Peanut Allergies on the Rise

What You Need To Know About Peanut Allergy?
Peanut allergy is a type of food allergy. Peanuts are one of the world’s most allergenic foods.

More than 1.5 million people in the US are affected with peanut allergy.

A peanut allergy is an allergy that is caused by the body’s reaction to particular substances. This is a life threatening allergy reaction.

Cause of peanut allergy:

*The most common cause of peanut allergy is direct contact with peanuts. This means while eating or touching peanuts can cause allergies.
*The other cause of peanut allergy is, when you inhale dust containing peanuts.
*The rarest case in which you can acquire peanut allergy is, during processing or handling of a food product which consists of peanuts.
*Peanut allergy is caused by the overreaction of the immune system. Immune system considers peanuts as the harmful substances and leads to the production of immunoglobulin E antibodies. These antibodies produce histamines which causes allergic reactions to occur.

Common food sources which contain peanut proteins include:

*Salad dressing
*Cereals and granola
*Almonds
*Pecans and walnuts
*Soy products
*Ground nuts
*Frozen desserts
*Peanut butter
*Baked food such as pastries
*Artificial tree nuts
*Asian foods such as Chinese foods
*Sunflower seeds
*chocolates
*peanut oils
*Beer nuts and peanut brittle
*Sauce made with nuts

Symptoms of peanut allergy:

*Peanut allergy symptoms are mild but in some cases they can become more severe. Allergic reaction appears immediately or a few hours after you ate.

*The first symptoms that you face are runny nose, an itchy skin rash such as hives, or stinging in the tongue or lips.

*The other symptoms of peanut allergy include:
-Vomiting
-Stomach pain
-Wheezing
-Coughing
-Nausea
-Diarrhea
-Sore throat
-Dizziness
-Atopic dermatitis
-Urticaria or hives
-Asthma
-Anaphylactic shock
-Swelling of the digestive tracts
-Difficulty in breathing or swallowing
-Sudden fatigue and rapid heartbeat
-Loss of consciousness, coma or death

Diagnosis of peanut allergy:

*Doctors will conduct the physical examination to identify the main problem.
*In some cases tests like skin test and blood test are also essential to identify the problem.
*In skin test your skin is pricked and exposed to small amounts of proteins found in peanuts to see if you have a skin test response.
*In blood test, your immune system response to peanuts is tested. It measures the amount of antibodies such as IgE in your blood.

Treatment for peanut allergy:

*There are no special medications for peanut allergy. The best treatment is simply to avoid exposure to peanuts and peanut proteins directly or indirectly.
*Avoid foods that made with peanut oil.
*Avoid cakes and pastries with unknown ingredients, especially carrot cake, pumpkin cake and fruits and nut rolls.
*Be careful with what you are eating and drinking. All food labels, cosmetics, creams and ointments should be read.
*Medications, such as antihistamines help to reduce peanut allergy.
*If you have severe reactions, you may need to take epinephrine with consultation of doctor.

Peanut Allergies on the Rise

What You Need To Know About Peanut Allergy?
Peanut allergy is a type of food allergy. Peanuts are one of the world’s most allergenic foods.

More than 1.5 million people in the US are affected with peanut allergy.

A peanut allergy is an allergy that is caused by the body’s reaction to particular substances. This is a life threatening allergy reaction.

Cause of peanut allergy:

*The most common cause of peanut allergy is direct contact with peanuts. This means while eating or touching peanuts can cause allergies.
*The other cause of peanut allergy is, when you inhale dust containing peanuts.
*The rarest case in which you can acquire peanut allergy is, during processing or handling of a food product which consists of peanuts.
*Peanut allergy is caused by the overreaction of the immune system. Immune system considers peanuts as the harmful substances and leads to the production of immunoglobulin E antibodies. These antibodies produce histamines which causes allergic reactions to occur.

Common food sources which contain peanut proteins include:

*Salad dressing
*Cereals and granola
*Almonds
*Pecans and walnuts
*Soy products
*Ground nuts
*Frozen desserts
*Peanut butter
*Baked food such as pastries
*Artificial tree nuts
*Asian foods such as Chinese foods
*Sunflower seeds
*chocolates
*peanut oils
*Beer nuts and peanut brittle
*Sauce made with nuts

Symptoms of peanut allergy:

*Peanut allergy symptoms are mild but in some cases they can become more severe. Allergic reaction appears immediately or a few hours after you ate.

*The first symptoms that you face are runny nose, an itchy skin rash such as hives, or stinging in the tongue or lips.

*The other symptoms of peanut allergy include:
-Vomiting
-Stomach pain
-Wheezing
-Coughing
-Nausea
-Diarrhea
-Sore throat
-Dizziness
-Atopic dermatitis
-Urticaria or hives
-Asthma
-Anaphylactic shock
-Swelling of the digestive tracts
-Difficulty in breathing or swallowing
-Sudden fatigue and rapid heartbeat
-Loss of consciousness, coma or death

Diagnosis of peanut allergy:

*Doctors will conduct the physical examination to identify the main problem.
*In some cases tests like skin test and blood test are also essential to identify the problem.
*In skin test your skin is pricked and exposed to small amounts of proteins found in peanuts to see if you have a skin test response.
*In blood test, your immune system response to peanuts is tested. It measures the amount of antibodies such as IgE in your blood.

Treatment for peanut allergy:

*There are no special medications for peanut allergy. The best treatment is simply to avoid exposure to peanuts and peanut proteins directly or indirectly.
*Avoid foods that made with peanut oil.
*Avoid cakes and pastries with unknown ingredients, especially carrot cake, pumpkin cake and fruits and nut rolls.
*Be careful with what you are eating and drinking. All food labels, cosmetics, creams and ointments should be read.
*Medications, such as antihistamines help to reduce peanut allergy.
*If you have severe reactions, you may need to take epinephrine with consultation of doctor.

Pertussis (Whooping Cough)

Pertussis, commonly known as whooping cough, is a highly contagious disease that can last for weeks and typically causes severe coughing fits. It is caused by the bacteria Bordetella pertussis and can be prevented with a vaccine. After the introduction of the vaccine for pertussis in 1940, incidence for the disease decreased by over 99 percent to a low of 1,010 cases in 1976. Recently, the trend has reversed with a peak of 25,000 cases in 2005 and more than 15,000 in 2006. Two-thirds of reported cases in 2005 were in adolescents or adults. Reasons for this increase include under-vaccination in infants, under- and misdiagnosis of pertussis in the past, decreased immunity from past vaccinations, and increased recognition of cases in adolescent and adult populations.

Pertussis is most severe in children under one year of age. From 2000 to 2004, 90 percent of the total 100 deaths related to pertussis occurred in infants less than four months old.

The CDC’s Advisory Committee on Immunization Practices (ACIP), the Committee on Infectious Diseases of the American Academy of Pediatrics and the American Academy of Family Physicians all recommend that children (6 weeks to 6 years old) routinely receive five doses of a combination vaccine, DTaP (diphtheria and tetanus toxoids plus a cellular pertussis vaccine) at the ages of 2, 4, 6, 15 to 18 months, and 4 to 6 years. ACIP also recommends that children 11 and 12 years of age receive a single dose of Tdap (tetanus, diphtheria and pertussis) instead of the usual diphtheria and tetanus booster. Recommendations also call for older adolescents (13 to18 years old) to receive a single dose of Tdap if they have not yet received a Tdap vaccination. Adults under 65 years of age are encouraged to receive one Tdap vaccination instead of a Td (tetanus and diphtheria) booster. Tdap is comprised of two vaccines and is licensed for use in adolescents and adults ages 10 to 64 years.

headache- preventive medicatin

Preventative medication may be prescribed for patients who have frequent migraine attacks (three or more a month), those who do not respond consistently to acute treatment, and when specific medicines are contraindicated because of other medical conditions (such as stroke or bleeding in the brain). Studies have reported that as many as 40% of these patients may benefit from preventative treatment. The U.S. Food and Drug Administration (FDA) has approved four prescription drugs for migraine prevention. These include the beta-blockers propranolol (Inderal®) and timolol (Blocadren®), and the anticonvulsants topiramate (Topamax®) and divalproex sodium (Depakote®).

Anticonvulsants: Anticonvulsant medicines, normally used for seizures, have been used to prevent migraine headaches. Examples of anticonvulsants that have been used are valproic acid (Depakote®, Depakote ER®, Depakene®), phenobarbital, gabapentin (Neurontin®), and topiramate (Topamax®). Control of the cortical spreading depression (CSD), is thought to be the reason for anticonvulsant effectiveness in preventing migraine attacks. Side effects include fatigue (tiredness), nausea, vomiting, and trembling.

Beta-blockers: Beta-blockers are a class of drugs that safely slow the heart beat and decrease blood pressure. Beta-blockers have been used for many years to prevent migraine headaches. In migraine prevention, beta-blockers help dilate (open) blood vessels in the brain, which may prevent the vascular (blood vessel) symptoms associated with a migraine attack, including vasoconstriction (blood vessel narrowing) and vasodilation (blood vessel widening). Beta-blockers can also help reduce physical symptoms associated with migraine attacks, such as anxiety, heart palpitations, and shaking,

Beta-blockers used in migraine prevention include propranolol (Inderal®), atenolol (Tenormin®), metoprolol (Lopressor®, Toprol XL®), and nadolol (Corgard®). Beta-blockers generally are well tolerated in most individuals. They can aggravate breathing difficulties in patients with asthma, chronic bronchitis (inflammation of the bronchial tubes), or emphysema (loss of lung function). In patients who already have slow heart rates (bradycardia) and heart block (defects in electrical conduction within the heart), beta-blockers can cause dangerously slow heartbeats. Beta-blockers can aggravate symptoms of heart failure. Other side effects include drowsiness, diarrhea, constipation, fatigue (tiredness), insomnia, nausea, depression, dreaming, memory loss, and impotence (loss of sexual performance).

Calcium channel blockers (CCBs): CCBs are a class of drugs normally used for high blood pressure, angina (chest pain), and arrhythmias (abnormal heart rhythms). CCBs also appear to alter serotonin (a brain chemical). Serotonin imbalances are a causative factor in developing a migraine. CCBs used in preventing migraine headaches are diltiazem (Cardizem®, Dilacor®, Tiazac®), and verapamil (Calan®, Verelan®, Isoptin®).The most common side effects of CCBs are constipation, nausea, headache, rash, edema (swelling of the legs with fluid), low blood pressure, drowsiness, and dizziness. Drinking grapefruit juice or eating grapefruit may cause levels of CCBs to rise, potentially leading to life threatening arrhythmias (irregular heart beats). Healthcare professionals recommend that individuals taking CCBs not consume grapefruit juice.

Hormone replacement therapy (HRT): For women with hormonal imbalances that may be causing the migraines, hormone replacement therapy (HRT) may be used, including estrogen and progesterone. HRT, however, may cause side effects such as blood clots, an increased risk of developing some types of cancers, and heart disease. Menstruating women at risk for migraines may be placed on oral contraceptives for HRT. Pre-pubescent girls that are at risk for migraine attacks will not be treated with HRT, but with other methods such as beta-blockers and anticonvulsants.

Lifestyle: Lifestyle changes, including decreasing stress levels, increasing exercise levels, and controlling the diet, have a major impact on migraine prevention and development. Lifestyle factors that are important in the prevention of migraines include regular sleep patterns, regular exercise (level depends upon the individual), limiting stress, limiting caffeine consumption to less than two caffeine-containing beverages a day, avoiding bright or flashing lights, and wearing sunglasses if sunlight is a trigger. Identifying and avoiding foods that trigger headaches is important. Healthcare professionals recommend keeping a food journal, where the individual writes down everything they have for each meal of the day. Then review the diary with a healthcare professional. It is impractical to adopt a diet that avoids all known migraine triggers; however, it is reasonable to avoid foods that consistently trigger migraine headaches. Triggers vary from one individual to another.

Tricyclic antidepressants (TCAs): TCAs are thought to prevent migraine headaches by altering the balance of serotonin, a neurotransmitter in the brain. Low levels of serotonin are thought to be a causative agent in migraine attacks. Chronic stress and depression can cause elevated levels of the stress hormone cortisol, which is produced in the adrenal glands. Cortisol can in turn cause imbalances in serotonin, leading to a migraine attack. The tricyclic antidepressants that have been used in preventing migraine headaches include amitriptyline (Elavil®), nortriptyline (Pamelor®, Aventyl®), doxepin (Sinequan®), and imipramine (Tofranil®). Side effects include constipation, dry mouth, low blood pressure (hypotension), increased heart rate, (tachycardia), urinary retention, sexual dysfunction, and weight gain. TCAs may cause excessive sedation and fatigue (tiredness).

Others: Other drugs less commonly used for migraine prevention include anti-serotonin medications, including methysergide (Sansert®), which prevent migraine headaches by constricting (making smaller) blood vessels and reducing inflammation of the blood vessels. Cyproheptadine (Periactin®) is an antihistamine that increases serotonin activity and is used occasionally in migraine prevention. Low levels of serotonin are a cause of migraine attacks.

Acute (Immediate):

Over-the-counter (OTC) treatments: The U.S. Food and Drug Administration (FDA) has approved three over-the-counter (OTC) products to treat migraine attacks. Excedrin® Migraine (a combination of aspirin, acetaminophen, and caffeine) is indicated for migraine and its associated symptoms such as head pain. Advil® Migraine and Motrin® Migraine Pain (both are ibuprofen) have anti-inflammatory action and are approved to treat migraine headache and its pain.

Triptans: The triptans attach to serotonin receptors on the blood vessels and nerves and thereby reduce inflammation and constrict (narrow) the blood vessels. A reduction in inflammation decreases pressure on nerves in the trigeminal nerve system (nerves in the cranium or head), which decreases the pain signals to the brain and stops the headache. Traditionally, triptans, which are prescription medicines, were prescribed for moderate or severe migraines after over-the-counter (OTC) analgesics such as ibuprofen (Advil®) and other simple measures failed. Newer studies suggest that triptans can be used as the first treatment for patients with migraines that are causing disability. Significant disability is defined as more than ten days of at least 50% disability during a three month period.

Triptans should be used early after the migraine begins, before the onset of pain or when the pain is mild. Using a triptan early in an attack increases its effectiveness, reduces side effects, and decreases the chance of recurrence of another headache during the following 24 hours. Used early, triptans can be expected to abort more than 80% of migraine headaches within two hours. Triptans include sumatriptan (Imitrex®), almotriptan (Axert®), naratriptan (Amerge®), rizatriptan (Maxalt®), zolmitriptan (Zomig®), frovatriptan (Frova®), and eletriptan (Relpax®).

The most common side effects of triptans are facial flushing, tingling of the skin, and a sense of tightness around the chest and throat. Other less common side effects include drowsiness, fatigue (tiredness), and dizziness. These side effects are short-lived and are not considered serious. Triptans are not used in pregnant women and are not generally used in young children.

In patients with severe nausea, a combination of a triptan and an anti-nausea medication, such as prochlorperazine (Compazine®), may be used.

Ergots: Ergots, like triptans, are medications that abort migraine headaches. Examples of ergots include ergotamine preparations (Cafergot®) and dihydroergotamine preparations (Migranal®, DHE-45®). Ergots, like triptans, cause constriction (narrowing) of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and the produce more negative effects on the heart than the triptans. Therefore, the ergots are not as safe as the triptans. Ergots are used to help stop the vasodilation (blood vessel widening) associated with a migraine attack. The ergots also are more prone to cause nausea and vomiting than the triptans. The ergots can cause prolonged contraction of the uterus and miscarriages in pregnant women.

Midrin: Midrin is used to abort migraine and tension headaches. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative). The combination medication can help take care of three potential factors associated with a migraine attack, including vasodilation, pain, and anxiety. Midrin® is most effective if used early during a headache. However, because of its potent blood vessel constricting effect, it should not be used in patients with high blood pressure, kidney disease, glaucoma (increased pressure in the eyes), atherosclerosis (hardening of the arteries), liver disease, or in patients taking monoamine oxidase inhibitors (MAOIs) including phenelzine (Nardil®), isocarboxazid (Marplan®), and tranylcypromine sulfate (Parnate®).

Other prescription medications: Some attacks may not be eliminated by acute therapy, and the individual requires pain-relieving measures. Due to the severity of the headaches, some patients may require a narcotic analgesic, including oxycodone (Percocet®), codeine, or meperidine (Demerol®). If the individual is experiencing frequent migraine attacks, the habitual use of opiate analgesics should be avoided. Opiates can cause addiction (both physical and mental) and may also cause rebound headaches, which are headaches that occur when the pain medicine no longer provides relief.

Butorphanol (Stadol NS®) is an opiate-like drug available for injection and intranasal (in the nose) administration. The normal dosage of Stadol NS® is one spray into the nostril, which usually relieves migraine symptoms in 15-30 minutes. This drug can be used every hour for relief. The use of Stadol NS® may result in dependency if used regularly for pain relief. Side effects include nausea and vomiting, nasal irritation, and sedation.

Butalbital, a barbiturate medication, is also used for the immediate relief of migraine headache pain. It is used in various prescription combinations with aspirin, acetaminophen, caffeine, or codeine (an opiate pain medication). These medications are potentially addicting and are not used as initial treatment. They are sometimes used for patients whose headaches fail to respond to over-the-counter (OTC) medications but who are not candidates for triptans either due to pregnancy or the risk of heart attack and stroke. Products include butalbital and acetaminophen (Axocet®, Bupap®, Cephadyn®, Phrenilin®, or Sedapap®); butalbital, acetaminophen, and caffeine (Fioricet®, Esgic®); butalbital and aspirin (Axotal®); butalbital, aspirin, and caffeine (Fiorinal®); butalbital, acetaminophen, caffeine, and codeine (Fioricet #3 with Codeine® or Fioricet w/ Codeine®); and butalbital, aspirin, caffeine, and codeine (Fiorinal #3 with Codeine® or Fiorinal w/ Codeine®).

headache- preventive medicatin

Preventative medication may be prescribed for patients who have frequent migraine attacks (three or more a month), those who do not respond consistently to acute treatment, and when specific medicines are contraindicated because of other medical conditions (such as stroke or bleeding in the brain). Studies have reported that as many as 40% of these patients may benefit from preventative treatment. The U.S. Food and Drug Administration (FDA) has approved four prescription drugs for migraine prevention. These include the beta-blockers propranolol (Inderal®) and timolol (Blocadren®), and the anticonvulsants topiramate (Topamax®) and divalproex sodium (Depakote®).

Anticonvulsants: Anticonvulsant medicines, normally used for seizures, have been used to prevent migraine headaches. Examples of anticonvulsants that have been used are valproic acid (Depakote®, Depakote ER®, Depakene®), phenobarbital, gabapentin (Neurontin®), and topiramate (Topamax®). Control of the cortical spreading depression (CSD), is thought to be the reason for anticonvulsant effectiveness in preventing migraine attacks. Side effects include fatigue (tiredness), nausea, vomiting, and trembling.

Beta-blockers: Beta-blockers are a class of drugs that safely slow the heart beat and decrease blood pressure. Beta-blockers have been used for many years to prevent migraine headaches. In migraine prevention, beta-blockers help dilate (open) blood vessels in the brain, which may prevent the vascular (blood vessel) symptoms associated with a migraine attack, including vasoconstriction (blood vessel narrowing) and vasodilation (blood vessel widening). Beta-blockers can also help reduce physical symptoms associated with migraine attacks, such as anxiety, heart palpitations, and shaking,

Beta-blockers used in migraine prevention include propranolol (Inderal®), atenolol (Tenormin®), metoprolol (Lopressor®, Toprol XL®), and nadolol (Corgard®). Beta-blockers generally are well tolerated in most individuals. They can aggravate breathing difficulties in patients with asthma, chronic bronchitis (inflammation of the bronchial tubes), or emphysema (loss of lung function). In patients who already have slow heart rates (bradycardia) and heart block (defects in electrical conduction within the heart), beta-blockers can cause dangerously slow heartbeats. Beta-blockers can aggravate symptoms of heart failure. Other side effects include drowsiness, diarrhea, constipation, fatigue (tiredness), insomnia, nausea, depression, dreaming, memory loss, and impotence (loss of sexual performance).

Calcium channel blockers (CCBs): CCBs are a class of drugs normally used for high blood pressure, angina (chest pain), and arrhythmias (abnormal heart rhythms). CCBs also appear to alter serotonin (a brain chemical). Serotonin imbalances are a causative factor in developing a migraine. CCBs used in preventing migraine headaches are diltiazem (Cardizem®, Dilacor®, Tiazac®), and verapamil (Calan®, Verelan®, Isoptin®).The most common side effects of CCBs are constipation, nausea, headache, rash, edema (swelling of the legs with fluid), low blood pressure, drowsiness, and dizziness. Drinking grapefruit juice or eating grapefruit may cause levels of CCBs to rise, potentially leading to life threatening arrhythmias (irregular heart beats). Healthcare professionals recommend that individuals taking CCBs not consume grapefruit juice.

Hormone replacement therapy (HRT): For women with hormonal imbalances that may be causing the migraines, hormone replacement therapy (HRT) may be used, including estrogen and progesterone. HRT, however, may cause side effects such as blood clots, an increased risk of developing some types of cancers, and heart disease. Menstruating women at risk for migraines may be placed on oral contraceptives for HRT. Pre-pubescent girls that are at risk for migraine attacks will not be treated with HRT, but with other methods such as beta-blockers and anticonvulsants.

Lifestyle: Lifestyle changes, including decreasing stress levels, increasing exercise levels, and controlling the diet, have a major impact on migraine prevention and development. Lifestyle factors that are important in the prevention of migraines include regular sleep patterns, regular exercise (level depends upon the individual), limiting stress, limiting caffeine consumption to less than two caffeine-containing beverages a day, avoiding bright or flashing lights, and wearing sunglasses if sunlight is a trigger. Identifying and avoiding foods that trigger headaches is important. Healthcare professionals recommend keeping a food journal, where the individual writes down everything they have for each meal of the day. Then review the diary with a healthcare professional. It is impractical to adopt a diet that avoids all known migraine triggers; however, it is reasonable to avoid foods that consistently trigger migraine headaches. Triggers vary from one individual to another.

Tricyclic antidepressants (TCAs): TCAs are thought to prevent migraine headaches by altering the balance of serotonin, a neurotransmitter in the brain. Low levels of serotonin are thought to be a causative agent in migraine attacks. Chronic stress and depression can cause elevated levels of the stress hormone cortisol, which is produced in the adrenal glands. Cortisol can in turn cause imbalances in serotonin, leading to a migraine attack. The tricyclic antidepressants that have been used in preventing migraine headaches include amitriptyline (Elavil®), nortriptyline (Pamelor®, Aventyl®), doxepin (Sinequan®), and imipramine (Tofranil®). Side effects include constipation, dry mouth, low blood pressure (hypotension), increased heart rate, (tachycardia), urinary retention, sexual dysfunction, and weight gain. TCAs may cause excessive sedation and fatigue (tiredness).

Others: Other drugs less commonly used for migraine prevention include anti-serotonin medications, including methysergide (Sansert®), which prevent migraine headaches by constricting (making smaller) blood vessels and reducing inflammation of the blood vessels. Cyproheptadine (Periactin®) is an antihistamine that increases serotonin activity and is used occasionally in migraine prevention. Low levels of serotonin are a cause of migraine attacks.

Acute (Immediate):

Over-the-counter (OTC) treatments: The U.S. Food and Drug Administration (FDA) has approved three over-the-counter (OTC) products to treat migraine attacks. Excedrin® Migraine (a combination of aspirin, acetaminophen, and caffeine) is indicated for migraine and its associated symptoms such as head pain. Advil® Migraine and Motrin® Migraine Pain (both are ibuprofen) have anti-inflammatory action and are approved to treat migraine headache and its pain.

Triptans: The triptans attach to serotonin receptors on the blood vessels and nerves and thereby reduce inflammation and constrict (narrow) the blood vessels. A reduction in inflammation decreases pressure on nerves in the trigeminal nerve system (nerves in the cranium or head), which decreases the pain signals to the brain and stops the headache. Traditionally, triptans, which are prescription medicines, were prescribed for moderate or severe migraines after over-the-counter (OTC) analgesics such as ibuprofen (Advil®) and other simple measures failed. Newer studies suggest that triptans can be used as the first treatment for patients with migraines that are causing disability. Significant disability is defined as more than ten days of at least 50% disability during a three month period.

Triptans should be used early after the migraine begins, before the onset of pain or when the pain is mild. Using a triptan early in an attack increases its effectiveness, reduces side effects, and decreases the chance of recurrence of another headache during the following 24 hours. Used early, triptans can be expected to abort more than 80% of migraine headaches within two hours. Triptans include sumatriptan (Imitrex®), almotriptan (Axert®), naratriptan (Amerge®), rizatriptan (Maxalt®), zolmitriptan (Zomig®), frovatriptan (Frova®), and eletriptan (Relpax®).

The most common side effects of triptans are facial flushing, tingling of the skin, and a sense of tightness around the chest and throat. Other less common side effects include drowsiness, fatigue (tiredness), and dizziness. These side effects are short-lived and are not considered serious. Triptans are not used in pregnant women and are not generally used in young children.

In patients with severe nausea, a combination of a triptan and an anti-nausea medication, such as prochlorperazine (Compazine®), may be used.

Ergots: Ergots, like triptans, are medications that abort migraine headaches. Examples of ergots include ergotamine preparations (Cafergot®) and dihydroergotamine preparations (Migranal®, DHE-45®). Ergots, like triptans, cause constriction (narrowing) of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and the produce more negative effects on the heart than the triptans. Therefore, the ergots are not as safe as the triptans. Ergots are used to help stop the vasodilation (blood vessel widening) associated with a migraine attack. The ergots also are more prone to cause nausea and vomiting than the triptans. The ergots can cause prolonged contraction of the uterus and miscarriages in pregnant women.

Midrin: Midrin is used to abort migraine and tension headaches. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative). The combination medication can help take care of three potential factors associated with a migraine attack, including vasodilation, pain, and anxiety. Midrin® is most effective if used early during a headache. However, because of its potent blood vessel constricting effect, it should not be used in patients with high blood pressure, kidney disease, glaucoma (increased pressure in the eyes), atherosclerosis (hardening of the arteries), liver disease, or in patients taking monoamine oxidase inhibitors (MAOIs) including phenelzine (Nardil®), isocarboxazid (Marplan®), and tranylcypromine sulfate (Parnate®).

Other prescription medications: Some attacks may not be eliminated by acute therapy, and the individual requires pain-relieving measures. Due to the severity of the headaches, some patients may require a narcotic analgesic, including oxycodone (Percocet®), codeine, or meperidine (Demerol®). If the individual is experiencing frequent migraine attacks, the habitual use of opiate analgesics should be avoided. Opiates can cause addiction (both physical and mental) and may also cause rebound headaches, which are headaches that occur when the pain medicine no longer provides relief.

Butorphanol (Stadol NS®) is an opiate-like drug available for injection and intranasal (in the nose) administration. The normal dosage of Stadol NS® is one spray into the nostril, which usually relieves migraine symptoms in 15-30 minutes. This drug can be used every hour for relief. The use of Stadol NS® may result in dependency if used regularly for pain relief. Side effects include nausea and vomiting, nasal irritation, and sedation.

Butalbital, a barbiturate medication, is also used for the immediate relief of migraine headache pain. It is used in various prescription combinations with aspirin, acetaminophen, caffeine, or codeine (an opiate pain medication). These medications are potentially addicting and are not used as initial treatment. They are sometimes used for patients whose headaches fail to respond to over-the-counter (OTC) medications but who are not candidates for triptans either due to pregnancy or the risk of heart attack and stroke. Products include butalbital and acetaminophen (Axocet®, Bupap®, Cephadyn®, Phrenilin®, or Sedapap®); butalbital, acetaminophen, and caffeine (Fioricet®, Esgic®); butalbital and aspirin (Axotal®); butalbital, aspirin, and caffeine (Fiorinal®); butalbital, acetaminophen, caffeine, and codeine (Fioricet #3 with Codeine® or Fioricet w/ Codeine®); and butalbital, aspirin, caffeine, and codeine (Fiorinal #3 with Codeine® or Fiorinal w/ Codeine®).

Converting atrial fibrillation to a normal rhythm

Converting AF to a normal rhythm can be accomplished with medications (chemical cardioversion) or by electrical shocks (electrical cardioversion). Doctors usually recommend that all patients with chronic sustained AF undergo at least one attempt at cardioversion, chemical or electrical. Successful cardioversion can alleviate symptoms, improve exercise tolerance, improve quality of life, and lower the risk of strokes. Doctors usually try medical cardioversion first, and, if medications fail, then try electrical cardioversion.
Patients who are more likely to attain and maintain a normal heart rhythm with either chemical or electrical cardioversion include:
Patients younger than 65 years of age
Patients who have had AF for a short time (less than 12 months)
Patients with normal-sized atria and ventricles
Patients who are having their first episode of AF
Cardioversion with medications. Before prescribing medications for cardioversion, the doctor usually controls the rate of ventricular contractions and thins the blood, usually with warfarin. 1) Available Medications. Medications used in cardioversion usually work by blocking the channels in the walls of cells through which ions travel (sodium channels, potassium channels, beta adrenergic channels, and calcium channels). Some examples of these medications include:
quinidine (Quinaglute)
procainamide (Procan SR)
disopyramide (Norpace)
flecainide (Tambocor)
sotalol (Betapace)
flecainide (Tambocor)
amiodarone (Cordarone) These medications are capable of converting AF to normal rhythm in about 50% of patients. They often are used long-term to maintain a normal rhythm and prevent recurrences of AF. 2) Disadvantages of using medications. Medications used for converting AF carry a small risk of causing other abnormal heart rhythms--they are said to be pro-arrhythmic--especially in patients with diseases of the heart muscle or coronary arteries. These abnormal heart rhythms can be more life-threatening than AF. Therefore, treatment with these medications often is initiated in the hospital while the patient's rhythm is continuously monitored for 24-72 hours. These medications may not be effective in the longer-term. Many patients eventually develop a recurrence of AF despite the medications. Medications used in treating atrial fibrillation often have important side effects. Many patients discontinue them because they cannot tolerate these side effects. For example, amiodarone is commonly used in treating AF because it is less pro-arrhythmic and has been shown to maintain a normal rhythm in up to 75% of patients. However, amiodarone frequently causes side effects and drug interactions. About 7 out of every 10 patients taking amiodarone experience some type of side effect, and between 1 in 5 and 1 in 20 experience side effects that are severe enough that the amiodarone must be stopped. Amiodarone can interact with other medications such as tricyclic antidepressants, e.g., amitriptyline (Elavil) or phenothiazine antipsychotics, e.g., chlorpromazine (Thorazine) and cause abnormal heart rhythms. Amiodarone interacts with warfarin and increases the risk of bleeding. This interaction with warfarin can occur as early as 4-6 days after the start of both drugs or can be delayed by a few weeks. Thus, doctors prescribing both warfarin and amiodarone will adjust the dose of warfarin to avoid excessive blood thinning. Amiodarone also can cause thyroid disturbances in the fetus when administered orally to the mother during pregnancy. Amiodarone also may affect thyroid function in adults. The most severe side effect of amiodarone is lung toxicity that potentially can be fatal. Because of this lung toxicity, patients should report any symptoms of cough, fever, or painful breathing to their doctors.
Electrical cardioversion. Electrical cardioversion is a procedure used by doctors to convert an abnormal heart rhythm (such as AF) to a normal rhythm (sinus rhythm). Electrical cardioversion requires the administration of an electrical shock over the chest. This electrical shock stops the abnormal electrical activity of the heart for a brief moment and allows the normal heart rhythm to take over. Although electrical cardioversion can be used to treat almost any abnormal fast heartbeat (such as atrial flutter and ventricular tachycardia), it is used most frequently to convert AF to a normal rhythm.
Warfarin usually is given for 3 to 4 weeks prior to cardioversion to minimize the risk of stroke that can occur during or shortly after cardioversion. Warfarin is continued for four to six weeks after successful cardioversion. For some patients requiring urgent electrical cardioversion, warfarin may not work fast enough to thin the blood. Therefore, these patients may be given heparin prior to electrical cardioversion. Heparin is a faster-acting blood thinner than warfarin, but it must be administered as a continuous intravenous infusion or as injections under the skin. After successful cardioversion, these patients can be switched from heparin to warfarin.
1) Method of cardioversion. Electrical cardioversions (urgent and elective) usually are performed in a hospital. For elective (non-urgent) electrical cardioversion, patients usually arrive at the hospital without eating in the morning. Necessary medications can be taken with small sips of water. Patients are given supplemental oxygen via nasal catheters, and an intravenous infusion of fluids is started. Electrodes (pads) are placed on the skin over the chest to continuously monitor the heart rhythm. Paddles then are placed over the chest and the upper back. Patients are sedated (anesthetized) intravenously with medications. This is followed by a strong electric shock through the paddles. The shock converts the AF to a normal rhythm. After cardioversion, patients are observed for several hours or overnight to make sure that their normal heart rhythm is stable.
2) Effectiveness of electrical cardioversion. Electrical cardioversion is more effective than medications alone in terminating AF and restoring a normal heart rhythm. Electrical cardioversion successfully restores a normal heart rhythm in over 95% of patients.
3) Limitations of electrical cardioversion. While electrical cardioversion is effective in converting AF to a normal heart rhythm, the normal rhythm may not continue for long. Approximately 75% of patients successfully treated with electrical cardioversion experience a recurrence of AF within 12-24 months. Older patients with enlarged atria and ventricles who have had AF for a long time are especially prone to recurrences. Thus, most patients who undergo successful cardioversion are placed on oral medications to prevent recurrences of AF.
4) Risks of electrical cardioversion. The risks of electrical cardioversion include stroke, heart attack, burns of the skin, and in rare instances, death.
5) Candidates for electrical cardioversion. Doctors usually recommend that all patients with chronic, sustained AF undergo at least one attempt at cardioversion. Cardioversion usually is attempted with medications first. If medications fail, electrical cardioversion can be considered. Sometimes a doctor may choose to use electrical cardioversion first if AF is of short duration (onset within 48 hours) and the transesophageal echocardiography shows no blood clots in the atria.
Electrical cardioversion is performed urgently (on an emergency basis) on patients with severe and potentially life-threatening symptoms caused by AF. For example, some patients with rapid AF can develop chest pain, shortness of breath, and dizziness or fainting. (Chest pain in these patients is due to an insufficient supply of blood to the heart muscles. Shortness of breath indicates ineffective pumping of blood by the ventricles. Fainting or dizziness usually is due to dangerously low blood pressure.)
Rate control therapy. Recent studies have shown that an acceptable alternative to cardioversion (chemical or electrical) is rate-control therapy. In rate-control therapy, the doctor will leave the patients in AF provided their rate of ventricular contractions is under good control, the output of blood from the heart is adequate, and their blood is adequately thinned by warfarin to prevent strokes. Heart rate in these patients can be controlled using medications such as beta-blockers, calcium channel blockers, or digoxin or AV node ablation with pacemaker implantation. Rate-control therapy is used to simplify therapy and avoid the side effects of anti-arrhythmic medications (medications used to treat and prevent AF).
Over long periods of observation, patients treated with rate-control therapy have similar survival and quality of life as compared to patients who undergo repeated electrical or chemical cardioversions.
Suitable candidates for rate-control therapy include:
Patients who have had AF for more than one year
Patients with significant disease of the heart valves
Patients with enlarged hearts as a result of heart failure or cardiomyopathy (heart muscle weakness)
Patients with significant or intolerable side effects with medications for AF

Converting atrial fibrillation to a normal rhythm

Converting AF to a normal rhythm can be accomplished with medications (chemical cardioversion) or by electrical shocks (electrical cardioversion). Doctors usually recommend that all patients with chronic sustained AF undergo at least one attempt at cardioversion, chemical or electrical. Successful cardioversion can alleviate symptoms, improve exercise tolerance, improve quality of life, and lower the risk of strokes. Doctors usually try medical cardioversion first, and, if medications fail, then try electrical cardioversion.
Patients who are more likely to attain and maintain a normal heart rhythm with either chemical or electrical cardioversion include:
Patients younger than 65 years of age
Patients who have had AF for a short time (less than 12 months)
Patients with normal-sized atria and ventricles
Patients who are having their first episode of AF
Cardioversion with medications. Before prescribing medications for cardioversion, the doctor usually controls the rate of ventricular contractions and thins the blood, usually with warfarin. 1) Available Medications. Medications used in cardioversion usually work by blocking the channels in the walls of cells through which ions travel (sodium channels, potassium channels, beta adrenergic channels, and calcium channels). Some examples of these medications include:
quinidine (Quinaglute)
procainamide (Procan SR)
disopyramide (Norpace)
flecainide (Tambocor)
sotalol (Betapace)
flecainide (Tambocor)
amiodarone (Cordarone) These medications are capable of converting AF to normal rhythm in about 50% of patients. They often are used long-term to maintain a normal rhythm and prevent recurrences of AF. 2) Disadvantages of using medications. Medications used for converting AF carry a small risk of causing other abnormal heart rhythms--they are said to be pro-arrhythmic--especially in patients with diseases of the heart muscle or coronary arteries. These abnormal heart rhythms can be more life-threatening than AF. Therefore, treatment with these medications often is initiated in the hospital while the patient's rhythm is continuously monitored for 24-72 hours. These medications may not be effective in the longer-term. Many patients eventually develop a recurrence of AF despite the medications. Medications used in treating atrial fibrillation often have important side effects. Many patients discontinue them because they cannot tolerate these side effects. For example, amiodarone is commonly used in treating AF because it is less pro-arrhythmic and has been shown to maintain a normal rhythm in up to 75% of patients. However, amiodarone frequently causes side effects and drug interactions. About 7 out of every 10 patients taking amiodarone experience some type of side effect, and between 1 in 5 and 1 in 20 experience side effects that are severe enough that the amiodarone must be stopped. Amiodarone can interact with other medications such as tricyclic antidepressants, e.g., amitriptyline (Elavil) or phenothiazine antipsychotics, e.g., chlorpromazine (Thorazine) and cause abnormal heart rhythms. Amiodarone interacts with warfarin and increases the risk of bleeding. This interaction with warfarin can occur as early as 4-6 days after the start of both drugs or can be delayed by a few weeks. Thus, doctors prescribing both warfarin and amiodarone will adjust the dose of warfarin to avoid excessive blood thinning. Amiodarone also can cause thyroid disturbances in the fetus when administered orally to the mother during pregnancy. Amiodarone also may affect thyroid function in adults. The most severe side effect of amiodarone is lung toxicity that potentially can be fatal. Because of this lung toxicity, patients should report any symptoms of cough, fever, or painful breathing to their doctors.
Electrical cardioversion. Electrical cardioversion is a procedure used by doctors to convert an abnormal heart rhythm (such as AF) to a normal rhythm (sinus rhythm). Electrical cardioversion requires the administration of an electrical shock over the chest. This electrical shock stops the abnormal electrical activity of the heart for a brief moment and allows the normal heart rhythm to take over. Although electrical cardioversion can be used to treat almost any abnormal fast heartbeat (such as atrial flutter and ventricular tachycardia), it is used most frequently to convert AF to a normal rhythm.
Warfarin usually is given for 3 to 4 weeks prior to cardioversion to minimize the risk of stroke that can occur during or shortly after cardioversion. Warfarin is continued for four to six weeks after successful cardioversion. For some patients requiring urgent electrical cardioversion, warfarin may not work fast enough to thin the blood. Therefore, these patients may be given heparin prior to electrical cardioversion. Heparin is a faster-acting blood thinner than warfarin, but it must be administered as a continuous intravenous infusion or as injections under the skin. After successful cardioversion, these patients can be switched from heparin to warfarin.
1) Method of cardioversion. Electrical cardioversions (urgent and elective) usually are performed in a hospital. For elective (non-urgent) electrical cardioversion, patients usually arrive at the hospital without eating in the morning. Necessary medications can be taken with small sips of water. Patients are given supplemental oxygen via nasal catheters, and an intravenous infusion of fluids is started. Electrodes (pads) are placed on the skin over the chest to continuously monitor the heart rhythm. Paddles then are placed over the chest and the upper back. Patients are sedated (anesthetized) intravenously with medications. This is followed by a strong electric shock through the paddles. The shock converts the AF to a normal rhythm. After cardioversion, patients are observed for several hours or overnight to make sure that their normal heart rhythm is stable.
2) Effectiveness of electrical cardioversion. Electrical cardioversion is more effective than medications alone in terminating AF and restoring a normal heart rhythm. Electrical cardioversion successfully restores a normal heart rhythm in over 95% of patients.
3) Limitations of electrical cardioversion. While electrical cardioversion is effective in converting AF to a normal heart rhythm, the normal rhythm may not continue for long. Approximately 75% of patients successfully treated with electrical cardioversion experience a recurrence of AF within 12-24 months. Older patients with enlarged atria and ventricles who have had AF for a long time are especially prone to recurrences. Thus, most patients who undergo successful cardioversion are placed on oral medications to prevent recurrences of AF.
4) Risks of electrical cardioversion. The risks of electrical cardioversion include stroke, heart attack, burns of the skin, and in rare instances, death.
5) Candidates for electrical cardioversion. Doctors usually recommend that all patients with chronic, sustained AF undergo at least one attempt at cardioversion. Cardioversion usually is attempted with medications first. If medications fail, electrical cardioversion can be considered. Sometimes a doctor may choose to use electrical cardioversion first if AF is of short duration (onset within 48 hours) and the transesophageal echocardiography shows no blood clots in the atria.
Electrical cardioversion is performed urgently (on an emergency basis) on patients with severe and potentially life-threatening symptoms caused by AF. For example, some patients with rapid AF can develop chest pain, shortness of breath, and dizziness or fainting. (Chest pain in these patients is due to an insufficient supply of blood to the heart muscles. Shortness of breath indicates ineffective pumping of blood by the ventricles. Fainting or dizziness usually is due to dangerously low blood pressure.)
Rate control therapy. Recent studies have shown that an acceptable alternative to cardioversion (chemical or electrical) is rate-control therapy. In rate-control therapy, the doctor will leave the patients in AF provided their rate of ventricular contractions is under good control, the output of blood from the heart is adequate, and their blood is adequately thinned by warfarin to prevent strokes. Heart rate in these patients can be controlled using medications such as beta-blockers, calcium channel blockers, or digoxin or AV node ablation with pacemaker implantation. Rate-control therapy is used to simplify therapy and avoid the side effects of anti-arrhythmic medications (medications used to treat and prevent AF).
Over long periods of observation, patients treated with rate-control therapy have similar survival and quality of life as compared to patients who undergo repeated electrical or chemical cardioversions.
Suitable candidates for rate-control therapy include:
Patients who have had AF for more than one year
Patients with significant disease of the heart valves
Patients with enlarged hearts as a result of heart failure or cardiomyopathy (heart muscle weakness)
Patients with significant or intolerable side effects with medications for AF

Converting atrial fibrillation to a normal rhythm

Converting AF to a normal rhythm can be accomplished with medications (chemical cardioversion) or by electrical shocks (electrical cardioversion). Doctors usually recommend that all patients with chronic sustained AF undergo at least one attempt at cardioversion, chemical or electrical. Successful cardioversion can alleviate symptoms, improve exercise tolerance, improve quality of life, and lower the risk of strokes. Doctors usually try medical cardioversion first, and, if medications fail, then try electrical cardioversion.
Patients who are more likely to attain and maintain a normal heart rhythm with either chemical or electrical cardioversion include:
Patients younger than 65 years of age
Patients who have had AF for a short time (less than 12 months)
Patients with normal-sized atria and ventricles
Patients who are having their first episode of AF
Cardioversion with medications. Before prescribing medications for cardioversion, the doctor usually controls the rate of ventricular contractions and thins the blood, usually with warfarin. 1) Available Medications. Medications used in cardioversion usually work by blocking the channels in the walls of cells through which ions travel (sodium channels, potassium channels, beta adrenergic channels, and calcium channels). Some examples of these medications include:
quinidine (Quinaglute)
procainamide (Procan SR)
disopyramide (Norpace)
flecainide (Tambocor)
sotalol (Betapace)
flecainide (Tambocor)
amiodarone (Cordarone) These medications are capable of converting AF to normal rhythm in about 50% of patients. They often are used long-term to maintain a normal rhythm and prevent recurrences of AF. 2) Disadvantages of using medications. Medications used for converting AF carry a small risk of causing other abnormal heart rhythms--they are said to be pro-arrhythmic--especially in patients with diseases of the heart muscle or coronary arteries. These abnormal heart rhythms can be more life-threatening than AF. Therefore, treatment with these medications often is initiated in the hospital while the patient's rhythm is continuously monitored for 24-72 hours. These medications may not be effective in the longer-term. Many patients eventually develop a recurrence of AF despite the medications. Medications used in treating atrial fibrillation often have important side effects. Many patients discontinue them because they cannot tolerate these side effects. For example, amiodarone is commonly used in treating AF because it is less pro-arrhythmic and has been shown to maintain a normal rhythm in up to 75% of patients. However, amiodarone frequently causes side effects and drug interactions. About 7 out of every 10 patients taking amiodarone experience some type of side effect, and between 1 in 5 and 1 in 20 experience side effects that are severe enough that the amiodarone must be stopped. Amiodarone can interact with other medications such as tricyclic antidepressants, e.g., amitriptyline (Elavil) or phenothiazine antipsychotics, e.g., chlorpromazine (Thorazine) and cause abnormal heart rhythms. Amiodarone interacts with warfarin and increases the risk of bleeding. This interaction with warfarin can occur as early as 4-6 days after the start of both drugs or can be delayed by a few weeks. Thus, doctors prescribing both warfarin and amiodarone will adjust the dose of warfarin to avoid excessive blood thinning. Amiodarone also can cause thyroid disturbances in the fetus when administered orally to the mother during pregnancy. Amiodarone also may affect thyroid function in adults. The most severe side effect of amiodarone is lung toxicity that potentially can be fatal. Because of this lung toxicity, patients should report any symptoms of cough, fever, or painful breathing to their doctors.
Electrical cardioversion. Electrical cardioversion is a procedure used by doctors to convert an abnormal heart rhythm (such as AF) to a normal rhythm (sinus rhythm). Electrical cardioversion requires the administration of an electrical shock over the chest. This electrical shock stops the abnormal electrical activity of the heart for a brief moment and allows the normal heart rhythm to take over. Although electrical cardioversion can be used to treat almost any abnormal fast heartbeat (such as atrial flutter and ventricular tachycardia), it is used most frequently to convert AF to a normal rhythm.
Warfarin usually is given for 3 to 4 weeks prior to cardioversion to minimize the risk of stroke that can occur during or shortly after cardioversion. Warfarin is continued for four to six weeks after successful cardioversion. For some patients requiring urgent electrical cardioversion, warfarin may not work fast enough to thin the blood. Therefore, these patients may be given heparin prior to electrical cardioversion. Heparin is a faster-acting blood thinner than warfarin, but it must be administered as a continuous intravenous infusion or as injections under the skin. After successful cardioversion, these patients can be switched from heparin to warfarin.
1) Method of cardioversion. Electrical cardioversions (urgent and elective) usually are performed in a hospital. For elective (non-urgent) electrical cardioversion, patients usually arrive at the hospital without eating in the morning. Necessary medications can be taken with small sips of water. Patients are given supplemental oxygen via nasal catheters, and an intravenous infusion of fluids is started. Electrodes (pads) are placed on the skin over the chest to continuously monitor the heart rhythm. Paddles then are placed over the chest and the upper back. Patients are sedated (anesthetized) intravenously with medications. This is followed by a strong electric shock through the paddles. The shock converts the AF to a normal rhythm. After cardioversion, patients are observed for several hours or overnight to make sure that their normal heart rhythm is stable.
2) Effectiveness of electrical cardioversion. Electrical cardioversion is more effective than medications alone in terminating AF and restoring a normal heart rhythm. Electrical cardioversion successfully restores a normal heart rhythm in over 95% of patients.
3) Limitations of electrical cardioversion. While electrical cardioversion is effective in converting AF to a normal heart rhythm, the normal rhythm may not continue for long. Approximately 75% of patients successfully treated with electrical cardioversion experience a recurrence of AF within 12-24 months. Older patients with enlarged atria and ventricles who have had AF for a long time are especially prone to recurrences. Thus, most patients who undergo successful cardioversion are placed on oral medications to prevent recurrences of AF.
4) Risks of electrical cardioversion. The risks of electrical cardioversion include stroke, heart attack, burns of the skin, and in rare instances, death.
5) Candidates for electrical cardioversion. Doctors usually recommend that all patients with chronic, sustained AF undergo at least one attempt at cardioversion. Cardioversion usually is attempted with medications first. If medications fail, electrical cardioversion can be considered. Sometimes a doctor may choose to use electrical cardioversion first if AF is of short duration (onset within 48 hours) and the transesophageal echocardiography shows no blood clots in the atria.
Electrical cardioversion is performed urgently (on an emergency basis) on patients with severe and potentially life-threatening symptoms caused by AF. For example, some patients with rapid AF can develop chest pain, shortness of breath, and dizziness or fainting. (Chest pain in these patients is due to an insufficient supply of blood to the heart muscles. Shortness of breath indicates ineffective pumping of blood by the ventricles. Fainting or dizziness usually is due to dangerously low blood pressure.)
Rate control therapy. Recent studies have shown that an acceptable alternative to cardioversion (chemical or electrical) is rate-control therapy. In rate-control therapy, the doctor will leave the patients in AF provided their rate of ventricular contractions is under good control, the output of blood from the heart is adequate, and their blood is adequately thinned by warfarin to prevent strokes. Heart rate in these patients can be controlled using medications such as beta-blockers, calcium channel blockers, or digoxin or AV node ablation with pacemaker implantation. Rate-control therapy is used to simplify therapy and avoid the side effects of anti-arrhythmic medications (medications used to treat and prevent AF).
Over long periods of observation, patients treated with rate-control therapy have similar survival and quality of life as compared to patients who undergo repeated electrical or chemical cardioversions.
Suitable candidates for rate-control therapy include:
Patients who have had AF for more than one year
Patients with significant disease of the heart valves
Patients with enlarged hearts as a result of heart failure or cardiomyopathy (heart muscle weakness)
Patients with significant or intolerable side effects with medications for AF