Rheumatic Heart Disease

Rheumatic Heart Disease

Rheumatic Heart Disease is an illness that occurs when the heart muscle is damaged due to rheumatic fever. Rheumatic fever is known as an inflammatory disease that will affect many areas of the body in addition to the heart. Other areas that can be affected are the brain, skin and joints. In the case of the heart, however, rheumatic fever, silently damages the valves to the point where they are not doing their job of regulating blood flow into, and out of, the heart. If you have had rheumatic fever in the past then it is a good idea to get checked for rheumatic heart disease. The disease can quietly cause many symptoms in a person that can slowly lead to heart failure. The important thing to remember is that if you are experiencing any of the symptoms to head to your doctor right away to get checked out.

Symptoms of Rheumatic Heart Disease

In most cases a person who gets rheumatic heart disease will have had rheumatic fever, and before that strep throat. If the strep throat is not properly cared for it can turn into rheumatic fever which can turn into rheumatic heart disease. The symptoms of rheumatic fever will begin to show up about three weeks after the symptoms of strep throat show up.
* Fever.
* Swollen and painful joints all over the body.
* Pain that starts in one joint but suddenly jumps to another joint without warning.
* Heart palpitations and a rapid heartbeat.
* Shortness of breath or trouble breathing during normal activities.
* Skin rashes all over the body.
* Extreme fatigue at all points during the day.
* Nodules under the skin that are small and pain free.

Preventing Rheumatic Heart Disease

* Treat strep throat with penicillin in order to prevent rheumatic fever from developing.
* Continuous antibiotic treatment until the symptoms of rheumatic fever subside.
* Living a healthy lifestyle. Take care of your body so your body takes care of you.

If you have been diagnosed with rheumatic fever then you are at risk for developing rheumatic heart disease. The disease can occur at any point in life even after you rid yourself of rheumatic fever. Since the onset is quick and sudden, it is important to take the time to properly monitor the condition with your doctor. If you are diagnosed with rheumatic heart disease your doctor will be able to get you on a treatment plan that can help to minimize the potential of serious consequences.

Types of Heart Disease

Heart disease has become a disease which is effecting maximum number of people. Heart disease effects the functions of the heart. Heart is the most important part of human body which pumps the blood to the blood cells. Inadequate supply of blood may to blood cells can lead to many complications. There are many types of heart disease and each type of heart disease effects the heart in one or another way. The death caused by heart disease has increased in the past few years. The new techniques of diagnosing the heart disease has helped in spreading the awareness about the disease. As the lifestyle of people is changing more and more people are becoming victim of heart disease. The types of heart disease are Coronary heart disease (CHD), Rheumatic heart disease, Heart rhythm disorders, High blood pressure, Hypertensive heart disease, Heart attack, Pulmonary heart disease, Ischemic heart disease, Heart murmurs and Tachycardia.

Types of Heart Disease

Coronary heart disease (CHD) is one of the types of heart disease. It is one of the common types of heart disease caused by inefficiency of blood supply. Most of the people suffer from this type of disease. The heart disease which is caused by the heart damage from rheumatic fever. There are many symptoms of Rheumatic heart disease and each symptom varies according to the heart damage. The heart rhythm disorder is also called as arrhythmia. It is the the disorder in the rhythm of heart. This heart disease can sometime be harmless and dangerous also. One of the common types of heart disease is the disease caused by high blood pressure. It is a disease which is effects maximum number of people. This heart disease is called hypertension. This type of heart disease has to be diagnosed properly to avoid further complications. It is also called as a silent killer. The blood pressure has to be constantly checked. High blood pressure can give arise to many problems. Headache, discomfort and tinnitus are some of the symptoms of blood pressure. Hypertensive heart disease is also a type of heart similar to the heart disease cause by high blood pressure. Symptoms of the hypertensive heart disease are shortness of breath, nausea, fatigue, irregular pulse and hypertension.

Heart attack is also one of the types of heart disease. It is very deadly and is causing maximum number of deaths. It is also called as cardiac arrest and the symptom of this disease is the chest pain. Emergency help is also required if the chest pain is too much. Sometime people mistake chest pain with common heart burn. Pulmonary heart disease is caused because of lung disorder. When the flow of blood to the lungs are blocked this causes lung pressure and eventually resulting in a heart disease. The common symptoms of this type of heart disease are syncope, shortness of breath, chest pain, dyspneea, etc. In heart murmur the heart beat of the heart sounds different from the normal beating. Tachycardia results from the fast and rapid heart beat.

Hypertensive cardiomyopathy

Hypertensive Cardiomyopathy

Hypertensive cardiomyopathy is caused by the excess depression of the myocardial systolic function that in turn increases the stress on the wall of the heart. An individual can have heart failure after functions like ventricular dilatation and depressed systolic remains after the hypertension correction. There are many kinds of heart diseases in which cardiomyopathy is another type. There are many types of cardiomyopathy as well. Hypertension is the major cause of hypertensive cardiomyopathy, hence the name. According to the classification given by WHO/ISFC, hypertensive cardiomyopathy are anything under the category of dilated, unclassified and restrictive. Pathophysiologic of this type of cardiomyopathy is distinct. People who suffer from heart disease are kept under observation and restriction in order to keep them out of stress as much as possible.

Distinct pathophysiologic in hypertension in dilated cardiomyopathy happens from extreme pressure on the systolic wall. In the overloading of right and left ventricles of systolic pressure, there is varieties of phenotypic expression that is qualitatively. This can include the dilation and systolic dysfunction but there is no thickness of the heart wall. Concentric hypertrophy with or without systolic dysfunction and vice versa is seen in hypertensive cardiomyopathy. Local neurohormonal mechanisms contributes to pathophysiology of hypertensive cardiomyopathies. The prognosis of hypertensive cardiomyopathy is possible by the existence of comorbid conditions like diabetes mellitus and diseases like coronary artery. The control of afterload too is another prognosis of hypertensive cardiomyopathy.

Hypertensive cardiomyopathy has treatment similar to ischemic dilated cardiomyopathy. The only difference is that the afterload of this heart disease has to be controlled more intensely. Pure antihypertensive vasodilators like amlodipine or a-blocking agents are added to the therapies of heart failure. The symptoms of hypertensive cardiomyopathy are similar to many heart diseases. The symptoms are fatigue, dyspnea, shortness of breath, great need to urinate at night, irregular pulse, weight gain, difficulty sleeping flat in bed, swelling of feet and nausea.

Hypertensive heart disease can give rise to complications known as cardiac arrhythmias, left ventricular hypertrophy, congestive heart failure, coronary heart disease and hypertensive cardiomyopathy. The inflammation of the heart muscles weakens the ability of the heart to pump blood into the other parts of the body. This causes lack of oxygen in the body giving rise to fatigue and restlessness. High blood pressure makes the wall of the heart to be under too much stress. Those with heart defects like congenital disease and valve disease are affected by the hypertensive cardiomyopathy or dilated cardiomyopathy. Immediate attention should be paid to those suffering from this disease. Patients with this type of heart disease must be under constant observation and not be allowed to be very stressed out.

Heart diseases are at times hereditary. In these cases, patients should not be over excited or stressed out. This leads to the formation of excess blood pressure inside the heart and the walls are inflamed not being able to take the pressure. The valves and arteries inside the heart are unable to handle the pressure. The clots too should be removed in order to avoid heart complications. With care and proper medications, there is full scope of recovery.

Symptoms of congestive heart failure

 
 









Symptoms of congestive heart failure have a great impact on a person’s life, considering this is a progressive and eventually fatal medical condition. Nowadays, in the economic well developed countries, people die because of the heart problems, more then they do from any other cause. It is important to know that symptoms of congestive heart failure have a fluctuating evolution: there are episodes with severe symptoms, followed by long periods of time when the situation is stable, nevertheless, even if people recover from the acute phase, they can’t return to the previous level of functionality. Also, it is very important to mention that is difficult to predict how much time is left to live once the diagnosis is established, because sudden death isn’t uncommon in these patients. Heart failure is not just a disease of an one individual, but a disease that affects the entire family.

What do you know about symptoms of congestive heart failure?

If you are one of the patients suffering from congestive heart failure, you should be informed about the symptoms of congestive heart failure and when to sick medical help. Every readmission to the hospital will increase mortality; there are medical articles that suggest a 20-30% increase of this risk with every readmission. You may experience shortness of breath during effort (exertion dyspnea), during night (nocturnal paroxysmal dyspnea) or even when you rest( in the advanced stages of the congestive heart failure). At the beginning, shortness of breath occurs only during great effort, but in time, daily activities that once were performed very easily, like dressing, shaving, eating etc, can produce shortness of breath and force the patient to give up on his/her social life and depend on other person’s help. Another form of rest dyspnea is orthopnea, meaning that you can’t breathe while lying in the bed and you require elevation of the head with pillows.
Other symptoms of congestive heart failure are palpitations, rapid heart beats, fatigue, fainting, blue coloring of the lips or limb extremities, accumulation of water in the limbs tissues (this  condition is called edema) lungs, pleural and abdominal cavities, heart murmurs.
Because heart can’t deliver enough blood to muscles, patients will experience weakness and heaviness in the limbs. A low blood flow to the kidneys will determine oliguria (diminished amount of urine), this condition appears in advanced stages, when the cardiac output is severely reduced.
Cerebral manifestations of low cardiac output are also symptoms of congestive heart failure: headaches, insomnia, confusion, memory impairment, anxiety or nightmares. In more severe cases, patients experience other symptoms of congestive heart failure that require special medical care: hallucinations, delirium, disorientation.
In the end, we will present a list with a few symptoms of congestive heart failure, which may guide patients to require medical help (they were published in a guide for caregivers, by The Washington Home Center for Palliative Care Studies):

• gain of 3 pounds or more within a few days or a week,
• increased swelling in hands, ankles or feet,
• difficulty breathing at any time or coughing at night,
• decreased urination,
• confusion, dizziness, or faintness,
• nausea or vomiting,
• increased fatigue,
• muscle cramps or weakness,
• any distressing symptom.

For more info on symptoms of congestive heart failure check with your doctor.

Heart palpitations anxiety

What is heart palpitations anxiety?

Anxiety and stress are maybe the “third millennium disorders” and it has “no age” as doctors from all medical specialties have to deal patients suffering from these conditions, both young and old. In some point of our life we all suffered or will suffer from stress or anxiety and many of us deal these conditions by themselves for a long time before they finally decide to sick medical help. Those words are so often used today that it may seem they are part of our life and we must accept them as a normal reaction. But this is not how it really is, because anxiety can change our lives dramatically and make us feel sick, unable to perform our daily duties or even things that used to give us pleasure. Many times when we speak of this disorder we think of heart palpitations anxiety, as it is a frequent symptom in people suffering from anxiety. Next we will find out what anxiety and heart palpitations anxiety really mean and how to deal it.
Anxiety is a medical condition defined as a psychological and physiological state characterized by  feelings of fear, worry, dread, psychological tension or stress that can determine emotional, cognitive, somatic and behavioral changes. This disorder can determine multiple symptoms and among them heart palpitations anxiety are more frequently.
How it feels to suffer from heart palpitations anxiety? Living with heart palpitations anxiety is definitely not easy or comfortable. During heart palpitations anxiety u may feel that your heart beats are too fast or irregular, or that your heart stops for a small period. U may feel dizzy or experience shortness of breath (or suffocation sensation) or even faint. In people that already suffer from heart disease, abnormal heart beats can affect the oxygen supply of the heart muscle and determine chest pain or even a heart attack.
Next we will present the case of a 34 years old women suffering from heart palpitations anxiety:
A 34-year-old female presented with a history of anxiety for the past 20 years. When she was 14, her teacher used to embarrass her in front of the class by making her to stand-up until her face turned red and all the class would laugh. In time she becomes very nervous and fearful about social situation and activities that could draw attention to her. In the highschool she had panic attacks everytime she supposed to make presentation and communicate in peers. She describes she experienced profuse sweetening, heart palpitation and rapid heartbeats, burning in the stomach and the need to get away. These symptoms persisted during university and at the age of 25 she finally sought for professional help. The clinical psychologist diagnosed the patient with social phobia, panic disorder, and mild agoraphobia. She underwent  once- or twice-weekly sessions of psychological therapy with great improvement, slowly she could integrate into the social activities and seemed to be “cured”, convincing her therapist to stop the therapy. After 3 years as she attended the medical school, symptoms reappeared, and they were even worse then the first time and she had to seek the help of a psychiatrist and follow a medical treatment.

In conclusion, heart palpitations anxiety together with other manifestations of anxiety are not easy to deal and live with, but medical help will allow patients suffering from this condition to have a better life.

Heart attack arm pain

Heart attack is a disease that sometimes can be fatal and some trivial symptoms such heart attack arm pain must make the patient to address to the doctor.
Heart attack is a condition in which the oxygen-rich blood flow is reduced or completely stopped, due to obstruction of an artery from the heart. Thus, after the obstruction occurs necrosis (premature death of cells or tissues) of a part of the heart. The most common reasons of heart attack are the excess of cholesterol in the body, obesity and stress.

Heart attack arm pain symptoms

Onset symptoms of heart attack may be different in women than in men. If symptoms of heart attack are not recognized in time the patient could die. Chest pain is the most common heart attack symptom that occurs in both men and women. Chest pain may occur both at rest and during exercise. There is no relationship between exercise level and a heart attack. Pain is initially located in the heart and spreads to the arms, neck and back.  As pain is higher and irradiation more distant, heart attack is more serious.

Heart attack arm pain

Heart attack arm pain occurs as discomfort in one or both arms, especially on the medial side of the arm.  Pain may be felt also in the last two fingers, the patient felt as numbness or tingling. Heart attack pain lasts longer than half an hour and the pain from angina pectoris (is a medical term used for temporary chest pain that occurs when the heart does not receive enough blood, but does not cause irreversible damage) takes a few minutes (2-5 minutes). Heart attack arm pain intensity in older adults is lower than in other because their heart structure shows changes. This makes patients to not go to the doctor and a possible heart attack to be discovered much later.
Heart attack arm pain can also be a symptom onset of heart attack. Heart attack arm pain especially in the left arm is the most common symptoms in women.  In addition to heart attack arm pain, women may also accuse shortness of breath (feeling like patient can’t get enough air), loss of appetite, asthenia, adinamie (patient feeling tired),   coughing or heart flutters. Sometimes the symptoms or signs as heart attack arm pain may occur suddenly and it can also develop slowly even hours or days before a heart attack occurs.
Heart attack pain does not disappear at rest or after administration of vasodilators      (for example nitrate administration). It may decrease in intensity, but reappears after a few minutes. Usually pain recedes to the administration of opioid (morphine, mialgin). But after the administration of opioid the pain may persist, but with lower intensity.
Sometimes arm pain may have another cause than heart attack. Heart attack arm pain appears from the shoulder to the finger tips, is continuous and lasts over half an hour. Stress or attack panic may cause chest pain with radiation in left arm. Other causes of arm pain may be arthritis, muscle cramps or spasms, damage to the nerve or to the disc or bad circulation of blood.

In conclusion, patients with cardiovascular risk who have pain in the arm must go to the doctor or call an ambulance immediately because it can be a heart attack arm pain.

Rapid heart beats after eating -worry or not

Rapid heart beats after eating - what should we be worried about?

Rapid heart beats

Some people experience rapid heart beats after eating and this can create an important discomfort as they begin to be afraid or avoid eating in order to prevent these irregular heart beats to occur. Others are worried they might have a heart disease that causes palpitations and sick medical help. In the next part of the article we will find out what is the meaning of these palpitation and how can we prevent them.
After a meal, the digestion process requires more blood in the stomach and intestine and that’s why the heart has to pump more blood in these organs. The process consisting in increasing the amount of blood in the abdominal area after a meal is very important as it helps the body to assimilate food. This routine activity can determine palpitations, because heart has to work harder then usually. Until now, heart palpitation after eating seems to be a normal manifestation that can occur during a daily physiological process of our body.
Along with palpitation, after eating there are other manifestations that can also occur:

• nausea
•  dizziness-it occurs because cerebral blood flow is reduced, as the stomach needs more blood then usually in order to digest the food.
•  fatigue or even exhaustion (the blood will accumulate in the digestive system, while other organs and among them, the brain, will receive a smaller amount of blood)
• chest pain after eating- many times, patient with coronary disease (chronic heart ischemia determined by deprivation of oxygen) can have a chest pains after eating
•  sweating
• insomnia-if you sleep immediately after a meal, you may have problems to fall asleep. Because during night digestion and digestive secretion used in this process are diminished, you may get indigestion with abdominal discomfort, nausea and vomiting.
•  shortness of breath-the stomach is full of food and presses against diaphragma, restricting lung expansion during breathing
•  abdominal discomfort-if we eat too much or meals which are difficult to digest

If we experience rapid heart beats after eating should we seek for medical help?

Even if sometimes, heart palpitation after eating it is a normal manifestation, there are other causes for this condition, which need to be evaluated and treated. The answer is yes, if we experience heart palpitation after eating we should pay a visit to our doctor and check if there is something wrong.
What is the cause for heart palpitations after eating?

•  sudden consumption of food after a long period of starvation. This is often seen in patients suffering from anorexia nervosa, when after a long time of not eating, they start the consumption of food, the level of blood sugar increases rapidly, followed by increased secretion of insulin, which can create arrhythmia and also decreases blood sugar. The rapid decrease of blood sugar will stimulate the secretion of adrenaline, which will stimulate heart activity and create palpitation (it is like when you hurry up a person and it is obviously that in some point she will do mistakes)
•  hiatal hernia– a small portion of the stomach protrudes into the chest through diaphragm (the muscle that separates chest from abdomen and looks like a roof). This condition is usually associated with gastroesophageal reflux disease and may lead to chest pain and palpitations.
•  obesity- usually these persons have a diet with lot of sugar and caffeine, with a sedentary lifestyle and they can experience palpitation and chest pain. Their body has a lot of fats and these fats will deposit on the blood vessels wall, blocking them and generating heart disease (coronary arteries disease-with deprivation of blood and oxygen in the heart tissues). Also, the heart has to work extra hard to pump blood into their stomach.
•  hormonal imbalance could be a possible cause of heart palpitation after eating. For example hyperthyroidism (a thyroid disorder with high level of hormones) determines heart palpitation, tachycardia, chest pain, shortness of breath etc.
•  Severe anemia can affect heart and determine tachycardia (rapid heart rate) or irregular heart beats. Because there is a small number of oxygen carriers, heart will try to pump the blood faster and faster in order to satisfy the tissues need for blood and oxygen. In the same time, heart needs oxygen for itself, working harder with less oxygen it is a very good condition for palpitation to occur. Persons that avoid eating meat, can have anemia, as the meat is the main source of iron.

How can we treat rapid heart beats after eating?

Preventing heart palpitation after eating should first start with a moderate diet and by this we mean to eat moderate amounts of food at regular intervals. It is not advisable to eat one meal after we starved ourselves an entire day. Regular meals in small proportion, regular exercise, losing weight and periodically check of the hormones level (since hormonal imbalance can determine heart dysfunction) are the solution to this medical issue.

Heart pain in women

Heart pain in women: a symptom that begins to trouble most frequently after menopause, when due to the absence of  estrogen hormones, women lose their „natural” protection against cardiovascular events. According to the studies made among patients with heart attack, heart pain in women is not a hallmark symptom as it is in men. This means that during a heart attack, heart pain in women is less likely to occur and we must pay attention to other signs and symptoms if we don’t want to miss a heart disorder. Although women lose their protection against cardiovascular disease after menopause, estrogen replacement must be indicated only in well selected cases, because this treatment can determine breast or endometrial cancer, blood cloths and stroke etc.

How can estrogen hormones prevent heart pain in women?

It is simple. Estrogen has an important role in lipid metabolism: these hormones decrease the level of LDL-cholesterol and increase the HDL cholesterol (also called „the healthy” cholesterol as it protects against atherosclerosis). Estrogens tend to decrease serum cholesterol concentrations and to increase serum triglyceride concentrations. The overall effect of these changes, together with the effects on blood vessels, is to protect against atherosclerosis and heart pain in women before menopause. As atherosclerosis is the most important cause for heart attacks and chronic heart ischemia (heart disease caused by insufficient oxygenation of the heart tissues, which occurs when blood vessels are blocked by atherosclerosis) it is clear now why estrogen is so important and how can this hormone prevent heart pain in women.

Heart pain in women, what does it mean?

Heart pain in women or chest pain are very often among old patients and challenge the doctor to consider a lot of differential diagnosis, although sometimes it is almost impossible to separate them. For example, a pathology of the spine that presses nerve roots can determine an intense pain, sometimes unbearable, radiating towards the abdomen or chest and can easily mimic a heart pain. An esophagitis with burning sensation in the chest, can be mistaken as a heart symptom, but it responds well to the medication used in ulcer treatment and the duration of symptoms is variable. Heart pain in women doest mean necessary that it is a heart attack, sometimes it is caused by a heart muscle infection or disorder. Other causes for heart pain are abnormal dilated blood vessels called aneurism or chest trauma. In some patients, during heart attack, the pain is felt in the upper part of the abdomen and it can be confused with a stomach or liver disease (like ulcer, gastritis etc.).

How do we manage heart pain?

Heart pain it is always a very disturbing symptom, described by patients as a sensation of pressure on the chest or constriction, but sometimes, associated with palpitations (irregular heart beats), shortness of breath, fatigue, sweating, agitation or even fainting. In conclusion, heart pain in women and men  can be treated with beta-blockers (drugs that increase heart tissues oxygenation, an example of such a drug is metoprolole), calcium channels blockers (make heart blood vessels larger; e.g. amlodipine) or the well known nitroglycerin.

Fibrillation of the heart

Fibrillation of the heart

In the next part of the article we will discuss about fibrillation of the heart, one type of irregular heart rate and what are the consequences for our body. Our heart is an organ that has a so called „automatism”, an intrinsic property of the cardiac tissue to create its own electric impulse, a signal that allows changes in cell metabolism in order to generate cardiac muscle contraction and therefore pumping blood into the arteries. This electric signal is generated in the sinus node (a structure capable of generating electric signal, located in right atrium) and then conducted through special structures until it reaches the ventricles (heart chambers that pump blood into the arteries). If these structures called pacemakers, can’t function normally, irregular heart rate occurs and one of them is fibrillation of the heart.

 What is fibrillation of the heart ?

What is fibrillation of the heart? And how many types of fibrillation of the heart exist? There are two types of fibrillation of the heart: one is called atrial fibrillation and another ventricular fibrillation. The difference between these types of fibrillation of the heart is not just in name, but also in origin and prognostic. The first type of fibrillation of the heart-the atrial fibrillation-is an irregular heart rate generated in multiple atrial cells (but not in the sinus node which is the „natural” heart pacemaker).
Patients with atrial fibrillation may experience palpitations, shortness of breath, chest pain, dizziness, drowsiness, fainting, but there are some patients that don’t complain of any symptom and they are diagnosed with the occasion of a routine medical check or when the complications occur. Usually, atrial fibrillation allows blood clots to form and they can flow in the arteries and block them, causing a condition known as ischemia: the tissues won’t receive enough blood and oxygen and cells start to die. In this situation, strokes, pulmonary embolism (clots in the pulmonary arteries that can lead to death), limbs ischemia (if untreated it can lead to amputation) can occur and can lead to patient’s death, if immediate  measures aren’t taken. On the electrocardiogram, in atrial fibrillation there is an irregular heart rate, without „P” waves (which are a mark of  heart rate generated by the sinus node) and the frequency of the heart beats can vary: low, average or rapid.
If this arrhythmia was discovered at its beginning, a conversion to the normal heart rate called sinus rhythm can be tried (either using medication or with electric shocks). After this procedure succeeded, other medication is needed in order to maintain the normal heart rate, to control the normal frequency of the heart beats and prevent blood clotting. In some patients, when the beginning of this arrhythmia is unknown, doctors will use only drugs to control the heart rate (beta blockers like metoprolole, atenolol; digoxin-a drug that increases heart contractility and also has antuarrthymic properties, very often used in the treatment of atrial fibrillation, calcium channel blockers like amlodipine, verapamil, diltiazem) and prevent blood clotting. Atrial fibrillation associated with rapid heart rate can be a severe medical condition affecting the level of consciousness and the only way to save patient life is the electrical conversion to the sinus rhythm using electric shocks.
The other type of fibrillation of the heart-ventricular fibrillation is an irregular heart rate generated in the ventricular cells and is not compatible with life, meaning that is one of the heart rate that generates cardiac arrest. Heart stops from beating and emergency measures of resuscitation are needed-cardiac massage alternating with artificial oxygenation of lungs, using facial masks with balloons or orotracheal intubation (which is preferred if it is possible to perform), electric shocks, specific medication like adrenaline, vasopressin, amiodarone. If in 30-45 minutes all these maneuvers are unsuccessfully, then the patient is declared dead.

As we saw above, fibrillation of the heart is a major heart disorder, that requires  special attention, knowledge, maneuvers and skills, since ventricular fibrillation is the most frequent cause of cardiac arrest in adults.