arrrhythmia

In heart failure, decreased cardiac output leads to a number of adaptive mechanisms. Among these, neuroendocrine activation including activation of the renin-angiotensin-aldosterone system, augmentation of vasopressin and endothelin release, and activation of the sympathetic nervous system occur. The increase of adrenergic drive is characterized by decreased baroreceptor sensitivity, increased plasma norepinephrine levels and cardiac norepinephrine spillover, and desensitization of postsynaptic β-adrenergic signal transduction...

Postero-lateral thoracotomy has many complications such as postoperative pain, limitation in the motion of the shoulder, decreasing pulmonary function from immobilization, increasing lung atelectasis from over-use of analgesia, and increasing pulmonary morbidity, especially in elderly patients. So, muscle-sparing thoracotomy appears to be a good alternative. But it has also many disadvantages such as seroma and the needs for drains, limitation of an accessible operative field, and difficulties with risky procedures...

Extensive clinical experience indicates that cardioversion is the most effective method now available for terminating cardiac tachyarrhythmias. This procedure is not accompanied by depression of myocardial contractility, conductivity, or excitability, a common sequel to the use of antiarrhythmic drugs. Furthermore, the incidence of complications with cardioversion is low. These features of effectiveness, safety, and simplicity permit cardioversion to be used by the noncardiologist physician, who may be less experienced than a cardiologist in recognizing arrrhythmias...