Smoking is a serious and extremely harmful addiction, and fortunately however, there are now plenty of diverse quit smoking aids that are obtainable so that if people want to stop smoking they have a way to do so.
One of the most standard and well known stop smoking aids is that of a stop smoking injection, and if this solution sounds interesting to you, then you are going to want to read on so that you can learn more about it and as well be able to decide whether or not it would be a good choice for you.
About The Quit Smoking Injection
The stop smoking injection is a sample of stop smoking aid which comes in an injection form, and you are given this stop smoking injection as a treatment so that you can have some form of drug support to help with the nicotine cravings when you are trying to quit smoking.
This stop smoking injection is in fact thought-about as being one of the most powerful forms of stop smoking remedy, and in fact it as a 70-80 percent success rate. The process of this injection is quite simple, as the injection itself involves substances that work by blocking the nicotine receptors in your brain.
Then, because your brain cannot recognize nicotine anymore, your appetite for nicotine will end up vanishing. After all, smoking is an addiction which is quite identical to any other addiction, for instance alcohol or other drugs.
Normally, just one of these injections will be enough to help someone quit smoking for good, however in some cases there may be a requested follow up injection. One of the best things about this selection is the fact that this kind of therapy is a medical therapy and that it takes place in a clinic under the control of experienced and well-informed doctors.
Therefore you know that it is safe and that you can trust this way and that should make you feel remarkably assured overall. After all there are plenty of other stop smoking methods which can seem unsafe or not effective, and so that is why if you are trying to quit smoking you should surely consider the option of the this injection, because it is definitely one of the options that you have.
One of the most crucial things, regardless of which method you actually end up using, is to remember that you are trying to stop smoking and by doing that you are doing something great for yourself.
Smoking is worse than just a bad habit. It’s considered a serious addiction and the cause of many diseases that could be prevented or reduced by simply quitting cigarettes.
The cure, nevertheless, for many, is sometimes harder to endure than the disease.
The attempt to stop smoking frequently is related to severe symptoms that can go from intense desires to lighting a cigarette up to anxiety, irritability, depression, chills and sweats, among others.
These uncomfortable side effects wile quit smoking are temporary and are also the first corporal expression to a further healthier life.
Medical examinations have shown that after 12 hours of having your last smoke, the carbon monoxide and the nicotine in the system begin to drop quickly and that’s when the lungs and heart start their recovery process.
A few days later, they may start to take place some physical changes. Taste and smell senses improve gradually and bad breathed starts to disappear.
Some smoker programs focus on blocking nicotine bases on former clinical investigations published in the Journal of Addictionology.
This procedure has shown an efficiency as hi as 85 to 90% in some clinics and centers.
Stop smoking depends mainly on a strong will Power. It’s a hard addiction to break, mainly because nicotine on chronic smokers has shown to produces pleasant effects: it increases the levels of dopamine in the body and this causes the organism to feel well, improving the concentration, reducing anxiety, stimulating and, at the same time, relaxing the person.
Like in most smokers programs, the first requirement to start the program it is almost mandatory to have taken the firm determination to stop smoking, eider for healthy reasons or as a preventive measure.
Besides the close relation that exists between cigarette smoking and cancer, General Surgeons report presented in the 2004 showed that almost all the organs of the body deteriorate in smokers at any age. Smoking contributes to the infection of surgery wounds, causes complications of diabetes, induces to prematurely aging and even shortens the life average.
It is advised to get a physician to perform a medical blood examination prior to a stop smoking treatment. In severe smoking addicted patience, it is also advised to complete a personal analysis to setup clear and reachable goals.
Afterwards a final examination precede the injection of the solution of two hourglasses, this medicines are combined to achieve to block the bodies desires to nicotine, as well as to diminish the symptoms that overcome due to the abstinence of cigarette smoking.
There are some chemical ingredients that the body produces naturally and witch security profile is well known because they have been used for years and besides they are not addictive.
In patients with, hart arrhythmias, prostate hypertrophy, pregnancy and glaucoma the injected treatment is defiantly not an option.
After the injections, the patient can feel sleepy and it’s required to be with someone that can take him home. This state can extend for six hours.
That same day, the patient receives an oral prescription that must be taken as indicated for a week, after which it is required to visit the doctor back for a follow up.
The severe abstinence symptoms can extend themselves over a period of three to four days and stop soon after.
great for yourself.
Thursday, December 3, 2009
Tobacco Smoking
I have smoked since I was 5 years of age.I was born June 1,1955.At the time of this aricle, have smoked almost 50 years.I know everything about smoking,the ffects of smoking,and everything about the medical implications.
many things occur after smoking tobacco.Some of these things will be discussed here.
Tobacco causes many dangers to occur;such as:
*depositing tar and nicotine in the lungs.The tars and nicotine are similar to petroleum jelly.They coat the lungs as well as burn the lungs.They are never dissolved or digested.
*The tars and nicotine burn the cilia from the lungs.The lungs naturally have hairs;called "cilia" which keep particles out of the lungs.
*nicotine poisons the body.It is as deadly as potassium cyanide.2 grams of eighther will result in death to a normal healthy human adult.Nicotine is cumulative in the body.
*The tars asphyxiate the body.By depositing in the lungs,the tars coat the lungs and prevent air to touch the lungs.This deteriorates the cells as well as prevents lung poes from taking oxygen into the bloodstream.
*After stopping smoking,damage still persists due to the tars remaining in the lungs and burning cells.the damage continues for a lifetime.
*smoking is not addictive;but,instead,causes discomfort during detoxification of the body.The uncomfortable side effects are merely experiences to the damage caused by the tobacco.To alleviate the discomfort,the smoker will smoke more to coat the wound with tars from the tobacco.
*The tars and nicotine are extensively burning.They may cause blisters to be formed in the lungs and throat.
*nicotine is no carcinogenic;but,may mutant cells sufficiently for cancerous culturing may occur.
*The lungs are burned very extensively.tissues are exposed to viruses and bacteria in the air.This may enhance disease contracturation.
*skin cell putrifaction induced infections
*coats internal skin cells and causes them to putrify by cells forming blisters to fight the nicotine and tar;then,the blisters to burst.There is no escape of white blood cells.
*disallowskin cells to discharge chemotoxins
many things occur after smoking tobacco.Some of these things will be discussed here.
Tobacco causes many dangers to occur;such as:
*depositing tar and nicotine in the lungs.The tars and nicotine are similar to petroleum jelly.They coat the lungs as well as burn the lungs.They are never dissolved or digested.
*The tars and nicotine burn the cilia from the lungs.The lungs naturally have hairs;called "cilia" which keep particles out of the lungs.
*nicotine poisons the body.It is as deadly as potassium cyanide.2 grams of eighther will result in death to a normal healthy human adult.Nicotine is cumulative in the body.
*The tars asphyxiate the body.By depositing in the lungs,the tars coat the lungs and prevent air to touch the lungs.This deteriorates the cells as well as prevents lung poes from taking oxygen into the bloodstream.
*After stopping smoking,damage still persists due to the tars remaining in the lungs and burning cells.the damage continues for a lifetime.
*smoking is not addictive;but,instead,causes discomfort during detoxification of the body.The uncomfortable side effects are merely experiences to the damage caused by the tobacco.To alleviate the discomfort,the smoker will smoke more to coat the wound with tars from the tobacco.
*The tars and nicotine are extensively burning.They may cause blisters to be formed in the lungs and throat.
*nicotine is no carcinogenic;but,may mutant cells sufficiently for cancerous culturing may occur.
*The lungs are burned very extensively.tissues are exposed to viruses and bacteria in the air.This may enhance disease contracturation.
*skin cell putrifaction induced infections
*coats internal skin cells and causes them to putrify by cells forming blisters to fight the nicotine and tar;then,the blisters to burst.There is no escape of white blood cells.
*disallowskin cells to discharge chemotoxins
Ethylene Oxide Data
General
Synonyms: amprolene, anprolene, anproline, dihydrooxirene, dimethylene oxide, ENT-26263, EO, epoxyethane, 1,2-epoxyethane, ethene oxide, ethox, merpol, oxane, oxacyclopropane, oxidoethane,oxiran, oxirane, oxirene, oxyfume, T-gas
Molecular formula: C2H4O
CAS No: 75-21-8
EC No: 200-849-9
Annex I Index No: 603-023-00-X
Physical data
Appearance: colourless gas
Melting point: -111 C
Boiling point: 10.7 C
Vapour density: 1.52 g/l
Vapour pressure:
Specific gravity: 0.882
Flash point: -20 C
Explosion limits: no upper limit - burns in its own atmosphere
Autoignition temperature:
Stability
Stable when isolated, but reacts violently with water, bases, oxidizing metals, acids, alcohols, alkali metals, ammonia, chemically active metals and their salts. Highly flammable. Forms explosive mixtures with air which may be ignited by rapid compression.
Toxicology
Carcinogen, mutagen, reproductive hazard, toxic. Severe irritant. Sensitizer. Toxic by inhalation, ingestion and through skin contact. Moderate levels (0.1% or less) may rapidly be fatal if inhaled. Typical OEL 1-5 ppm.
Toxicity data
(The meaning of any abbreviations which appear in this section is given here.)
ORL-RAT LD50 72 mg kg-1
IHL-RAT LC50 800 ppm/4h
SCU-RAT LD50 187 mg kg-1
IHL-HMN TCLO 12500 ppm/10s
IHL-WMN TCLO 500 ppm/2m
IHL-MUS LC50 836 ppm/4h
Irritation data
(The meaning of any abbreviations which appear in this section is given here.)
SKN-HMN 1%/7s
EYE-RBT 18 mg/6h mod
Risk phrases
(The meaning of any risk phrases which appear in this section is given here.)
R12 R23 R24 R25 R36 R37 R38 R45 R46.
Personal protection
Safety glasses, gloves, high quality ventilation. Avoid sparks and any form of ignition.
Safety phrases
(The meaning of any safety phrases which appear in this section is given here.)
S45 S53
Synonyms: amprolene, anprolene, anproline, dihydrooxirene, dimethylene oxide, ENT-26263, EO, epoxyethane, 1,2-epoxyethane, ethene oxide, ethox, merpol, oxane, oxacyclopropane, oxidoethane,oxiran, oxirane, oxirene, oxyfume, T-gas
Molecular formula: C2H4O
CAS No: 75-21-8
EC No: 200-849-9
Annex I Index No: 603-023-00-X
Physical data
Appearance: colourless gas
Melting point: -111 C
Boiling point: 10.7 C
Vapour density: 1.52 g/l
Vapour pressure:
Specific gravity: 0.882
Flash point: -20 C
Explosion limits: no upper limit - burns in its own atmosphere
Autoignition temperature:
Stability
Stable when isolated, but reacts violently with water, bases, oxidizing metals, acids, alcohols, alkali metals, ammonia, chemically active metals and their salts. Highly flammable. Forms explosive mixtures with air which may be ignited by rapid compression.
Toxicology
Carcinogen, mutagen, reproductive hazard, toxic. Severe irritant. Sensitizer. Toxic by inhalation, ingestion and through skin contact. Moderate levels (0.1% or less) may rapidly be fatal if inhaled. Typical OEL 1-5 ppm.
Toxicity data
(The meaning of any abbreviations which appear in this section is given here.)
ORL-RAT LD50 72 mg kg-1
IHL-RAT LC50 800 ppm/4h
SCU-RAT LD50 187 mg kg-1
IHL-HMN TCLO 12500 ppm/10s
IHL-WMN TCLO 500 ppm/2m
IHL-MUS LC50 836 ppm/4h
Irritation data
(The meaning of any abbreviations which appear in this section is given here.)
SKN-HMN 1%/7s
EYE-RBT 18 mg/6h mod
Risk phrases
(The meaning of any risk phrases which appear in this section is given here.)
R12 R23 R24 R25 R36 R37 R38 R45 R46.
Personal protection
Safety glasses, gloves, high quality ventilation. Avoid sparks and any form of ignition.
Safety phrases
(The meaning of any safety phrases which appear in this section is given here.)
S45 S53
Poisonous Fruits and Vegetables
supermarket sold fruits and vegetables are grown commercially.The growers utilize ethylene oxide as a ripener.thylene oxide is an extremely toxic carcinogenic chemical.
Chem Service's Nicotine Material Safety Data Sheet(s)
from Chem Service
Other Material Safety Information for Nicotine:
International Chemical Safety Cards : Nicotine
l-Nicotine, 99+%
--------------------------------------------------------------------------------
CHEM SERVICE -- F2123 NICOTINE
MATERIAL SAFETY DATA SHEET
NSN: 655000F037521
Manufacturer's CAGE: 8Y898
Part No. Indicator: A
Part Number/Trade Name: F2123 NICOTINE
===========================================================================
General Information
===========================================================================
Company's Name: CHEM SERVICE INC
Company's Street: 660 TOWER LN
Company's P. O. Box: 3108
Company's City: WEST CHESTER
Company's State: PA
Company's Country: US
Company's Zip Code: 19381-3108
Company's Emerg Ph #: 215-692-3026/800-452-9994
Company's Info Ph #: 215-692-3026/800-452-9994
Record No. For Safety Entry: 001
Tot Safety Entries This Stk#: 001
Status: SE
Date MSDS Prepared: 02NOV92
Safety Data Review Date: 14DEC94
Preparer's Company: CHEM SERVICE INC
Preparer's St Or P. O. Box: 660 TOWER LN
Preparer's City: WEST CHESTER
Preparer's State: PA
Preparer's Zip Code: 19381-3108
MSDS Serial Number: BWJGR
===========================================================================
Ingredients/Identity Information
===========================================================================
Proprietary: NO
Ingredient: NICOTINE
Ingredient Sequence Number: 01
NIOSH (RTECS) Number: QS5250000
CAS Number: 54-11-5
OSHA PEL: 0.5 MG/CUM
ACGIH TLV: 0.5 MG/CUM (SKIN)
===========================================================================
Physical/Chemical Characteristics
===========================================================================
Appearance And Odor: COLORLESS TO YELLOW LIQUID W/AMMONIA LIKE ODOR.
Boiling Point: 476.6F
Melting Point: -112F
Vapor Pressure (MM Hg/70 F): 4.25
Solubility In Water: MISCIBLE
===========================================================================
Fire and Explosion Hazard Data
===========================================================================
Flash Point: 213.8F
Lower Explosive Limit: 0.7
Upper Explosive Limit: 4
Extinguishing Media: CO2, DRY CHEMICAL POWDER/SPRAY.
Unusual Fire And Expl Hazrds: SENSITIVE TO LIGHT & AIR.
===========================================================================
Reactivity Data
===========================================================================
Stability: YES
Cond To Avoid (Stability): LIGHT, AIR & MOISTURE.
Materials To Avoid: STRONG OXIDIZING AGENTS/ACIDS.
Hazardous Decomp Products: TOXIC FUMES.
Hazardous Poly Occur: NO
===========================================================================
Health Hazard Data
===========================================================================
LD50-LC50 Mixture: ORAL LD50 (RAT/MOUSE): 50 MG/KG
Route Of Entry - Inhalation: YES
Route Of Entry - Skin: YES
Route Of Entry - Ingestion: YES
Health Haz Acute And Chronic: MAY BE FATAL IF ABSORBED THROUGH SKIN/
INHALED/INGESTED. EXPOSURE CAN CAUSE LIVER & KIDNEY DAMAGE/ADVERSE
REPRODUCTIVE EFFECTS/DELAYED LUNG INJURY/CARDIOVASCULAR SYSTEM INJURY/
RESPIRATORY TRACT IRRITATION/DELAYED ADVERSE HEALTH EFFECTS/NERVOUS SYSTEM
INJURY. POSSIBLE CUMULATIVE POISON. (SEE SUPP)
Carcinogenicity - NTP: NO
Carcinogenicity - IARC: NO
Carcinogenicity - OSHA: NO
Explanation Carcinogenicity: NONE
Signs/Symptoms Of Overexp: IRRITATION, CYANOSIS, GI DISTURBANCES.
Emergency/First Aid Proc: EYES: FLUSH CONTINUOUSLY W/WATER FOR 15-2O MINS.
SKIN: FLUSH W/WATER FOR 15-20 MINS. IF NOT BURNED, WASH W/SOAP & WATER.
INHALATION: REMOVE TO FRESH AIR. GIVE CPR/OXYGEN IF NEEDED. KEEP WARM &
QUIET. INGESTION: INDUCE VOMITING. DON'T GIVE LIQUIDS/INDUCE VOMITING IF
UNCONSCIOUS/CONVULSING. IF VOMITING OCCURS, WATCH CLOSELY TO AVOID AIRWAY
OBSTRUCTION. OBTAIN MEDICAL ATTENTION IN ALL CASES.
===========================================================================
Precautions for Safe Handling and Use
===========================================================================
Steps If Matl Released/Spill: EVACUATE AREA. WEAR APPRORPRIATE OSHA
REGULATED EQUIPMENT. VENTILATE AREA. ABSORB ON VERMICULITE/SIMILAR
MATERIAL. SWEEP UP & PLACE IN APPROPRIATE CONTAINER/HOLD FOR DISPOSAL. WASH
CONTAMINATED SURFACES TO REMOVE ANY RESIDUES.
Waste Disposal Method: BURN IN A CHEMICAL INCINERATOR EQUIPPED W/AN
AFTERBURNER & SCRUBBER IAW/FEDERAL, STATE & LOCAL REGULATIONS.
Precautions-Handling/Storing: STORE IN A COOL DRY PLACE ONLY W/COMPATIBLE
CHEMICALS. KEEP TIGHTLY CLOSED. MARTERIAL IS HYGROSCOPIC. DARK COLORS
DOESN'T AFFECT PURITY.
Other Precautions: AVOID CONTACT W/SKIN, EYES & CLOTHING. DON'T BREATH
VAPORS. CONTACT LENSES SHOULDN'T BE WORN IN THE LABORATORY. ALL CHEMICALS
SHOULD BE CONSIDERED HAZARDOUS. AVOID DIRECT PHYSICAL CONTACT.
===========================================================================
Control Measures
===========================================================================
Respiratory Protection: WEAR APPROPRIATE OSHA/MSHA APPROVED SAFETY
EQUIPMENT.
Ventilation: CHEMICAL SHOULD BE HANDLED ONLY IN A HOOD.
Eye Protection: EYE SHIELDS
Work Hygienic Practices: REMOVE/LAUNDER CONTAMINATED CLOTHING BEFORE
REUSE.
Suppl. Safety & Health Data: HEALTH HAZARDS CONT'D: POSSIBLE TERATOGEN -
CAUSES EMBRYO-FETAL DAMAGE.
===========================================================================
Transportation Data
===========================================================================
===========================================================================
Disposal Data
===========================================================================
===========================================================================
Label Data
===========================================================================
Label Required: YES
Label Status: G
Common Name: F2123 NICOTINE
Special Hazard Precautions: MAY BE FATAL IF ABSORBED THROUGH SKIN/INHALED/
INGESTED. EXPOSURE CAN CAUSE LIVER & KIDNEY DAMAGE/ADVERSE REPRODUCTIVE
EFFECTS/DELAYED LUNG INJURY/CARDIOVASCULAR SYSTEM INJURY/RESPIRATORY TRACT
IRRITATION/DELAYED ADVERSE HEALTH EFFECTS/NERVOUS SYSTEM INJURY. POSSIBLE
CUMULATIVE POISON. (SEE SUPP) IRRITATION, CYANOSIS, GI DISTURBANCES.
Label Name: CHEM SERVICE INC
Label Street: 660 TOWER LN
Label P.O. Box: 3108
Label City: WEST CHESTER
Label State: PA
Label Zip Code: 19381-3108
Label Country: US
Label Emergency Number: 215-692-3026/800-452-9994
from Chem Service
Other Material Safety Information for Nicotine:
International Chemical Safety Cards : Nicotine
l-Nicotine, 99+%
--------------------------------------------------------------------------------
CHEM SERVICE -- F2123 NICOTINE
MATERIAL SAFETY DATA SHEET
NSN: 655000F037521
Manufacturer's CAGE: 8Y898
Part No. Indicator: A
Part Number/Trade Name: F2123 NICOTINE
===========================================================================
General Information
===========================================================================
Company's Name: CHEM SERVICE INC
Company's Street: 660 TOWER LN
Company's P. O. Box: 3108
Company's City: WEST CHESTER
Company's State: PA
Company's Country: US
Company's Zip Code: 19381-3108
Company's Emerg Ph #: 215-692-3026/800-452-9994
Company's Info Ph #: 215-692-3026/800-452-9994
Record No. For Safety Entry: 001
Tot Safety Entries This Stk#: 001
Status: SE
Date MSDS Prepared: 02NOV92
Safety Data Review Date: 14DEC94
Preparer's Company: CHEM SERVICE INC
Preparer's St Or P. O. Box: 660 TOWER LN
Preparer's City: WEST CHESTER
Preparer's State: PA
Preparer's Zip Code: 19381-3108
MSDS Serial Number: BWJGR
===========================================================================
Ingredients/Identity Information
===========================================================================
Proprietary: NO
Ingredient: NICOTINE
Ingredient Sequence Number: 01
NIOSH (RTECS) Number: QS5250000
CAS Number: 54-11-5
OSHA PEL: 0.5 MG/CUM
ACGIH TLV: 0.5 MG/CUM (SKIN)
===========================================================================
Physical/Chemical Characteristics
===========================================================================
Appearance And Odor: COLORLESS TO YELLOW LIQUID W/AMMONIA LIKE ODOR.
Boiling Point: 476.6F
Melting Point: -112F
Vapor Pressure (MM Hg/70 F): 4.25
Solubility In Water: MISCIBLE
===========================================================================
Fire and Explosion Hazard Data
===========================================================================
Flash Point: 213.8F
Lower Explosive Limit: 0.7
Upper Explosive Limit: 4
Extinguishing Media: CO2, DRY CHEMICAL POWDER/SPRAY.
Unusual Fire And Expl Hazrds: SENSITIVE TO LIGHT & AIR.
===========================================================================
Reactivity Data
===========================================================================
Stability: YES
Cond To Avoid (Stability): LIGHT, AIR & MOISTURE.
Materials To Avoid: STRONG OXIDIZING AGENTS/ACIDS.
Hazardous Decomp Products: TOXIC FUMES.
Hazardous Poly Occur: NO
===========================================================================
Health Hazard Data
===========================================================================
LD50-LC50 Mixture: ORAL LD50 (RAT/MOUSE): 50 MG/KG
Route Of Entry - Inhalation: YES
Route Of Entry - Skin: YES
Route Of Entry - Ingestion: YES
Health Haz Acute And Chronic: MAY BE FATAL IF ABSORBED THROUGH SKIN/
INHALED/INGESTED. EXPOSURE CAN CAUSE LIVER & KIDNEY DAMAGE/ADVERSE
REPRODUCTIVE EFFECTS/DELAYED LUNG INJURY/CARDIOVASCULAR SYSTEM INJURY/
RESPIRATORY TRACT IRRITATION/DELAYED ADVERSE HEALTH EFFECTS/NERVOUS SYSTEM
INJURY. POSSIBLE CUMULATIVE POISON. (SEE SUPP)
Carcinogenicity - NTP: NO
Carcinogenicity - IARC: NO
Carcinogenicity - OSHA: NO
Explanation Carcinogenicity: NONE
Signs/Symptoms Of Overexp: IRRITATION, CYANOSIS, GI DISTURBANCES.
Emergency/First Aid Proc: EYES: FLUSH CONTINUOUSLY W/WATER FOR 15-2O MINS.
SKIN: FLUSH W/WATER FOR 15-20 MINS. IF NOT BURNED, WASH W/SOAP & WATER.
INHALATION: REMOVE TO FRESH AIR. GIVE CPR/OXYGEN IF NEEDED. KEEP WARM &
QUIET. INGESTION: INDUCE VOMITING. DON'T GIVE LIQUIDS/INDUCE VOMITING IF
UNCONSCIOUS/CONVULSING. IF VOMITING OCCURS, WATCH CLOSELY TO AVOID AIRWAY
OBSTRUCTION. OBTAIN MEDICAL ATTENTION IN ALL CASES.
===========================================================================
Precautions for Safe Handling and Use
===========================================================================
Steps If Matl Released/Spill: EVACUATE AREA. WEAR APPRORPRIATE OSHA
REGULATED EQUIPMENT. VENTILATE AREA. ABSORB ON VERMICULITE/SIMILAR
MATERIAL. SWEEP UP & PLACE IN APPROPRIATE CONTAINER/HOLD FOR DISPOSAL. WASH
CONTAMINATED SURFACES TO REMOVE ANY RESIDUES.
Waste Disposal Method: BURN IN A CHEMICAL INCINERATOR EQUIPPED W/AN
AFTERBURNER & SCRUBBER IAW/FEDERAL, STATE & LOCAL REGULATIONS.
Precautions-Handling/Storing: STORE IN A COOL DRY PLACE ONLY W/COMPATIBLE
CHEMICALS. KEEP TIGHTLY CLOSED. MARTERIAL IS HYGROSCOPIC. DARK COLORS
DOESN'T AFFECT PURITY.
Other Precautions: AVOID CONTACT W/SKIN, EYES & CLOTHING. DON'T BREATH
VAPORS. CONTACT LENSES SHOULDN'T BE WORN IN THE LABORATORY. ALL CHEMICALS
SHOULD BE CONSIDERED HAZARDOUS. AVOID DIRECT PHYSICAL CONTACT.
===========================================================================
Control Measures
===========================================================================
Respiratory Protection: WEAR APPROPRIATE OSHA/MSHA APPROVED SAFETY
EQUIPMENT.
Ventilation: CHEMICAL SHOULD BE HANDLED ONLY IN A HOOD.
Eye Protection: EYE SHIELDS
Work Hygienic Practices: REMOVE/LAUNDER CONTAMINATED CLOTHING BEFORE
REUSE.
Suppl. Safety & Health Data: HEALTH HAZARDS CONT'D: POSSIBLE TERATOGEN -
CAUSES EMBRYO-FETAL DAMAGE.
===========================================================================
Transportation Data
===========================================================================
===========================================================================
Disposal Data
===========================================================================
===========================================================================
Label Data
===========================================================================
Label Required: YES
Label Status: G
Common Name: F2123 NICOTINE
Special Hazard Precautions: MAY BE FATAL IF ABSORBED THROUGH SKIN/INHALED/
INGESTED. EXPOSURE CAN CAUSE LIVER & KIDNEY DAMAGE/ADVERSE REPRODUCTIVE
EFFECTS/DELAYED LUNG INJURY/CARDIOVASCULAR SYSTEM INJURY/RESPIRATORY TRACT
IRRITATION/DELAYED ADVERSE HEALTH EFFECTS/NERVOUS SYSTEM INJURY. POSSIBLE
CUMULATIVE POISON. (SEE SUPP) IRRITATION, CYANOSIS, GI DISTURBANCES.
Label Name: CHEM SERVICE INC
Label Street: 660 TOWER LN
Label P.O. Box: 3108
Label City: WEST CHESTER
Label State: PA
Label Zip Code: 19381-3108
Label Country: US
Label Emergency Number: 215-692-3026/800-452-9994
Material Safety Data Sheets
What is a Material Safety Data Sheet (MSDS)?
A Material Safety Data Sheet (MSDS) is a document that contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with the chemical product. It is an essential starting point for the development of a complete health and safety program. It also contains information on the use, storage, handling and emergency procedures all related to the hazards of the material. The MSDS contains much more information about the material than the label. MSDSs are prepared by the supplier or manufacturer of the material. It is intended to tell what the hazards of the product are, how to use the product safely, what to expect if the recommendations are not followed, what to do if accidents occur, how to recognize symptoms of overexposure, and what to do if such incidents occur.
Do I need an MSDS?
In Canada, every material that is controlled by WHMIS (Workplace Hazardous Materials Information System) must have an accompanying MSDS that is specific to each individual product or material (both the product name and supplier on the MSDS must match the material in use).
What information is on the MSDS?
There are nine (9) categories of information that must be present on an MSDS in Canada. These categories are specified in the Controlled Products Regulations and include:
Product Information: product identifier (name), manufacturer and suppliers names, addresses, and emergency phone numbers
Hazardous Ingredients
Physical Data
Fire or Explosion Hazard Data
Reactivity Data: information on the chemical instability of a product and the substances it may react with
Toxicological Properties: health effects
Preventive Measures
First Aid Measures
Preparation Information: who is responsible for preparation and date of preparation of MSDS
The Controlled Products Regulations prescribes what information must be present in more detail.
Are MSDSs using the 16-heading format acceptable in Canada?
Yes, as long as two conditions are met. First, all the required information specified under Column III of Schedule I of the Controlled Products Regulations (CPR) must be addressed. All headings and subheadings that are on the MSDS must be addressed by providing the required information or by stating that the information is not available or not applicable, whichever is appropriate.
Second, the statement "This product has been classified in accordance with the hazard criteria of the CPR and the MSDS contains all of the information required by the CPR" must appear under the section heading "Regulatory Information".
Why is my MSDS so hard to understand?
Traditionally the intended readers of MSDSs were occupational hygienists and safety professionals. Now the audience also includes employers, workers, supervisors, nurses, doctors, emergency responders and workers. To ensure that MSDS users can quickly find the information that they need, the information should be in an easy-to-read format and written in a clear, precise and understandable manner.
For most people who work with controlled products, there are some sections that are more important than others. You should always read the name of the chemical, know the hazards, understand safe handling and storage instructions, as well as understand what to do in an emergency.
Is all the information I need on the MSDS?
Not necessarily. A lot of health hazard information, for example, is written in general terms. Your health and safety specialist, occupational health nurse or family doctor should be able to help you find more information if needed.
When would I use an MSDS?
Always be familiar with the hazards of a product BEFORE you start using it. You should look at a MSDS, match the name of the chemical on your container to the one on the MSDS, know the hazards, understand safe handling and storage instructions, as well as understand what to do in an emergency.
Why do some MSDSs look different?
MSDSs look different because only certain content of the MSDS is specified by law. The format is left up to the manufacturer or supplier who writes the MSDS. Some manufacturers/suppliers put more details in than what is required. However, the information for the nine basic categories must always be in a Canadian MSDS for a controlled product.
Can an MSDS be too old?
Yes. Under WHMIS law, an MSDS for a controlled product must not be more than three years old. If you are still using a product that you bought more than three years ago, you may not have a current MSDS. Contact the manufacturer or supplier again and ask for a newer version of the MSDS.
The three-year time limit does not apply to MSDSs for non-controlled products (i.e. products that do not meet WHMIS criteria).
How often should an MSDS be updated?
If new, significant information becomes available before the three years has elapsed, the supplier is required to update the product label and MSDS.
If there is no new information on the ingredients by the end of the three-year period, the supplier should review the MSDS and the label for accuracy, revise it where necessary, and revise the preparation date on the MSDS.
As an employer, do I have responsibilities for MSDSs?
Yes. Employers must make sure that all controlled products have an up-to-date (less than three years old) MSDS when it enters the workplace. The MSDSs must be readily available to the workers who are exposed to the controlled product and to the health and safety committee or representative. If a controlled product is made in the workplace, the employer has a duty to prepare an MSDS for any of these products.
Employers may computerize the MSDS information as long as all employees have access to and are trained on how to use the computer, the computers are kept in working order, and that the employer makes a hard copy of the MSDS available to the employee or safety and health committee/representative upon request.
A Material Safety Data Sheet (MSDS) is a document that contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with the chemical product. It is an essential starting point for the development of a complete health and safety program. It also contains information on the use, storage, handling and emergency procedures all related to the hazards of the material. The MSDS contains much more information about the material than the label. MSDSs are prepared by the supplier or manufacturer of the material. It is intended to tell what the hazards of the product are, how to use the product safely, what to expect if the recommendations are not followed, what to do if accidents occur, how to recognize symptoms of overexposure, and what to do if such incidents occur.
Do I need an MSDS?
In Canada, every material that is controlled by WHMIS (Workplace Hazardous Materials Information System) must have an accompanying MSDS that is specific to each individual product or material (both the product name and supplier on the MSDS must match the material in use).
What information is on the MSDS?
There are nine (9) categories of information that must be present on an MSDS in Canada. These categories are specified in the Controlled Products Regulations and include:
Product Information: product identifier (name), manufacturer and suppliers names, addresses, and emergency phone numbers
Hazardous Ingredients
Physical Data
Fire or Explosion Hazard Data
Reactivity Data: information on the chemical instability of a product and the substances it may react with
Toxicological Properties: health effects
Preventive Measures
First Aid Measures
Preparation Information: who is responsible for preparation and date of preparation of MSDS
The Controlled Products Regulations prescribes what information must be present in more detail.
Are MSDSs using the 16-heading format acceptable in Canada?
Yes, as long as two conditions are met. First, all the required information specified under Column III of Schedule I of the Controlled Products Regulations (CPR) must be addressed. All headings and subheadings that are on the MSDS must be addressed by providing the required information or by stating that the information is not available or not applicable, whichever is appropriate.
Second, the statement "This product has been classified in accordance with the hazard criteria of the CPR and the MSDS contains all of the information required by the CPR" must appear under the section heading "Regulatory Information".
Why is my MSDS so hard to understand?
Traditionally the intended readers of MSDSs were occupational hygienists and safety professionals. Now the audience also includes employers, workers, supervisors, nurses, doctors, emergency responders and workers. To ensure that MSDS users can quickly find the information that they need, the information should be in an easy-to-read format and written in a clear, precise and understandable manner.
For most people who work with controlled products, there are some sections that are more important than others. You should always read the name of the chemical, know the hazards, understand safe handling and storage instructions, as well as understand what to do in an emergency.
Is all the information I need on the MSDS?
Not necessarily. A lot of health hazard information, for example, is written in general terms. Your health and safety specialist, occupational health nurse or family doctor should be able to help you find more information if needed.
When would I use an MSDS?
Always be familiar with the hazards of a product BEFORE you start using it. You should look at a MSDS, match the name of the chemical on your container to the one on the MSDS, know the hazards, understand safe handling and storage instructions, as well as understand what to do in an emergency.
Why do some MSDSs look different?
MSDSs look different because only certain content of the MSDS is specified by law. The format is left up to the manufacturer or supplier who writes the MSDS. Some manufacturers/suppliers put more details in than what is required. However, the information for the nine basic categories must always be in a Canadian MSDS for a controlled product.
Can an MSDS be too old?
Yes. Under WHMIS law, an MSDS for a controlled product must not be more than three years old. If you are still using a product that you bought more than three years ago, you may not have a current MSDS. Contact the manufacturer or supplier again and ask for a newer version of the MSDS.
The three-year time limit does not apply to MSDSs for non-controlled products (i.e. products that do not meet WHMIS criteria).
How often should an MSDS be updated?
If new, significant information becomes available before the three years has elapsed, the supplier is required to update the product label and MSDS.
If there is no new information on the ingredients by the end of the three-year period, the supplier should review the MSDS and the label for accuracy, revise it where necessary, and revise the preparation date on the MSDS.
As an employer, do I have responsibilities for MSDSs?
Yes. Employers must make sure that all controlled products have an up-to-date (less than three years old) MSDS when it enters the workplace. The MSDSs must be readily available to the workers who are exposed to the controlled product and to the health and safety committee or representative. If a controlled product is made in the workplace, the employer has a duty to prepare an MSDS for any of these products.
Employers may computerize the MSDS information as long as all employees have access to and are trained on how to use the computer, the computers are kept in working order, and that the employer makes a hard copy of the MSDS available to the employee or safety and health committee/representative upon request.
Gray Hair
for gray hair to be restored to its normal color,nutrients must firstly be restored in the body.
Gray hair occurs from a magnesium imbalance.to restore hair to its natural color,magnesium nutrients must be taken.
Gray hair occurs from a magnesium imbalance.to restore hair to its natural color,magnesium nutrients must be taken.
Tuesday, November 24, 2009
Tobacco Technical Data
Tabacum (U. S. P.)—Tobacco.
Nicotiana alata
Nicotiana repanda
Nicotiana rustica
Nicotiana tabacum
Preparation: Ointment of Tobacco
"The commercial, dried leaves of Nicotiana Tabacum, Linné"—(U. S. P.).
Nat. Ord.—Solanaceae.
COMMON NAME AND SYNONYM: Leaf tobacco; Tabaci folia.
ILLUSTRATION: Bentley and Trimen, Med. Plants, 191.
Botanical Source.—This is an annual herb, with a long, fibrous root, and an erect, round, hairy, viscid stem, branched toward the top, and from 4 to 6 feet in height. The alternate leaves are sessile, ovate or lanceolate, acuminate, decurrent, viscid, pale green, 1 or 2 feet long, and 6 or 8 inches broad. The under surface of the tobacco leaf is marked by a prominent, thick midrib, sending off, at acute angles, lateral veins, which terminate near the margin of the leaf in a curved manner. The flowers are rose-colored, and produced in panicles at the ends of the stems and branches. The bracts are linear and acute. The calyx is urceolate, hairy, glutinous, half as long as the corolla, and ends in 5 acute segments. Corolla funnel-shaped, swelling toward the top, the border dull-red, expanding, with 5 acute, crimped lobes. Stamens 5; filaments inclined to one side, with oblong anthers. Ovary ovate; style long and slender; stigma capitate and cloven. Capsule ovate, invested with the calyx, 2-celled, 2-valved, but opening crosswise at top, and loculicidal. The seeds are very numerous, small, somewhat reniform, and attached to a fleshy receptacle (L.—W.—R.).
History.—Tobacco is a native of the warmer parts of America, and was first exported to England, in 1586, by Sir Walter Raleigh. According to the authors of the Pharmacographia, it was carried to Europe by the Spaniards on their return from discovering America (1492), and employed for its medicinal effects. At present, it is raised in many parts of the world, and especially in the middle states of this country. The strongest and more commonly used tobacco is raised in Virginia, but the Cuban or Havana leaf is preferred by smokers. The plant flowers in July. In cultivating tobacco the seeds are thickly sown in beds of prepared soil; the young plants are reset in the last month of spring, into fields, where they are placed in rows at distances of 2, 3, or 4 feet apart, and, in order to obviate the flowering and consequent formation of seed, the tops are removed from time to time. Close vigilance is required until the plant is ready for harvest, which is generally in the last summer month, when the matured plants are cut off just above their roots, hung up in bundles under sheds to dry, after which the leaves are removed from the stalks and packed in hogsheads or boxes for market. There are several varieties of this plant, all of which appear to possess analogous virtues. Soil and the peculiar method adopted in raising this plant, as well as the various methods of curing the leaf, will influence the quality of the final product. (For a detailed account of the production and treatment of the more important tobacco grades of commerce, see L. Janke, Forschungsberichte über Lebensmittel, 1897, pp. 58-69.)
Description.—Commercial tobacco is usually of a dark-brown or orange-brown color; though its shades differ, of a powerful, heavy, disagreeable odor, and a peculiar, bitter, sickening taste, followed by a very disagreeable sense of acridity in the fauces. The dark leaves are much stronger and more powerful in their action than the light-colored. The U. S. P. describes dried tobacco leaves as follows: "Up to 50 Cm. (20 inches) long, oval or ovate-lanceolate, acute, entire, brown, friable, glandular-hairy, of a heavy, peculiar odor, and a nauseous, bitter, and acrid taste"—(U.S. P.). Water or alcohol extract the virtues of dried tobacco leaves. Continued boiling materially impairs their activity.
Chemical Composition.—The aroma of dried tobacco leaves is due to a small quantity of tobacco camphor or nicotianin (Vauquelin, 1809; Hermbstädt, 1823); it is volatile with steam, forms white, scaly crystals, is of neutral reaction, little soluble in water, soluble in alcohol and ether. The toxic properties of tobacco leaves are due to the alkaloid nicotine, discovered by Posselt and Reimann, in 1828, yet the quality of tobacco for smoking purposes does not depend on the quantity of nicotine present. The latter varies in the different grades of leaf from 0.4 to as high as 8 per cent. Smoking tobacco contains less (about 0.4 to 1.3 per cent), owing to partial volatilization of nicotine in the curing process. The alkaloid exists in the leaves combined with malic and citric acids, of which 10 to 14 per cent is present in dried leaves. These acids are supposed to be chiefly combined with potassium. The dried leaves yield a large amount of ash (18 to 27 per cent). Potassium nitrate is among the mineral constituents, occurring especially in the midrib, and may amount to as much as 10 per cent (Flückiger, Pharmacognosie des Pflanzenreichs, 3d ed., 1891, p. 715). Other constituents of the fresh leaves are albuminous matters (25 per cent), gum, (5 per cent), resin (4 to 6 per cent), tannic acid, sugar (tabacose, Attfield, 1884), wax, calcium oxalate, etc. The poisonous constituents of tobacco smoke are small amounts of carbon monoxide, hydrogen sulphide, and hydrogen cyanide, somewhat larger quantities of picoline bases (methyl pyridines), and considerable amounts of nicotine (R. Kissling, see Amer. Jour. Pharm., 1882, pp. 492 and 628; and H. Thoms, Berichte d. Deutsch. Pharm. Ges., 1900, p. 19).
NICOTINE (Nicotia, C10H14N2), when freshly distilled, is a colorless, mobile liquid, of an intense, peculiar odor, differing from the accustomed tobacco odor, and an acrid, burning taste. It is very poisonous. Exposed to air and light, it turns dark, and partly resinifies. It is slowly volatilized at ordinary temperature, and can be distilled with the vapors of boiling water. Heated by itself, it boils, with decomposition, at about 240° C. (464° F.), but does not decompose in an atmosphere of hydrogen. It begins to distill at a much lower temperature (146° C., or 294.8° F.). It is miscible with water, alcohol, ether, chloroform, and fatty oils, the solutions being strongly alkaline. Nicotine is heavier than water, and forms salts with acids, which do not easily crystallize. It is a pyridine derivative, forming, upon oxidation, nicotinic acid (beta-pyridine-carbonic acid) C5H4N.COOH). (Also see A. Pinner's researches, Archiv der Pharm., 1893, p. 378, and 1895, P . 572.) Nicotine may be obtained by adding to a concentrated tobacco extract, solution of caustic soda or lime, distilling with steam, extracting the distillate with ether, and carefully evaporating the solvent. (For another method, that of Schloesing, see this Dispensatory, preceding edition.) R. Kissling (Fresenius' Zeitschrift f. Analyt. Chem., 1882, pp. 64-90) assays tobacco by agitating 20 grammes, in powder form, with alcoholic caustic soda, exhausting the mixture with ether, carefully distilling off the greater part of the solvent, adding diluted caustic soda to the residue, distilling off the nicotine with steam, and titrating each 100 Cc. of the distillate with volumetric sulphuric acid solution, using rosolic acid for indicator. (For other methods, see Archiv der Pharm., 1893, p. 658; and Jour. Amer. Chem. Soc. Proc., 1899, p. 32.)
Action, Medical Uses, and Dosage.—Tobacco and, in a greater degree, its alkaloid, nicotine, exhibit powerful acro-narcotic properties. Applied to the nose, it occasions sneezing and increased mucous flow. Internally, in small amounts, they produce acrid heat in the throat, gastric warmth, nausea, and sometimes purging. Salivation and diuresis are increased. They allay general unrest and quiet mental inquietude, and give to the patient a sense of languid repose. Larger doses, however, produce a hot, acrid, and raw feeling in the throat and fauces, extreme nausea, vomiting, diarrhoea, and great prostration of muscular and nervous power. Muscular relaxation, with trembling of the extremities, is marked; great anxiety, mental confusion, feeble pulse, pale countenance, and marked depression of heart-action, are prominent among the effects. The body is bathed in cold sweat, the breathing oppressed and laborious, there is photophobia and impaired hearing, the limbs are helpless, and faintness, followed by unconsciousness, may supervene. These effects may occur from the use of tobacco in any form, whether internally or externally applied. Those accustomed to the disgusting habit of chewing or smoking tobacco, become so tolerant of the effects of the weed as not to become affected, or but slightly so, in the manner described. Even in these there is, however, more or less nervous impairment, which becomes manifest when the weed is withdrawn for a day or more. The pernicious habit of cigarette smoking, now under the ban of the law, in regard to minors, in many localities, has done incalculable harm—a rapid pulse, irritable heart (tobacco heart), disordered innervation, nervous prostration, general debility, emaciation, dyspepsia, and a train of other evils, being the result of intemperance in the use of this plant. Toxic (tobacco) amblyopia is frequently produced by the excessive use of tobacco. In chronic tobacco poisoning, there may be epithelial cancer of the mouth, tongue, or lips, or other destructive ulcers of the mouth, follicular pharyngitis, bronchorrhoea, feeble and rapid cardiac action, color-blindness, etc. Nicotine acts chiefly upon the sympathetic and spinal nervous systems, and, when it kills, does so by paralysis of the heart, or respiratory paralysis (asphyxia). In point of toxic power, nicotine is asserted to be second only to prussic acid. A single drop has killed a rabbit in 3 1/2 minutes (Taylor). Among celebrated murders, that of a brother killed with nicotine, by Count and Countess Bocarmé (Ann. d'Hyg., 1851), is a matter of historical record. A child of 3 years was killed from blowing bubbles from an old pipe which had not been used for a year, but had been washed previous to being used by the child. The symptoms were those of narcotic poisoning (Taylor, Med. Jurisp., p. 204). In poisoning by tobacco, the use of stimulants may be resorted to. Among these may be mentioned strychnine, whiskey, and ether, subcutaneously; aromatic spirit of ammonia, tannin and iodides (chemical antagonists), camphor, digitalis, strophanthus, internally; and external heat.
Tobacco infusion is more apt to affect the heart, and its smoke to act on the nervous system—the former being followed by great feebleness of the pulse, fluttering of the heart, faintness, alarm, etc., while the latter occasions nausea and vomiting, followed by drowsiness. Medicinally, it is a sedative, emetic, diuretic, expectorant, discutient, antispasmodic, errhine, antiseptic, and sialagogue. Tobacco should be seldom employed internally, as we have other agents much safer and fully as effectual to meet every desired indication. However, a tincture of the fresh plant has been advised as a sedative in respiratory disorders of children, and a water (Aqua Nicotianae Tabacum Spirituosae Rademacheri; see Scudder's Spec. Med., p. 187, for formula (not in the 1870 edition)) has been advised in the brain complications of fevers, in both wandering and fixed acute rheumatism, in brain and spinal cord affections, and in cholera morbus and Asiatic cholera. The alkaloid nicotine, and, in some instances, tobacco, have been most potent in the relief of tetanus. The larger doses may be employed—from 1/2 to 1 drop of nicotine, hypodermatically. For other purposes only the small doses hereinafter advised should be given.
Tobacco is seldom used as an emetic, except in cases where, from extreme insensibility of the stomach, ordinary emetics will not operate. The smoke injected into the rectum, or the leaf itself, in the shape of a suppository, and introduced into the rectum, or an enema of tobacco, has been beneficial in strangulated hernia, obstinate constipation front spasm of the bowels, in retention of urine from spasmodic urethral stricture, hysterical convulsions, worms, and in spasms caused by lead; likewise in spasmodic croup, spasmodic asthma, and constipation, with inflammation of peritoneum, to produce evacuations of the bowels, moderating reaction, and dispelling tympanites. To use the infusion of smoke, blow the smoke into milk or water and inject. Hiccough has been relieved by swallowing tobacco smoke. In spasmodic croup and spasm of the rima glottidis, a plaster made of Scotch snuff and lard, and applied to the throat and chest, has proved very effectual; or a cataplasm of the leaves may be employed. Inhalation of tobacco smoke sometimes relieves a tickling, irritable cough, produced by irritation or other nervous action in the larynx or trachea; spasmodic laryngitis has also been similarly relieved. An ointment of tobacco has been found valuable in several forms of cutaneous disease, as scabies, urticaria, etc. Fresh cuts may be treated with tobacco moistened from time to time with alcohol. The leaves, in combination with belladonna or stramonium leaves, will be found an excellent application to old, obstinate ulcers, painful tumors, and for spasmodic affections. A reputed cure for piles, is the application and maintenance there, for 3 or 4 hours, of a wet leaf to the parts. The inspissated juice has cured facial neuralgia, being rubbed along the track of the affected nerve. Topically, the leaves or an infusion, applied by means of a compress, allay pain in rheumatism, gout, orchitis, epididymitis, buboes, and other glandular inflammations, scirrhous and scrofulous tumors, phimosis, paraphimosis, boils, painful hemorrhoids, and erysipelatous inflammations. An enema of tobacco has given relief in dysentery, but extreme caution should be observed in its use. An ointment (tobacco, 1 drachm, to lard, 1 ounce), has been advised to relax rigid os uteri during parturition. Rectal ascarides and lumbricoid worms have been expelled by the inflation of the rectum with tobacco smoke, or by injection of the infusion. It has also been used to destroy maggots in the nose and ear. In using tobacco at all, great caution should always be observed, and if it produce great depression (as it is apt to do very suddenly), or too lasting a sedative effect, stimulants, as ammonia or brandy, should be administered. The quantity for an injection ought not to exceed 20 grains at first; if this fails, cautiously increase it, for even 1/2 drachm has often proved fatal. If the injection does not come away in 5 minutes, it should be assisted by throwing up a large quantity of warm water. A wine of tobacco may be used in from 1 to 20-drop doses. Nicotine is too dangerous for general use. The beginning dose should not exceed 1/100 grain, although as high as 1 grain has been recommended. The dose of tobacco, as an emetic, is 5 grains.
Related Species and Preparation.—Other species of Nicotiana have been cultivated for their leaves. Some which figured as distinct species, are now regarded as varieties of Nicotiana Tabacum. Among these are N. petiolata, Agardh; N. fruticosa, Linné; N. macrophylla, Lehman, etc. The species said to be cultivated in Cuba, yielding Havana leaf, is the Nicotiana repanda, Willdenow, though Vidal denies this, stating that only N. Tabacum is there grown. Shiras or Persian tobacco is reputed the product of N. persica, Linné. That known as tumbaki (of Turkish and Persian tobacco) has in the past been attributed to N. rustica and N. persica, but is now said to be the product of N. Tabacum (Kew Bulletin, 1891). Latakia tobacco, formerly said to be the product of N. rustica, is now held to be the flowering heads and capsules of N. Tabacum flavored by being exposed to the smoke of Pinus halipensis, Aiton (Dyer).
Other tomes: - Howe's bio - Howe's bio
DYNAMYNE.—This name was given by Lloyd Brothers to a preparation which contains the alkaloids of tobacco. It is a green-colored, hydro-alcoholic liquid, and is designed for external use only. The name was selected at the request of the late Prof. A. J. Howe, M.D., who desired a characteristic term for a preparation he prescribed extensively and valued highly. Dynamyne, when well diluted with water, is destructive to many plant insects, but does not appear to materially affect the plants to which it is applied. Owing to its toxic nature, care should be exercised in handling or inhaling it. Dynamyne is an agent of great value, and is fast becoming established as a remedy to relieve pain, both deep-seated and superficial. A solution of 1 to 4 fluid drachms of dynamyne in 1 pint of water, may be applied to localized inflammations, to relieve the pains of neuralgia, rheumatism, felons, abscesses, pleurodynia, etc., and many other conditions in which the local effects of tobacco, in a more pronounced degree, are desired. It should not be administered internally.
Nicotiana alata
Nicotiana repanda
Nicotiana rustica
Nicotiana tabacum
Preparation: Ointment of Tobacco
"The commercial, dried leaves of Nicotiana Tabacum, Linné"—(U. S. P.).
Nat. Ord.—Solanaceae.
COMMON NAME AND SYNONYM: Leaf tobacco; Tabaci folia.
ILLUSTRATION: Bentley and Trimen, Med. Plants, 191.
Botanical Source.—This is an annual herb, with a long, fibrous root, and an erect, round, hairy, viscid stem, branched toward the top, and from 4 to 6 feet in height. The alternate leaves are sessile, ovate or lanceolate, acuminate, decurrent, viscid, pale green, 1 or 2 feet long, and 6 or 8 inches broad. The under surface of the tobacco leaf is marked by a prominent, thick midrib, sending off, at acute angles, lateral veins, which terminate near the margin of the leaf in a curved manner. The flowers are rose-colored, and produced in panicles at the ends of the stems and branches. The bracts are linear and acute. The calyx is urceolate, hairy, glutinous, half as long as the corolla, and ends in 5 acute segments. Corolla funnel-shaped, swelling toward the top, the border dull-red, expanding, with 5 acute, crimped lobes. Stamens 5; filaments inclined to one side, with oblong anthers. Ovary ovate; style long and slender; stigma capitate and cloven. Capsule ovate, invested with the calyx, 2-celled, 2-valved, but opening crosswise at top, and loculicidal. The seeds are very numerous, small, somewhat reniform, and attached to a fleshy receptacle (L.—W.—R.).
History.—Tobacco is a native of the warmer parts of America, and was first exported to England, in 1586, by Sir Walter Raleigh. According to the authors of the Pharmacographia, it was carried to Europe by the Spaniards on their return from discovering America (1492), and employed for its medicinal effects. At present, it is raised in many parts of the world, and especially in the middle states of this country. The strongest and more commonly used tobacco is raised in Virginia, but the Cuban or Havana leaf is preferred by smokers. The plant flowers in July. In cultivating tobacco the seeds are thickly sown in beds of prepared soil; the young plants are reset in the last month of spring, into fields, where they are placed in rows at distances of 2, 3, or 4 feet apart, and, in order to obviate the flowering and consequent formation of seed, the tops are removed from time to time. Close vigilance is required until the plant is ready for harvest, which is generally in the last summer month, when the matured plants are cut off just above their roots, hung up in bundles under sheds to dry, after which the leaves are removed from the stalks and packed in hogsheads or boxes for market. There are several varieties of this plant, all of which appear to possess analogous virtues. Soil and the peculiar method adopted in raising this plant, as well as the various methods of curing the leaf, will influence the quality of the final product. (For a detailed account of the production and treatment of the more important tobacco grades of commerce, see L. Janke, Forschungsberichte über Lebensmittel, 1897, pp. 58-69.)
Description.—Commercial tobacco is usually of a dark-brown or orange-brown color; though its shades differ, of a powerful, heavy, disagreeable odor, and a peculiar, bitter, sickening taste, followed by a very disagreeable sense of acridity in the fauces. The dark leaves are much stronger and more powerful in their action than the light-colored. The U. S. P. describes dried tobacco leaves as follows: "Up to 50 Cm. (20 inches) long, oval or ovate-lanceolate, acute, entire, brown, friable, glandular-hairy, of a heavy, peculiar odor, and a nauseous, bitter, and acrid taste"—(U.S. P.). Water or alcohol extract the virtues of dried tobacco leaves. Continued boiling materially impairs their activity.
Chemical Composition.—The aroma of dried tobacco leaves is due to a small quantity of tobacco camphor or nicotianin (Vauquelin, 1809; Hermbstädt, 1823); it is volatile with steam, forms white, scaly crystals, is of neutral reaction, little soluble in water, soluble in alcohol and ether. The toxic properties of tobacco leaves are due to the alkaloid nicotine, discovered by Posselt and Reimann, in 1828, yet the quality of tobacco for smoking purposes does not depend on the quantity of nicotine present. The latter varies in the different grades of leaf from 0.4 to as high as 8 per cent. Smoking tobacco contains less (about 0.4 to 1.3 per cent), owing to partial volatilization of nicotine in the curing process. The alkaloid exists in the leaves combined with malic and citric acids, of which 10 to 14 per cent is present in dried leaves. These acids are supposed to be chiefly combined with potassium. The dried leaves yield a large amount of ash (18 to 27 per cent). Potassium nitrate is among the mineral constituents, occurring especially in the midrib, and may amount to as much as 10 per cent (Flückiger, Pharmacognosie des Pflanzenreichs, 3d ed., 1891, p. 715). Other constituents of the fresh leaves are albuminous matters (25 per cent), gum, (5 per cent), resin (4 to 6 per cent), tannic acid, sugar (tabacose, Attfield, 1884), wax, calcium oxalate, etc. The poisonous constituents of tobacco smoke are small amounts of carbon monoxide, hydrogen sulphide, and hydrogen cyanide, somewhat larger quantities of picoline bases (methyl pyridines), and considerable amounts of nicotine (R. Kissling, see Amer. Jour. Pharm., 1882, pp. 492 and 628; and H. Thoms, Berichte d. Deutsch. Pharm. Ges., 1900, p. 19).
NICOTINE (Nicotia, C10H14N2), when freshly distilled, is a colorless, mobile liquid, of an intense, peculiar odor, differing from the accustomed tobacco odor, and an acrid, burning taste. It is very poisonous. Exposed to air and light, it turns dark, and partly resinifies. It is slowly volatilized at ordinary temperature, and can be distilled with the vapors of boiling water. Heated by itself, it boils, with decomposition, at about 240° C. (464° F.), but does not decompose in an atmosphere of hydrogen. It begins to distill at a much lower temperature (146° C., or 294.8° F.). It is miscible with water, alcohol, ether, chloroform, and fatty oils, the solutions being strongly alkaline. Nicotine is heavier than water, and forms salts with acids, which do not easily crystallize. It is a pyridine derivative, forming, upon oxidation, nicotinic acid (beta-pyridine-carbonic acid) C5H4N.COOH). (Also see A. Pinner's researches, Archiv der Pharm., 1893, p. 378, and 1895, P . 572.) Nicotine may be obtained by adding to a concentrated tobacco extract, solution of caustic soda or lime, distilling with steam, extracting the distillate with ether, and carefully evaporating the solvent. (For another method, that of Schloesing, see this Dispensatory, preceding edition.) R. Kissling (Fresenius' Zeitschrift f. Analyt. Chem., 1882, pp. 64-90) assays tobacco by agitating 20 grammes, in powder form, with alcoholic caustic soda, exhausting the mixture with ether, carefully distilling off the greater part of the solvent, adding diluted caustic soda to the residue, distilling off the nicotine with steam, and titrating each 100 Cc. of the distillate with volumetric sulphuric acid solution, using rosolic acid for indicator. (For other methods, see Archiv der Pharm., 1893, p. 658; and Jour. Amer. Chem. Soc. Proc., 1899, p. 32.)
Action, Medical Uses, and Dosage.—Tobacco and, in a greater degree, its alkaloid, nicotine, exhibit powerful acro-narcotic properties. Applied to the nose, it occasions sneezing and increased mucous flow. Internally, in small amounts, they produce acrid heat in the throat, gastric warmth, nausea, and sometimes purging. Salivation and diuresis are increased. They allay general unrest and quiet mental inquietude, and give to the patient a sense of languid repose. Larger doses, however, produce a hot, acrid, and raw feeling in the throat and fauces, extreme nausea, vomiting, diarrhoea, and great prostration of muscular and nervous power. Muscular relaxation, with trembling of the extremities, is marked; great anxiety, mental confusion, feeble pulse, pale countenance, and marked depression of heart-action, are prominent among the effects. The body is bathed in cold sweat, the breathing oppressed and laborious, there is photophobia and impaired hearing, the limbs are helpless, and faintness, followed by unconsciousness, may supervene. These effects may occur from the use of tobacco in any form, whether internally or externally applied. Those accustomed to the disgusting habit of chewing or smoking tobacco, become so tolerant of the effects of the weed as not to become affected, or but slightly so, in the manner described. Even in these there is, however, more or less nervous impairment, which becomes manifest when the weed is withdrawn for a day or more. The pernicious habit of cigarette smoking, now under the ban of the law, in regard to minors, in many localities, has done incalculable harm—a rapid pulse, irritable heart (tobacco heart), disordered innervation, nervous prostration, general debility, emaciation, dyspepsia, and a train of other evils, being the result of intemperance in the use of this plant. Toxic (tobacco) amblyopia is frequently produced by the excessive use of tobacco. In chronic tobacco poisoning, there may be epithelial cancer of the mouth, tongue, or lips, or other destructive ulcers of the mouth, follicular pharyngitis, bronchorrhoea, feeble and rapid cardiac action, color-blindness, etc. Nicotine acts chiefly upon the sympathetic and spinal nervous systems, and, when it kills, does so by paralysis of the heart, or respiratory paralysis (asphyxia). In point of toxic power, nicotine is asserted to be second only to prussic acid. A single drop has killed a rabbit in 3 1/2 minutes (Taylor). Among celebrated murders, that of a brother killed with nicotine, by Count and Countess Bocarmé (Ann. d'Hyg., 1851), is a matter of historical record. A child of 3 years was killed from blowing bubbles from an old pipe which had not been used for a year, but had been washed previous to being used by the child. The symptoms were those of narcotic poisoning (Taylor, Med. Jurisp., p. 204). In poisoning by tobacco, the use of stimulants may be resorted to. Among these may be mentioned strychnine, whiskey, and ether, subcutaneously; aromatic spirit of ammonia, tannin and iodides (chemical antagonists), camphor, digitalis, strophanthus, internally; and external heat.
Tobacco infusion is more apt to affect the heart, and its smoke to act on the nervous system—the former being followed by great feebleness of the pulse, fluttering of the heart, faintness, alarm, etc., while the latter occasions nausea and vomiting, followed by drowsiness. Medicinally, it is a sedative, emetic, diuretic, expectorant, discutient, antispasmodic, errhine, antiseptic, and sialagogue. Tobacco should be seldom employed internally, as we have other agents much safer and fully as effectual to meet every desired indication. However, a tincture of the fresh plant has been advised as a sedative in respiratory disorders of children, and a water (Aqua Nicotianae Tabacum Spirituosae Rademacheri; see Scudder's Spec. Med., p. 187, for formula (not in the 1870 edition)) has been advised in the brain complications of fevers, in both wandering and fixed acute rheumatism, in brain and spinal cord affections, and in cholera morbus and Asiatic cholera. The alkaloid nicotine, and, in some instances, tobacco, have been most potent in the relief of tetanus. The larger doses may be employed—from 1/2 to 1 drop of nicotine, hypodermatically. For other purposes only the small doses hereinafter advised should be given.
Tobacco is seldom used as an emetic, except in cases where, from extreme insensibility of the stomach, ordinary emetics will not operate. The smoke injected into the rectum, or the leaf itself, in the shape of a suppository, and introduced into the rectum, or an enema of tobacco, has been beneficial in strangulated hernia, obstinate constipation front spasm of the bowels, in retention of urine from spasmodic urethral stricture, hysterical convulsions, worms, and in spasms caused by lead; likewise in spasmodic croup, spasmodic asthma, and constipation, with inflammation of peritoneum, to produce evacuations of the bowels, moderating reaction, and dispelling tympanites. To use the infusion of smoke, blow the smoke into milk or water and inject. Hiccough has been relieved by swallowing tobacco smoke. In spasmodic croup and spasm of the rima glottidis, a plaster made of Scotch snuff and lard, and applied to the throat and chest, has proved very effectual; or a cataplasm of the leaves may be employed. Inhalation of tobacco smoke sometimes relieves a tickling, irritable cough, produced by irritation or other nervous action in the larynx or trachea; spasmodic laryngitis has also been similarly relieved. An ointment of tobacco has been found valuable in several forms of cutaneous disease, as scabies, urticaria, etc. Fresh cuts may be treated with tobacco moistened from time to time with alcohol. The leaves, in combination with belladonna or stramonium leaves, will be found an excellent application to old, obstinate ulcers, painful tumors, and for spasmodic affections. A reputed cure for piles, is the application and maintenance there, for 3 or 4 hours, of a wet leaf to the parts. The inspissated juice has cured facial neuralgia, being rubbed along the track of the affected nerve. Topically, the leaves or an infusion, applied by means of a compress, allay pain in rheumatism, gout, orchitis, epididymitis, buboes, and other glandular inflammations, scirrhous and scrofulous tumors, phimosis, paraphimosis, boils, painful hemorrhoids, and erysipelatous inflammations. An enema of tobacco has given relief in dysentery, but extreme caution should be observed in its use. An ointment (tobacco, 1 drachm, to lard, 1 ounce), has been advised to relax rigid os uteri during parturition. Rectal ascarides and lumbricoid worms have been expelled by the inflation of the rectum with tobacco smoke, or by injection of the infusion. It has also been used to destroy maggots in the nose and ear. In using tobacco at all, great caution should always be observed, and if it produce great depression (as it is apt to do very suddenly), or too lasting a sedative effect, stimulants, as ammonia or brandy, should be administered. The quantity for an injection ought not to exceed 20 grains at first; if this fails, cautiously increase it, for even 1/2 drachm has often proved fatal. If the injection does not come away in 5 minutes, it should be assisted by throwing up a large quantity of warm water. A wine of tobacco may be used in from 1 to 20-drop doses. Nicotine is too dangerous for general use. The beginning dose should not exceed 1/100 grain, although as high as 1 grain has been recommended. The dose of tobacco, as an emetic, is 5 grains.
Related Species and Preparation.—Other species of Nicotiana have been cultivated for their leaves. Some which figured as distinct species, are now regarded as varieties of Nicotiana Tabacum. Among these are N. petiolata, Agardh; N. fruticosa, Linné; N. macrophylla, Lehman, etc. The species said to be cultivated in Cuba, yielding Havana leaf, is the Nicotiana repanda, Willdenow, though Vidal denies this, stating that only N. Tabacum is there grown. Shiras or Persian tobacco is reputed the product of N. persica, Linné. That known as tumbaki (of Turkish and Persian tobacco) has in the past been attributed to N. rustica and N. persica, but is now said to be the product of N. Tabacum (Kew Bulletin, 1891). Latakia tobacco, formerly said to be the product of N. rustica, is now held to be the flowering heads and capsules of N. Tabacum flavored by being exposed to the smoke of Pinus halipensis, Aiton (Dyer).
Other tomes: - Howe's bio - Howe's bio
DYNAMYNE.—This name was given by Lloyd Brothers to a preparation which contains the alkaloids of tobacco. It is a green-colored, hydro-alcoholic liquid, and is designed for external use only. The name was selected at the request of the late Prof. A. J. Howe, M.D., who desired a characteristic term for a preparation he prescribed extensively and valued highly. Dynamyne, when well diluted with water, is destructive to many plant insects, but does not appear to materially affect the plants to which it is applied. Owing to its toxic nature, care should be exercised in handling or inhaling it. Dynamyne is an agent of great value, and is fast becoming established as a remedy to relieve pain, both deep-seated and superficial. A solution of 1 to 4 fluid drachms of dynamyne in 1 pint of water, may be applied to localized inflammations, to relieve the pains of neuralgia, rheumatism, felons, abscesses, pleurodynia, etc., and many other conditions in which the local effects of tobacco, in a more pronounced degree, are desired. It should not be administered internally.
Friday, September 25, 2009
JET LAG PREVENTION
Don't let jet lag spoil that much needed holiday trip to paradise or stop you from closing that career enhancing deal you've been working on for months.
Arriving full of excitement and anticipation is great, but finding that you can't sleep at night, you're tired during the day and you've got an upset stomach and a headache can do a lot more than just take the edge off your trip.
If you're seeking ways of preventing jet lag, or looking for the perfect jet lag remedy, then here are seven tips to start you on your search.
Tip 1. Clear the decks before your departure.
A much overlooked aspect of jet lag is the part played by stress. Running around trying to do a 1001 last minute jobs in the week before you fly. Worrying about whether the house will be safe. Sitting up until midnight the night before your flight paying the household bills. Sound familiar?
Plan well in advance and make sure that you've taken care of everything at least three or four days before you go. Then take it easy, get lots of rest and set aside time specifically for relaxation.
Tip 2. Start adjusting your bedtime before you go.
In the two weeks before your trip start to gradually adjust your bedtime. If you're flying east, bring your bedtime forward by ten or fifteen minutes each night so that, by the time you leave, you're going to bed about two hours earlier than normal. This will 'narrow the gap' between the time at which your body wants to go to bed and the time that the clock says you should go to bed at your destination.
Similarly, if you're traveling west, put your bedtime back by ten or fifteen minutes each day.
Tip 3. Reduce you caffeine intake.
Coffee, as well as other caffeinated drinks, both speeds up and slows down your internal body clock, depending upon the time of day that you consume it. When you're settled into a regular pattern of sleep this doesn't necessarily present too much of a problem, as the effects can tend to 'balance out'. However, when your body clock finds itself at odds with local time the effects of caffeine can be quite marked and add considerably to the problems of jet lag.
Tip 4. Avoid Pills.
With the exception of any prescribed medication that you normally take, you should avoid sleeping pills, so-called 'jet lag' pills and over the counter medication for jet lag. Not only do these have little or no beneficial effect, many of them can actually add to your problems.
In particular, avoid the common temptation to take sleeping pills during your flight. They may well help you to get to sleep on the aircraft, but they will add to your problems when you arrive at your destination.
Tip 5. Dress comfortably for your flight.
Choose comfortable and loose fitting clothes to travel in and tuck a pair of slippers into your carry-on luggage to wear on board the aircraft. It's nice to be able to get dressed up and go out once you reach your destination but nobody is going to expect you to get dressed up to the nines while you're traveling.
Tip 6. Get out in the sunshine.
Once you reach your destination get out into daylight as much as possible during the first few days of your trip. Daylight sends powerful signals to your body clock and you'll find that it adjusts far more quickly if it is exposed to the normal cycle of daylight and darkness at your destination. So take advantage of this and don't hide yourself away indoors.
Tip 7. Take something special with you.
It can often be difficult settling in strange surroundings and, in particular, relaxing sufficiently to fall asleep. So, take one or two items of special significance with you, perhaps a family photograph or a favorite bedside ornament, to help give a little bit of the feel of home.
Copyright 2005 Donald Saunders http://help-me-to-sleep.com
Attention Ezine Editors / Website Owners
Feel free to reprint this article in its entirety in your ezine or on your website so long as you leave all links intact, do not modify the contentand include the resource box shown above. You may of course use your own affiliate link in the resource box.
For details of our affiliate program, please visit our website at http://help-me-to-sleep.com/affiliates
If you do use this article, please send me a note so that I can take a quick look. Many thanks.
Donald Saunders is the author of a number of health related publications including "Jet Lag - A Natural Approach". Jet lag ruins many trips, but the solution is simpler than you might think. Click here for more information on Jet Lag
Arriving full of excitement and anticipation is great, but finding that you can't sleep at night, you're tired during the day and you've got an upset stomach and a headache can do a lot more than just take the edge off your trip.
If you're seeking ways of preventing jet lag, or looking for the perfect jet lag remedy, then here are seven tips to start you on your search.
Tip 1. Clear the decks before your departure.
A much overlooked aspect of jet lag is the part played by stress. Running around trying to do a 1001 last minute jobs in the week before you fly. Worrying about whether the house will be safe. Sitting up until midnight the night before your flight paying the household bills. Sound familiar?
Plan well in advance and make sure that you've taken care of everything at least three or four days before you go. Then take it easy, get lots of rest and set aside time specifically for relaxation.
Tip 2. Start adjusting your bedtime before you go.
In the two weeks before your trip start to gradually adjust your bedtime. If you're flying east, bring your bedtime forward by ten or fifteen minutes each night so that, by the time you leave, you're going to bed about two hours earlier than normal. This will 'narrow the gap' between the time at which your body wants to go to bed and the time that the clock says you should go to bed at your destination.
Similarly, if you're traveling west, put your bedtime back by ten or fifteen minutes each day.
Tip 3. Reduce you caffeine intake.
Coffee, as well as other caffeinated drinks, both speeds up and slows down your internal body clock, depending upon the time of day that you consume it. When you're settled into a regular pattern of sleep this doesn't necessarily present too much of a problem, as the effects can tend to 'balance out'. However, when your body clock finds itself at odds with local time the effects of caffeine can be quite marked and add considerably to the problems of jet lag.
Tip 4. Avoid Pills.
With the exception of any prescribed medication that you normally take, you should avoid sleeping pills, so-called 'jet lag' pills and over the counter medication for jet lag. Not only do these have little or no beneficial effect, many of them can actually add to your problems.
In particular, avoid the common temptation to take sleeping pills during your flight. They may well help you to get to sleep on the aircraft, but they will add to your problems when you arrive at your destination.
Tip 5. Dress comfortably for your flight.
Choose comfortable and loose fitting clothes to travel in and tuck a pair of slippers into your carry-on luggage to wear on board the aircraft. It's nice to be able to get dressed up and go out once you reach your destination but nobody is going to expect you to get dressed up to the nines while you're traveling.
Tip 6. Get out in the sunshine.
Once you reach your destination get out into daylight as much as possible during the first few days of your trip. Daylight sends powerful signals to your body clock and you'll find that it adjusts far more quickly if it is exposed to the normal cycle of daylight and darkness at your destination. So take advantage of this and don't hide yourself away indoors.
Tip 7. Take something special with you.
It can often be difficult settling in strange surroundings and, in particular, relaxing sufficiently to fall asleep. So, take one or two items of special significance with you, perhaps a family photograph or a favorite bedside ornament, to help give a little bit of the feel of home.
Copyright 2005 Donald Saunders http://help-me-to-sleep.com
Attention Ezine Editors / Website Owners
Feel free to reprint this article in its entirety in your ezine or on your website so long as you leave all links intact, do not modify the contentand include the resource box shown above. You may of course use your own affiliate link in the resource box.
For details of our affiliate program, please visit our website at http://help-me-to-sleep.com/affiliates
If you do use this article, please send me a note so that I can take a quick look. Many thanks.
Donald Saunders is the author of a number of health related publications including "Jet Lag - A Natural Approach". Jet lag ruins many trips, but the solution is simpler than you might think. Click here for more information on Jet Lag
Saturday, August 22, 2009
BEWARE OF SUPRAVENTRICULAR TACHYCARDIA
supraventricular tachycardia is a malady that is potentially fatal.if not administered to,the heart will work too hard and possibly malfunction completely.here are a list of symptms:[1]difficulty breathing[2]dizziness and unconsciousness;especially when standing up too fast[3]numbness over parts of;or the entire body]4]chest pains similar to a heart attac[5]a feeling of blood rushing from the arms,chest;or, both to the head[6]sometimes,weakness and pain in the legs;or, other parts of the body[7]and various other symptoms depending on the severity and personthe home remedy for supraventricular tachycardia is to do or mor of the following:[1]cough[2]place cold water over the head[3]pull in the abs[4]if nothing else works,lay down with a cool breeze blowing over your bodyif these symptoms become chronic:[1]take larger doses[a little more than daily recommended]of electrolytes;or,2 electrolyte stamina tablets[2]rehydratesupraventricular tachycardia is caused by many things.some causes are:[1]exposure to excessive heat[2]excesive dehydration[3]sitting for long periods of time[such as desk work][4]lack of exercise[5]kidney disoders[6]excessive caffeine intake[dehydration][7]sliped vertebrae in between the shoulders[8]and other casesif you experience these symptoms,take precautions immediately.supraventricular tachycardia is potentially fatal.
Friday, August 21, 2009
AORTIC ANEURYSM
What is an aortic aneurysm?
An aortic aneurysm (say “a-OR-tik AN-yuh-rih-zum”) is a bulge in a section of the aorta, the body’s main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.
Aneurysms can form in any section of the aorta, but they are most common in the belly area (abdominal aortic aneurysm). They can also happen in the upper body (thoracic aortic aneurysm). Thoracic aortic aneurysms are also known as ascending or descending aortic aneurysms.
What causes an aortic aneurysm?
The wall of the aorta is normally very elastic. It can stretch and then shrink back as needed to adapt to blood flow. But some medical problems, such as high blood pressure and atherosclerosis (hardening of the arteries), weaken the artery walls. These problems, along with the wear and tear that naturally occurs with aging, can result in a weak aortic wall that bulges outward.
What are the symptoms?
Most aortic aneurysms don't cause symptoms. Sometimes a doctor finds them during exams or tests done for other reasons. People who do have symptoms complain of belly, chest, or back pain and discomfort. The symptoms may come and go or stay constant.
In the worst case, an aneurysm can burst, or rupture. This causes severe pain and bleeding. It often leads to death within minutes to hours.
An aortic aneurysm can also lead to other problems. Blood flow often slows in the bulging section of an aortic aneurysm, causing clots to form. If a blood clot breaks off from an aortic aneurysm in the chest area, it can travel to the brain and cause a stroke. Blood clots that break off from an aortic aneurysm in the belly area can block blood flow to the belly or legs.
How is an aortic aneurysm diagnosed?
Aneurysms are often diagnosed by chance during exams or tests done for other reasons. In some cases, they are found during a screening test for aneurysms. Screening tests help your doctor look for a certain disease or condition before any symptoms appear. Experts recommend screening tests for aneurysms for men who are:
Ages 65 to 75 and have ever smoked. 1
At least 60 years old and have a first-degree relative (for example, father or brother) who has had an aneurysm. 2
These men are more likely to have an aneurysm than are women or nonsmoking men.
If your doctor thinks you have an aneurysm, you may have tests such as an ultrasound, a CT scan, or an MRI to find out where it is and how big it is.
How is it treated?
Treatment of an aortic aneurysm is based on how big it is and how fast it is growing. If you have a large or fast-growing aneurysm, you need surgery to fix it. In most cases, a doctor will replace the damaged part of the blood vessel with a man-made graft.
Small aneurysms rarely rupture and are usually treated with high blood pressure medicine, such as beta-blockers. This medicine helps to lower blood pressure and stress on the aortic wall. If you don't have surgery, you will have routine ultrasound tests to see if the aneurysm is getting bigger.
Even if your aneurysm does not grow or rupture, you may be at risk for heart problems. Your doctor may suggest that you exercise more, eat a heart-healthy diet, and stop smoking. He or she may also prescribe medicines to help lower high cholesterol.
Cause
Abdominal and thoracic aortic aneurysms are caused by a number of factors, including:
Hardening of the arteries (atherosclerosis). Exactly how atherosclerosis leads to abdominal aortic aneurysms is unclear. It is thought that atherosclerosis causes changes in the lining of the artery wall that may affect oxygen and nutrient flow to the aortic wall tissues. The resulting tissue damage and breakdown may lead to the development of an aneurysm.
Genetics. In some people who have Marfan's syndrome, Ehlers-Danlos syndrome, or other inherited conditions, the walls of the major arteries, including the aorta, are weakened. Aortic aneurysms run in families.
Aging. The aorta naturally becomes less elastic and stiffer with age, increasing the risk of an abdominal aortic aneurysm.
Infections. Infections such as syphilis and endocarditis, an infection of the lining of the heart, can cause aneurysms.
Injury. A sudden, intense blow to the chest or abdomen, such as hitting the steering wheel in a car accident, can damage the aorta.
Inflammation. Inflammation of the aorta can weaken the aortic wall. Although researchers have investigated several conditions, what causes the aorta to become inflamed is not clear.
Thoracic aortic aneurysms are much less common than abdominal aortic aneurysms. 3 They are often caused by an abnormal breakdown of the elastic fibers in the aortic wall. Other causes of thoracic aneurysms include aortic coarctation (often resulting from a genetic disorder such as Turner's syndrome).
Symptoms
Most people with aortic aneurysms, especially ones in the chest area (thoracic aortic aneurysms), do not have symptoms. But symptoms may begin to occur if the aneurysm gets bigger and puts pressure on surrounding organs.
Abdominal aortic aneurysm
The most common symptoms of abdominal aortic aneurysm include general abdominal (belly) pain or discomfort, which may come and go or be constant. Other symptoms include:
Pain in the chest, abdomen, lower back, or flank (over the kidneys), possibly spreading to the groin, buttocks, or legs. The pain may be deep, aching, gnawing, and/or throbbing, and may last for hours or days. It is generally not affected by movement, although certain positions may be more comfortable than others.
A pulsating sensation in the abdomen.
A "cold foot" or a black or blue painful toe can happen if an abdominal aortic aneurysm produces a blood clot that breaks off and blocks blood flow to the legs or feet.
Fever or weight loss, if it is an inflammatory aortic aneurysm.
People younger than age 50 are more likely to have symptoms from abdominal aortic aneurysms than those older than 50. 3
Thoracic aortic aneurysm
Symptoms of a thoracic aortic aneurysm are most evident when the aneurysm occurs where the aorta curves down (aortic arch). They may include:
Chest pain, generally described as deep and aching or throbbing. This is the most frequent symptom.
Back pain.
A cough or shortness of breath if the aneurysm is in the area of the lungs.
Hoarseness.
Difficulty or pain while swallowing.
If an aortic aneurysm bursts, or ruptures, there is sudden, severe pain, an extreme drop in blood pressure, and signs of shock. Without immediate medical treatment, death occurs.
The symptoms of aortic aneurysm are similar to the symptoms of other problems that cause chest or belly pain such as coronary artery disease and peptic ulcer disease.
What Increases Your Risk
The leading risk factors for an aortic aneurysm are:
Advanced age.
Being male.
High blood pressure.
Smoking.
Family history of abdominal aortic aneurysms in first-degree relatives (parent, brother, or sister).
Alcohol (more than 2 drinks a day).
When to Call a Doctor
Call 911 or other emergency services immediately if you have signs of a ruptured aortic aneurysm such as:
Sudden, severe pain.
An extreme drop in blood pressure.
Signs of shock.
If you witness a person become unconscious, call 911 or other emergency services and start cardiopulmonary resuscitation (CPR). The emergency operator can coach you on how to perform CPR. For more information about CPR, see the Rescue Breathing and Cardiopulmonary Resuscitation section of the topic Dealing With Emergencies.
Call a doctor immediately if you have:
A pulsating mass in your abdomen.
Sudden weakness in the lower extremities on one side of the body.
Chest pain you have not experienced before.
A "cold foot" or a black or blue painful toe for no apparent reason.
Call for a doctor appointment if you have:
Pain in the chest, abdomen, or lower back, possibly spreading to the groin, buttocks, or legs. The pain may be deep, aching, gnawing, and/or throbbing, and may last for hours or days. It is generally not affected by movement, although certain positions may be more comfortable than others.
Fever or weight loss for no apparent reason.
Who to see
Health professionals who can evaluate symptoms that may be related to an aortic aneurysm and order the tests needed for further evaluation of symptoms include:
Family medicine physicians.
Internists.
Nurse practitioners.
Physician assistants.
Cardiologists or vascular surgeons.
If you have a fast-growing aortic aneurysm, you may be referred to a vascular surgeon, who can evaluate your need for surgery.
Exams and Tests
Aortic aneurysms are often discovered during an X-ray, ultrasound, or echocardiogram done for other reasons. Sometimes, an abdominal aneurysm is felt during a routine physical examination. If this is the case, your doctor will perform a medical history and physical examination.
When an aneurysm is suspected or diagnosed, it is important to:
Pinpoint the location of the aneurysm.
Estimate its size.
Determine how fast it is growing and whether surgical treatment is needed.
Determine whether other blood vessels are involved.
Detect the presence of blood clots or inflammation.
Tests to help determine the location, size, and rate of growth of an aneurysm include:
Abdominal ultrasound. Ultrasounds help your doctor know if your aneurysm is growing. If your aneurysm is large, you may need an ultrasound every 6 to 12 months. If your aneurysm is small, you may need one every 2 to 3 years.
Computed tomography (CT) and magnetic resonance angiogram (MRA), which are used if a view more detailed than an ultrasound is needed. This is important when information is needed about the aneurysm's relation to the blood vessels of the kidney or other organs. Your doctor needs this information especially before surgery. CT is used to watch the growth of a thoracic aortic aneurysm.
Echocardiogram, an ultrasound exam used to study the heart. A transthoracic echocardiogram (TTE) or a transesophageal echocardiogram (TEE) may be done to diagnose thoracic aortic aneurysm.
Angiogram. An angiogram can help determine the size of the aneurysm and the presence of aortic dissections, blood clots, or other blood vessel involvement.
One of the most important goals of testing is to estimate the risk that an aneurysm may burst, or rupture, and to compare the risk of rupture to the risks of surgery. If an aortic aneurysm is detected, tests such as abdominal ultrasound can be used to closely follow any change in the size or other characteristics of the aneurysm and help measure the risk for rupture.
Early Detection
Your doctor may recommend an abdominal ultrasound screening test if you are a man who is:
Age 65 to 75 and has ever smoked. 1
At least 60 years old and who has a first-degree relative (for example, father or brother) who has had an aneurysm. 2
The recommendation does not apply to women or nonsmoking men, because they are less likely to have an abdominal aortic aneurysm. Screening is not considered beneficial for these groups.
People who have Marfan's syndrome, Ehlers-Danlos syndrome, or another condition that puts them at risk may benefit from screening.
Treatment Overview
After you are diagnosed with an aortic aneurysm, your doctor will evaluate:
Whether you need surgery.
Whether you will be able to withstand a major surgery.
Whether you can avoid surgery, at least for the present.
Factors such as the shape and flexibility of the aorta and heart valves are also considered in deciding how to treat an aortic aneurysm.
When surgery is recommended
Aortic aneurysms that are causing symptoms or enlarging rapidly are considered at risk of rupturing. Surgery is usually recommended if either of these factors is present.
In men, surgery is also typically recommended for abdominal aortic aneurysms that are 5.5 cm or larger in diameter. In women, surgery may be recommended for smaller aneurysms. Some doctors perform surgery when the aneurysm is smaller, although the risk of rupture is considered low for aneurysms less than 5.5 cm in diameter. 4, 5
Surgery is also recommended when a small aortic aneurysm grows more than 0.5 cm within 6 months.
Surgical repair of thoracic aortic aneurysms is usually recommended when they reach 5.5 to 6.0 cm in diameter.
The decision to have surgery, delay surgery, or not have surgery at all depends on other factors also. These factors may include older age or medical problems that make surgery more dangerous.
Medical treatment for aortic aneurysm
Smaller aneurysms (less than 5.5 cm in diameter) that are not at high risk for rupturing are generally treated with medicine used to treat high blood pressure, such as a beta-blocker. Beta-blockers may decrease the rate at which aneurysms grow. In general, the risks of surgery to repair smaller aneurysms outweigh the possible benefits, because smaller aneurysms rarely rupture.
If surgery is not done to repair your aneurysm, you will have regular tests to see if it is getting bigger.
You may need to take medicine to treat high cholesterol and high blood pressure. While these measures have not been proven to slow aneurysm growth, they can improve your life in other ways. These measures reduce your risk of dying from heart attack and stroke, which kills most (66%) people with aneurysms. 6 For more information, see the topics High Cholesterol and High Blood Pressure (Hypertension).
Despite some claims, taking antioxidant vitamins has not been proven to reduce the risk of aneurysm or the risk of rupture.
Lifestyle changes for aortic aneurysm
Smoking increases the rate of aneurysm growth by 20% to 25% per year, which significantly increases the risk of rupture. 6 Your doctor will strongly recommend that you stop smoking and possibly prescribe medicines and therapy to help you do so. Studies show that nicotine replacement therapy, use of the medicine bupropion (Zyban or Wellbutrin), and supportive therapy significantly increase long-term success in quitting. 7 And if you use a nicotine replacement product or take bupropion or nortriptyline, you can double your chances of quitting for at least 6 months. 8, 9 Another medicine called varenicline (Chantix) that blocks the effects of nicotine on the brain can also greatly increase your chances of quitting smoking. 10 For more information, see the topic Quitting Smoking. Avoid secondhand smoke too.
Your doctor will probably recommend that you make other lifestyle changes, such as following a heart-healthy diet, limiting alcohol, and exercising. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
Ongoing Concerns
Aortic aneurysms are hard to detect, as they often do not cause symptoms. Most people with aortic aneurysms are unaware they have them, and they are often diagnosed during an evaluation for another problem.
If you are diagnosed with an aortic aneurysm, you need to monitor its size and rate of growth. Set up regular exams with your health professional and learn all you can about aneurysms, because complications such as rupture or blood clots can be serious.
Living With an Aortic Aneurysm
If you have an aortic aneurysm, you need close medical monitoring and possibly treatment. Talk with your doctor about how often you should come in for testing.
Home treatment is appropriate to help prevent or control conditions that may be causing you to have an aortic aneurysm, such as atherosclerosis or high blood pressure.
Stop smoking. Avoid secondhand smoke too. Smoking increases the rate of aneurysm growth by 20% to 25% per year, which significantly increases the risk of rupture. 6 Try nicotine replacement therapy, use of the medicine bupropion (Zyban or Wellbutrin), and supportive therapy. When used together, studies show these methods significantly increase your long-term success in quitting. 7 For more information, see the topic Quitting Smoking.
Control high blood pressure. To control high blood pressure, eat a low-sodium diet, and get regular exercise. For more information, see the topic High Blood Pressure (Hypertension).
Control high cholesterol. To control high cholesterol, eat a low-fat, low-cholesterol diet and get regular exercise. For more information, see the topic High Cholesterol.
Manage your weight. Losing weight will not likely change the course of an aortic aneurysm, but it may lower the risk of complications if you eventually need surgery. For more information, see the topic Weight Management.
Exercise. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
Limit alcohol. Limit alcohol to no more than 2 drinks a day.
Medications
Medicines used to treat high blood pressure, such as beta-blockers, may be used to slow the growth rate of an aortic aneurysm.
If you have high cholesterol, your doctor might recommend that you take medicines, such as statins, to lower it. Having high cholesterol increases your risk of atherosclerosis, which can cause aortic aneurysms and other conditions, such as coronary artery disease and stroke.
Surgery
Thoracic or abdominal aortic aneurysms that are large, causing symptoms, or rapidly getting bigger are considered at risk of rupturing. Surgery is usually recommended if any one of these factors is present. Your doctor will consider:
Whether you need urgent surgery.
Whether you will be able to withstand a major surgery.
Whether you can avoid surgery, at least for the present.
When making a decision about surgery for an aortic aneurysm, the benefits in relation to the risks of surgery must be considered, as well as the risks of major surgery. People who are at significant risk from surgery may elect to use medical management or another technique such as a stent graft procedure.
Your doctor will closely monitor the size and rate of growth of smaller aneurysms using abdominal ultrasound, computed tomography (CT) scan, or other imaging tests.
Abdominal aortic aneurysms
In men, surgery is typically recommended for abdominal aortic aneurysms that are causing symptoms or that are 5.5 cm or larger in diameter. In women, surgery may be recommended for smaller aneurysms. Some doctors perform surgery when the aneurysm is smaller, although the risk of rupture is considered low for aneurysms less than 5.5 cm in diameter. 4, 5
Surgery is also recommended for small aneurysms that have grown more than .5 cm within 6 months.
The decision to have surgery, delay surgery, or not have surgery at all depends on other factors also. These factors may include older age or medical problems that make surgery more dangerous.
Surgical repair of aortic aneurysms
Both traditional surgery and endovascular aortic repair are used to treat aortic aneurysms. Talk to your doctor about which surgery is best for you.
If you have surgery, your doctor will make a large cut in your chest or belly. Then, your aneurysm will be removed and the damaged portion of your blood vessel will be replaced with a man-made graft.
Some aortic aneurysms can be repaired without traditional surgery, using endovascular aortic repair. A tube called a stent graft is inserted through an artery in the groin. The stent graft makes a bridge between the healthy parts of the aorta (above and below the aneurysm). Although this procedure works well right away, experts do not know enough about its long-term effects. Because of this, you will need regular X-rays or CT scans for as long as you have the graft.
Thoracic aortic aneurysms
Your doctor will recommend that you have surgery for a thoracic aortic aneurysm based on the following guidelines:
If the aneurysm is located where the aorta ascends up out of the heart, surgery is recommended when it reaches 5.5 to 6.0 cm in diameter.
If the aneurysm is located where the aorta begins to descend, surgery is recommended when it reaches 6.0 cm in diameter.
In those with Marfan's syndrome, surgery is recommended when the aneurysm reaches 5.5 cm in diameter.
If the aneurysm causes significant aortic regurgitation, surgery is recommended.
Surgeons and institutions around the country have differing experiences with aortic aneurysms and may follow different protocols in the treatment of the disease. The most important factor to remember is that every case is unique and complicated. You should work with your doctor to decide which treatment is best for you.
If surgery is chosen, your doctor will evaluate your overall health, including assessments of your heart, lungs, and circulatory system, the kidneys, and the gastrointestinal system. The decision whether to have surgery is based on the outcome of these evaluations. The risk of death or injury during the operation increases if other disease is present.
If the evaluation of your heart indicates that you have significant heart disease, you should undergo coronary artery bypass surgery (CABG) or coronary angioplasty prior to repairing an aortic aneurysm. This is because coronary artery disease is the most important underlying factor contributing to complications, such as heart attack, in the period before and after the operation. Other complications, such as stroke and infection of the graft, can also occur.
Kidney disease, chronic lung disease, and cirrhosis of the liver may raise the risk of death and complications during the operation.
Smoking and high blood pressure put a person at a higher risk for complications from surgery. They are also risk factors for the rupture of an abdominal aortic aneurysm.
It is not an option to wait until an aneurysm has ruptured before surgery is done. Most people who have a ruptured aortic aneurysm die. Surgery for a ruptured aneurysm is dangerous because of the large amount of blood loss.
Other Places To Get Help
Online Resource
VascularWeb
Web Address:
www.vascularweb.org
VascularWeb is provided by the Society for Vascular Surgery. This Web site provides information about vascular conditions for patients and families. VascularWeb can help you learn about how to prevent and treat vascular diseases, learn about vascular screening, and find a vascular surgeon.
Organization
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.americanheart.org
Call the American Heart Association (AHA) to find your nearest local or state AHA group. AHA can provide brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support. AHA's Web site also has information on physical activity, diet, and various heart-related conditions.
An aortic aneurysm (say “a-OR-tik AN-yuh-rih-zum”) is a bulge in a section of the aorta, the body’s main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.
Aneurysms can form in any section of the aorta, but they are most common in the belly area (abdominal aortic aneurysm). They can also happen in the upper body (thoracic aortic aneurysm). Thoracic aortic aneurysms are also known as ascending or descending aortic aneurysms.
What causes an aortic aneurysm?
The wall of the aorta is normally very elastic. It can stretch and then shrink back as needed to adapt to blood flow. But some medical problems, such as high blood pressure and atherosclerosis (hardening of the arteries), weaken the artery walls. These problems, along with the wear and tear that naturally occurs with aging, can result in a weak aortic wall that bulges outward.
What are the symptoms?
Most aortic aneurysms don't cause symptoms. Sometimes a doctor finds them during exams or tests done for other reasons. People who do have symptoms complain of belly, chest, or back pain and discomfort. The symptoms may come and go or stay constant.
In the worst case, an aneurysm can burst, or rupture. This causes severe pain and bleeding. It often leads to death within minutes to hours.
An aortic aneurysm can also lead to other problems. Blood flow often slows in the bulging section of an aortic aneurysm, causing clots to form. If a blood clot breaks off from an aortic aneurysm in the chest area, it can travel to the brain and cause a stroke. Blood clots that break off from an aortic aneurysm in the belly area can block blood flow to the belly or legs.
How is an aortic aneurysm diagnosed?
Aneurysms are often diagnosed by chance during exams or tests done for other reasons. In some cases, they are found during a screening test for aneurysms. Screening tests help your doctor look for a certain disease or condition before any symptoms appear. Experts recommend screening tests for aneurysms for men who are:
Ages 65 to 75 and have ever smoked. 1
At least 60 years old and have a first-degree relative (for example, father or brother) who has had an aneurysm. 2
These men are more likely to have an aneurysm than are women or nonsmoking men.
If your doctor thinks you have an aneurysm, you may have tests such as an ultrasound, a CT scan, or an MRI to find out where it is and how big it is.
How is it treated?
Treatment of an aortic aneurysm is based on how big it is and how fast it is growing. If you have a large or fast-growing aneurysm, you need surgery to fix it. In most cases, a doctor will replace the damaged part of the blood vessel with a man-made graft.
Small aneurysms rarely rupture and are usually treated with high blood pressure medicine, such as beta-blockers. This medicine helps to lower blood pressure and stress on the aortic wall. If you don't have surgery, you will have routine ultrasound tests to see if the aneurysm is getting bigger.
Even if your aneurysm does not grow or rupture, you may be at risk for heart problems. Your doctor may suggest that you exercise more, eat a heart-healthy diet, and stop smoking. He or she may also prescribe medicines to help lower high cholesterol.
Cause
Abdominal and thoracic aortic aneurysms are caused by a number of factors, including:
Hardening of the arteries (atherosclerosis). Exactly how atherosclerosis leads to abdominal aortic aneurysms is unclear. It is thought that atherosclerosis causes changes in the lining of the artery wall that may affect oxygen and nutrient flow to the aortic wall tissues. The resulting tissue damage and breakdown may lead to the development of an aneurysm.
Genetics. In some people who have Marfan's syndrome, Ehlers-Danlos syndrome, or other inherited conditions, the walls of the major arteries, including the aorta, are weakened. Aortic aneurysms run in families.
Aging. The aorta naturally becomes less elastic and stiffer with age, increasing the risk of an abdominal aortic aneurysm.
Infections. Infections such as syphilis and endocarditis, an infection of the lining of the heart, can cause aneurysms.
Injury. A sudden, intense blow to the chest or abdomen, such as hitting the steering wheel in a car accident, can damage the aorta.
Inflammation. Inflammation of the aorta can weaken the aortic wall. Although researchers have investigated several conditions, what causes the aorta to become inflamed is not clear.
Thoracic aortic aneurysms are much less common than abdominal aortic aneurysms. 3 They are often caused by an abnormal breakdown of the elastic fibers in the aortic wall. Other causes of thoracic aneurysms include aortic coarctation (often resulting from a genetic disorder such as Turner's syndrome).
Symptoms
Most people with aortic aneurysms, especially ones in the chest area (thoracic aortic aneurysms), do not have symptoms. But symptoms may begin to occur if the aneurysm gets bigger and puts pressure on surrounding organs.
Abdominal aortic aneurysm
The most common symptoms of abdominal aortic aneurysm include general abdominal (belly) pain or discomfort, which may come and go or be constant. Other symptoms include:
Pain in the chest, abdomen, lower back, or flank (over the kidneys), possibly spreading to the groin, buttocks, or legs. The pain may be deep, aching, gnawing, and/or throbbing, and may last for hours or days. It is generally not affected by movement, although certain positions may be more comfortable than others.
A pulsating sensation in the abdomen.
A "cold foot" or a black or blue painful toe can happen if an abdominal aortic aneurysm produces a blood clot that breaks off and blocks blood flow to the legs or feet.
Fever or weight loss, if it is an inflammatory aortic aneurysm.
People younger than age 50 are more likely to have symptoms from abdominal aortic aneurysms than those older than 50. 3
Thoracic aortic aneurysm
Symptoms of a thoracic aortic aneurysm are most evident when the aneurysm occurs where the aorta curves down (aortic arch). They may include:
Chest pain, generally described as deep and aching or throbbing. This is the most frequent symptom.
Back pain.
A cough or shortness of breath if the aneurysm is in the area of the lungs.
Hoarseness.
Difficulty or pain while swallowing.
If an aortic aneurysm bursts, or ruptures, there is sudden, severe pain, an extreme drop in blood pressure, and signs of shock. Without immediate medical treatment, death occurs.
The symptoms of aortic aneurysm are similar to the symptoms of other problems that cause chest or belly pain such as coronary artery disease and peptic ulcer disease.
What Increases Your Risk
The leading risk factors for an aortic aneurysm are:
Advanced age.
Being male.
High blood pressure.
Smoking.
Family history of abdominal aortic aneurysms in first-degree relatives (parent, brother, or sister).
Alcohol (more than 2 drinks a day).
When to Call a Doctor
Call 911 or other emergency services immediately if you have signs of a ruptured aortic aneurysm such as:
Sudden, severe pain.
An extreme drop in blood pressure.
Signs of shock.
If you witness a person become unconscious, call 911 or other emergency services and start cardiopulmonary resuscitation (CPR). The emergency operator can coach you on how to perform CPR. For more information about CPR, see the Rescue Breathing and Cardiopulmonary Resuscitation section of the topic Dealing With Emergencies.
Call a doctor immediately if you have:
A pulsating mass in your abdomen.
Sudden weakness in the lower extremities on one side of the body.
Chest pain you have not experienced before.
A "cold foot" or a black or blue painful toe for no apparent reason.
Call for a doctor appointment if you have:
Pain in the chest, abdomen, or lower back, possibly spreading to the groin, buttocks, or legs. The pain may be deep, aching, gnawing, and/or throbbing, and may last for hours or days. It is generally not affected by movement, although certain positions may be more comfortable than others.
Fever or weight loss for no apparent reason.
Who to see
Health professionals who can evaluate symptoms that may be related to an aortic aneurysm and order the tests needed for further evaluation of symptoms include:
Family medicine physicians.
Internists.
Nurse practitioners.
Physician assistants.
Cardiologists or vascular surgeons.
If you have a fast-growing aortic aneurysm, you may be referred to a vascular surgeon, who can evaluate your need for surgery.
Exams and Tests
Aortic aneurysms are often discovered during an X-ray, ultrasound, or echocardiogram done for other reasons. Sometimes, an abdominal aneurysm is felt during a routine physical examination. If this is the case, your doctor will perform a medical history and physical examination.
When an aneurysm is suspected or diagnosed, it is important to:
Pinpoint the location of the aneurysm.
Estimate its size.
Determine how fast it is growing and whether surgical treatment is needed.
Determine whether other blood vessels are involved.
Detect the presence of blood clots or inflammation.
Tests to help determine the location, size, and rate of growth of an aneurysm include:
Abdominal ultrasound. Ultrasounds help your doctor know if your aneurysm is growing. If your aneurysm is large, you may need an ultrasound every 6 to 12 months. If your aneurysm is small, you may need one every 2 to 3 years.
Computed tomography (CT) and magnetic resonance angiogram (MRA), which are used if a view more detailed than an ultrasound is needed. This is important when information is needed about the aneurysm's relation to the blood vessels of the kidney or other organs. Your doctor needs this information especially before surgery. CT is used to watch the growth of a thoracic aortic aneurysm.
Echocardiogram, an ultrasound exam used to study the heart. A transthoracic echocardiogram (TTE) or a transesophageal echocardiogram (TEE) may be done to diagnose thoracic aortic aneurysm.
Angiogram. An angiogram can help determine the size of the aneurysm and the presence of aortic dissections, blood clots, or other blood vessel involvement.
One of the most important goals of testing is to estimate the risk that an aneurysm may burst, or rupture, and to compare the risk of rupture to the risks of surgery. If an aortic aneurysm is detected, tests such as abdominal ultrasound can be used to closely follow any change in the size or other characteristics of the aneurysm and help measure the risk for rupture.
Early Detection
Your doctor may recommend an abdominal ultrasound screening test if you are a man who is:
Age 65 to 75 and has ever smoked. 1
At least 60 years old and who has a first-degree relative (for example, father or brother) who has had an aneurysm. 2
The recommendation does not apply to women or nonsmoking men, because they are less likely to have an abdominal aortic aneurysm. Screening is not considered beneficial for these groups.
People who have Marfan's syndrome, Ehlers-Danlos syndrome, or another condition that puts them at risk may benefit from screening.
Treatment Overview
After you are diagnosed with an aortic aneurysm, your doctor will evaluate:
Whether you need surgery.
Whether you will be able to withstand a major surgery.
Whether you can avoid surgery, at least for the present.
Factors such as the shape and flexibility of the aorta and heart valves are also considered in deciding how to treat an aortic aneurysm.
When surgery is recommended
Aortic aneurysms that are causing symptoms or enlarging rapidly are considered at risk of rupturing. Surgery is usually recommended if either of these factors is present.
In men, surgery is also typically recommended for abdominal aortic aneurysms that are 5.5 cm or larger in diameter. In women, surgery may be recommended for smaller aneurysms. Some doctors perform surgery when the aneurysm is smaller, although the risk of rupture is considered low for aneurysms less than 5.5 cm in diameter. 4, 5
Surgery is also recommended when a small aortic aneurysm grows more than 0.5 cm within 6 months.
Surgical repair of thoracic aortic aneurysms is usually recommended when they reach 5.5 to 6.0 cm in diameter.
The decision to have surgery, delay surgery, or not have surgery at all depends on other factors also. These factors may include older age or medical problems that make surgery more dangerous.
Medical treatment for aortic aneurysm
Smaller aneurysms (less than 5.5 cm in diameter) that are not at high risk for rupturing are generally treated with medicine used to treat high blood pressure, such as a beta-blocker. Beta-blockers may decrease the rate at which aneurysms grow. In general, the risks of surgery to repair smaller aneurysms outweigh the possible benefits, because smaller aneurysms rarely rupture.
If surgery is not done to repair your aneurysm, you will have regular tests to see if it is getting bigger.
You may need to take medicine to treat high cholesterol and high blood pressure. While these measures have not been proven to slow aneurysm growth, they can improve your life in other ways. These measures reduce your risk of dying from heart attack and stroke, which kills most (66%) people with aneurysms. 6 For more information, see the topics High Cholesterol and High Blood Pressure (Hypertension).
Despite some claims, taking antioxidant vitamins has not been proven to reduce the risk of aneurysm or the risk of rupture.
Lifestyle changes for aortic aneurysm
Smoking increases the rate of aneurysm growth by 20% to 25% per year, which significantly increases the risk of rupture. 6 Your doctor will strongly recommend that you stop smoking and possibly prescribe medicines and therapy to help you do so. Studies show that nicotine replacement therapy, use of the medicine bupropion (Zyban or Wellbutrin), and supportive therapy significantly increase long-term success in quitting. 7 And if you use a nicotine replacement product or take bupropion or nortriptyline, you can double your chances of quitting for at least 6 months. 8, 9 Another medicine called varenicline (Chantix) that blocks the effects of nicotine on the brain can also greatly increase your chances of quitting smoking. 10 For more information, see the topic Quitting Smoking. Avoid secondhand smoke too.
Your doctor will probably recommend that you make other lifestyle changes, such as following a heart-healthy diet, limiting alcohol, and exercising. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
Ongoing Concerns
Aortic aneurysms are hard to detect, as they often do not cause symptoms. Most people with aortic aneurysms are unaware they have them, and they are often diagnosed during an evaluation for another problem.
If you are diagnosed with an aortic aneurysm, you need to monitor its size and rate of growth. Set up regular exams with your health professional and learn all you can about aneurysms, because complications such as rupture or blood clots can be serious.
Living With an Aortic Aneurysm
If you have an aortic aneurysm, you need close medical monitoring and possibly treatment. Talk with your doctor about how often you should come in for testing.
Home treatment is appropriate to help prevent or control conditions that may be causing you to have an aortic aneurysm, such as atherosclerosis or high blood pressure.
Stop smoking. Avoid secondhand smoke too. Smoking increases the rate of aneurysm growth by 20% to 25% per year, which significantly increases the risk of rupture. 6 Try nicotine replacement therapy, use of the medicine bupropion (Zyban or Wellbutrin), and supportive therapy. When used together, studies show these methods significantly increase your long-term success in quitting. 7 For more information, see the topic Quitting Smoking.
Control high blood pressure. To control high blood pressure, eat a low-sodium diet, and get regular exercise. For more information, see the topic High Blood Pressure (Hypertension).
Control high cholesterol. To control high cholesterol, eat a low-fat, low-cholesterol diet and get regular exercise. For more information, see the topic High Cholesterol.
Manage your weight. Losing weight will not likely change the course of an aortic aneurysm, but it may lower the risk of complications if you eventually need surgery. For more information, see the topic Weight Management.
Exercise. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
Limit alcohol. Limit alcohol to no more than 2 drinks a day.
Medications
Medicines used to treat high blood pressure, such as beta-blockers, may be used to slow the growth rate of an aortic aneurysm.
If you have high cholesterol, your doctor might recommend that you take medicines, such as statins, to lower it. Having high cholesterol increases your risk of atherosclerosis, which can cause aortic aneurysms and other conditions, such as coronary artery disease and stroke.
Surgery
Thoracic or abdominal aortic aneurysms that are large, causing symptoms, or rapidly getting bigger are considered at risk of rupturing. Surgery is usually recommended if any one of these factors is present. Your doctor will consider:
Whether you need urgent surgery.
Whether you will be able to withstand a major surgery.
Whether you can avoid surgery, at least for the present.
When making a decision about surgery for an aortic aneurysm, the benefits in relation to the risks of surgery must be considered, as well as the risks of major surgery. People who are at significant risk from surgery may elect to use medical management or another technique such as a stent graft procedure.
Your doctor will closely monitor the size and rate of growth of smaller aneurysms using abdominal ultrasound, computed tomography (CT) scan, or other imaging tests.
Abdominal aortic aneurysms
In men, surgery is typically recommended for abdominal aortic aneurysms that are causing symptoms or that are 5.5 cm or larger in diameter. In women, surgery may be recommended for smaller aneurysms. Some doctors perform surgery when the aneurysm is smaller, although the risk of rupture is considered low for aneurysms less than 5.5 cm in diameter. 4, 5
Surgery is also recommended for small aneurysms that have grown more than .5 cm within 6 months.
The decision to have surgery, delay surgery, or not have surgery at all depends on other factors also. These factors may include older age or medical problems that make surgery more dangerous.
Surgical repair of aortic aneurysms
Both traditional surgery and endovascular aortic repair are used to treat aortic aneurysms. Talk to your doctor about which surgery is best for you.
If you have surgery, your doctor will make a large cut in your chest or belly. Then, your aneurysm will be removed and the damaged portion of your blood vessel will be replaced with a man-made graft.
Some aortic aneurysms can be repaired without traditional surgery, using endovascular aortic repair. A tube called a stent graft is inserted through an artery in the groin. The stent graft makes a bridge between the healthy parts of the aorta (above and below the aneurysm). Although this procedure works well right away, experts do not know enough about its long-term effects. Because of this, you will need regular X-rays or CT scans for as long as you have the graft.
Thoracic aortic aneurysms
Your doctor will recommend that you have surgery for a thoracic aortic aneurysm based on the following guidelines:
If the aneurysm is located where the aorta ascends up out of the heart, surgery is recommended when it reaches 5.5 to 6.0 cm in diameter.
If the aneurysm is located where the aorta begins to descend, surgery is recommended when it reaches 6.0 cm in diameter.
In those with Marfan's syndrome, surgery is recommended when the aneurysm reaches 5.5 cm in diameter.
If the aneurysm causes significant aortic regurgitation, surgery is recommended.
Surgeons and institutions around the country have differing experiences with aortic aneurysms and may follow different protocols in the treatment of the disease. The most important factor to remember is that every case is unique and complicated. You should work with your doctor to decide which treatment is best for you.
If surgery is chosen, your doctor will evaluate your overall health, including assessments of your heart, lungs, and circulatory system, the kidneys, and the gastrointestinal system. The decision whether to have surgery is based on the outcome of these evaluations. The risk of death or injury during the operation increases if other disease is present.
If the evaluation of your heart indicates that you have significant heart disease, you should undergo coronary artery bypass surgery (CABG) or coronary angioplasty prior to repairing an aortic aneurysm. This is because coronary artery disease is the most important underlying factor contributing to complications, such as heart attack, in the period before and after the operation. Other complications, such as stroke and infection of the graft, can also occur.
Kidney disease, chronic lung disease, and cirrhosis of the liver may raise the risk of death and complications during the operation.
Smoking and high blood pressure put a person at a higher risk for complications from surgery. They are also risk factors for the rupture of an abdominal aortic aneurysm.
It is not an option to wait until an aneurysm has ruptured before surgery is done. Most people who have a ruptured aortic aneurysm die. Surgery for a ruptured aneurysm is dangerous because of the large amount of blood loss.
Other Places To Get Help
Online Resource
VascularWeb
Web Address:
www.vascularweb.org
VascularWeb is provided by the Society for Vascular Surgery. This Web site provides information about vascular conditions for patients and families. VascularWeb can help you learn about how to prevent and treat vascular diseases, learn about vascular screening, and find a vascular surgeon.
Organization
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.americanheart.org
Call the American Heart Association (AHA) to find your nearest local or state AHA group. AHA can provide brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support. AHA's Web site also has information on physical activity, diet, and various heart-related conditions.
ATRIAL FIBRILLATION
Atrial fibrillation (say “A-tree-uhl fih-bruh-LAY-shun”) is an irregular heart rhythm (arrhythmia) that starts in the upper parts (atria) of the heart.
Normally, the heart beats in a strong, steady rhythm. In atrial fibrillation, a problem with the heart’s electrical system causes the atria to quiver, or fibrillate. The quivering upsets the normal rhythm between the atria and the lower parts (ventricles) of the heart. The lower parts may beat fast and without a regular rhythm.
Atrial fibrillation is dangerous because it greatly increases the risk of stroke. If the heart doesn't beat strongly, blood can collect, or pool, in the atria. Pooled blood is more likely to form clots. If the heart pumps a clot into the bloodstream, the clot can travel to the brain and block blood flow, causing a stroke. Atrial fibrillation can also lead to heart failure.
What causes atrial fibrillation?
Conditions that damage or strain the heart commonly cause atrial fibrillation. These include:
High blood pressure.
Coronary artery disease (CAD).
Heart attack.
Heart valve disease, especially diseases of the mitral valve.
Atrial fibrillation may also be caused by:
Other medical problems, such as lung disease, pneumonia, or a high thyroid level (hyperthyroidism).
Heart surgery.
Heavy alcohol use. Having more than 3 drinks a day over many years can cause long-lasting atrial fibrillation. Drinking a large amount of alcohol at one time (binge drinking) may also cause a spell (episode) of atrial fibrillation.
Use of stimulants. These include caffeine, nicotine, medicines such as decongestants, and illegal drugs such as cocaine.
Use of some prescription medicines, such as albuterol or theophylline.
Sometimes doctors can't find the cause. Doctors call this lone atrial fibrillation.
What are the symptoms?
Symptoms may include:
Feeling dizzy or lightheaded.
Feeling out of breath.
Feeling weak and tired.
A feeling that the heart is fluttering, racing, or pounding (palpitations).
A feeling that the heart is beating unevenly.
Chest pain (angina).
Fainting.
Atrial fibrillation is common, especially in older adults, and it may not cause obvious symptoms. If you have any of the symptoms listed, see your doctor. Finding and treating atrial fibrillation right away can help you avoid serious problems.
How is atrial fibrillation diagnosed?
The doctor will ask questions about your past health, do a physical exam, and order tests. The best way to find out if you have atrial fibrillation is to have an electrocardiogram (EKG or ECG). An EKG is a test that checks for problems with the heart’s electrical activity.
You might also have lab tests, a chest X-ray, and an echocardiogram. An echocardiogram can show how well your heart is pumping and whether your heart valves are damaged.
How is it treated?
A number of treatments may be used for atrial fibrillation. Which treatments are best for you depend on the cause, your symptoms, and your risk of stroke.
Doctors sometimes use a procedure called cardioversion to try to get the heartbeat back to a normal rhythm. This can be done using either medicine or a low-voltage electrical shock (electrical cardioversion). Atrial fibrillation often comes back after cardioversion.
If you have mild symptoms, or if atrial fibrillation returns after cardioversion, your doctor may prescribe medicines to control your heart rate and help prevent stroke. These may include:
Rhythm-control medicines (antiarrhythmics) to help return the heart to its normal rhythm and keep it there.
Rate-control medicines to keep the heart from beating too fast during atrial fibrillation.
Many people with atrial fibrillation need to take blood-thinning (anticoagulant) medicine to help prevent strokes. People at low risk for stroke may take daily aspirin instead. If you are age 55 or older and have atrial fibrillation, you can find your risk of stroke using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
Cardioversion and medicines don't work for some people who continue to have bothersome symptoms. In these cases, doctors sometimes recommend a procedure called ablation. Ablation destroys small areas of the heart. This creates scar tissue, which blocks or destroys areas that cause or maintain the irregular heart rhythm. Afterward, you may need a pacemaker to keep your heart beating regularly.
What can you do at home for atrial fibrillation?
Atrial fibrillation is often the result of heart disease or damage. So making changes that improve the condition of your heart may also improve your overall health.
Don't smoke. Avoid secondhand smoke, too. Quitting smoking can quickly reduce your risk of stroke and heart attack.
Eat a heart-healthy diet with plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil.
Get regular exercise on most, preferably all, days of the week. Your doctor can suggest a safe level of exercise for you.
Control your cholesterol and blood pressure. If you have diabetes, keep your blood sugar in your target range.
Manage your stress level. Stress can damage your heart.
Avoid caffeine, alcohol, and stimulants.
Avoid getting sick from the flu. Get a flu shot every year.
Cause
Atrial fibrillation is caused by a problem with the electrical activity of the heart.
Conditions that damage the heart muscle or strain the heart may cause atrial fibrillation. These include:
High blood pressure, a condition in which the force of blood against artery walls is too strong. Normal blood pressure is 119 millimeters of mercury (mm Hg) systolic over 79 mm Hg diastolic or below.
Coronary artery disease and heart attack. Coronary artery disease is caused by the buildup of plaque on the inside of the coronary arteries. These blood vessels supply oxygen-rich blood to the heart muscle.
Heart failure. Heart failure occurs when the heart is not able to pump blood effectively.
Heart valve disease, most often mitral valve disease. Heart valve disease occurs when a heart valve is damaged or narrowed and does not properly control the flow of blood through and out of the heart.
Cardiomyopathy. Cardiomyopathy damages the heart muscle and decreases the amount of blood it can pump.
Myocarditis, which is inflammation of the heart muscle. Myocarditis may occur after a viral, fungal, or bacterial infection or another illness, such as diphtheria, rheumatic fever, or tuberculosis.
Rheumatic heart disease. Rheumatic heart disease is damage to the heart muscle and heart valves that results from rheumatic fever.
Congenital heart disease. Congenital heart defects are structural heart problems or abnormalities that have been present since birth.
Endocarditis. Endocarditis can damage the heart muscle and heart valves.
Wolff-Parkinson-White syndrome, which causes rapid or irregular rhythms (arrhythmias) in the heart.
Heart surgery, such as coronary artery bypass or valve surgery, can trigger atrial fibrillation. In people older than 65, any surgery can trigger atrial fibrillation and raise the risk of complications, such as a stroke. In these cases, atrial fibrillation may be short-lasting. Treatment can return the heart to a normal rhythm.
Other conditions that cause atrial fibrillation include:
Chronic obstructive pulmonary disease (COPD), a group of diseases that make it difficult to breathe because air does not flow easily out of the lungs.
Pneumonia, which is an inflammation of the lungs that is most often caused by infection with bacteria or a virus.
Pulmonary embolism. Pulmonary embolism is the sudden blockage of blood flow in an artery in the lungs.
Hyperthyroidism, a condition in which the thyroid gland produces too much thyroid hormone.
Use of alcohol. Long-term, heavy alcohol use seems to be linked to atrial fibrillation. Besides long-term use, drinking a large amount of alcohol at one time (binge drinking) may also cause an episode of atrial fibrillation.
Use of stimulants. These include medicines, such as theophylline, amphetamines, and decongestants that contain stimulants (such as pseudoephedrine); illegal drugs, such as cocaine, methamphetamines, or crank; and excessive nicotine or caffeine.
Use of some prescription medicines, such as albuterol or theophylline.
Pericarditis, which is an inflammation of the sac around the heart. Pericarditis can temporarily irritate the heart muscle.
Atrial fibrillation caused by a condition that is treatable, such as pneumonia or hyperthyroidism, often goes away when that condition is treated.
Atrial fibrillation can sometimes develop in people who do not have heart disease or other health conditions. This is called lone atrial fibrillation.
Symptoms
Symptoms of atrial fibrillation include:
Heart palpitations.
Irregular pulse.
Shortness of breath, especially during physical activity or emotional stress.
Weakness, fatigue.
Dizziness, confusion.
Lightheadedness or fainting (syncope).
Chest pain (angina).
Atrial fibrillation is often discovered during routine medical checkups because many people do not have symptoms. Others may notice an irregular pulse but do not have other symptoms.
Mild symptoms may develop immediately. More serious problems may develop after the start of atrial fibrillation and over the course of several days. So it is important to identify and treat atrial fibrillation as soon as possible to avoid serious problems.
Serious complications such as a stroke or heart failure may occur before atrial fibrillation is discovered.
What Increases Your Risk
Risk factors for atrial fibrillation include:
Age older than 60.
Being white and male.
Heart failure.
Heart valve disease.
High blood pressure.
Coronary artery disease and heart attack.
Obesity.
Obstructive sleep apnea.
A family history of atrial fibrillation.
Surgery on the heart.
A history of rheumatic fever.
Infection, such as pneumonia or endocarditis.
Lung disease, such as asthma or chronic obstructive pulmonary disease (COPD).
Metabolic conditions, such as hyperthyroidism or diabetes.
Use of alcohol. Long-term, heavy alcohol use seems to be linked to atrial fibrillation.
Use of stimulants. These include medicines, such as theophylline, amphetamines, and decongestants that contain stimulants (such as pseudoephedrine); illegal drugs, such as cocaine, methamphetamines, or crank; and excessive nicotine or caffeine.
Use of some prescription medicines, such as albuterol or theophylline.
Congenital heart disease and surgical repair of congenital heart disease.
When to Call a Doctor
Some symptoms of atrial fibrillation need urgent medical evaluation.
Call 911 or other emergency services immediately if you:
Have severe chest pain.
Experience any signs of a stroke.
Feel faint and have an irregular heartbeat.
If you see someone pass out, call 911 or other emergency services immediately.
Call your doctor if you have:
An irregular heart rate.
Heart palpitations.
Periods of unexplained lightheadedness, dizziness, or confusion.
An episode of fainting or you come close to fainting for no apparent reason.
Shortness of breath that gets worse with exercise.
Who to See
The following health professionals can detect, diagnose and, in some cases, treat atrial fibrillation:
General practitioner
Family doctor
Internist
Nurse practitioner (NP)
Physician assistant (PA)
In general, the extent to which you will need specialized care will depend upon the severity of your symptoms and the complexity of your individual case. Many people who have only mild symptoms or whose arrhythmia is not causing other problems may continue to see their primary care doctors for the ongoing management of the condition.
But some people with atrial fibrillation have severe symptoms and may benefit from regular monitoring and treatment by a more specialized physician, such as a:
Cardiologist.
Cardiac electrophysiologist.
Exams and Tests
An electrocardiogram (EKG, ECG) is the best and simplest way to determine whether you have atrial fibrillation. An electrocardiogram is a recording of the electrical activity of your heart. It is usually done along with a medical history and physical exam. During your exam, your doctor will take your blood pressure to determine whether you have high blood pressure. Your doctor will also listen to your heart to see if you have a heart murmur.
If your doctor suspects that you have atrial fibrillation that comes and goes, he or she may ask you to use a device to record your heart rhythm on a continuous basis. This is referred to by several names, including ambulatory electrocardiogram, ambulatory EKG, Holter monitoring, 24-hour EKG, or cardiac event monitoring.
Your doctor may do more tests to see whether you have damage to your heart or heart valves. An exercise electrocardiogram, also called a stress test, will help your doctor see whether you have coronary artery disease. An echocardiogram gives your doctor a lot of information about your heart. It can show whether your heart valves are damaged, how well your heart is pumping, and whether you have heart failure or have had a heart attack.
You may also have a blood test to check for hyperthyroidism. Hyperthyroidism develops when the thyroid gland makes too much thyroid hormone.
You may get an X-ray if your exams show that you might have heart failure or a problem in your lungs, such as pneumonia.
If you take anticoagulant medications for atrial fibrillation, you will need to have frequent blood tests to monitor how long it takes for your blood to clot (prothrombin time).
Treatment Overview
Treating atrial fibrillation is important for several reasons. An irregular, rapidly beating heart can weaken the heart muscle and cause it to dilate or stretch out. This can increase your risk of developing heart failure or having chest pain or even a heart attack. Also, atrial fibrillation can greatly increase your risk of having a stroke. Atrial fibrillation can also cause symptoms that are hard to live with.
Many people are able to live full and active lives while being treated for atrial fibrillation. To stay healthy, you will probably need to take medicines, including an anticoagulant or aspirin, medicines to slow heart rate, or possibly rhythm-control medicines.
Initial treatment
If atrial fibrillation is causing your heart to pump dangerously fast or your blood pressure to drop dramatically, you will probably be taken to the hospital for treatment to restore your blood pressure and heart rate to normal. If atrial fibrillation is not causing severe symptoms, you may be treated on an outpatient basis. Treatment for people who have just started having episodes of atrial fibrillation usually includes trying to convert the heart to a normal rhythm. Sometimes anticoagulant medicines are used to prevent clots and stroke.
If you have had atrial fibrillation forless than 48 hours, your doctor may perform a procedure called cardioversion, using either medicine or a low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm).
If atrial fibrillation has lasted for more than 48 hours, attempting cardioversion could cause a stroke. In this case, you may need to take the anticoagulant medicine warfarin (such as Coumadin) for several weeks before your doctor tries cardioversion. Taking anticoagulants reduces the chance that a clot might travel from the heart to the brain after cardioversion.
If you are not sure how long you have had atrial fibrillation, you are also at risk of having a clot in your heart. If you are not having severe symptoms, such as fainting, your doctor will probably also recommend that you take anticoagulants for several weeks before cardioversion to prevent a stroke.
If you have severe symptoms and you are not sure how long you have had atrial fibrillation, your doctor may try to restore your heart to a normal rhythm immediately. In this case, your doctor will use a transesophageal echocardiogram to determine whether you have a clot in your heart that could cause a stroke. The results of this test will determine what your doctor does next:
If the heart is clear of clots, cardioversion can be attempted. Anticoagulants are used after to prevent strokes.
If there is a clot in the heart, your doctor will prescribe anticoagulants before trying cardioversion.
Cardioversion usually works to restore a normal sinus rhythm. But in many cases the heart rhythm goes back to atrial fibrillation.
Should I try cardioversion?
Ongoing treatment
When atrial fibrillation comes on suddenly, lasts a short time, and goes away on its own, it is called paroxysmal atrial fibrillation. Typically, episodes of paroxysmal atrial fibrillation come on more often and last longer over time.
Having paroxysmal atrial fibrillation can raise your risk of stroke. If you are at an average to high risk of having a stroke, your doctor may prescribe long-term use of an anticoagulant medicine, warfarin (such as Coumadin), to reduce this risk. You may be at average to high risk of stroke if you are older than 75 or have a history of heart disease, high blood pressure, diabetes, or stroke. If you are at low risk of having a stroke or you cannot take warfarin, you may need to take aspirin daily.
You may also need to take rhythm-control medicines (antiarrhythmics) to try to prevent paroxysmal atrial fibrillation from recurring.
Doctors may recommend the "pill in the pocket" approach for people with paroxysmal atrial fibrillation. With this approach, you can take a single dose of an antiarrhythmic drug when you feel palpitations instead of taking the medicine every day. For some people, this stops atrial fibrillation episodes. It may also reduce medicine side effects and the need to be seen in the emergency room or be hospitalized. But not everyone can use this treatment. Before you can take the "pill in the pocket" approach, your doctor will want to make sure that you do not have any other heart disease and that your heart's electrical system is normal.
Over time, episodes of atrial fibrillation typically last longer and often do not go away on their own. This is called persistent atrial fibrillation. When you have had atrial fibrillation for a long time, it is more difficult to return your heart to a normal rhythm (also called a normal sinus rhythm). When cardioversion is not an option or does not work, medicines are usually given to control the heart rate and prevent stroke.
Rate-control medicines. Rate-control medicines are used if your heart rate is too fast. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. They usually do not return your heart to a normal rhythm—in other words, your heartbeat will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. Most people tolerate an irregular heart rhythm if the rate is kept between 60 and 100 beats per minute.
Rhythm-control medicines. Rhythm-control medicines (antiarrhythmics) are still considered valuable for the treatment of atrial fibrillation. If symptoms persist despite rate-control medicines and in certain other cases, rhythm-control medicines are often prescribed. These medicines help return the heart to its normal rhythm and keep atrial fibrillation from returning.
Research studies have changed the way persistent atrial fibrillation is treated in many cases. The studies found that traditionally prescribed rhythm-control medicines were expensive, often had side effects, and did not produce better results than rate-control medicines. Still, rate-control and rhythm-control medicines are both effective treatments for atrial fibrillation. Your doctor will likely talk with you about which of these treatments might be best for you.
Anticoagulant medicines. Most people with atrial fibrillation should take warfarin (such as Coumadin), an anticoagulation medicine, to prevent blood clots that can lead to a stroke. Warfarin can prevent stroke and save lives in people who have an average to high risk of stroke. If you have high blood pressure, diabetes, heart failure, or a history of transient ischemic attack (TIA) or stroke, you may be at average to high risk of stroke. Talk to your doctor about whether you should take warfarin.
For people with a low risk of stroke or those who cannot take warfarin, daily aspirin may be recommended.
If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
For information about whether to take anticoagulants, see:
Should I take anticoagulants to prevent stroke?
For instructions on how to take anticoagulants, see:
Atrial fibrillation: Taking anticoagulants safely.
If you take warfarin, don't suddenly change your intake of foods that are rich in vitamin K. Vitamin K can interfere with the action of anticoagulants, making it more likely that your blood will clot. For more information, see:
Anticoagulants: Vitamin K and your diet.
Treatment if the condition gets worse
For some people with atrial fibrillation, medicines to slow the heart rate or control its rhythm do not work. These people continue to have a rapid, irregular heart rate. In these cases, doctors sometimes recommend a nonsurgical procedure called catheter ablation or a surgical procedure called the maze procedure. Experts suggest that these procedures should be performed in a medical center where the staff has experience with the procedures.
Catheter ablation
Catheter ablation for atrial fibrillation is relatively new and is still being studied. Catheter ablation destroys the heart tissue that causes atrial fibrillation and keeps atrial fibrillation going after it starts. Thin wires are inserted into a vein in the groin and guided into the heart. The wires have an attachment at the tip. The attachment sends out very hot or very cold temperatures. This heat or cold destroys the tissue that causes atrial fibrillation or the tissue that keeps it happening.
Catheter ablation is most successful at treating paroxysmal atrial fibrillation. In people with persistent or chronic atrial fibrillation, the success rate is lower. Catheter ablation is an invasive procedure and has some serious risks. Catheter ablation should only be done in people who have tried other treatments but continue to have serious symptoms. As the procedure becomes more effective and safe, doctors may use it as one of the first treatments for atrial fibrillation.
Ablation procedures either try to cure atrial fibrillation (focal ablation, circumferential ablation, or pulmonary vein ablation) or try to control your symptoms (nodal ablation).
Ablation to cure atrial fibrillation. Focal, circumferential, and pulmonary vein catheter ablation are used to try to cure atrial fibrillation. Focal ablation, also known as targeted ablation, is used to destroy the specific areas that are firing off abnormal electrical impulses and causing atrial fibrillation. Circumferential ablation is used to destroy the tissue that lets atrial fibrillation continue. Sometimes a doctor uses both focal and circumferential ablation.
Sometimes, abnormal impulses come from inside a pulmonary vein and cause atrial fibrillation. (The pulmonary veins bring blood back from the lungs to the heart.) Catheter ablation in the pulmonary vein can block these impulses and prevent atrial fibrillation from happening.
A pacemaker device is usually not needed when only specific areas are destroyed.
Ablation to control symptoms of atrial fibrillation. Nodal catheter ablation may be used to control symptoms of atrial fibrillation when the cause cannot be stopped. Nodal catheter ablation destroys your atrioventricular (AV) node and blocks electrical signals to your lower heart chambers (ventricles). After nodal catheter ablation, you will need a permanent pacemaker to regulate your heart rhythm. Nodal ablation can control your heart rate and reduce your symptoms, but it does not prevent or cure atrial fibrillation. So you will probably need to take the anticoagulant warfarin (Coumadin, for example).
Heart problems: Living with a pacemaker or ICD
Maze procedure
A surgical procedure to cure atrial fibrillation is called the maze procedure. The maze procedure is usually done during open-heart surgery. The procedure creates scar tissue that blocks excess electrical impulses from traveling through your heart. Because of the risks involved with open-heart surgery, this procedure is used only in people who have severe symptoms and are having heart surgery for other reasons. Doctors are developing less invasive surgical maze techniques. These may be less painful and easier to recover from.
Ongoing Concerns
Atrial fibrillation with heart disease
Heart disease—including high blood pressure, heart valve disease, and coronary artery disease—is the most common cause of atrial fibrillation. Seen mostly in people older than 65, this type of atrial fibrillation is often the most complicated to manage.
At first, people usually have paroxysmal atrial fibrillation. Paroxysmal episodes go away on their own. They may last anywhere from a few seconds to a few weeks and may not cause symptoms.
Paroxysmal atrial fibrillation episodes may recur for weeks or years, although usually the disease progresses, and atrial fibrillation becomes persistent, meaning that it no longer goes away on its own. Your doctor may try a procedure called cardioversion, using either medicine or low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm). The decision to try cardioversion is based upon how bothersome you find the symptoms and how long the episode of atrial fibrillation has persisted.
If the heart cannot be converted to a normal rhythm or does not stay in a normal rhythm, medicines are used to control the heart rate and prevent it from becoming dangerously fast. Many people are able to live full and active lives while being treated for atrial fibrillation. Others may need further treatment because they develop shortness of breath, weakness, fainting, or other significant symptoms.
Lone atrial fibrillation
In rare cases, doctors cannot find the cause of atrial fibrillation. These cases are called lone atrial fibrillation. Lone atrial fibrillation occurs more often in people younger than 65. It often stops on its own, or it may need to be treated.
Treatment may be needed if a rapid heartbeat causes discomfort, decreased energy, or other unacceptable symptoms. Adults older than age 75 with lone atrial fibrillation are at risk for stroke and require treatment with the anticoagulant medicine warfarin (such as Coumadin).
Stroke risk
Atrial fibrillation increases your chance of having a stroke. When blood does not completely empty out of the rapidly beating atria, a clot can develop in the blood that pools in the atria. The clot may travel from the heart to the brain, causing a stroke.
People with atrial fibrillation and no damage to the heart valves are 6 times more likely to have a stroke than people without atrial fibrillation. The risk of stroke is significantly higher if heart valve damage is present. This risk of stroke also increases with age and with high blood pressure, diabetes, heart failure, or a previous stroke or transient ischemic attack (TIA). Taking anticoagulant medicines greatly reduces your risk of blood clots and stroke.
If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: Are You at Risk for a Stroke if You Have Atrial Fibrillation?
If atrial fibrillation is not treated, it can further damage the heart and cause serious complications, such as heart failure.
You can lower your risk of complications by controlling high blood pressure.
Prevention
A healthy lifestyle, proper nutrition, treatment for high blood pressure, and other measures can prevent atrial fibrillation by protecting you from heart disease. Manage your stress, exercise regularly, control your blood pressure, and do not smoke.
For tips on starting a walking program, see:
Heart disease: Walking for a healthy heart.
Experts also recommend that adults eat at least two servings of fish each week, particularly fish such as salmon, trout, and tuna, for a healthy heart. Also, one study found that eating baked or broiled fish may reduce your risk for developing atrial fibrillation. 1 For more information, see the topic Coronary Artery Disease.
Avoid medicines, alcohol, and stimulants—such as caffeine or nicotine—that may contribute to the development of atrial fibrillation.
Take antibiotics when directed to do so by your doctor to lower your chance of getting a heart infection (endocarditis). Infection in the heart may lead to atrial fibrillation. For more information, see the topic Endocarditis.
Because atrial fibrillation raises your risk for stroke and many people do not have symptoms of atrial fibrillation, the U.S. National Stroke Association recommends that everyone, particularly those ages 55 and older and those who have other stroke risk factors, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.
Living With Atrial Fibrillation
Because atrial fibrillation is often the result of a heart condition, making changes to improve your heart condition will usually improve your overall health. Some of these changes include:
Quitting smoking and avoiding secondhand smoke. Quitting smoking may be the most important step you can take to prevent coronary artery disease. For more information, see the topic Quitting Smoking.
Controlling your cholesterol. This can be accomplished by diet and exercise, and medicines if needed.
Controlling your blood pressure. Follow a low-sodium, low-fat, and low-saturated fat diet; increase your exercise; decrease alcohol intake; and take medicines, if needed, to control your blood pressure.
Trying a balanced, low-fat and low-sodium diet, such as one based on the American Heart Association's healthy diet guidelines. 2 For more information, see:
Heart disease: Eating a heart-healthy diet.
Eating more fish. Experts recommend that adults eat at least two servings of fish each week, particularly fish such as salmon, trout, and tuna, for a healthy heart. Also, a recent study found that eating baked or broiled fish may reduce your risk for developing atrial fibrillation. 1
Not using alcohol, caffeine, or stimulants, such as methamphetamines or cocaine. Be aware that some nonprescription medicines, especially cold and herbal remedies, contain stimulants that can trigger atrial fibrillation. Talk to your doctor or pharmacist before taking any new medicine.
Trying an exercise program. Exercise has many positive effects: weight management, cholesterol reduction, blood pressure control, blood sugar leveling in diabetes, triglyceride reduction, mood elevation, and increased strength. Try to exercise on most, preferably all, days of the week. Talk to your doctor before starting an exercise program. For more information, see the topic Cardiac Rehabilitation.
Avoid getting sick from the flu. Get a flu shot every year.
Being on the alert for signs of obstructive sleep apnea because many people with atrial fibrillation also have obstructive sleep apnea.
Using complementary options to help control your stress. Examples include:
Yoga.
Biofeedback.
Meditation.
Taking anticoagulant medicine
If you are taking anticoagulant medicine, such as warfarin (Coumadin, for example), it is important to follow a few precautions:
Take your medicine at the same time each day.
Call your doctor if you miss a dose of anticoagulant.
Do not switch medicine brands without talking to your doctor.
Check with your doctor before using any nonprescription medicines, especially ones that contain aspirin. To help keep track of all of your medicines, use a medication planner (What is a PDF document?) .
Wear a medical alert ID bracelet, pendant, or charm to let others know that you take anticoagulants. Ask your pharmacist for information about ordering one.
Tell any new doctor you consult that you are taking anticoagulant medicine. This includes your dentist.
Be on the alert for signs of bleeding, and call your doctor immediately if any of these signs occur.
Get regular blood tests to check your clotting time. When you are taking an anticoagulant, you will have your blood drawn and tested regularly so that your doctor can monitor the level of the anticoagulant in your blood. The test that measures how long it takes your blood to clot is called prothrombin time, or pro-time.
Before a surgery or some tests (such as a colonoscopy), talk to your doctor about whether you need to stop taking your anticoagulant for a short time before the procedure. Stopping the anticoagulant helps prevent extra bleeding during the surgery or test. Your doctor will tell you when it is safe to start taking your medicine again.
Eat a balanced diet. Don't suddenly change your intake of foods that are rich in vitamin K. Vitamin K can interfere with the action of anticoagulants, making it more likely that your blood will clot. For more information, see:
Anticoagulants: Vitamin K and your diet.
Tell your doctor if you are not able to eat for several days or have stomach upset, diarrhea, or fever or if you have a major change in your diet for other reasons. It is important not to have sudden changes in your diet.
Avoid excessive use of alcohol. If you drink, do so only in moderation. Alcohol decreases the effect of anticoagulants. Alcohol also affects your balance and coordination and raises your risk of injury from a fall.
Don't smoke. And avoid secondhand smoke. Smoking affects how the body uses medicine and increases the blood's clotting effects.
Avoid activities that have a high risk for injury, such as skiing, football, or other contact sports. An injury could result in excessive bleeding if you are taking anticoagulants.
Modify your environment to help prevent falls.
Because atrial fibrillation raises your risk for stroke and many people do not have symptoms of atrial fibrillation, the U.S. National Stroke Association recommends that everyone, particularly those ages 55 and older, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.
Medications
Medicine treatment decisions are based on the cause of your atrial fibrillation, your symptoms, and your risk for complications. You will likely take a medicine to help prevent a stroke. You may also take a medicine that controls your heart rate or your heart rhythm.
Treatment with medicine is often needed for many years when heart disease is the cause of atrial fibrillation.
Rate-control medicines are used if your heart rate is too fast. Your doctor may give them to you to see if your atrial fibrillation symptoms are present when your heart rate is under control. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. Rate-control medicines may not be an option if you have a lot of symptoms with atrial fibrillation.
In a study called the AFFIRM trial, rate-control medicines were found to be preferable to antiarrhythmic medicines as a first treatment for certain people with atrial fibrillation, specifically older people at risk for stroke who did not have severe symptoms. The study found that antiarrhythmic medicines were expensive, often had side effects, and did not produce better results in this group of people. 3
Unlike antiarrhythmic medicines, rate-control medicines usually do not return your heart to a normal rhythm. In other words, your heart rhythm will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. Most people tolerate an irregular heart rhythm if the rate is kept between 60 and 100 beats per minute.
Rhythm-control medicines are sometimes used to try to convert atrial fibrillation to a normal sinus rhythm. Rhythm-control medicines, also called antiarrhythmic medicines, are also used to try to maintain normal sinus rhythm when symptoms persist despite rate-control medications and in certain other cases.
Anticoagulant medicines, such as warfarin (Coumadin, for example), are recommended for most people with atrial fibrillation who are at average to high risk of stroke.
If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
For more information on anticoagulants, see:
Should I take anticoagulants to prevent stroke?
Atrial fibrillation: Taking anticoagulants safely.
Anticoagulants: Vitamin K and your diet.
If you are at low risk of stroke or cannot take anticoagulants, your doctor may recommend that you take aspirin. It is not as effective as anticoagulant medicines in preventing clots, but it does not have as many side effects. Other antiplatelet medicines, such as clopidogrel (Plavix), may be used if you are unable to tolerate aspirin.
What to Think About
Some of these medicines may also be used to treat coronary artery disease, heart failure, and high blood pressure.
Surgery
The maze procedure, a surgery to correct atrial fibrillation, may be an option. Usually medicines and catheter ablation are tried before surgery is considered. But you may be a candidate for this surgery, especially if you are already having heart surgery for another reason, such as mitral valve replacement or coronary artery bypass surgery. If this is the case, the maze procedure can be done at the same time.
The maze procedure involves creating scar tissue that blocks excess electrical impulses from traveling through your heart. It usually requires open-heart surgery, but less invasive surgical methods are being developed.
Other Treatment
Electrical cardioversion is frequently used for atrial fibrillation to restore a normal sinus rhythm if the heart rhythm does not convert on its own. You may also elect to have cardioversion if you find your symptoms bothersome.
If your atrial fibrillation has recently started and it has been continuously present for less than 48 hours, your doctor may consider using electrical cardioversion or antiarrhythmic medicines to convert your heart to a normal rhythm. If your atrial fibrillation has lasted for more than 48 hours, it is possible that the blood that is pooling in the quivering upper heart chambers (atria) has led to the formation of blood clots. Cardioversion could cause a blood clot to be pumped into the bloodstream, travel to the brain, and cause a stroke.
If you've had atrial fibrillation for more than 48 hours, your doctor will probably prescribe anticoagulants for several weeks to reduce the risk of stroke before attempting cardioversion.
But if you have severe symptoms, such as very low blood pressure, you may have cardioversion immediately. In this case, your doctor may use a transesophageal echocardiogram to assess whether you have any clots in your heart that could cause a stroke. If the transesophageal echocardiogram shows that your heart is clear of clots, you may have cardioversion. Anticoagulant medicine is taken for at least 3 weeks after cardioversion.
If medicines do not keep you in normal rhythm and you continue to be bothered by your symptoms, catheter ablation might help you. Catheter ablation is used to try to cure atrial fibrillation or to control the heart rate. The procedure destroys small areas in the heart that might be causing atrial fibrillation or keep it going. You may need a permanent pacemaker along with catheter ablation.
Should I try cardioversion?
Do I need a pacemaker?
Other Places To Get Help
Organizations
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.americanheart.org
Call the American Heart Association (AHA) to find your nearest local or state AHA group. AHA can provide brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support. AHA's Web site also has information on physical activity, diet, and various heart-related conditions.
Heart Rhythm Society
1400 K Street NW
Suite 500
Washington, DC 20005
Phone:
(202) 464-3400
Fax:
(202) 464-3401
Web Address:
www.hrsonline.org
The Heart Rhythm Society provides information for patients and the public about heart rhythm problems. The Web site includes a section that focuses on patient information. This information includes causes, prevention, tests, treatment, and patient stories about heart rhythm problems. You can use the Find a Specialist section of the Web site to search for a heart rhythm specialist practicing in your area.
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating heart, lung, and blood diseases.
Normally, the heart beats in a strong, steady rhythm. In atrial fibrillation, a problem with the heart’s electrical system causes the atria to quiver, or fibrillate. The quivering upsets the normal rhythm between the atria and the lower parts (ventricles) of the heart. The lower parts may beat fast and without a regular rhythm.
Atrial fibrillation is dangerous because it greatly increases the risk of stroke. If the heart doesn't beat strongly, blood can collect, or pool, in the atria. Pooled blood is more likely to form clots. If the heart pumps a clot into the bloodstream, the clot can travel to the brain and block blood flow, causing a stroke. Atrial fibrillation can also lead to heart failure.
What causes atrial fibrillation?
Conditions that damage or strain the heart commonly cause atrial fibrillation. These include:
High blood pressure.
Coronary artery disease (CAD).
Heart attack.
Heart valve disease, especially diseases of the mitral valve.
Atrial fibrillation may also be caused by:
Other medical problems, such as lung disease, pneumonia, or a high thyroid level (hyperthyroidism).
Heart surgery.
Heavy alcohol use. Having more than 3 drinks a day over many years can cause long-lasting atrial fibrillation. Drinking a large amount of alcohol at one time (binge drinking) may also cause a spell (episode) of atrial fibrillation.
Use of stimulants. These include caffeine, nicotine, medicines such as decongestants, and illegal drugs such as cocaine.
Use of some prescription medicines, such as albuterol or theophylline.
Sometimes doctors can't find the cause. Doctors call this lone atrial fibrillation.
What are the symptoms?
Symptoms may include:
Feeling dizzy or lightheaded.
Feeling out of breath.
Feeling weak and tired.
A feeling that the heart is fluttering, racing, or pounding (palpitations).
A feeling that the heart is beating unevenly.
Chest pain (angina).
Fainting.
Atrial fibrillation is common, especially in older adults, and it may not cause obvious symptoms. If you have any of the symptoms listed, see your doctor. Finding and treating atrial fibrillation right away can help you avoid serious problems.
How is atrial fibrillation diagnosed?
The doctor will ask questions about your past health, do a physical exam, and order tests. The best way to find out if you have atrial fibrillation is to have an electrocardiogram (EKG or ECG). An EKG is a test that checks for problems with the heart’s electrical activity.
You might also have lab tests, a chest X-ray, and an echocardiogram. An echocardiogram can show how well your heart is pumping and whether your heart valves are damaged.
How is it treated?
A number of treatments may be used for atrial fibrillation. Which treatments are best for you depend on the cause, your symptoms, and your risk of stroke.
Doctors sometimes use a procedure called cardioversion to try to get the heartbeat back to a normal rhythm. This can be done using either medicine or a low-voltage electrical shock (electrical cardioversion). Atrial fibrillation often comes back after cardioversion.
If you have mild symptoms, or if atrial fibrillation returns after cardioversion, your doctor may prescribe medicines to control your heart rate and help prevent stroke. These may include:
Rhythm-control medicines (antiarrhythmics) to help return the heart to its normal rhythm and keep it there.
Rate-control medicines to keep the heart from beating too fast during atrial fibrillation.
Many people with atrial fibrillation need to take blood-thinning (anticoagulant) medicine to help prevent strokes. People at low risk for stroke may take daily aspirin instead. If you are age 55 or older and have atrial fibrillation, you can find your risk of stroke using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
Cardioversion and medicines don't work for some people who continue to have bothersome symptoms. In these cases, doctors sometimes recommend a procedure called ablation. Ablation destroys small areas of the heart. This creates scar tissue, which blocks or destroys areas that cause or maintain the irregular heart rhythm. Afterward, you may need a pacemaker to keep your heart beating regularly.
What can you do at home for atrial fibrillation?
Atrial fibrillation is often the result of heart disease or damage. So making changes that improve the condition of your heart may also improve your overall health.
Don't smoke. Avoid secondhand smoke, too. Quitting smoking can quickly reduce your risk of stroke and heart attack.
Eat a heart-healthy diet with plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil.
Get regular exercise on most, preferably all, days of the week. Your doctor can suggest a safe level of exercise for you.
Control your cholesterol and blood pressure. If you have diabetes, keep your blood sugar in your target range.
Manage your stress level. Stress can damage your heart.
Avoid caffeine, alcohol, and stimulants.
Avoid getting sick from the flu. Get a flu shot every year.
Cause
Atrial fibrillation is caused by a problem with the electrical activity of the heart.
Conditions that damage the heart muscle or strain the heart may cause atrial fibrillation. These include:
High blood pressure, a condition in which the force of blood against artery walls is too strong. Normal blood pressure is 119 millimeters of mercury (mm Hg) systolic over 79 mm Hg diastolic or below.
Coronary artery disease and heart attack. Coronary artery disease is caused by the buildup of plaque on the inside of the coronary arteries. These blood vessels supply oxygen-rich blood to the heart muscle.
Heart failure. Heart failure occurs when the heart is not able to pump blood effectively.
Heart valve disease, most often mitral valve disease. Heart valve disease occurs when a heart valve is damaged or narrowed and does not properly control the flow of blood through and out of the heart.
Cardiomyopathy. Cardiomyopathy damages the heart muscle and decreases the amount of blood it can pump.
Myocarditis, which is inflammation of the heart muscle. Myocarditis may occur after a viral, fungal, or bacterial infection or another illness, such as diphtheria, rheumatic fever, or tuberculosis.
Rheumatic heart disease. Rheumatic heart disease is damage to the heart muscle and heart valves that results from rheumatic fever.
Congenital heart disease. Congenital heart defects are structural heart problems or abnormalities that have been present since birth.
Endocarditis. Endocarditis can damage the heart muscle and heart valves.
Wolff-Parkinson-White syndrome, which causes rapid or irregular rhythms (arrhythmias) in the heart.
Heart surgery, such as coronary artery bypass or valve surgery, can trigger atrial fibrillation. In people older than 65, any surgery can trigger atrial fibrillation and raise the risk of complications, such as a stroke. In these cases, atrial fibrillation may be short-lasting. Treatment can return the heart to a normal rhythm.
Other conditions that cause atrial fibrillation include:
Chronic obstructive pulmonary disease (COPD), a group of diseases that make it difficult to breathe because air does not flow easily out of the lungs.
Pneumonia, which is an inflammation of the lungs that is most often caused by infection with bacteria or a virus.
Pulmonary embolism. Pulmonary embolism is the sudden blockage of blood flow in an artery in the lungs.
Hyperthyroidism, a condition in which the thyroid gland produces too much thyroid hormone.
Use of alcohol. Long-term, heavy alcohol use seems to be linked to atrial fibrillation. Besides long-term use, drinking a large amount of alcohol at one time (binge drinking) may also cause an episode of atrial fibrillation.
Use of stimulants. These include medicines, such as theophylline, amphetamines, and decongestants that contain stimulants (such as pseudoephedrine); illegal drugs, such as cocaine, methamphetamines, or crank; and excessive nicotine or caffeine.
Use of some prescription medicines, such as albuterol or theophylline.
Pericarditis, which is an inflammation of the sac around the heart. Pericarditis can temporarily irritate the heart muscle.
Atrial fibrillation caused by a condition that is treatable, such as pneumonia or hyperthyroidism, often goes away when that condition is treated.
Atrial fibrillation can sometimes develop in people who do not have heart disease or other health conditions. This is called lone atrial fibrillation.
Symptoms
Symptoms of atrial fibrillation include:
Heart palpitations.
Irregular pulse.
Shortness of breath, especially during physical activity or emotional stress.
Weakness, fatigue.
Dizziness, confusion.
Lightheadedness or fainting (syncope).
Chest pain (angina).
Atrial fibrillation is often discovered during routine medical checkups because many people do not have symptoms. Others may notice an irregular pulse but do not have other symptoms.
Mild symptoms may develop immediately. More serious problems may develop after the start of atrial fibrillation and over the course of several days. So it is important to identify and treat atrial fibrillation as soon as possible to avoid serious problems.
Serious complications such as a stroke or heart failure may occur before atrial fibrillation is discovered.
What Increases Your Risk
Risk factors for atrial fibrillation include:
Age older than 60.
Being white and male.
Heart failure.
Heart valve disease.
High blood pressure.
Coronary artery disease and heart attack.
Obesity.
Obstructive sleep apnea.
A family history of atrial fibrillation.
Surgery on the heart.
A history of rheumatic fever.
Infection, such as pneumonia or endocarditis.
Lung disease, such as asthma or chronic obstructive pulmonary disease (COPD).
Metabolic conditions, such as hyperthyroidism or diabetes.
Use of alcohol. Long-term, heavy alcohol use seems to be linked to atrial fibrillation.
Use of stimulants. These include medicines, such as theophylline, amphetamines, and decongestants that contain stimulants (such as pseudoephedrine); illegal drugs, such as cocaine, methamphetamines, or crank; and excessive nicotine or caffeine.
Use of some prescription medicines, such as albuterol or theophylline.
Congenital heart disease and surgical repair of congenital heart disease.
When to Call a Doctor
Some symptoms of atrial fibrillation need urgent medical evaluation.
Call 911 or other emergency services immediately if you:
Have severe chest pain.
Experience any signs of a stroke.
Feel faint and have an irregular heartbeat.
If you see someone pass out, call 911 or other emergency services immediately.
Call your doctor if you have:
An irregular heart rate.
Heart palpitations.
Periods of unexplained lightheadedness, dizziness, or confusion.
An episode of fainting or you come close to fainting for no apparent reason.
Shortness of breath that gets worse with exercise.
Who to See
The following health professionals can detect, diagnose and, in some cases, treat atrial fibrillation:
General practitioner
Family doctor
Internist
Nurse practitioner (NP)
Physician assistant (PA)
In general, the extent to which you will need specialized care will depend upon the severity of your symptoms and the complexity of your individual case. Many people who have only mild symptoms or whose arrhythmia is not causing other problems may continue to see their primary care doctors for the ongoing management of the condition.
But some people with atrial fibrillation have severe symptoms and may benefit from regular monitoring and treatment by a more specialized physician, such as a:
Cardiologist.
Cardiac electrophysiologist.
Exams and Tests
An electrocardiogram (EKG, ECG) is the best and simplest way to determine whether you have atrial fibrillation. An electrocardiogram is a recording of the electrical activity of your heart. It is usually done along with a medical history and physical exam. During your exam, your doctor will take your blood pressure to determine whether you have high blood pressure. Your doctor will also listen to your heart to see if you have a heart murmur.
If your doctor suspects that you have atrial fibrillation that comes and goes, he or she may ask you to use a device to record your heart rhythm on a continuous basis. This is referred to by several names, including ambulatory electrocardiogram, ambulatory EKG, Holter monitoring, 24-hour EKG, or cardiac event monitoring.
Your doctor may do more tests to see whether you have damage to your heart or heart valves. An exercise electrocardiogram, also called a stress test, will help your doctor see whether you have coronary artery disease. An echocardiogram gives your doctor a lot of information about your heart. It can show whether your heart valves are damaged, how well your heart is pumping, and whether you have heart failure or have had a heart attack.
You may also have a blood test to check for hyperthyroidism. Hyperthyroidism develops when the thyroid gland makes too much thyroid hormone.
You may get an X-ray if your exams show that you might have heart failure or a problem in your lungs, such as pneumonia.
If you take anticoagulant medications for atrial fibrillation, you will need to have frequent blood tests to monitor how long it takes for your blood to clot (prothrombin time).
Treatment Overview
Treating atrial fibrillation is important for several reasons. An irregular, rapidly beating heart can weaken the heart muscle and cause it to dilate or stretch out. This can increase your risk of developing heart failure or having chest pain or even a heart attack. Also, atrial fibrillation can greatly increase your risk of having a stroke. Atrial fibrillation can also cause symptoms that are hard to live with.
Many people are able to live full and active lives while being treated for atrial fibrillation. To stay healthy, you will probably need to take medicines, including an anticoagulant or aspirin, medicines to slow heart rate, or possibly rhythm-control medicines.
Initial treatment
If atrial fibrillation is causing your heart to pump dangerously fast or your blood pressure to drop dramatically, you will probably be taken to the hospital for treatment to restore your blood pressure and heart rate to normal. If atrial fibrillation is not causing severe symptoms, you may be treated on an outpatient basis. Treatment for people who have just started having episodes of atrial fibrillation usually includes trying to convert the heart to a normal rhythm. Sometimes anticoagulant medicines are used to prevent clots and stroke.
If you have had atrial fibrillation forless than 48 hours, your doctor may perform a procedure called cardioversion, using either medicine or a low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm).
If atrial fibrillation has lasted for more than 48 hours, attempting cardioversion could cause a stroke. In this case, you may need to take the anticoagulant medicine warfarin (such as Coumadin) for several weeks before your doctor tries cardioversion. Taking anticoagulants reduces the chance that a clot might travel from the heart to the brain after cardioversion.
If you are not sure how long you have had atrial fibrillation, you are also at risk of having a clot in your heart. If you are not having severe symptoms, such as fainting, your doctor will probably also recommend that you take anticoagulants for several weeks before cardioversion to prevent a stroke.
If you have severe symptoms and you are not sure how long you have had atrial fibrillation, your doctor may try to restore your heart to a normal rhythm immediately. In this case, your doctor will use a transesophageal echocardiogram to determine whether you have a clot in your heart that could cause a stroke. The results of this test will determine what your doctor does next:
If the heart is clear of clots, cardioversion can be attempted. Anticoagulants are used after to prevent strokes.
If there is a clot in the heart, your doctor will prescribe anticoagulants before trying cardioversion.
Cardioversion usually works to restore a normal sinus rhythm. But in many cases the heart rhythm goes back to atrial fibrillation.
Should I try cardioversion?
Ongoing treatment
When atrial fibrillation comes on suddenly, lasts a short time, and goes away on its own, it is called paroxysmal atrial fibrillation. Typically, episodes of paroxysmal atrial fibrillation come on more often and last longer over time.
Having paroxysmal atrial fibrillation can raise your risk of stroke. If you are at an average to high risk of having a stroke, your doctor may prescribe long-term use of an anticoagulant medicine, warfarin (such as Coumadin), to reduce this risk. You may be at average to high risk of stroke if you are older than 75 or have a history of heart disease, high blood pressure, diabetes, or stroke. If you are at low risk of having a stroke or you cannot take warfarin, you may need to take aspirin daily.
You may also need to take rhythm-control medicines (antiarrhythmics) to try to prevent paroxysmal atrial fibrillation from recurring.
Doctors may recommend the "pill in the pocket" approach for people with paroxysmal atrial fibrillation. With this approach, you can take a single dose of an antiarrhythmic drug when you feel palpitations instead of taking the medicine every day. For some people, this stops atrial fibrillation episodes. It may also reduce medicine side effects and the need to be seen in the emergency room or be hospitalized. But not everyone can use this treatment. Before you can take the "pill in the pocket" approach, your doctor will want to make sure that you do not have any other heart disease and that your heart's electrical system is normal.
Over time, episodes of atrial fibrillation typically last longer and often do not go away on their own. This is called persistent atrial fibrillation. When you have had atrial fibrillation for a long time, it is more difficult to return your heart to a normal rhythm (also called a normal sinus rhythm). When cardioversion is not an option or does not work, medicines are usually given to control the heart rate and prevent stroke.
Rate-control medicines. Rate-control medicines are used if your heart rate is too fast. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. They usually do not return your heart to a normal rhythm—in other words, your heartbeat will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. Most people tolerate an irregular heart rhythm if the rate is kept between 60 and 100 beats per minute.
Rhythm-control medicines. Rhythm-control medicines (antiarrhythmics) are still considered valuable for the treatment of atrial fibrillation. If symptoms persist despite rate-control medicines and in certain other cases, rhythm-control medicines are often prescribed. These medicines help return the heart to its normal rhythm and keep atrial fibrillation from returning.
Research studies have changed the way persistent atrial fibrillation is treated in many cases. The studies found that traditionally prescribed rhythm-control medicines were expensive, often had side effects, and did not produce better results than rate-control medicines. Still, rate-control and rhythm-control medicines are both effective treatments for atrial fibrillation. Your doctor will likely talk with you about which of these treatments might be best for you.
Anticoagulant medicines. Most people with atrial fibrillation should take warfarin (such as Coumadin), an anticoagulation medicine, to prevent blood clots that can lead to a stroke. Warfarin can prevent stroke and save lives in people who have an average to high risk of stroke. If you have high blood pressure, diabetes, heart failure, or a history of transient ischemic attack (TIA) or stroke, you may be at average to high risk of stroke. Talk to your doctor about whether you should take warfarin.
For people with a low risk of stroke or those who cannot take warfarin, daily aspirin may be recommended.
If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
For information about whether to take anticoagulants, see:
Should I take anticoagulants to prevent stroke?
For instructions on how to take anticoagulants, see:
Atrial fibrillation: Taking anticoagulants safely.
If you take warfarin, don't suddenly change your intake of foods that are rich in vitamin K. Vitamin K can interfere with the action of anticoagulants, making it more likely that your blood will clot. For more information, see:
Anticoagulants: Vitamin K and your diet.
Treatment if the condition gets worse
For some people with atrial fibrillation, medicines to slow the heart rate or control its rhythm do not work. These people continue to have a rapid, irregular heart rate. In these cases, doctors sometimes recommend a nonsurgical procedure called catheter ablation or a surgical procedure called the maze procedure. Experts suggest that these procedures should be performed in a medical center where the staff has experience with the procedures.
Catheter ablation
Catheter ablation for atrial fibrillation is relatively new and is still being studied. Catheter ablation destroys the heart tissue that causes atrial fibrillation and keeps atrial fibrillation going after it starts. Thin wires are inserted into a vein in the groin and guided into the heart. The wires have an attachment at the tip. The attachment sends out very hot or very cold temperatures. This heat or cold destroys the tissue that causes atrial fibrillation or the tissue that keeps it happening.
Catheter ablation is most successful at treating paroxysmal atrial fibrillation. In people with persistent or chronic atrial fibrillation, the success rate is lower. Catheter ablation is an invasive procedure and has some serious risks. Catheter ablation should only be done in people who have tried other treatments but continue to have serious symptoms. As the procedure becomes more effective and safe, doctors may use it as one of the first treatments for atrial fibrillation.
Ablation procedures either try to cure atrial fibrillation (focal ablation, circumferential ablation, or pulmonary vein ablation) or try to control your symptoms (nodal ablation).
Ablation to cure atrial fibrillation. Focal, circumferential, and pulmonary vein catheter ablation are used to try to cure atrial fibrillation. Focal ablation, also known as targeted ablation, is used to destroy the specific areas that are firing off abnormal electrical impulses and causing atrial fibrillation. Circumferential ablation is used to destroy the tissue that lets atrial fibrillation continue. Sometimes a doctor uses both focal and circumferential ablation.
Sometimes, abnormal impulses come from inside a pulmonary vein and cause atrial fibrillation. (The pulmonary veins bring blood back from the lungs to the heart.) Catheter ablation in the pulmonary vein can block these impulses and prevent atrial fibrillation from happening.
A pacemaker device is usually not needed when only specific areas are destroyed.
Ablation to control symptoms of atrial fibrillation. Nodal catheter ablation may be used to control symptoms of atrial fibrillation when the cause cannot be stopped. Nodal catheter ablation destroys your atrioventricular (AV) node and blocks electrical signals to your lower heart chambers (ventricles). After nodal catheter ablation, you will need a permanent pacemaker to regulate your heart rhythm. Nodal ablation can control your heart rate and reduce your symptoms, but it does not prevent or cure atrial fibrillation. So you will probably need to take the anticoagulant warfarin (Coumadin, for example).
Heart problems: Living with a pacemaker or ICD
Maze procedure
A surgical procedure to cure atrial fibrillation is called the maze procedure. The maze procedure is usually done during open-heart surgery. The procedure creates scar tissue that blocks excess electrical impulses from traveling through your heart. Because of the risks involved with open-heart surgery, this procedure is used only in people who have severe symptoms and are having heart surgery for other reasons. Doctors are developing less invasive surgical maze techniques. These may be less painful and easier to recover from.
Ongoing Concerns
Atrial fibrillation with heart disease
Heart disease—including high blood pressure, heart valve disease, and coronary artery disease—is the most common cause of atrial fibrillation. Seen mostly in people older than 65, this type of atrial fibrillation is often the most complicated to manage.
At first, people usually have paroxysmal atrial fibrillation. Paroxysmal episodes go away on their own. They may last anywhere from a few seconds to a few weeks and may not cause symptoms.
Paroxysmal atrial fibrillation episodes may recur for weeks or years, although usually the disease progresses, and atrial fibrillation becomes persistent, meaning that it no longer goes away on its own. Your doctor may try a procedure called cardioversion, using either medicine or low-voltage electrical shock (electrical cardioversion), to return the irregular heartbeat to a normal rhythm (normal sinus rhythm). The decision to try cardioversion is based upon how bothersome you find the symptoms and how long the episode of atrial fibrillation has persisted.
If the heart cannot be converted to a normal rhythm or does not stay in a normal rhythm, medicines are used to control the heart rate and prevent it from becoming dangerously fast. Many people are able to live full and active lives while being treated for atrial fibrillation. Others may need further treatment because they develop shortness of breath, weakness, fainting, or other significant symptoms.
Lone atrial fibrillation
In rare cases, doctors cannot find the cause of atrial fibrillation. These cases are called lone atrial fibrillation. Lone atrial fibrillation occurs more often in people younger than 65. It often stops on its own, or it may need to be treated.
Treatment may be needed if a rapid heartbeat causes discomfort, decreased energy, or other unacceptable symptoms. Adults older than age 75 with lone atrial fibrillation are at risk for stroke and require treatment with the anticoagulant medicine warfarin (such as Coumadin).
Stroke risk
Atrial fibrillation increases your chance of having a stroke. When blood does not completely empty out of the rapidly beating atria, a clot can develop in the blood that pools in the atria. The clot may travel from the heart to the brain, causing a stroke.
People with atrial fibrillation and no damage to the heart valves are 6 times more likely to have a stroke than people without atrial fibrillation. The risk of stroke is significantly higher if heart valve damage is present. This risk of stroke also increases with age and with high blood pressure, diabetes, heart failure, or a previous stroke or transient ischemic attack (TIA). Taking anticoagulant medicines greatly reduces your risk of blood clots and stroke.
If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: Are You at Risk for a Stroke if You Have Atrial Fibrillation?
If atrial fibrillation is not treated, it can further damage the heart and cause serious complications, such as heart failure.
You can lower your risk of complications by controlling high blood pressure.
Prevention
A healthy lifestyle, proper nutrition, treatment for high blood pressure, and other measures can prevent atrial fibrillation by protecting you from heart disease. Manage your stress, exercise regularly, control your blood pressure, and do not smoke.
For tips on starting a walking program, see:
Heart disease: Walking for a healthy heart.
Experts also recommend that adults eat at least two servings of fish each week, particularly fish such as salmon, trout, and tuna, for a healthy heart. Also, one study found that eating baked or broiled fish may reduce your risk for developing atrial fibrillation. 1 For more information, see the topic Coronary Artery Disease.
Avoid medicines, alcohol, and stimulants—such as caffeine or nicotine—that may contribute to the development of atrial fibrillation.
Take antibiotics when directed to do so by your doctor to lower your chance of getting a heart infection (endocarditis). Infection in the heart may lead to atrial fibrillation. For more information, see the topic Endocarditis.
Because atrial fibrillation raises your risk for stroke and many people do not have symptoms of atrial fibrillation, the U.S. National Stroke Association recommends that everyone, particularly those ages 55 and older and those who have other stroke risk factors, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.
Living With Atrial Fibrillation
Because atrial fibrillation is often the result of a heart condition, making changes to improve your heart condition will usually improve your overall health. Some of these changes include:
Quitting smoking and avoiding secondhand smoke. Quitting smoking may be the most important step you can take to prevent coronary artery disease. For more information, see the topic Quitting Smoking.
Controlling your cholesterol. This can be accomplished by diet and exercise, and medicines if needed.
Controlling your blood pressure. Follow a low-sodium, low-fat, and low-saturated fat diet; increase your exercise; decrease alcohol intake; and take medicines, if needed, to control your blood pressure.
Trying a balanced, low-fat and low-sodium diet, such as one based on the American Heart Association's healthy diet guidelines. 2 For more information, see:
Heart disease: Eating a heart-healthy diet.
Eating more fish. Experts recommend that adults eat at least two servings of fish each week, particularly fish such as salmon, trout, and tuna, for a healthy heart. Also, a recent study found that eating baked or broiled fish may reduce your risk for developing atrial fibrillation. 1
Not using alcohol, caffeine, or stimulants, such as methamphetamines or cocaine. Be aware that some nonprescription medicines, especially cold and herbal remedies, contain stimulants that can trigger atrial fibrillation. Talk to your doctor or pharmacist before taking any new medicine.
Trying an exercise program. Exercise has many positive effects: weight management, cholesterol reduction, blood pressure control, blood sugar leveling in diabetes, triglyceride reduction, mood elevation, and increased strength. Try to exercise on most, preferably all, days of the week. Talk to your doctor before starting an exercise program. For more information, see the topic Cardiac Rehabilitation.
Avoid getting sick from the flu. Get a flu shot every year.
Being on the alert for signs of obstructive sleep apnea because many people with atrial fibrillation also have obstructive sleep apnea.
Using complementary options to help control your stress. Examples include:
Yoga.
Biofeedback.
Meditation.
Taking anticoagulant medicine
If you are taking anticoagulant medicine, such as warfarin (Coumadin, for example), it is important to follow a few precautions:
Take your medicine at the same time each day.
Call your doctor if you miss a dose of anticoagulant.
Do not switch medicine brands without talking to your doctor.
Check with your doctor before using any nonprescription medicines, especially ones that contain aspirin. To help keep track of all of your medicines, use a medication planner (What is a PDF document?) .
Wear a medical alert ID bracelet, pendant, or charm to let others know that you take anticoagulants. Ask your pharmacist for information about ordering one.
Tell any new doctor you consult that you are taking anticoagulant medicine. This includes your dentist.
Be on the alert for signs of bleeding, and call your doctor immediately if any of these signs occur.
Get regular blood tests to check your clotting time. When you are taking an anticoagulant, you will have your blood drawn and tested regularly so that your doctor can monitor the level of the anticoagulant in your blood. The test that measures how long it takes your blood to clot is called prothrombin time, or pro-time.
Before a surgery or some tests (such as a colonoscopy), talk to your doctor about whether you need to stop taking your anticoagulant for a short time before the procedure. Stopping the anticoagulant helps prevent extra bleeding during the surgery or test. Your doctor will tell you when it is safe to start taking your medicine again.
Eat a balanced diet. Don't suddenly change your intake of foods that are rich in vitamin K. Vitamin K can interfere with the action of anticoagulants, making it more likely that your blood will clot. For more information, see:
Anticoagulants: Vitamin K and your diet.
Tell your doctor if you are not able to eat for several days or have stomach upset, diarrhea, or fever or if you have a major change in your diet for other reasons. It is important not to have sudden changes in your diet.
Avoid excessive use of alcohol. If you drink, do so only in moderation. Alcohol decreases the effect of anticoagulants. Alcohol also affects your balance and coordination and raises your risk of injury from a fall.
Don't smoke. And avoid secondhand smoke. Smoking affects how the body uses medicine and increases the blood's clotting effects.
Avoid activities that have a high risk for injury, such as skiing, football, or other contact sports. An injury could result in excessive bleeding if you are taking anticoagulants.
Modify your environment to help prevent falls.
Because atrial fibrillation raises your risk for stroke and many people do not have symptoms of atrial fibrillation, the U.S. National Stroke Association recommends that everyone, particularly those ages 55 and older, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.
Medications
Medicine treatment decisions are based on the cause of your atrial fibrillation, your symptoms, and your risk for complications. You will likely take a medicine to help prevent a stroke. You may also take a medicine that controls your heart rate or your heart rhythm.
Treatment with medicine is often needed for many years when heart disease is the cause of atrial fibrillation.
Rate-control medicines are used if your heart rate is too fast. Your doctor may give them to you to see if your atrial fibrillation symptoms are present when your heart rate is under control. These medicines include beta-blockers, calcium channel blockers, and/or digoxin. Rate-control medicines may not be an option if you have a lot of symptoms with atrial fibrillation.
In a study called the AFFIRM trial, rate-control medicines were found to be preferable to antiarrhythmic medicines as a first treatment for certain people with atrial fibrillation, specifically older people at risk for stroke who did not have severe symptoms. The study found that antiarrhythmic medicines were expensive, often had side effects, and did not produce better results in this group of people. 3
Unlike antiarrhythmic medicines, rate-control medicines usually do not return your heart to a normal rhythm. In other words, your heart rhythm will still be irregular. But these medicines can keep your heart from beating at a dangerously fast rate. Most people tolerate an irregular heart rhythm if the rate is kept between 60 and 100 beats per minute.
Rhythm-control medicines are sometimes used to try to convert atrial fibrillation to a normal sinus rhythm. Rhythm-control medicines, also called antiarrhythmic medicines, are also used to try to maintain normal sinus rhythm when symptoms persist despite rate-control medications and in certain other cases.
Anticoagulant medicines, such as warfarin (Coumadin, for example), are recommended for most people with atrial fibrillation who are at average to high risk of stroke.
If you are age 55 or older and have atrial fibrillation, you can find your risk of having a stroke in the next 5 years using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
For more information on anticoagulants, see:
Should I take anticoagulants to prevent stroke?
Atrial fibrillation: Taking anticoagulants safely.
Anticoagulants: Vitamin K and your diet.
If you are at low risk of stroke or cannot take anticoagulants, your doctor may recommend that you take aspirin. It is not as effective as anticoagulant medicines in preventing clots, but it does not have as many side effects. Other antiplatelet medicines, such as clopidogrel (Plavix), may be used if you are unable to tolerate aspirin.
What to Think About
Some of these medicines may also be used to treat coronary artery disease, heart failure, and high blood pressure.
Surgery
The maze procedure, a surgery to correct atrial fibrillation, may be an option. Usually medicines and catheter ablation are tried before surgery is considered. But you may be a candidate for this surgery, especially if you are already having heart surgery for another reason, such as mitral valve replacement or coronary artery bypass surgery. If this is the case, the maze procedure can be done at the same time.
The maze procedure involves creating scar tissue that blocks excess electrical impulses from traveling through your heart. It usually requires open-heart surgery, but less invasive surgical methods are being developed.
Other Treatment
Electrical cardioversion is frequently used for atrial fibrillation to restore a normal sinus rhythm if the heart rhythm does not convert on its own. You may also elect to have cardioversion if you find your symptoms bothersome.
If your atrial fibrillation has recently started and it has been continuously present for less than 48 hours, your doctor may consider using electrical cardioversion or antiarrhythmic medicines to convert your heart to a normal rhythm. If your atrial fibrillation has lasted for more than 48 hours, it is possible that the blood that is pooling in the quivering upper heart chambers (atria) has led to the formation of blood clots. Cardioversion could cause a blood clot to be pumped into the bloodstream, travel to the brain, and cause a stroke.
If you've had atrial fibrillation for more than 48 hours, your doctor will probably prescribe anticoagulants for several weeks to reduce the risk of stroke before attempting cardioversion.
But if you have severe symptoms, such as very low blood pressure, you may have cardioversion immediately. In this case, your doctor may use a transesophageal echocardiogram to assess whether you have any clots in your heart that could cause a stroke. If the transesophageal echocardiogram shows that your heart is clear of clots, you may have cardioversion. Anticoagulant medicine is taken for at least 3 weeks after cardioversion.
If medicines do not keep you in normal rhythm and you continue to be bothered by your symptoms, catheter ablation might help you. Catheter ablation is used to try to cure atrial fibrillation or to control the heart rate. The procedure destroys small areas in the heart that might be causing atrial fibrillation or keep it going. You may need a permanent pacemaker along with catheter ablation.
Should I try cardioversion?
Do I need a pacemaker?
Other Places To Get Help
Organizations
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.americanheart.org
Call the American Heart Association (AHA) to find your nearest local or state AHA group. AHA can provide brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support. AHA's Web site also has information on physical activity, diet, and various heart-related conditions.
Heart Rhythm Society
1400 K Street NW
Suite 500
Washington, DC 20005
Phone:
(202) 464-3400
Fax:
(202) 464-3401
Web Address:
www.hrsonline.org
The Heart Rhythm Society provides information for patients and the public about heart rhythm problems. The Web site includes a section that focuses on patient information. This information includes causes, prevention, tests, treatment, and patient stories about heart rhythm problems. You can use the Find a Specialist section of the Web site to search for a heart rhythm specialist practicing in your area.
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating heart, lung, and blood diseases.
Subscribe to:
Comments (Atom)