Treatment of Atrial Fibrillation, Part II

Anticoagulant Drugs:  Warfarin has been the standard anticoagulant drug for the past 50 years and is given for a variety of cardiovascular conditions to prevent blood clots, including patients with coronary disease and prosthetic heart valves.  Warfarin is inexpensive.  Regular blood tests (a prothrombin time) are required, usually monthly, to determine the anticoagulant level (INR) is necessary if the patient is taking warfarin.  Recently newer drugs called "thrombin inhibitors" have been introduced that are equal to warfarin in effectiveness and do not require regular blood tests.  These drugs include Pradaxa (Dabigatran), Eliquist (Apixabam) and .  Xarelto (Ruaoxiban) and Savaysa (Endoxibam).  However, the thrombin inhibitors are quite expensive.  The Doctor should discuss the  pros and cons of these anticoagulant medication to use with the.  The one down side to these thrombin inhibitor drugs is that they are not readily reversible should you have a bleeding ulcer, auto accident, some other bleeding episode.  Current research looks very promising that this aspect will soon be solved.

Cardioversion:  Cardioversion (converting the heart back to normal regular rhythum) is accomplished by putting the patient briefly to sleep and applying an electrical charge to the chest using a machine and the paddles that everyone sees regularly on TV.  Cardioversion is ususally successful, but there is a tendency for the A.fib to recur, primarily because cardioversion does not address the root cause of the A.fib in the first place.  Never the less, cardioversion it is worth a try because some patients are able to be converted to normal rhythm and the A.fib never returns.

Medications:  A number of medications have been tried over the years to treat A.fib, but most of them have been abandoned because they tend to aggravate rather than control the A.fib.  The one medicine that has been shown to be effective is called Multac (amiodarone).  The main problem with Multac is a long and serious list of side effects.  The patient will need to be watched very closely for the first several months after starting the drug.

Ablation:  Ablation is a procedure that necessitates a cardiac catheterization and the use of catheters to perform electrical mapping inside the heart.  The aim is to search for a specific electrical focus causing the A.fib.   If such a focus is found then this focus is "ablated" (destroyed) by delivering an electrical charge through the catheter.  There are no incisions.  The results of ablation are encouraging, but it doesn't work in every patient.  In general it is a procedure of last resort when all else has failed.  The doctors that do ablation are called cardiac electrophysiologists.

Pacemakers:  Pacemakers are often inserted in patients with A.fib whose pulse rate has become so slow, about 40, that the patient has difficulty being up and about.  Weakness, dizzyness, fatigue, loss of energy develop primarily because of low cardiac output due to the low heart rate.  Pacemakers are very effective in this situation because they maintain a minimum heart rate of at least 60-70 beats per minute and the patients symptoms are greatly improved.

Summary:  A.fib is a common heart problem in the elderly and is associated with stroke, something we all want to prevent.  It requires close and persistent attention to medical management over long periods of time.  The treatments are variable and differ widely from patient to patient.  Stay in close touch with your doctor to avoid problems and be sure to maintain your anticoagulant level within the prescribed range.

ATRIAL FIBRILLATION

Atria Fibrillation (A. fib) is the most common heart rhythm disturbance in our society.  A.fib increases with age. The cause is not entirely clear, but it probably is related to a number of factors.  A.fib, as the name implies, affects the atria or the upper chambers of the heart.  The job of the atria is to contract and fill the lower chambers, the ventricles, just prior to heart contraction.

A.fib is a condition in which the regular, synchronous contractions of the atria is lost.  The loss of atrial contraction means the ventricles fill with blood by the force of gravity.  If one were able to look at a heart in A. fib you would see the atria  quivering, but not contracting.  The quivering is due to each muscle bundle contracting at its own inherent rate and not in synchrony with its neighbor.  The result is a very erratic, irregular heart beat.  If you put your finger on the pulse of a patient in A. fib you would find it difficult to count the beats because some are very strong beats and others very weak.  This variable pulse is due to inadequate filling of the ventricles between beats.

A.fib is important to recognize because it carries greater risk than most heart arrhythmias.  The diagnosis is made by taking an electrocardiogram (ECG).  If you happen to notice that your heart is skipping it is important to get to the doctor so the correct diagnosis can be made.  The presence of A.fib puts you in a special category of those patients who are at a higher risk of STROKE than those that do not have A.fib.

Gun Control and School Shootings

I want to enter the discussion on guns and mass shootings.   My wife and I, along with another couple,  made a cycling trip to Ireland in 1988.  We spent 10 touring southern Ireland and then rented a car to visit Northern Ireland to visit relatives of the other couple.  Once we crossed the border into Northern Ireland we noticed  every police station was a virtual fortress surrounded by high fences, barb wire and obstruction s to prevent any person or vehicle to enter the area.  The first night in a B&B we heard a loud explosion.  In the morning the sky was filled with helicopters ferrying injured soldiers to a local hospital.  The IRA had bombed a SCHOOL BUS of British soldiers on a road nearby.

We are not far from that reality at the present time with all of our education institutionsvirtually under siege.  We must do everything we can to prevent such events from developingWe must protect our children and provide the needed safety.

   
The Founding Fathers, when writing the second amendment, did not have in mind that the citizens would buy and accumulate military grade weapons.  How encompassing is the second amendment?  There is no mention of specific arms that is approved for the ordinary citizens.  Does the second amendment include machine guns, grenade launchers, bazooka’s and other heavy weapons.  I think not.  What if one our school buses was bombed or riddled with bullets?  The second amendments provisions were written for self defense, not aggressive mass 

killings.  General Grant allowed the confederate soldiers to keep their side arms for self defense.

 
We need to put a stop to this nonsense and start bringing order out of chaos.  There is no need for any citizen to own anything more than a hunting rifle or two and a single handgun.Certainly there is no need for anyone to be able to buy 400 rounds of military grade ammunition without being questioned.   Or accumulate an arsenal of 20 or thirty guns including military grade weapons.  Freedom has limits.

 
Lets put our thinking caps on and solve this issue while preserving the individual right tobear arms and prevent any more mass killings. Please give me your comments.