supraventricular tachycardias) or wide complex tachycardias. "Narrow" and "wide" refer to the width of the QRS complex on the ECG. Narrow complex tachycardias tend to originate in the atria, while wide complex tachycardias tend to originate in the ventricles. Tachycardias can be further classified as either regular or irregular.
[edit]Sinus tachycardia
[edit]Ventricular tachycardia
Ventricular tachycardia (VT or V-tach) is a potentially life-threatening cardiac arrhythmia that originates in the ventricles. It is usually a regular, wide complex tachycardia with a rate between 120 and 250 beats per minute. Ventricular tachycardia has the potential of degrading to the more serious ventricular fibrillation. Ventricular tachycardia is a common, and often lethal, complication of a myocardial infarction (heart attack).
Exercise-induced ventricular tachycardia is a phenomenon related to sudden deaths, especially in patients with severe heart disease (ischemia, acquired valvular heartand congenital heart disease) accompanied with left ventricular dysfunction.[3] A case of a death from exercise-induced VT was the death on a basketball court of Hank Gathers, the Loyola Marymount basketball star, in March 1990.[4]
Both of these rhythms normally last for only a few seconds to minutes (paroxysmal tachycardia), but if VT persists it is extremely dangerous, often leading to ventricular fibrillation.
[edit]Supraventricular tachycardia
This is a type tachycardia that originates from above the ventricles, such as the atria. It is sometimes known as paroxysmal atrial tachycardia (PAT). Several types of supraventricular tachycardia are known to exist.
[edit]Atrial fibrillation
Atrial fibrillation is one of the most common cardiac arrhythmias. It is generally an irregular, narrow complex rhythm. However, it may show wide QRS complexes on the ECG if a bundle branch block is present. At high rates, the QRS complex may also become wide due to the Ashman phenomenon. It may be difficult to determine the rhythm's regularity when the rate exceeds 150 beats per minute. Depending on the patient's health and other variables such as medications taken for rate control, atrial fibrillation may cause heart rates that span from 50 to 250 beats per minute (or even higher if an accessory pathway is present). However, new onset atrial fibrillation tends to present with rates between 100 and 150 beats per minute.
[edit]AV nodal reentrant tachycardia (AVNRT)
AV nodal reentrant tachycardia is the most common reentrant tachycardia. It is a regular narrow complex tachycardia that usually responds well to the Valsalva maneuver or the drug adenosine. However, unstable patients sometimes require synchronized cardioversion. Definitive care may include catheter ablation.
[edit]AV reentrant tachycardia
AV reentrant tachycardia (AVRT) requires an accessory pathway for its maintenance. AVRT may involve orthodromic conduction (where the impulse travels down the AV node to the ventricles and back up to the atria through the accessory pathway) or antidromic conduction (which the impulse travels down the accessory pathway and back up to the atria through the AV node). Orthodromic conduction usually results in a narrow complex tachycardia, and antidromic conduction usually results in a wide complex tachycardia that often mimics ventricular tachycardia. Most antiarrhythmics are contraindicated in the emergency treatment of AVRT, because they may paradoxically increase conduction across the accessory pathway.
[edit]Junctional tachycardia
Junctional tachycardia is an automatic tachycardia originating in the AV junction. It tends to be a regular, narrow complex tachycardia and may be a sign of digitalis toxicity.
[edit]Hemodynamic responses
The body has several feedback mechanisms to maintain adequate blood flow and blood pressure. If blood pressure decreases, the heart beats faster in an attempt to raise it. This is called reflex tachycardia. This can happen in response to a decrease in blood volume (through dehydration or bleeding), or an unexpected change in blood flow. The most common cause of the latter is orthostatic hypotension (also called postural hypotension). Fever, hyperventilation and severe infections can also cause tachycardia, primarily due to increase in metabolic demands.
[edit]Autonomic and endocrine
An increase in sympathetic nervous system stimulation causes the heart rate to increase, both by the direct action of sympathetic nerve fibers on the heart and by causing the endocrine system to release hormones such as epinephrine (adrenaline), which have a similar effect. Increased sympathetic stimulation is usually due to physical or psychological stress. This is the basis for the so-called "Fight or Flight" response, but such stimulation can also be induced by stimulants such as ephedrine, amphetaminesor cocaine. Certain endocrine disorders such as pheochromocytoma can also cause epinephrine release and can result in tachycardia independent nervous system stimulation. Hyperthyroidism can also cause tachycardia.[5]
[edit]Management
The management of tachycardia depends on the underlying cause.
If it is due to an underlying cardiac conduction abnormality chemical conversion (with antiarrhythmics), electrical conversion (giving external shocks to convert the heart to a normal rhythm) or use of drugs to simply control heart rate may be used.
If the tachycardia originates from the sinus node (sinus tachycardia), treatment of the underlying cause of sinus tachycardia is usually sufficient. On the other hand, if the tachycardia is of a potentially lethal origin (i.e.: ventricular tachycardia) treatment with anti arrhythmic agents or with electrical cardioversion may be required. Below is a brief discussion of some of the main tachyarrhythmias and their treatments.
The electrocardiac management of atrial fibrillation and atrial flutter is either through medications or electrical cardioversion. Pharmacologic management of these arrhythmias typically involves diltiazem or verapamil as well as beta-blocking agents such as atenolol. The decision to use electrical cardioversion depends heavily on the hemodynamic stability of the presenting patient; in general those patients who are unable to sustain their systemic functions are electrically converted although conversion to a normal sinus rhythm can be performed with amiodarone. An interesting type of atrial fibrillation which must be carefully managed is when it appears in combination withWolff-Parkinson-White syndrome. In this case, calcium channel blockers, beta-blockers and digoxin must be avoided to prevent precipitation of ventricular tachycardia. Here,procainamide or quinidine are often used. Of note: patients who have been in atrial fibrillation for more than 48 hours should not be converted to normal sinus rhythm unless they have been anti-coagulated to an INR of 2-3 for at least 4 weeks. This is to help prevent blood clots embolizing from the heart chambers to the rest of the body where they can cause adverse events like a stroke.
In the case of narrow complex tachycardias (junctional, atrial or paroxysmal), the treatment in general is to first give the patient adenosine (to slow conduction through the AV node) and then perform Valsalva maneuvers to slow the rhythm. If this does not convert the patient, amiodarone, calcium channel blockers or beta-blockers are commonly employed to stabilize the patient. Again as in atrial fibrillation, if a patient is unstable, the decision to electrically cardiovert him/her should be made.
With wide complex tachyarrhythmias or ventricular tachyarrhythmias, in general most are highly unstable and cause the patient significant distress and would be electrically converted. However one notable exception is monomorphic ventricular tachycardia which patients may tolerate but can be treated pharmacologically with amiodarone orlidocaine.
Above all, the treatment modality is tailored to the individual, and varies based on the mechanism of the tachycardia (where it is originating from within the heart), on the duration of the tachycardia, how well the individual is tolerating the fast heart rate, the likelihood of recurrence once the rhythm is terminated, and any co-morbid conditionsthe individual is suffering from.
Sunday, November 7, 2010
Kecewa..
Monday, September 13, 2010
Rania - 10 months...
Friday, March 26, 2010
Dosa sebarkan fitnah
HATI adalah organ paling utama dalam tubuh manusia dan nikmat paling agung diberikan Allah sebagai titik untuk menilai keikhlasan. Di hati lahirnya niat yang menjadi penentu sesuatu amalan diterima sebagai pahala atau sebaliknya.
Hati perlu dijaga dan dipelihara dengan baik supaya tidak rosak, sakit, buta, keras dan tidak mati bagi mengelak penyakit masyarakat yang berpunca daripada hati.
Kerosakan pada hati membawa kepada kerosakan seluruh nilai hidup pada diri seseorang individu. Penyakit hati yang menyerang kebanyakan kita ialah penyakit fitnah, sama ada menjadi penyebar atau mudah mempercayai fitnah.
Perbuatan fitnah adalah sebahagian perbuatan mengadu-domba yang mudah menyebabkan permusuhan dua pihak yang dikaitkan dengan fitnah berkenaan.
Masyarakat yang dipenuhi budaya fitnah akan hidup dalam keadaan gawat. Sebelah pihak sibuk menyebarkan fitnah dan sebelah pihak lagi terpaksa berusaha menangkis fitnah itu.
Natijah akibat perbuatan itu boleh mencetus persengketaan dan mungkin berakhir dengan tragedi kerugian harta benda dan nyawa. Individu yang suka menyebar fitnah sentiasa mencari kejadian atau berita boleh dijadikan bahan fitnah.
Dengan sedikit maklumat, berita itu terus disebarkan melalui pelbagai saluran yang merebak dengan mudah. Berita sensasi, terutama berkaitan individu ternama dan selebriti mudah mendapat perhatian khalayak.
Justeru, Allah memberi peringatan mengenai bahaya fitnah. Firman-Nya yang bermaksud: “Dan fitnah itu lebih besar bahayanya daripada pembunuhannya.†(Surah al-Baqarah, ayat 191)
Apabila fitnah tersebar secara berleluasa, ia bermakna nilai agama sudah musnah dalam diri seseorang atau masyarakat. Islam bertegas tidak membenarkan sebarang bentuk fitnah biarpun untuk tujuan apa sekalipun.
Rasulullah SAW bersabda bermaksud: “Akan muncul suatu ketika di mana ilmu Islam dihapuskan, muncul pelbagai fitnah, berleluasa sifat kedekut dan banyak berlaku jenayah.†(Hadis riwayat Muslim)
Penyebaran fitnah mudah berlaku dalam era teknologi komunikasi moden sekarang. Kemudahan khidmat pesanan ringkas (SMS), laman web dan emel membolehkan penyebaran maklumat tanpa memerlukan bertemu secara berdepan, lebih mudah, cepat, meluas dan murah.
Teknologi yang sepatutnya digunakan untuk kebaikan disalahgunakan untuk menyebarkan fitnah. Penyebaran fitnah melalui SMS yang berleluasa memaksa kerajaan menetapkan peraturan semua pemilik kad prabayar didaftarkan.
Islam mempunyai kaedah lebih ketat bagi memastikan kebenaran sesuatu berita supaya tidak terperangkap dengan berita berunsur fitnah. Wajib bagi Muslim menghalusi setiap berita diterima supaya tidak terbabit dalam kancah berita berunsur fitnah.
Sebarang berita diterima perlu dipastikan kesahihannya. Kebijaksanaan dan kewarasan fikiran amat penting digunakan bagi memastikan tidak terpedaya dengan berita berunsur fitnah.
Firman Allah bermaksud: “Wahai orang yang beriman, jika datang kepada kamu seorang fasik membawa sesuatu berita, maka selidik (untuk menentukan) kebenarannya, supaya kamu tidak menimpakan sesuatu kaum dengan perkara tidak diingini, dengan sebab kejahilan kamu (mengenainya) sehingga menyebabkan kamu menyesali perkara yang kamu lakukan.†(Surah al-Hujurat, ayat 6)
Banyak pihak yang turut terbabit menyebar fitnah sebenarnya tidak mempunyai sebarang kepentingan berkaitannya. Tetapi, disebabkan amalan menyebar fitnah sudah menjadi kebiasaan, banyak yang turut menyertainya dan seperti mendapat kepuasan daripada perbuatan itu.
Fitnah biasanya disebarkan bertujuan memburukkan individu atau kumpulan. Pada masa sama, perbuatan itu dapat menonjolkan dirinya sebagai lebih baik dan lebih layak berbanding orang yang diburukkan itu.
Dosa membuat fitnah digolongkan sebagai dosa sesama manusia. Justeru, dosa itu tidak akan diampunkan Allah, melainkan orang yang difitnah itu memberi keampunan terhadap perbuatan itu.
Mungkin ramai menyangka perbuatan menyebarkan berita fitnah sekadar satu kesalahan kecil. Sebab itu, perbuatan seumpamanya dilakukan seperti tiada apa merugikan.
Hakikatnya, dosa membuat fitnah menjauhkan diri dari syurga. Sabda Rasulullah SAW bermaksud: “Tidak masuk syurga orang yang suka menyebarkan fitnah.†(Hadis riwayat Bukhari dan Muslim)
Dosa menyebar fitnah umpama api membakar ranting kering kerana ia cepat merebak dan akan menjadi abu sepenuhnya. Dosa menyebar fitnah menyebabkan pahala terdahulu dihilangkan sehinggakan penyebar fitnah akan menjadi muflis di akhirat nanti.
Penyebar khabar angin biasanya menyebut perkataan ‘dengar khabar’ mengenai berita yang disebarkan. Bagaimanapun, apabila berita tersebar daripada seorang ke seorang, maklumat yang belum sahih itu sudah hilang dan kemudian disebarkan seperti berita benar.
Dalam Islam, sesuatu berita benar tetap tidak boleh disebarkan jika orang yang berkaitan cerita itu tidak mahu ia disebarkan kepada orang lain. Menyebarkan berita benar tetap dilarang, inikan pula menyebarkan berita tidak benar.
Imam Ghazali dalam buku Ihya Ulumuddin menjelaskan perbuatan membocorkan rahsia orang lain dan menjejaskan kehormatannya dengan cara membuka rahsianya yang tidak mahu diketahui orang lain dianggap sebagai perbuatan mengadu-domba dan fitnah.
Mengenai berita benar dan berita tidak benar yang disebarkan tanpa kebenaran atau kerelaan orang berkaitan, Rasulullah SAW bersabda bermaksud: “Adakah kamu semua mengetahui apakah ghibah (mengumpat)? Sahabat menjawab: Allah dan Rasul-Nya lebih mengetahui. Lalu Baginda meneruskan sabdanya: Kamu berkata mengenai saudara kamu perkara yang tidak disenanginya. Lalu ditanya oleh seorang sahabat: Walaupun saya berkata perkara yang benar-benar berlaku pada dirinya?’ Rasulullah bersabda lanjut: “Jika kamu berkata mengenai perkara yang benar-benar berlaku pada dirinya bererti kamu mengumpatnya, jika perkara yang tidak berlaku pada dirinya bererti kamu memfitnahnya.†(Hadis riwayat Abu Hurairah)
Larangan mencari dan membocorkan rahsia orang lain jelas dilarang Allah seperti dijelaskan dalam firman-Nya bermaksud: “Dan janganlah kamu mengintip atau mencari-cari kesalahan dan keaiban orang lain.†(Surah al-Hujurat, ayat 12)
Justeru, setiap Muslim perlu bijak menilai sesuatu berita bagi mengelak daripada menerima dan kemudian menyebarkan sesuatu berita berunsur fitnah.
Perkara pertama perlu diberi perhatian untuk memastikan kesahihan berita ialah memastikan sumber berita itu, yakni siapakah yang mula menyebarkan berita dan rantaian orang yang membawa berita itu.
Umat Islam tentu tidak lupa pada sejarah menyebabkan kematian khalifah ketiga kerajaan Islam di Madinah iaitu Uthman Affan, yang berpunca daripada fitnah disebarkan kumpulan ekstremis agama.
Penyebaran fitnah turut menjadi penyebab kepada peperangan sesama Islam atau perang saudara ketika zaman pemerintahan Saidina Ali dan zaman selepas itu.
Fitnah juga meruntuhkan kekuatan Bani Umaiyah malah, sejarah kejatuhan empayar besar kerajaan Melayu Melaka tidak terkecuali kerana fitnah. Ubat bagi penyakit hati ialah dengan memperbanyakkan taubat dan selalu berzikir.