2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sana M Al-Khatib, William G Stevenson, Michael J Ackerman, William J Bryant, David J Callans, Anne B Curtis, Barbara J Deal, Timm Dickfeld, Michael E Field, Gregg C Fonarow, Anne M Gillis, Christopher B Granger, Stephen C Hammill, Mark A Hlatky, José A Joglar, G Neal Kay, Daniel D Matlock, Robert J Myerburg, Richard L Page
Circulation 2018 September 25, 138 (13): e210-e271
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阿伟 王

Prinzmetal's or Prinzmetal angina (/ˈprɪntsmɛtəl/, sounds like "prints metal") (also known as variant angina, vasospastic angina (VSA), angina inversa, or coronary vessel spasm) is a syndrome typically consisting of angina (cardiac chest pain) atrest that occurs in cycles.

Prinzmetal's angina - Wikipedia


阿伟 王

Sudden death syndrome


阿伟 王

Clinically one may observe a milder form of torsade en pointe, thst is the patient experiences some sort of discomfort in the chest, a dizzy feeling a fast heart rate, 170 per minute regular, reverting to normal, but i put to you, a présage of ventricular dysfunction, and i also put to you Sudden desth syndrome


阿伟 王

So they are not safe to be in the community, they do not have proper judgement, but
But they apparently have
The choice
They apparently miraculously recover when they want to smoke
No questions asked oh I know the hospital tells us of programs etc
But the are not looking as to why
These particular people
Anyone who is on neuroleptics can understand
Of course, they now are able to process what is needed to live
At the cost of
Well ? Being not very awake
It's as simple as that
Look at the research at hand
Some useful
Nicotine acts at same places in the brain as neuroleptics
Fair enough
The ascending reticular formation
Arousal centre par excellence non !?
Yes nicotine sort of may replace neuroleptics at sites of neurotransmission, yes it' improves cognition. Cognition is not arousal. Cognition has to do with doing some work., psychiatric patients I put to you, smoke to be aroused , it's a temporary thing , it's not always an addiction, which of course can Co exist , compounding the Problem, smoking wakes them up from that terrible feeling . Every time they smoke they get a positive reinforcement. Conditioning is occurring nothing to do with pleasure centres because of nicotine all to do with effect of nicotine on arousal. Yes so the solution is to
Explain clearly the difference
Why most people smoke. And why psychiatric patients probably in the majority, i suppose at first ale on smoking. Telling them about atherosclerosis, etc does not stop them, witness the universal habit of these patients, then look at prognosis, horrific much worse than even cardiac patients- oh it has to do with economical situation of psych patients compared to say cardiac patients .. told me a psychiatrist in charge of ST George Hospital Sydney


阿伟 王

Even a temporary lack of oxygen due to spasm- seen in angina as we all know, even in a so called stable angina- the hypothesis is therefore that combination of lithium, smoking causes PAT ( which I have myself observed - by the time patient got monitored sinus rhythm had reestablished itself. The argument goes like this. This is merely a warning sign for the more serious ventricular arrhythmias and in final case sudden death syndrome. As a GP in half houses, one had to be blind not to see all those psychiatric patients smoking their heads off . Apparently such patients can be scheduled for their own good , but are soon allowed sorties, not only that I was told by a very reliable patient, hospitals gave them free cigarettes..


阿伟 王

我哈沒有看這個话题。 可是我知道是没有也一点的
Important omission in research so far, serious consideration of sudden death, smoking cigarettes , to improve arousal not cognition, in psychiatric patients taking neuroleptic, such as lithium - which acts on neurone action potential, just like electrical conduction in heart, action potential, operon conditioning as treatment not patches of nicotine as these psychiatric patients may not have an addiction to nicotine, but smoking to improve their yearning for arousal, which neuroleptic clearly affect. Hypothesis that, smoking may cause coronary artery spasm - distinct from long term effects of smoking - which drs all too happy to talk to their patients about- offering the choice....of not smoking taking nicotine patches etc. Smoking is is hypothesised causes therefore spasm of coronary vessels, causing some anoxia to myocardial cells, heart muscle electrical conduction may be affected- the hypothesis is that this is the case, so that chemicals such as lithium for example - we know about clonazepam - clearly making one think of having been found to have a worse protective effect -20-30 % compared to for example olanzepam and other ketone containing neuroleptics, lithium works on neurones action potential. Hypothesis is that it may well affect cardiac conduction in a heart where there is a - even thiugh maybe temporary, causing supra ventricular tachycardia- at first - own observation, which could well progress to ventricular arrhythmia


阿伟 王

The hypothesis is that the same phenomenon is responsible for sudden desth syndrome, in psychiatric patients who take neuroleptics, especially like clonazepam, and i put to you, like lithium, and who smoke, on the basis of myocardial cell temporary, anoxia, irritability of cardiac functioning and interference with normal electrical conduction from pacemaker , affecting action potential to atria, and ventricle.


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