Tag Archives: Atrial fibrillation

Arrhythmia

Definition:
The heart is a pump that functions by pushing the blood through its four chambers. The blood is “pushed” through in a controlled sequence of muscular contractions. The sequence is controlled by bundles of cells which control the electrical activity of the heart. When the sequence is disturbed, heart arrhythmias occur.

Arrhythmias are abnormal rhythms of the heart.  Arrhythmias cause the heart to pump blood less effectively.  Most cardiac arrhythmias are temporary and benign.  Most temporary and benign arrhythmias are those where your heart skips a beat or has an extra beat. The occasional skip or extra beat is often caused by strong emotions or exercise. Nonetheless, some arrhythmias may be life-threatening and require treatment.

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Types of Arrhythmias:
Arrhythmias can be divided into two main categories ventricular and supraventricular.  Supraventricular arrhythmias occur in the heart’s two upper chambers called the atrium.  Ventricular arrhythmias occur in the heart’s two lower chambers called the ventricles.


Electrical conduction in the heart originates in the SA node and travels through the AV node to the ventricles, resulting in a heart beat.
Supraventricular and Ventricular arrhythmias are further defined by the speed of the heartbeats: very slow, very fast and fast uncoordinated.  A very slow heart rate is called bradycardia.  In bradycardia, the heart rate is less than 60 beats per minute. A very fast heart rate is called Tachycardia meaning the heart beats faster than 100 beats per minute. A fast uncoordinated heart rate is called Fibrillation.  Fibrillation is the most serious form of arrhythmia are contractions of individual heart muscle fibers.  Arrhythmias cause nearly 250,000 deaths each year.

Supraventricular Arrhythmia

A very common long term arrhythmia is atrial fibrillation. Atrial fibrillation is very abnormal.  A normal heart beats between 60 and 100 times a minute. However, in atrial fibrillation, the atria (upper lobes of the heart) beat 400 to 600 times per minute. In response to this, the ventricles usually beat irregularly at a rate of 170 to 200 times per minute. So in Atrial Fibrillation, the upper part of the heart may beat up to 8 times as much as a normal heart.  Unfortunately, atrial fibrillation is seen in many types of heart disease; once established, it usually lasts a lifetime.

Ventricular Arrhythmia
One of the most serious arrhythmias is sustained ventricular tachycardia. In sustained ventricular tachycardia, there are consecutive impulses that arise from the ventricles at a heart rate of 100 beats or more per minute until stopped by drug treatment or electrical conversion. This condition is very dangerous.  It is dangerous because it may degenerate further into a totally disorganized electrical activity known as ventricular fibrillation. In ventricular fibrillation, heart’s action is so disorganized that it quivers and does not contract, thus failing to pump blood.

SADS:
SADS, or sudden arrhythmic death syndrome, is a term used to describe sudden death due to cardiac arrest brought on by an arrhythmia in the absence of any structural heart disease on autopsy. The most common cause of sudden death in the US is coronary artery disease.[citation needed] Approximately 300,000 people die suddenly of this cause every year in the US.[citation needed] SADS occurs from other causes. There are many inherited conditions and heart diseases that can affect young people and subsequently cause sudden death. Many of these victims have no symptoms before dying suddenly.

Causes of SADS in young people include viral myocarditis, long QT syndrome, Brugada syndrome, Catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia

Signs and symptoms:
The term cardiac arrhythmia covers a very large number of very different conditions.

The most common symptom of arrhythmia is an abnormal awareness of heartbeat, called palpitations. These may be infrequent, frequent, or continuous. Some of these arrhythmias are harmless (though distracting for patients) but many of them predispose to adverse outcomes.

Some arrhythmias do not cause symptoms, and are not associated with increased mortality. However, some asymptomatic arrhythmias are associated with adverse events. Examples include a higher risk of blood clotting within the heart and a higher risk of insufficient blood being transported to the heart because of weak heartbeat. Other increased risks are of embolisation and stroke, heart failure and sudden cardiac death.

If an arrhythmia results in a heartbeat that is too fast, too slow or too weak to supply the body’s needs, this manifests as a lower blood pressure and may cause lightheadedness or dizziness, or fainting.

Some types of arrhythmia result in cardiac arrest, or sudden death.

Medical assessment of the abnormality using an electrocardiogram is one way to diagnose and assess the risk of any given arrhythmia.

Causes:
Many types of heart disease cause arrhythmia.  Coronary disease is often a trigger.  It triggers arrhythmia because coronary heart disease produces scar tissue in the heart.  This scar tissue disrupts the transmission of signals which control the heart rhythm.  Some people are born with arrhythmias, meaning the condition is congenital. Atherosclerosis is also a factor in causing arrhythmia. Other medical conditions such as diabetes and high blood pressure also are factors. Furthermore,  stress, caffeine, smoking, alcohol, and some over-the-counter cough and cold medicines can affect your heart’s natural beating pattern.

Diagnosis:
Many different techniques are used to diagnose arrhythmia.  The techniques include:

•A standard electrocardiogram (ECG or EKG).
An EKG is the best test for diagnosing arrhythmia. This test helps doctors analyze the electrical currents of your heart and determines the type of arrhythmia you have.

•Holter monitoring.
Holter monitoring gets a continuous reading of your heart rate and rhythm over a 24-hour period (or more). You wear a recording device (the Holter monitor), which is connected to small metal disks on your chest. With certain types of monitors, you can push a “record” button to capture a rhythm when you feel symptoms. Doctors can then look at a printout of the recording to find out what causes your arrhythmia.

•Trans telephonic monitoring. Transtelephonic monitoring documents problems that may not be detected within a 24-hour period. The devices used for this type of test are smaller than a Holter monitor. One of the devises is about the size of a beeper, the other device is worn like a wristwatch. Like with Holter monitoring, you wear the recording device. When you feel the symptoms of an arrhythmia, you can telephone a monitoring station, where a record can be made. If you cannot get to a telephone during your symptoms, you can turn on the device’s memory function. Later, you can send the recorded information to a monitoring station by using a telephone. These devices also work during episodes of fainting.

•Electrophysiology studies (EPS). Electrophysiology studies are usually performed in a cardiac catheterization laboratory. In this procedure, a long, thin tube (called a catheter) is inserted through an artery in your leg and guided to your heart. A map of electrical impulses from your heart is sent through the wire to find out what kind of arrhythmia you have and where it starts. During the study, doctors can give you controlled electrical impulses to show how your heart reacts. Medicines may also be tested at this time to see which medicines will stop the arrhythmia. Once the electrical pathways causing the arrhythmia are found, radio waves can be sent through the catheter to destroy them.

•A tilt-table exam. A tilt-table exam is a way to evaluate your heart’s rhythm in cases of fainting. The test is noninvasive, which means that doctors will not use needles or catheters. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted to 65 degrees. The changing angle puts stress on the area of the nervous system that maintains your heart rate and blood pressure. Doctors can see how your heart responds under carefully supervised conditions of stress.

Treatment:

Treatment of arrhythmia depend on the type of arrhythmia, the patients age, physical condition and age.  Methods are available for prevention of arrhythmia.  These methods include relaxation techniques to reduce stress, limit intake of caffeine, nicotine, alcohol and stimulant drugs. Many arrhythmias require no treatment, they are naturally controlled by the body’s immune system. However if it is  necessary that arrhythmias must be controlled, they can be controlled by drugs, Cardioversion, Automatic implantable defibrillators or an Artificial pacemaker. Arrhythmias are very serious.

Arrhythmias that start in the lower chambers of the heart (the ventricles) are more serious than those that start in the upper chambers (the atria).

Management:
The method of cardiac rhythm management depends firstly on whether or not the affected person is stable or unstable. Treatments may include physical maneuvers, medications, electricity conversion, or electro or cryo cautery.

Physical maneuvers
A number of physical acts can increase parasympathetic nervous supply to the heart, resulting in blocking of electrical conduction through the AV node. This can slow down or stop a number of arrhythmias that originate above or at the AV node (you may click to see: supraventricular tachycardias). Parasympathetic nervous supply to the heart is via the vagus nerve, and these maneuvers are collectively known as vagal maneuvers.

Antiarrhy
thmic drugsMain article: Antiarrhythmic agents
There are many classes of antiarrhythmic medications, with different mechanisms of action and many different individual drugs within these classes. Although the goal of drug therapy is to prevent arrhythmia, nearly every antiarrhythmic drug has the potential to act as a pro-arrhythmic, and so must be carefully selected and used under medical supervision.

Other drugs

A number of other drugs can be useful in cardiac arrhythmias.

Several groups of drugs slow conduction through the heart, without actually preventing an arrhythmia. These drugs can be used to “rate control” a fast rhythm and make it physically tolerable for the patient.

Some arrhythmias promote blood clotting within the heart, and increase risk of embolus and stroke. Anticoagulant medications such as warfarin and heparins, and anti-platelet drugs such as aspirin can reduce the risk of clotting.

Electricity
Dysrhythmias may also be treated electrically, by applying a shock across the heart — either externally to the chest wall, or internally to the heart via implanted electrodes.

Cardioversion is either achieved pharmacologically or via the application of a shock synchronised to the underlying heartbeat. It is used for treatment of supraventricular tachycardias. In elective cardioversion, the recipient is usually sedated or lightly anesthetized for the procedure.

Defibrillation differs in that the shock is not synchronised. It is needed for the chaotic rhythm of ventricular fibrillation and is also used for pulseless ventricular tachycardia. Often, more electricity is required for defibrillation than for cardioversion. In most defibrillation, the recipient has lost consciousness so there is no need for sedation.

Defibrillation or cardioversion may be accomplished by an implantable cardioverter-defibrillator (ICD).

Electrical treatment of dysrhythmia also includes cardiac pacing. Temporary pacing may be necessary for reversible causes of very slow heartbeats, or bradycardia, (for example, from drug overdose or myocardial infarction). A permanent pacemaker may be placed in situations where the bradycardia is not expected to recover.

Electrical cautery
Some cardiologists further sub-specialise into electrophysiology. In specialised catheter laboratories, they use fine probes inserted through the blood vessels to map electrical activity from within the heart. This allows abnormal areas of conduction to be located very accurately, and subsequently destroyed with heat, cold, electrical or laser probes.

This may be completely curative for some forms of arrhythmia, but for others, the success rate remains disappointing. AV nodal reentrant tachycardia is often curable. Atrial fibrillation can also be treated with this technique (e.g. pulmonary vein isolation), but the results are less reliable.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mamashealth.com/ardiag.asp
http://www.mamashealth.com/arrhythmia.asp
http://hrssc.com/hrssc-patient-resource-how-to-diagnose-arrhythmias.html
http://www.nsmc.partners.org/web/service/heart_arrhythmia
http://www1.ecardio.com/PS/Cardiac.aspx
http://www.medicompinc.com/holter_service.html

http://www.nhlbi.nih.gov/health/dci/Diseases/ekg/ekg_during.html

http://commons.wikimedia.org/wiki/File:Heart_conduct_atrialfib.gif

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Atrial Fibrillation

Definition:
Atrial fibrillation (AF or A-fib) is the most common cardiac arrhythmia (abnormal heart rhythm) and involves the two upper chambers (atria) of the heart. Its name comes from the fibrillating (i.e. quivering) of the heart muscles of the atria, instead of a coordinated contraction. It can often be identified by taking a pulse and observing that the heartbeats don’t occur at regular intervals. However, a stronger indicator of AF is the absence of P waves on an electrocardiogram (ECG or EKG), which are normally present when there is a coordinated atrial contraction at the beginning of each heart beat. Risk increases with age, with 8% of people over 80 having AF.

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In AF, the normal electrical impulses that are generated by the sinoatrial node are overwhelmed by disorganized electrical impulses that originate in the atria and pulmonary veins, leading to conduction of irregular impulses to the ventricles that generate the heartbeat. The result is an irregular heartbeat which may occur in episodes lasting from minutes to weeks, or it could occur all the time for years. The natural tendency of AF is to become a chronic condition. Chronic AF leads to a small increase in the risk of death.

Atrial fibrillation is often asymptomatic, and is not in itself generally life-threatening, but may result in palpitations, fainting, chest pain, or congestive heart failure. People with AF usually have a significantly increased risk of stroke (up to 7 times that of the general population). Stroke risk increases during AF because blood may pool and form clots in the poorly contracting atria and especially in the left atrial appendage (LAA).[4] The level of increased risk of stroke depends on the number of additional risk factors. If a person with AF has none, the risk of stroke is similar to that of the general population. However, many people with AF do have additional risk factors and AF is a leading cause of stroke.

Atrial fibrillation may be treated with medications which either slow the heart rate or revert the heart rhythm back to normal. Synchronized electrical cardioversion may also be used to convert AF to a normal heart rhythm. Surgical and catheter-based therapies may also be used to prevent recurrence of AF in certain individuals. People with AF are often given anticoagulants such as warfarin to protect them from stroke.

Classification: The American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC) recommend in their guidelines the following classification system based on simplicity and clinical relevance.

AF Category…………… Defining Characteristics
First detected ……………….  only one diagnosed episode
Paroxysmal…………………..recurrent episodes that self-terminate in less than 7 days
Persistent……………………….recurrent episodes that last more than 7 days
Permanent……………………..an ongoing long-term episode

All atrial fibrillation patients are initially in the category called first detected AF. These patients may or may not have had previous undetected episodes. If a first detected episode self-terminates in less than 7 days and then another episode begins later on, the case has moved into the category of paroxysmal AF. Although patients in this category have episodes lasting up to 7 days, in most cases of paroxysmal AF the episodes will self-terminate in less than 24 hours. If instead the episode lasts for more than 7 days, it is unlikely to self-terminate and it is called persistent AF. In this case, the episode may be terminated by cardioversion. If cardioversion is unsuccessful or it is not attempted, and the episode is ongoing for a long time (e.g. a year or more), the patient’s AF is called permanent.

Episodes that last less than 30 seconds are not considered in this classification system. Also, this system does not apply to cases where the AF is a secondary condition that occurs in the setting of a primary condition that may be the cause of the AF.

Using this classification system, it’s not always clear what an AF case should be called. For example, a case may fit into the paroxysmal AF category some of the time, while other times it may have the characteristics of persistent AF. One may be able to decide which category is more appropriate by determining which one occurs most often in the case under consideration.

In addition to the above four AF categories, which are mainly defined by episode timing and termination, the ACC/AHA/ESC guidelines describe additional AF categories in terms of other characteristics of the patient.

#Lone atrial fibrillation (LAF) – absence of clinical or echocardiographic findings of other cardiovascular disease (including hypertension), related pulmonary disease, or cardiac abnormalities such as enlargement of the left atrium, and age under 60 years

#Nonvalvular AF – absence of rheumatic mitral valve disease, a prosthetic heart valve, or mitral valve repair

#Secondary AF – occurs in the setting of a primary condition which may be the cause of the AF, such as acute myocardial infarction, cardiac surgery, pericarditis, myocarditis, hyperthyroidism, pulmonary embolism, pneumonia, or other acute pulmonary disease

Although atrial fibrillation itself usually isn’t life-threatening, it is a medical emergency. It can lead to complications. Treatments for atrial fibrillation may include medications and other interventions to try to alter the heart’s electrical system.

Symptoms:
A heart in atrial fibrillation doesn’t beat efficiently. It may not be able to pump enough blood out to your body with each heartbeat.

Some people with atrial fibrillation have no symptoms and are unaware of their condition until it’s discovered during a physical examination. Those who do have atrial fibrillation symptoms may experience:

#Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flopping in your chest
#Decreased blood pressure
#Weakness
#Lightheadedness
#Confusion
#Shortness of breath
#Chest pain

Atrial fibrillation may be:

#Occasional. In this case it’s called paroxysmal (par-ok-SIZ-mul) atrial fibrillation. You may have symptoms that come and go, lasting for a few minutes to hours and then stopping on their own.
#Chronic. With chronic atrial fibrillation, symptoms may last until they’re treated.

Time to see a doctor:-
If you have any symptoms of atrial fibrillation, make an appointment with your doctor. Your doctor should be able to tell you if your symptoms are caused by atrial fibrillation or another heart arrhythmia.

If you have chest pain, seek emergency medical assistance immediately. Chest pain could signal that you’re having a heart attack.

Causes:
To pump blood, your heart muscles must contract and relax in a coordinated rhythm. Contraction and relaxation are controlled by electrical signals that travel through your heart muscle.

Your heart consists of four chambers — two upper chambers (atria) and two lower chambers (ventricles). Within the upper right chamber of your heart (right atrium) is a group of cells called the sinus node. This is your heart’s natural pacemaker. The sinus node produces the impulse that starts each heartbeat.

Normally, the impulse travels first through the atria and then through a connecting pathway between the upper and lower chambers of your heart called the atrioventricular (AV) node. As the signal passes through the atria, they contract, pumping blood from your atria into the ventricles below. As the signal passes through the AV node to the ventricles, the ventricles contract, pumping blood out to your body.

.Sinus rhythm.

..Atrial fibrillation

In atrial fibrillation, the upper chambers of your heart (atria) experience chaotic electrical signals. As a result, they quiver. The AV node — the electrical connection between the atria and the ventricles — is overloaded with impulses trying to get through to the ventricles. The ventricles also beat rapidly, but not as rapidly as the atria. The reason is that the AV node is like a highway on-ramp — only so many cars can get on at one time.

The result is a fast and irregular heart rhythm. The heart rate in atrial fibrillation may range from 100 to 175 beats a minute. The normal range for a heart rate is 60 to 100 beats a minute.

Possible causes of atrial fibrillation :-

Abnormalities or damages to the heart’s structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include:

#High blood pressure
#Heart attacks
#Abnormal heart valves
#Congenital heart defects
#An overactive thyroid or other metabolic imbalance
#Exposure to stimulants such as medications, caffeine or tobacco, or to alcohol
#Sick sinus syndrome — improper functioning of the heart’s natural pacemaker
#Emphysema or other lung diseases
#Previous heart surgery
#Viral infections
#Stress due to pneumonia, surgery or other illnesses
#Sleep apnea
However, some people who have atrial fibrillation don’t have any heart defects or damage, a condition called lone atrial fibrillation. In lone atrial fibrillation, the cause is often unclear, and serious complications are rare.

Atrial flutter :
Atrial flutter is similar to atrial fibrillation, but slower. If you have atrial flutter, the abnormal heart rhythm in your atria is more organized and less chaotic than the abnormal patterns common with atrial fibrillation. Sometimes you may have atrial flutter that develops into atrial fibrillation and vice versa. The symptoms, causes and risk factors of atrial flutter are similar to those of atrial fibrillation. For example, strokes are a common concern in someone with atrial flutter. As with atrial fibrillation, atrial flutter is usually not life-threatening when it’s properly treated.

Risk Factors:-

Risk factors for atrial fibrillation include:

#Age. The older you are, the greater your risk of developing atrial fibrillation.
#Heart disease. Anyone with heart disease, including valve problems, history of heart attack and heart surgery, has an increased risk of atrial fibrillation.
#High blood pressure. Having high blood pressure, especially if it’s not well controlled with lifestyle changes or medications, can increase your risk of atrial fibrillation.
#Other chronic conditions. People with thyroid problems, sleep apnea and other medical problems have an increased risk of atrial fibrillation.
#Drinking alcohol. For some people, drinking alcohol can trigger an episode of atrial fibrillation. Binge drinking — having five drinks in two hours for men, or four drinks for women — may put you at higher risk.
#Family history. An increased risk of atrial fibrillation runs in some families.

Complications:-

Clots and stroke :
One of the most common complications with atrial fibrillation is the formation of blood clots in the heart. As the blood in the upper chambers of the heart (atria) of a patient with atrial fibrillation does not flow out in a normal manner and is very turbulent, there is a greater likelihood of blood clots forming. The clots may then find their way into the lower chambers of the heart (ventricles) and eventually end up in the lungs or in the general circulation. Clots in the general circulation may eventually block arteries in the brain, causing a stroke.

A patient with atrial fibrillation is twice as likely to develop a stroke compared to other people. 5% of patients with atrial fibrillation get a stroke each year. The risk is even greater the older the patient is. The following factors raise the risk of stroke even more for patients with atrial fibrillation:

#Hypertension (high blood pressure)
#Diabetes
#Heart failure
#A history of blood clots (embolism)

Strokes may be severe and can cause paralysis of part of the body, speech problems, and even death.

Heart failure:
If the atrial fibrillation is not controlled the heart is likely to get weaker. This may lead to heart failure. Heart failure is when the heart does not pump blood around the body efficiently or properly. The patient’s left side, right side, or even both sides of the body can be affected.

Alzheimer’s disease:
There is a strong relationship between atrial fibrillation and the development of Alzheimer’s disease, according to researchers at Researchers at Intermountain Medical Center in Salt Lake City.

Diagnosis:-
The evaluation of atrial fibrillation involves diagnosis, determination of the etiology of the arrhythmia, and classification of the arrhythmia. A minimal evaluation should be performed in all individuals with AF. This includes a history and physical examination, ECG, transthoracic echocardiogram, and routine bloodwork. Certain individuals may benefit from an extended evaluation which may include an evaluation of the heart rate response to exercise, exercise stress testing, a chest x-ray, trans-esophageal echocardiography, and other studies.

Screening
Screening for atrial fibrillation is not generally performed, although a study of routine pulse checks or ECGs during routine office visits found that the annual rate of detection of AF in elderly patients improved from 1.04% to 1.63%; selection of patients for prophylactic anticoagulation would improve stroke risk in that age category.[9]

Routine primary care visit
This estimated sensitivity of the routine primary care visit is 64%. This low result probably reflects the pulse not being checked routinely or carefully.

Minimal evaluation
The minimal evaluation of atrial fibrillation should generally be performed in all individuals with AF. The goal of this evaluation is to determine the general treatment regimen for the individual. If results of the general evaluation warrant it, further studies may be then performed.

History and physical examination
The history of the individual’s atrial fibrillation episodes is probably the most important part of the evaluation. Distinctions should be made between those who are entirely asymptomatic when they are in AF (in which case the AF is found as an incidental finding on an ECG or physical examination) and those who have gross and obvious symptoms due to AF and can pinpoint whenever they go into AF or revert to sinus rhythm.

Routine bloodwork
While many cases of AF have no definite cause, it may be the result of various other problems (see below). Hence, renal function and electrolytes are routinely determined, as well as thyroid-stimulating hormone (commonly suppressed in hyperthyroidism and of relevance if amiodarone is administered for treatment) and a blood count.

In acute-onset AF associated with chest pain, cardiac troponins or other markers of damage to the heart muscle may be ordered. Coagulation studies (INR/aPTT) are usually performed, as anticoagulant medication may be commenced

Electrocardiogram
Atrial fibrillation is diagnosed on an electrocardiogram (ECG), an investigation performed routinely whenever an irregular heart beat is suspected. Characteristic findings are the absence of P waves, with unorganized electrical activity in their place, and irregular R-R intervals due to irregular conduction of impulses to the ventricles.

When ECGs are used for screening, the SAFE trial found that electronic software, primary care physicians and the combination of the two had the following sensitivities and specificities:

#Interpreted by software: sensitivity = 83%, specificity = 99%
#Interpreted by a primary care physician: sensitivity = 80%, specificity = 92%
#Interpreted by a primary care physician with software: sensitivity = 92%, specificity = 91%

If paroxysmal AF is suspected but an ECG during an office visit only shows a regular rhythm, AF episodes may be detected and documented with the use of ambulatory Holter monitoring (e.g. for a day). If the episodes are too infrequent to be detected by Holter monitoring with reasonable probability, then the patient can be monitored for longer periods (e.g. a month) with an ambulatory event monitor.

Echocardiography.
A non-invasive transthoracic echocardiogram (TTE) is generally performed in newly diagnosed AF, as well as if there is a major change in the patient’s clinical state. This ultrasound-based scan of the heart may help identify valvular heart disease (which may greatly increase the risk of stroke), left and right atrial size (which indicates likelihood that AF may become permanent), left ventricular size and function, peak right ventricular pressure (pulmonary hypertension), presence of left ventricular hypertrophy and pericardial disease.

Significant enlargement of both the left and right atria is associated with long-standing atrial fibrillation and, if noted at the initial presentation of atrial fibrillation, suggests that the atrial fibrillation is likely to be of a longer duration than the individual’s symptoms.

Extended evaluation
An extended evaluation is generally not necessary in most individuals with atrial fibrillation, and is only performed if abnormalities are noted in the limited evaluation, if a reversible cause of the atrial fibrillation is suggested, or if further evaluation may change the treatment course.

Chest X-ray
A chest X-ray is generally only performed if a pulmonary cause of atrial fibrillation is suggested, or if other cardiac conditions are suspected (particularly congestive heart failure.) This may reveal an underlying problem in the lungs or the blood vessels in the chest.  In particular, if an underlying pneumonia is suggested, then treatment of the pneumonia may cause the atrial fibrillation to terminate on its own.

Transesophageal echocardiogram
A normal echocardiography (transthoracic or TTE) has a low sensitivity for identifying thrombi (blood clots) in the heart. If this is suspected – e.g. when planning urgent electrical cardioversion – a transesophageal echocardiogram (TEE) is preferred.

The TEE has much better visualization of the left atrial appendage than transthoracic echocardiography. This structure, located in the left atrium, is the place where thrombus is formed in more than 90% of cases in non-valvular (or non-rheumatic) atrial fibrillation or flutter. TEE has a high sensitivity for locating thrombus in this area   and can also detect sluggish bloodflow in this area that is suggestive of thrombus formation.

If no thrombus is seen on TEE, the incidence of stroke, (immediately after cardioversion is performed), is very low.

Ambulatory holter monitoring
A Holter monitor is a wearable ambulatory heart monitor that continuously monitors the heart rate and heart rhythm for a short duration, typically 24 hours. In individuals with symptoms of significant shortness of breath with exertion or palpitations on a regular basis, a holter monitor may be of benefit to determine if rapid heart rates (or unusually slow heart rates) during atrial fibrillation are the cause of the symptoms.

Exercise stress testing
Some individuals with atrial fibrillation do well with normal activity but develop shortness of breath with exertion. It may be unclear if the shortness of breath is due to a blunted heart rate response to exertion due to excessive AV node blocking agents, a very rapid heart rate during exertion, or due to other underlying conditions such as chronic lung disease or coronary ischemia. An exercise stress test will evaluate the individual’s heart rate response to exertion and determine if the AV node blocking agents are contributing to the symptoms.

Treatments:-
In some people, a specific event or an underlying condition, such as a thyroid disorder, may trigger atrial fibrillation. If the condition that triggered your atrial fibrillation can be treated, you might not have any more heart rhythm problems — or at least not for quite some time. If your symptoms are bothersome or if this is your first episode of atrial fibrillation, your doctor may attempt to reset the rhythm

The treatment option best for you will depend on how long you’ve had atrial fibrillation, how bothersome your symptoms are and the underlying cause of your atrial fibrillation. Generally, the goals of treating atrial fibrillation are to:

#Reset the rhythm or control the rate
#Prevent blood clots
The strategy you and your doctor choose depends on many factors, including whether you have other problems with your heart and if you’re able to take medications that can control your heart rhythm. In some cases, you may need a more invasive treatment, such as surgery or medical procedures using catheters.

Resetting your heart’s rhythm
Ideally, to treat atrial fibrillation, the heart rate and rhythm are reset to normal. To correct your condition, doctors may be able to reset your heart to its regular rhythm (sinus rhythm) using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long you’ve had it.

Cardioversion can be done in two ways:

#Cardioversion with drugs. This form of cardioversion uses medications called anti-arrhythmics to help restore normal sinus rhythm. Depending on your heart condition, your doctor may recommend trying intravenous or oral medications to return your heart to normal rhythm. This is often done in the hospital with continuous monitoring of your heart rate. If your heart rhythm returns to normal, your doctor often will prescribe the same anti-arrhythmic or a similar one to try to prevent more spells of atrial fibrillation.
#Electrical cardioversion. In this brief procedure, an electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock stops your heart’s electrical activity momentarily. When your heart begins again, the hope is that it resumes its normal rhythm. The procedure is performed during anesthesia.
Before cardioversion, you may be given a blood-thinning medication, such as warfarin (Coumadin), for several weeks to reduce the risk of blood clots and stroke. Unless the episode of atrial fibrillation lasted less than 24 hours, you’ll need to take warfarin for at least four to six weeks after cardioversion to prevent a blood clot from forming even after your heart is back in normal rhythm. Warfarin is a powerful medication that can have dangerous side effects if not taken exactly as directed by your doctor. If you have any concerns about taking warfarin, talk to your doctor.

Or, instead of taking warfarin, you may have a test called transesophageal echocardiography — which can tell your doctor if you have any heart blood clots — just before cardioversion. In transesophageal echocardiography, a tube is passed down your esophagus and detailed ultrasound images are made of your heart. You’ll be sedated during the test.

Maintaining a normal heart rhythm
After electrical cardioversion, anti-arrhythmic medications often are prescribed to help prevent future episodes of atrial fibrillation. Commonly used medications include:

#Amiodarone (Cordarone, Pacerone)
#Propafenone (Rythmol)
#Sotalol (Betapace)
#Dofetilide (Tikosyn)
Although these drugs can help maintain a normal heart rhythm in many people, they can cause side effects, including:

#Nausea
#Dizziness
#Fatigue
Rarely, they may cause ventricular arrhythmias — life-threatening rhythm disturbances originating in the heart’s lower chambers. These medications may be needed indefinitely. Even with medications, the chance of another episode of atrial fibrillation is high.

Heart rate control
Sometimes atrial fibrillation can’t be converted to a normal heart rhythm. Then the goal is to slow the heart rate to between 60 and 100 beats a minute (rate control). Heart rate control can be achieved two ways:

#Medications. Traditionally, doctors have prescribed the medication digoxin (Lanoxin). It can control heart rate at rest, but not as well during activity. Most people require additional or alternative medications, such as calcium channel blockers or beta blockers.
#Atrioventricular (AV) node ablation. If medications don’t work, or you have side effects, AV node ablation may be another option. The procedure involves applying radio frequency energy to the pathway connecting the upper and lower chambers of your heart (AV node) through a long, thin tube (catheter) to destroy this small area of tissue.

The procedure prevents the atria from sending electrical impulses to the ventricles. The atria continue to fibrillate, though, and anticoagulant medication is still required. A pacemaker is then implanted to establish a normal rhythm. After AV node ablation, you’ll need to continue to take blood-thinning medications to reduce the risk of stroke, because your heart rhythm is still atrial fibrillation.

Other surgical and catheter procedures
Sometimes medications or cardioversion to control atrial fibrillation doesn’t work. In those cases, your doctor may recommend a procedure to destroy the area of heart tissue that’s causing the erratic electrical signals and restore your heart to a normal rhythm. These options can include:

#Radiofrequency catheter ablation. In many people who have atrial fibrillation and an otherwise normal heart, atrial fibrillation is caused by rapidly discharging triggers, or “hot spots.” These hot spots are like abnormal pacemaker cells that fire so rapidly that the upper chambers of your heart quiver instead of beating efficiently.

Radiofrequency energy directed to these hot spots through a catheter inserted in an artery near your collarbone or leg may be used to destroy these hot spots, scarring the tissue so the erratic electrical signals are normalized. This corrects the arrhythmia without the need for medications or implantable devices. In some cases, other types of catheters that can freeze the heart tissue (cryotherapy) are used.

#Surgical maze procedure. The maze procedure is often done during an open-heart surgery. Using a scalpel, doctors create several precise incisions in the upper chambers of your heart to create a pattern of scar tissue. Because scar tissue doesn’t carry electricity, it interferes with stray electrical impulses that cause atrial fibrillation. Radiofrequency or cryotherapy can also be used to create the scars, and there are several variations of the surgical maze technique. The procedure has a high success rate, but because it usually requires open-heart surgery, it’s generally reserved for people who don’t respond to other treatments or when it can be done during other necessary heart surgery, such as coronary artery bypass surgery or heart valve repair. Some people need a pacemaker implanted after the procedure.

Preventing blood clots
Most people who have atrial fibrillation or who are undergoing certain treatments for atrial fibrillation are at especially high risk of blood clots that can lead to stroke. The risk is even higher if other heart disease is present along with atrial fibrillation. Your doctor may prescribe blood-thinning medications (anticoagulants) such as warfarin (Coumadin) in addition to medications designed to treat your irregular heartbeat. Many people have spells of atrial fibrillation and don’t even know it — so you may need lifelong anticoagulants even after your rhythm has been restored to normal. If you’re prescribed warfarin, carefully follow your doctor’s instructions on taking it. Warfarin is a powerful medication that can have dangerous side effects.

Change of Lifestyle :

You may need to make lifestyle changes that improve the overall health of your heart, especially to prevent or treat conditions such as high blood pressure. Your doctor may suggest that you:

#Eat heart-healthy foods and avoid Junk or Fast food
#Reduce your salt intake, which can help lower blood pressure
#Increase your physical activity
#Quit smoking
#Pratice regular Exercise Or walk for about 45 minutes daily

Avoid drinking more than one drink of alcohol for women or more than two drinks for men a day.

Prevention:-
There are some things you can do to try to prevent recurrent spells of atrial fibrillation. You may need to reduce or eliminate caffeinated and alcoholic beverages from your diet, because they can sometimes trigger an episode of atrial fibrillation. It’s also important to be careful when taking over-the-counter (OTC) medications. Some, such as cold medicines containing pseudoephedrine, contain stimulants that can trigger atrial fibrillation. Also, some OTC medications can have dangerous interactions with anti-arrhythmic medications.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Atrial_fibrillation
http://www.mayoclinic.com/health/atrial-fibrillation/DS00291
http://www.medicalnewstoday.com/info/atrial-fibrillation/

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Heart Block

A diagram of a heart with an ECG indicator; di...Image via Wikipedia

Definition:
A heart block is a disease in the electrical system of the heart. This is opposed to coronary artery disease, which is disease of the blood vessels of the heart. While coronary artery disease can cause angina (chest pain) or myocardial infarction (heart attack), heart block can cause lightheadedness, syncope (fainting), and palpitations.

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The heart has four chambeacemaker is called the sinoatrial (SA) node or sinus node. It’s a small mass of specialized crs. The top two are called the atria. The bottom two are called the ventricles.
The heart’s “natural” pells in the heart’s right atrium. It produces electrical impulses that make your heart beat. For your heart to beat properly, the signal must travel from the SA node down a specific path to reach the ventricles. As the signal goes from the atria to the ventricles, it passes through specialized conducting tissue called the atrioventricular (A’tre-o-ven-TRIK’u-ler) (AV) node.

On an electrocardiogram (e-lek”tro-KAR’de-o-gram) (ECG), a portion of the graph called the P wave shows the impulse passing through the atria. Another portion of the graph, the QRS wave, shows the impulse passing through the ventricles. As long as the impulse is transmitted normally, the heart pumps and beats at a regular pace.

Sometimes the signal from the heart’s upper to lower chambers is impaired or doesn’t transmit. This is “heart block” or “AV block.” This does not mean that the blood flow or blood vessels are blocked.

Heart block is classified according to the level of impairment — first-degree heart block, second-degree heart block or third-degree (complete) heart block.

Types of heart block
A heart block can be a blockage at any level of the electrical conduction system of the heart.

1.Blocks that occur within the sinoatrial node (SA node) are described as SA nodal blocks.
2.Blocks that occur within the atrioventricular node (AV node) are described as AV nodal blocks.
3.Blocks that occur below the AV node are known as infra-Hisian blocks (named after the bundle of His).
4.Blocks that occur within the left or right bundle branches are known as bundle branch blocks.
5.Blocks that occur within the fascicles of the left bundle branch are known as hemiblocks.

Clinically speaking, most of the important heart blocks are AV nodal blocks and infra-Hisian blocks.

Types of SA nodal blocks
The SA nodal blocks rarely give symptoms. This is because if an individual had complete block at this level of the conduction system (which is uncommon), the secondary pacemaker of the heart would be at the AV node, which would fire at 40 to 60 beats a minute, which is enough to retain consciousness in the resting state.

Types of SA nodal blocks include:

SA node Wenckebach (Mobitz I)
SA node Mobitz II
SA node exit block
In addition to the above blocks, the SA node can be suppressed by any other arrhythmia that reaches it. This includes retrograde conduction from the ventricles, ectopic atrial beats, atrial fibrillation, and atrial flutter.

The difference between SA node block and SA node suppression is that in SA node block an electrical impulse is generated by the SA node that doesn’t make the atria contract. In SA node suppression, on the other hand, the SA node doesn’t generate an electrical impulse because it is reset by the electrical impulse that enters the SA node.

Types of AV nodal blocks
There are four basic types of AV nodal block:

First degree AV block
Second degree AV block
Type 1 second degree AV block (Mobitz I) (also known as Wenckebach phenomenon)
Third degree AV block (Complete heart block)

Types of infra-Hisian block
Infrahisian block describes block of the distal conduction system. Types of infrahisian block include:

Type 2 second degree heart block (Mobitz II)
Left bundle branch block
Left anterior fascicular block
Left posterior fascicular block
Right bundle branch block
Of these types of infrahisian block, Mobitz II heart block is considered most important because of the possible progression to complete heart block.

Symptoms:
The symptoms and severity of heart block depend on which type you have. First-degree heart block rarely causes severe symptoms.

Second-degree heart block may result in the heart skipping a beat or beats. This type of heart block also can make you feel dizzy or faint.

Third-degree heart block limits the heart’s ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment, because it can be fatal.

A medical device called a pacemaker is used to treat third-degree heart block and some cases of second-degree heart block.

This device uses electrical pulses to make the heart beat at a normal rate.

Sometimes, however, there are no symptoms at all.

It is important to note that during a period of heart block, persons may not know how to describe what they are feeling. They may have trouble keeping up with other persons, realize they are having “spells” and want to sit down and rest.

Causes:
Heart block has a variety of causes. It can sometimes be a result of a congenital defect. It can also occur after a heart attack or as a result of myocarditis (inflammation of the heart muscle), cardiomyopathy (a disorder of the heart muscle) and other types of heart disease. Although these conditions are more common in older people, young people can also be affected.

Heart block may also occur after heart surgery and in this case may be either temporary or permanent. Wenckebach block may occur as a result of taking too much digoxin, or can occur after a heart attack. Heart block may be caused by coronary artery disease, inflammation of the heart muscle, rheumatic fever, or overdose of certain heart drugs. Treatment depends on the degree of heart block experienced. Some cases need no treatment while others require medication or an artificial pacemakers.

Diagnosis

Heart block may occur spontaneously with unpredictable timing. Therefore, in some cases, the condition may require specialized tests to acquire an accurate diagnosis. If your doctor suspects that a person has heart block, he or she will order one or more of the following diagnostic tests to determine the cause of person’s symptoms.

Electrocardiogram –– An electrocardiogram (ECG or EKG) records the heart’s electrical activity. Small patches called electrodes are placed on person’s chest, arms and legs, and are connected by wires to the ECG machine. The electrical impulses of your child’s heart are translated into a graph or chart, enabling doctors to determine the pattern of electrical current flow in the heart and to diagnose arrhythmias.

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Holter Monitor — A Holter monitor is a small, portable machine that the person wears for 24 hours. It is about the size of a portable tape player and provides a continuous 24-hour recording of your child’s heartbeat onto a tape. You will be asked to keep a diary of your activities and symptoms. This monitor may detect arrhythmias that might not show up on a resting electrocardiogram, which only records a heartbeat for a few seconds at rest.

Event Monitor — This is a small monitor about the size of a pager that the person can have for up to a month. Since the arrhythmia may occur at unpredictable times, this will help to record the abnormal rhythm when he or she is experiencing symptoms. He or she can just push a button on the pager and record the heartbeat. The recording can than be transmitted by phone to the doctor.

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Exercise Stress Test –– An exercise stress or treadmill test, records the electrical activity of the person’s heart during exercise, which differs from the heart’s electrical activity at rest.

Electrophysiology Study –– In an electrophysiology (EP) study, doctors insert special electrode catheters — long, flexible wires — into veins and guide them into the heart. These catheters sense electrical impulses and also may be used to stimulate different areas of the heart. Doctors can then locate the sites that are causing arrhythmias. The EP study allows doctors to examine an arrhythmia under controlled conditions and acquire more accurate, detailed information than with any other diagnostic test.

Treatment
Heart block is a rhythm disturbance that can be treated with the implantation of a permanent pacemaker. The pacemaker helps your heart beat consistently. A pacemaker is a medical device that regulates the heart beat. It consists of two parts — the generator and the lead. The generator is a small metal container with a battery and tiny computer. The lead is an insulated wire that carries electrical impulses to the heart to ensure a stable heartbeat.

The computer in the pacemaker is constantly monitoring your heartbeat. This is called sensing. When the pacemaker senses your heartbeat, it continues to “watch” or monitor your heart and does not send a signal to stimulate the heart to beat. If no electrical impulse is sensed by the pacemaker, it sends out a signal to stimulate your childs heart to beat.

Proper Yoga exercise specially Deep Breathing and Pranayama are very helpful for all types of heart block.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.americanheart.org/presenter.jhtml?identifier=4611
http://en.wikipedia.org/wiki/Heart_block
http://www.nhlbi.nih.gov/health/dci/Diseases/hb/hb_whatis.html
http://www.ucsfhealth.org/childrens/medical_services/heart_center/arrhythmia/conditions/block/diagnosis.html
http://heart-disease.health-cares.net/heart-block-causes.php

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Palpitation

Palpitation, a common problem, is a state in which the heart beats forcibly and maybe, irregularly. It enables the person to become aware of the action of his heart. It is a distressing condition but is not always serious.

Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. In some patients with palpitations, no heart disease or abnormal heart rhythms can be found. Reasons for their palpitations are unknown. In others, palpitations result from abnormal heart rhythms (arrhythmias). Arrhythmias refer to heartbeats that are too slow, too rapid, irregular, or too early. Rapid arrhythmias (greater than 100 beats per minute) are called tachycardias. Slow arrhythmias (slower than 60 beats per minute) are called bradycardias. Irregular heart rhythms are called fibrillations (as in atrial fibrillation). When a single heartbeat occurs earlier than normal, it is called a premature contraction. Abnormalities in the atria, the ventricles, the SA node, and the AV node of the heart can lead to arrhythmias.

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It is an awareness of the beating of the heart, whether it is too slow, too fast, irregular, or at its normal frequency. Palpitations may be brought on by overexertion, adrenaline, alcohol, disease (such as hyperthyroidism) or drugs, or as a symptom of panic disorder. More colloquially, it can also refer to a shaking motion. It can also happen in mitral stenosis.

Nearly everyone experiences an occasional awareness of their heart beating, but when it occurs frequently, it can indicate a problem. Palpitations may be associated with heart problems, but also with anemias and thyroid malfunction.

Attacks can last for a few seconds or hours, and may occur very infrequently, or more than daily. Palpitations alongside other symptoms, including sweating, faintness, chest pain or dizziness, indicate irregular or poor heart function and should be looked into.

Palpitations may also be associated with anxiety and panic attacks, in which case psychological assessment is recommended.

Types of palpitation
People describe their palpitations in many different ways, but there are some common patterns:

The heart “stops”
Those who experience palpitations may have the feeling that their heart stops beating for a moment, and then starts again with a “thump” or a “bang”. Usually this feeling is actually caused by an extra beat (premature beat or extrasystole) that happens earlier than the next normal beat, and results in a pause until the next normal beat comes through. People are not usually aware of the early, extra beat, but may be aware of the pause, which follows it (the heart seems to stop). The beat after the pause is more forceful than normal, giving the “thumping” sensation.

The heart is “fluttering” in the chest
Any rapid heartbeat (or tachycardia) can give rise to this feeling. A rapid, regular fluttering in the chest may be associated with sensation of pounding in the neck as well, due to simultaneous contraction of the upper, priming chambers of the heart (the atria) and the lower, main pumping chambers (the ventricles). If the fluttering in the chest feels very irregular, then it is likely that the underlying rhythm is atrial fibrillation. During this type of rhythm abnormality, the atria beat so rapidly and irregularly that they seem to be quivering, rather than contracting. The ventricles are activated more rapidly than normal (tachycardia) and in a very irregular pattern..

Types:
Palpitations may be associated with feelings of anxiety or panic. It is normal to feel the heart thumping when feeling terrified or scared, but it may be difficult to know whether the palpitations or the panicked feeling came first. Unfortunately, since it can take some time before a clear diagnosis is made in a patient complaining of palpitations, people are sometimes told initially that the problem is anxiety.

Stressful situations cause an increase in the level of stress hormones, such as adrenaline, circulating in the blood, and there are some types of abnormal heart rhythm that can be stimulated by adrenaline excess, or by exercise. It may be possible to diagnose these sorts of palpitations by performing simple tests, such as an exercise test, while monitoring the ECG.

Some types of abnormal heart rhythm seem to be affected by posture. For many people, standing up straight after bending over can provoke a rapid heart rate. Often these attacks can be abolished again by lying down. Many people, if not all, are more aware of the heartbeat when lying quietly in bed at night. This is partly because at that time, the attention is not focused on other things, but also because the slower heart beat at rest can allow more premature beats to occur.

Symptoms:
The main symptom of palpitation of the heart is a kind of ‘thumping’ feeling in the chest .The patient feels a real discomfort in the front of the chest .The pulse rate may become faster than normal.
Many times, the person experiencing palpitations may not be aware of anything apart from the abnormal heart rhythm itself. But palpitations can be associated with other things such as tightness in the chest, shortness of breath, dizziness or light-headedness. Depending on the type of rhythm problem, these symptoms may be just momentary or more prolonged. Actual blackouts or near blackouts, associated with palpitations, should be taken seriously because they often indicate the presence of important underlying heart disease.

Probable Causes:

Palpitation of the heart may occur due to a variety of factors, most of which may not be related to the heart itself. Anything, which increases the workload of the heart, may bring on this condition. Some persons may experience palpitations when lying on the left side, because the heart is nearer the chest wall in that position. Many nervous persons suffer from this condition. Although palpitations do occur among other symptoms in serious heart disease, the vast majority of cases is due to anxiety and has no direct connection with heart disease whatsoever. Other causes contribution to this condition is an overfull stomach, flatulence, and constipation. Excessive smoking may also give rise to this disorder.

Diagnosis

The most important initial clue to the diagnosis is one’s description of the palpitations. The approximate age of the person when first noticed and the circumstances under which they occur are important, as is information about caffeine intake. It is also very helpful to know how they start and stop (abruptly or not), whether or not they are regular, and approximately how fast the pulse rate is during an attack. If the person has discovered a way of stopping the palpitations, that is also helpful information.

The diagnosis is usually not made by a routine medical examination and electrical tracing of the heart’s activity (ECG), because most people cannot arrange to have their symptoms while visiting the doctor. Nevertheless, findings such as a heart murmur or an abnormality of the ECG, which could point to the probable diagnosis, may be discovered. In particular, ECG changes that can be associated with specific disturbances of the heart rhythm may be picked up; so routine physical examination and ECG remain important in the assessment of palpitations.

Blood tests, particularly tests of thyroid gland function are also important baseline investigations (an overactive thyroid gland is a potential cause for palpitations; the treatment in that case is to treat the thyroid gland over-activity).

The next level of diagnostic testing is usually 24 hour (or longer) ECG monitoring, using a form of tape recorder (a bit like a Walkman), which can record the ECG continuously during a 24-hour period. If symptoms occur during monitoring it is a simple matter to examine the ECG recording and see what the cardiac rhythm was at the time. For this type of monitoring to be helpful, the symptoms must be occurring at least once a day. If they are less frequent then the chances of detecting anything with continuous 24, or even 48-hour monitoring, are quite remote.

Other forms of monitoring are available, and these can be useful when symptoms are infrequent. A continuous-loop event recorder monitors the ECG continuously, but only saves the data when the wearer activates it. Once activated, it will save the ECG data for a period of time before the activation and for a period of time afterwards – the cardiologist who is investigating the palpitations can program the length of these periods. A new type of continuous-loop recorder has been developed recently that may be helpful in people with very infrequent, but disabling symptoms. This recorder is implanted under the skin on the front of the chest, like a pacemaker. It can be programmed and the data examined using an external device that communicates with it by means of a radio signal.

Investigation of heart structure can also be important. The heart in most people with palpitations is completely normal in its physical structure, but occasionally abnormalities such as valve problems may be present. Usually, but not always, the cardiologist will be able to detect a murmur in such cases, and an echo scan of the heart (echocardiogram) will often be performed to document the heart’s structure. This is a painless test performed using sound waves and is virtually identical to the scanning done in pregnancy to look at the fetus.


Modern medical Treatment

Treating heart palpitations depends greatly on the nature of the problem. In many patients, excessive caffeine intake triggers heart palpitations. In this case, treatment simply requires caffeine intake reduction. For severe cases, medication is often prescribed.

A variety of medications manipulate heart rhythm, which can be used to try to prevent palpitations. If severe palpitations occur, a beta-blocking drug is commonly prescribed. These block the effect of adrenaline on the heart, and are also used for the treatment of angina and high blood pressure. However, they can cause drowsiness, sleep disturbance, depression, impotence, and can aggravate asthma. Other anti-arrhythmic drugs can be employed if beta-blockers are not appropriate.

If heart palpitations become severe, antiarrhythmic medication can be injected intravenously. If this treatment fails, cardioversion may be required. Cardioversion is usually performed under a short general anaesthesia, and involves delivering an electric shock to the chest, which stops the abnormal rhythm and allows the normal rhythm to continue.

For some patients, often those with specific underlying problems found in ECG tests, an electrophysiological study may be advised. This procedure involves inserting a series of wires into a vein in the groin, or the side of the neck, and positioning them inside the heart. Once in position, the wires can be used to record the ECG from different sites within the heart, and can also start and stop abnormal rhythms to further accurate diagnosis. If appropriate, i.e. if an electrical “short circuit” is shown to be responsible for the abnormal rhythm, then a special wire can be used to cut the “short circuit” by placing a small burn at the site. This is known as “radiofrequency ablation” and is curative in the majority of patients with this condition.

Atrial fibrillation has been discussed in a separate article. Treatment may include medication to control heart rate, or cardioversion to support normal heart rhythm. Patients may require medication after a cardioversion to maintain a normal rhythm. In some patients, if attacks of atrial fibrillation occur frequently despite medication, ablation of the connection between the atria and the ventricles (with implantation of a pacemaker) may be advised. A very important risk of atrial fibrillation is the increased risk of stroke. Management of atrial fibrillation usually includes some form of blood thinning treatment.

Very rarely, palpitations are associated with an increased risk blackouts, and even premature death. Generally speaking, serious arrhythmias occur in patients who are known to have heart disease, or carry a genetic predisposition for heart disease or related abnormalities and complications.

Palpitations, in the setting of the above problems, or occurrences such as blackouts or near blackouts, should be taken seriously. Even if ultimately nothing is found, a doctor should be contacted immediately to arrange the appropriate investigations, especially if palpitations occur with blackouts or if any of the above conditions are noticed.

Ayurvedic & Herbal Healing Options:

Ayurvedic Suppliments: 1. Stress Guard 2. Aswagandharisthra 3.Keshari Kalp 4. Brahmi Bati (Click to buy)

Herbal Home Remedy: Grapes,Aswagandha, Satabari and Brahmi… these herbs helps to get rid of any kind of palpitition.

Click to learn more herbal home remedy

Diet Option: The patient suffering from palpitation of the heart should take a simple diet of natural foods, with emphasis on fresh fruits, and raw or lightly cooked vegetables. He should avoid tea, coffee, alcohol, chocolate, soft drinks, food colorings, white rice, and condiments. He should restrict his diet to three meals a day .He should take fruits, milk, and a handful of nuts or seeds, fresh vegetables.

Life Style:Patient should do meditation every day. Swimming, skipping and cycling is also good for health.

Yoga Option: 1. Basic Breathing Exercise(Pranayama) 2. The Shoulder Stand (Sarvang Asana) 3. Shavasana(Total Body Rest)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Resources:

http://www.allayurveda.com/ail_palpitation.htm
http://en.wikipedia.org/wiki/Palpitation

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Snoring

Snoring is a noise produced when an individual breathes (usually produced when breathing in) during sleep which in turn causes vibration of the soft palate and uvula (that thing that hangs down in the back of the throat). The word “apnea” means the abscence of breathing.
All snorers have incomplete obstruction ( a block) of the upper airway. Many habitual snorers have complete episodes of upper airway obstruction where the airway is completly blocked for a period of time, usually 10 seconds or longer. This silence is usually followed by snorts and gasps as the individual fights to take a breath. When an individual snores so loudly that it disturbs others, obstructive sleep apnea is almost certain to be present.

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There is snoring that is an indicator of obstructive sleep apnea and there is also primary snoring.

Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).

How Does Primary Snoring Differ from Snoring that Indicates Obstructive Sleep Apnea?
A complaint of snoring by an observer
No evidence of insomnia or excessive sleepiness due to the snoring
Dryness of the mouth upon awakening
A polysomnogram (sleep study) that shows:
Snoring and other sounds often occurring for long episodes during the sleep period
No associated abrupt arousals, arterial oxygen desaturation (lowered amount of oxygen in the blood) or cardiac disturbances
Normal sleep patterns
Normal respiratory patterns during sleep
No signs of other sleep disorders
What can be done about primary snoring?
First of all, it is absolutely necessary to rule out obstructive sleep apnea or other sleep disorders. Be wary of any doctor who says it is not necessary. Behavioral and lifestyle changes may be suggested. Losing weight, sleeping on your side, refraining from alcohol and sedatives are often recommended.

The Causes Of Snoring:
Modern research reveals snoring to often have more than one cause. These include the many factors that lead to nasal blockage such as nasal allergy or deformities of the nasal septum (the cartilage partition between the two sides of the nose) and other internal nasal structures. This nasal blockage can contribute to poor nasal airflow into the lungs and can in turn set the soft tissues of the palate (roof of the mouth) and throat vibrating. These vibrations cause the loud fluttering noise of snoring.

Other factors which can influence the snoring condition are obesity; lack of fitness or aging and associated loss of general muscle tone, congestion of the throat due to the reflux of stomach acid (heartburn); and the effects of alcohol or smoking.

Congestion of the throat tissues leads to swelling of fluids within the tissues. This causes loss of muscle tone and generally makes the lining tissues of the airways flop. Where nasal congestion causes faulty or turbulent airflow through the airway, then the resonance of these floppy tissues contributes to the noise known as snoring.

Correction of snoring may not only require surgical intervention, but will probably also need cessation of smoking, minimised alcohol consumption, control of gastric acid reflux where neccessary and weight control
.

The Anatomy of the Upper Airway Passages.

CURE & TREATMENT:
Pillar Procedure
The Pillar Procedure is a new snoring treatment.
It is an operation carried out under local anaesthetic in most cases. Three tiny implants, made from woven polyester, are injected into the tissues of the soft palate. Floppiness of the soft palate, that part of the roof of the mouth which extends from the bony hard palate to the uvula (or central, dangling portion of the soft palate), is a frequent contributor to snoring. Stiffening the soft palate has been well known to quieten snoring in selected cases. However, palatal stiffening is suitable for patients who have been carefully evaluated by an ear, nose and throat surgeon with an interest in snoring problems. It does not assist every patient. Other factors may be contributing to snoring in these patients.

Now, what are Pillar implants?
The Pillar implants, made from polyester material, were developed in Europe and now have FDA US Government authority approval for surgical use. This material has been frequently used in medical products and can be safely inserted within the body. The implant creates a fibrous capsule around the implant which is the mechanism of the stiffening.

How do they work?
During the Pillar Procedure, three tiny woven inserts are placed in the soft palate to help reduce both the vibration that causes snoring and the ability of the soft palate to obstruct the airway. The Pillar inserts add structural support to the soft palate over time and prevents palatal fluttering (snoring).

The complex anatomical structure of the upper airway passages is due to the close association of the air, food and fluid passages. We not only breathe through our mouth and nose, but we also eat and drink through our mouth. The food passages of the mouth, throat and oesophagus leading to the stomach are separated from the airway by the soft palate and epiglottis and associated structures of the larynx or voicebox. This normally prevents food or fluid passing into the air passages and lungs. Occasional strong coughing fits are reminders that this is not always the case!

The nasal air passages serve to moisten the air intake and also provide the olfactory, or smell sense. Alternating congestion of the nasal passages helps channel the air intake between the two lungs.

ORAL/DENTAL DEVICES
There are mouth/oral devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways.

Some devices:
bring the jaw forward or
elevate the soft palate or
retain the tongue (from falling back in the airway and thus decreasing snoring).

SURGERY
There is also surgery. Snoring is Not Funny, Not Hopeless. There is uvulopalatopharyngoplasty (UPPP) or Laser-Assisted Uvulopalatoplasty (LAUP), that involves removing excess tissue from the throat.

The newest surgery, approved by the FDA in July 1997 for treating snoring is called somnoplasty and uses radio frequency waves to remove excess tissue.

Injection Snoreplasty and Non-Surgical Snoring Cures are some other options.

10 Natural Tip for a Silent Night

Home Remedy of Snoring…….(1)

Home Remedy …………...(2 )

Regular Yoga Exercises like Meditation, Breathing Exercise etc. are also a permanent cure for snoring and sleep apnea.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Source: www.snoring.com.au

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