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Arrhythmias are irregular or abnormal heart beats, the most common of which is called atrial fibrillation. Arrhythmias are very common and are often a mere annoyance. However, they can also be responsible for life-threatening medical emergencies that result in cardiac arrest and sudden death. Dr. Saliba answers questions about atrial fibrillation and other abnormal beats.
Walid Saliba, MD Staff Cardiologist, and Director, Electrophysiology Lab, Tomsich Department of Cardiovascular Medicine Miller Family Heart & Vascular Institute
Cleveland_Clinic_Host: Thank you for joining us. Let's begin with the questions.
az1435t: had an ablation for afib/flutter 12 months ago; continue to have incidents ~4-6 weeks mostly when I exercise. These are not as long lasting usually less than 10 min because I know better what is happening. Drugs are not an option due to low BP...cardiologist is in a wait and see mode - is that the best approach?
Dr_Walid_Saliba: This is an acceptable approach however if you are bothered and having symptoms, considerations for repeat ablation is possible.
msiegel123546: I was recently hospitalized after passing out from a drop in blood pressure. While in the hospital I went into A-Fib. after iv medication I reverted back to sinus rhythm. I was told that I was dehydrated from a uti and was overmedicated with atenolol. Is it possible that this was a one time problem or is this going to be a long time problem? I was given a heart cath and everything was wide open, even where I had a stent put in 10 years ago.
Dr_Walid_Saliba: It is possible where this may be a one time occurrence however it is more likely that you will develop afib sometime down the road. Keep up your follow up appointments with your cardiologist.
jeanny: Does AFIB interfere with Carotid Artery Surgery?
Dr_Walid_Saliba: It should not - no
Susie818: I have pain in my back when I am in afib... right side, under my shoulder blade. Is this normal?
Dr_Walid_Saliba: no - that is not normal - this needs to be evaluated by your cardiologist.
Kara: IS THERE A PACER FOR ATRIAL FIB?
Dr_Walid_Saliba: No - there is not.
Gene: am a 78 year old male with reasonably good health. I have occasional episodes of atrial fibrillation. They usually last less than twelve hours and clear up on their own. This has been going on for a few years. Up until now I have been taking two 81 mg aspirin a day. I recently saw a cardiologist and he ran tests that were all ok. I monitor my blood pressure and pulse several times a day I fell I know any time that I am in afib. I do have a low heart rate generally in the low 50's. This has been caused in the past by caffeine and certain medications. I try to avoid anything that could cause afib. Would it be advisable for me to be on a blood thinner?
Dr_Walid_Saliba: In the absence of diabetes, heart disease, htn, prior history of stroke, age alone does not necessarily require that you be on blood thinner at this point in time. However, it is our recommendation in the absence of contraindication for blood thinning; to initiate such therapy in somebody like you.
harvey: are there any contra-indications or adverse medication reactions to taking stimulant medications related to ADD/ADHD patients, with atrial fibrillation?
Dr_Walid_Saliba: Stimulant medications can trigger extra beats and potentially atrial fib in patients who are susceptible to it. Should this occur, then this medication should be avoided.
Jimj13: Will a person have to take pills for the rest of his life.
Dr_Walid_Saliba: Potentially so.
nofun: My doctor has put me on 300 mg of Flecainide a day. He feels an ablation is not the answer for me since I had one about 7 years ago and it did not work. I still have irregular heart rhythms while on this drug. My concern is what are the long range problems using this drug.
Dr_Walid_Saliba: you can still have another ablation even if the first one did not work. Potential long term side effects of flecainide include visual problems, tremors among others.
Mooshka: I see that flecainide has long term usage side effects such as vision loss; does Sotalol have any negative consequences from prolonged use?
Dr_Walid_Saliba: Sotalol has the potential side effect of creating dangerous rhythm problems which your cardiologist should monitor for while you take it.
CynthiaB: About a year and a half ago I had an episode of diagnosed a-fib and tachycardia requiring trip to ER to correct. Cardiologist performed several tests; no heart disease was found; I have good BP. I continue to have infrequent episodes of AF (feels like it to me) lasting 1-4 hours then converting to normal sinus rhythm. Recently these events began to increase to about one every two weeks (yet, I had none in Dec or Jan) of varying degree of intensity. I have worn heart monitors a couple of times with no discernable AF results. My doctor states he does not know if this is what I am experiencing each time this occurs, and it occurs too infrequently to do anything about it. He prescribed 1/2 tablet of 10 mg Bystolic to take during event. (I cannot tolerate metroprolol). Doctor stated I must get an EKG when this occurs; however, events only occur when I am at rest quite late in the evening. (More to this story but space limitations here.) Are there any other ways to approach this, or should I stay my course?
Dr_Walid_Saliba: As long as you have infrequent episodes and you are not bothered by them - there is no reason to be aggressive about it. Nevertheless there are long term monitors that we can give you to try to determine the exact mechanisms of your tachycardia. The treatment thereafter will depend on the arrhythmia and the burden in terms of frequency and duration.
philjc: Is there a replacement for Coumadin that has less interaction with other meds?
Dr_Walid_Saliba: There is a new drug recently approved in the US - on the market called Pradaxa
traveler: I was diagnosed with A-Fib in Dec. 2008 and have taken Warfarin and Sotolol since that time. I would appreciate your thoughts on the new medication, Pradaxa, to replace the Warfarin and eliminate the monthly blood tests. Are there any "risky" side-effects with Pradaxa?
Dr_Walid_Saliba: Pradaxa is a new medication with side effects related to mostly bleeding similar to Coumadin. At this time changing from Coumadin to Pradaxa is a matter of convenience.
Cleveland_Clinic_Host: There are many questions about Pradaxa. Dr. Saliba, can you please talk about your thoughts on the medication?
Dr_Walid_Saliba: Pradaxa is an alternative to Coumadin. It is more expensive and does not require monitoring. Patients should consider Pradaxa if they are having problems achieving adequate INR or blood thinning with Coumadin or it is inconvenient for them to have frequent monitoring. Or - by personal preference.
tlg43: I had a single bypass and a maze procedure at CC to fix by continuous AF which was very bad. Could not sleep laying down the last couple of days before going to the ER. After 2 years I have had no problems at all. Feeling about 100%. I am 68 years old and was wondering what is your opinion about stop taking 5mg of warfarin a day?
Dr_Walid_Saliba: If you do not have any more atrial fibrillation and do not have diabetes - then it would not be unreasonable to switch from Coumadin to aspirin - talk to your doctor
philjc: Specifically can Ibuprofen be used for arthritis pain relief when on Paradaxa?
Dr_Walid_Saliba: Yes.
ronald: I have been in Atrial Fib from early Feb 2011 and have been on Warfarin Sodium since. Prior to this episode I had an episode of Atrial Fib approximately 16 months before. I was started on Sotalol HCL and went through a TEE and a conversion which lasted to this latest episode. The only other episode was approximately 17 years ago. Today I went through a TEE and conversion process. The TEE was no problem but the conversion did not work. What meaning should I get from this and what can I expect? I'm really down in the dumps to go through this without any results.
Dr_Walid_Saliba: If the cardioversion was not able to restore normal rhythm then there are certain tricks such as moving the pads to restore a normal rhythm. If on the other hand, you had early recurrence of afib early or soon after cardioversion then the treatment should involve either a change in anti arrhythmic medication or possibility of catheter ablation.
Dancefast: I went to two different heart doctors. One doctor told me to do nothing at all about it and just stay on aspirin, which I have been on for many years. I have been taking aspirin for 40 years. My dad told me it was good for my health. The doctor said this may go away, but if it does not, when I hit 75 years of age I will have to be put on another blood thinner. The other doctor wanted to give me an electrical cardioversion. I read about this cardioversion and it was not all that good. Its success rate is less than 50%. What do I do? When I check my pulse, I do feel that it is off sometimes. But that's no big deal. I do not have any of the symptoms like skipped heartbeats, thud, racing, or erratic heartbeat. I have nothing that is scary at all. My blood pressure is always very good and my pulse is always 68 to 95. Ninety-five is after working out. So, what do I do? Jack
Dr_Walid_Saliba: Since this is the first episode of afib a trial of restoring normal rhythm with cardioversion is not unreasonable. This would require taking blood thinning medication. You should talk to your cardiologist about this.
JBD: How long can you be in fib before going to hospital and electro conversion?
Dr_Walid_Saliba: If you are not on a blood thinning medication then it is advisable to go to the hospital within the first 48 hours. If you are on blood thinning meds and do not have symptoms, then you can potentially wait to your convenience. If you are having symptoms - then you should go to the hospital
jjsjjs_1: I have had AFib for over 20 years. Last July I had a Maze procedure as part of my mitral valve repair by Dr Gillinov. I still have the AFib. Would cardioversion be appropriate? Any other suggestions?
Dr_Walid_Saliba: A cardioversion would be appropriate at this point of time as the maze surgery has matured by now.
truquest: I am 77 and have irregular h b below 50 and over 130 no symptoms also a fib was diagnosed. multaq took care of the higher end but increased 6the lower heart rates. is cardioversion a good option?
Dr_Walid_Saliba: Yes - cardioversion to restore normal rhythm is a good initial option.
Dr_Walid_Saliba: Try cardioversion somewhere else or try medications in conjunction with cardioversion - or consider ablation.
Beaner7: Is Cardiac Cryoblation safer than Radiofrequency ablation for PAF with accompanying dysrythmias?
Dr_Walid_Saliba: The risk profile of cryoablation is pretty much equal to radiofrequency of ablation - it depends on the operator and center where these modalities are used.
Beaner7: Is it better to have more probable hot spots ablated than beginning with just ablation around the pulmonary veins? Wouldn't that approach put the patient at higher chance of having a repeat ablation for other problem areas?
Dr_Walid_Saliba: The approach to afib ablation is variable and depends on the center where this is performed. To be able to ablate the hot spots the patient would need to go into afib repeatedly during the procedure to map it. Since this is not usually the case, ablation around the pulmonary veins has been shown to work in 75 - 85% of the patients.
jane: I had an Amplatzer Occluder implanted for an ASD five years ago. Recently I have gone into constant a-fib. I am on 400mg of amiodarone and 480 mg of diltiazen daily. I have been on both for the 5 years, but doses were increased about 3 weeks ago. They are now talking ablation. I'm frightened about doing this with the occluder and can only find one case on the internet. Where do I go from here? Jane
Dr_Walid_Saliba: We have performed several ablations in patients for atrial fibrillation with an amplatzer occluder device. We usually determine at the time of the procedure with echo if there is an area around the device that allows access to the left atrium. This has not been a problem so far
ctgirl: My husband had a heart ablation and the doctor said it was only 75% success rate. He is also on atenolol 50 mg twice a day and when needed. He still has afib, what else does he need to do?
Dr_Walid_Saliba: He can try anti-arrhythmic medications or a repeat ablation.
jonS: This is for the Afib chat: How do patients that are scheduled for an ablation handle the anxiety? I am actually excited about the possibility of being free of afib but am concerned that I will have a hard time with anxiety prior to the procedure - my blood pressure goes way up just because of normal doctor visits let alone a procedure like this.
Dr_Walid_Saliba: Your doctor can help you by prescribing low dose anti-anxiety pills for a few days before the procedure - this will not impact the procedure.
Beaner7: Is it true that even after a successful ablation all problematic areas, that the heart tissue will be creative and establish new pathways that can cause a recurrence of AFib in the future? If so - how many months or years does that take to develop?
Dr_Walid_Saliba: Recurrence of afib usually results from recovery of function of the areas that were targeted for ablation. Usually this occurs in the first 1 - 3 months after the procedure.
ctgirl: My husband has had a heart oblation, but he still has a lot of a-fib, what can I do for him when this happens?
Dr_Walid_Saliba: If he symptomatic and bothered by it, then a trial of antiarrhythmic medication or redo ablation should be considered.
jsilks: When I look for ablation success rates they tend to focus on 6 months or a year after the procedure. I would like to know what the data shows at 2, 5, 10, etc years. Would you please touch on success rates over extended periods?
Dr_Walid_Saliba: The success rate on the average at 1 year is around 70% (25 - 90%). Thereafter, beyond the first year, an initially successful ablation patient has a 2 - 3 % recurrence rate per year. Probably due to pr0gression of underlying disease.
donald: How successful is ablation for periodic AFIB?
Dr_Walid_Saliba: The success rate at one year is 75 - 85%.
brody: If I am failing the meds Betapace, should I have ablation and is it dangerous.
Dr_Walid_Saliba: You can either have an ablation or try another medication. The ablation carries a risk of 2 - 3 % complication rate.
jsilks: I watched a Cleveland Clinic video in which they showed an ablation procedure being performed while the heart was exposed. In that procedure they used what appeared to be a collar array to wrap around the target area. The collar was then energized and the ablation was complete. How is this task completed in the non-surgical method? Is there a similar collar with an outside diameter array or is the procedure performed more like a welder using a single tip to complete a weld on a pipe?
Dr_Walid_Saliba: The second example - it is used by a catheter applying radiofrequency energy with the help of computerized navigation and mapping tools.
jsilks: Can PVCs and afib be treated in one ablation procedure?
Dr_Walid_Saliba: Yes however this increases the duration of the procedure and the patient needs to have frequent pvcs to allow mapping and ablation.
dana: What is the typical recuperation time after an ablation, to where one could return to gym and long walks?
Dr_Walid_Saliba: 2 - 3days
soccerchic: I am a health 45 yr old female with no underlying heart condition or abnormality. I've had one incident of afib (I was able to feel it) that lasted 72 hrs, until 24 hrs on propafanone (150 mg). Cardiologist switched me from warfarin to full strength aspirin. Can I expect to see another occurrence of the afib? At my age how many occurrences would warrant ablation?
Dr_Walid_Saliba: It is highly probable that you will have reoccurrence. But it is difficult to know the time frame at this point. Ablation is indicated if occurrences increase to the point where it is not satisfactory with your quality of life.
jsilks: I am on meds, which seem to help but not completely. I have started the process to come to Cleveland Clinic. Is there a waiting period for an ablation?
Dr_Walid_Saliba: There is a waiting period but we can accommodate patients in cancellation spots - we also monitor and assist you with symptom management until your ablation procedure.
Svetlana: I have recently heard about treatment for AF - Cryo Maze, promising the complete recovery for 95% of people underwent this surgery. Please tell its advantages before Ablation? Thank you
Dr_Walid_Saliba: First of all - it is surgical whereas ablation is percutaneous. It does not carry any specific advantages as far as success rate. 95% may be over inflated.
smartini: I understand from a previous chat that the metabolites of alcohol can trigger atrial fibrillation. Is it possible that metabolites from exercise or other daily activity can trigger afib/flutter? Is any research being done in this area? If so, please explain how it might benefit afib patients.
Dr_Walid_Saliba: It is not totally understand what are the triggers of afib. But in some patients (and not others) alcohol and or exercise can be a trigger. Nevertheless, exercise is recommended as it improves the overall cardiovascular status of the patient. Research is underway to better understand the triggers of the many aspects of atrial fibrillation.
John: I experienced afib as an outcome of heart valve repair surgery at Cleveland Clinic in January 2007. It was identified while in recovery step down and then stabilized before discharge. As a consequence, I was prescribed amiodarone for a limited time upon discharge. I stopped taking it after about 1-2 months per my local cardiologist. I've had numerous follow ups during the first year and annually since with my local cardiologist. My understanding is in this case, I should not have a reoccurrence of atrial fibrillation and that it was not an uncommon outcome of surgery on a temporary basis. To the best of my knowledge, I have not had any episodes of afib since stopping amiodarone. That said, I did not know I went into afib in the hospital initially. I was told that I was in afib. The question is: is it correct that I shouldn't go back into afib just due to what happened from the surgery??
Dr_Walid_Saliba: Occurrence of afib after valve surgery is around 40%. This does not increase the risk of future atrial fibrillation down the road. Now that you have stopped the amiodarone you will need to have regular follow up with your physician to know if you go into atrial fib. One is not concerned in your situation with the symptoms since you are not having any - but rather the assoc risk of stroke that comes with afib and which you would need to be on blood thinning medications for.
n39wc: Can heart burn cause Afib or is it more probable that Afib will cause the heart burn feeling? If heart burn could cause Afib what can we do to identify this as the cause? I will get your answer from the transcript, thank you
Dr_Walid_Saliba: Infrequently, gastrointestinal symptoms such as reflux, heart burn, full stomach may trigger atrial fib. Treatment of these triggers may decrease the occurrence of afib but it is also possible for afib to cause a feeling of heart burn.
Diamond: I have had 2 episodes of aFib. One in Oct, the other in Jan. All tests came back fine. Not on any med but do have a "pill in the pocket" in the event I have another episode. Seems strange to me. Mr. Internal Med. Dr. said say off caffeine. Cardiologist has not given such instruction. Can caffeine cause A fib
Dr_Walid_Saliba: Caffeine can trigger atrial fibrillation in some patients. Stay off caffeine would be recommended.
Kara: CAN ATRIAL FIB BE CAUSED BY AN ELECTROLYTE IMBALANCE?
Dr_Walid_Saliba: Triggers of afib can be facilitated by low magnesium or low potassium
Janee: I have had one known case of AF. I have a CHADS Score of 1 (high blood pressure which is treated with medication and is now normal). However, I also have sleep apnea which is not being treated because I cannot use a CPAP. What is the relationship of sleep apnea and AF?
Dr_Walid_Saliba: There is a relationship between the two conditions. The treatment of one may alleviate but usually does not cure the other.
jsilks: As luck would have it I have gone into afib during this chat, which brings up a question: Why is it that my afib seems to be on some type of cycle? I go through periods when my afib happens quite frequently (once a day for about 30 minutes) and other times when I would swear that I am free from it forever. why is that?
Dr_Walid_Saliba: That is the nature of the disease - if it bothers you - consider treatment, medication or ablation. We would be happy to see you at Cleveland Clinic.
wattsms: I was diagnosed with bradycardia in December and a pacemaker was implanted. A catheterization found no problems in the arteries. In early January atrial fib developed and I was hospitalized, given sotalol. The Afib continued to increase. Now out of the hospital, Multaq was tried along with Pradaxa. My system reacted very negatively to one or all of these drugs. And the afib continued to increase. At one point I was at 70%. I was sent to another doctor to get and ablation. Instead he took me off the medication and sent me to a sleep doctor. My afib decreased to %16 in four weeks. After two sleep studies, it has been determined that I have central sleep apnea. Is it possible that treating the sleep apnea will "cure" the afib? How much afib could a heart tolerate without special treatment?
Dr_Walid_Saliba: Treatment of sleep apnea may decrease the atrial fibrillation. The treatment for atrial fib is primarily dependent on symptoms and burden of the afib in terms of frequency and duration.
scottie: In paroxysmal AF, are there any common triggers and is it generally more common at night (mine is) ? Can bradycardia or low BP trigger an episode? Does body position act as a trigger? Any particular ways of avoiding it?
Dr_Walid_Saliba: Some forms of afib are more common at night and occur during sleep. You tend to feel them more if you are sleeping on the left side - the treatment is the same - ie. medications and/or ablation.
traveler: If I have trouble in a high altitude (mountains) is their a danger since I have A-Fib? I was told to avoid high altitudes. Also could A-Fib be triggered by any allergies (food or air-borne)?
Dr_Walid_Saliba: Afib could be triggered by altitude as well as by allergies. But - this shows that you have a predisposition for atrial fib from other potential triggers.
Bruce: I have bradycardia symptoms are there any less invasive treatment options than a pacemaker, and if not are there different types of pacemakers? Thank you
Dr_Walid_Saliba: IF you have bradycardia associated with symptoms then the treatment is pacemaker. There are different types of pacemaker in terms of number of leads or wires and different companies. Your doctor should be choosing the suitable one depending on your suitable condition.
baltimorejay: Regarding "benign" PVCs in someone with a structurally normal heart - Do you think that there will be more effective treatments for this specific condition in the coming years? If so do you think it will be more drug-based, improvements in ablation, or something different.? Many of us suffer with this condition, to the tune of, at times, hundreds or thousands of PVCs a day. The medical community says they are not life-threatening, but constantly dealing with them and the fear that they will worsen at any time, can in itself be life-threatening.
Dr_Walid_Saliba: For the time being the treatment is an attempt at drug therapy but ablation offers a cure. You should consider an ablation if you are having symptoms; if the pvcs affect your heart function; or if the pvcs are very frequent with complex morphology. Ablation of pvcs is commonly performed with a high success rate.
dana: What are the criteria to have an ablation performed? If you're in sinus rhythm sometimes and afib others, does this make the ablation more difficult and, if so, does it affect the success rate?
Dr_Walid_Saliba: An ablation should be performed if you are having symptoms related to afib. The affect that you go in and out of afib does not make the procedure more difficult and in fact, has a better success rate.
Nubianspirit: I never had palpitations or PVC's until after the birth of my last child. Can menopause trigger them and if so can they eventually stop on their own or is this how my heart will beat for the rest of my life.
Dr_Walid_Saliba: It is possible for the frequency of pvcs to wax and wane after the next few years. Aggressive treatment with medications or ablation should be considered if significant symptoms exist.
ushiggsme_1: I have been diagnosed as experiencing PVCs on a regular basis (which I can feel). I also sometimes feel as if my heart is about to beat out of my chest. How are PVCs and Afib related? Does one lead to the other? I have had repair for coarctation of aorta twice and now concerned about stroke risk.
Dr_Walid_Saliba: They are not necessarily related.
songcanary: At rest, I have occasional rapid heartbeats that are relieved by coughing. What is this called? I have had several recent echocardiograms and one heart MRI that have all been read as normal. Thank you.
Dr_Walid_Saliba: The mechanism of the rapid heart beats need to be evaluated using a monitor such as a holter or event recorder. depending on the nature of your palpitations, your treatment would be directed accordingly. It would be interesting to know why you had the echo and heart MRI. Sometimes abnormal heart diseases have purely electrical causes and not necessarily associated with abnormal structural disease.
stevemc: I just returned from the hospital 3 days ago from having the worst cardiac event that I have had thus far. My heart stopped for 5 seconds, then one very strong beat then multiple faster beats. BP 170/110 for over an hour. They did CAT scan, ultra-sound and nuclear stress test and all is OK. Blood work and multiple EKG's Ok. I was sent home with a script for Paxil. The doctor believes that my neck fusion problems and TOS in my left arm is causing my problems, then anxiety is causing the elevated PB and irregular beats. Is this possible and your recommendation for Anxiety meds. for this problem. I would rather not take Paxil.
Dr_Walid_Saliba: Anxiety can cause palpitations. The specific treatment of these palpitations depends on their nature and frequency which is determined by heart mentoring
Nubianspirit: I developed palpitations right after an emergency C-section 12 years ago. I have had EKG's and Holter's but I'm told not to worry. How can I not. They scare me. Can they become a problem since I have had them for 12 years now?
Dr_Walid_Saliba: it depends on the nature and mechanism of these palpitations and what the monitors show during these episodes. Most are benign but some require aggressive treatment predominantly for symptom relief.
Ajax: I have attempted to wear a long term heart monitor but was extremely allergic to the nickel in the conductive gel. Are there any alternatives available? At the time, last year, I was told there was not. I was only able to tolerate the monitor for six days.
Dr_Walid_Saliba: there are hypoallergenic electrodes that can be used that are commonly used in pediatric patients.
CHAUMONT: I had submitted a question. I have three moldy prolapsed heart valves. My Doctor says not to worry about them. Did this have a bearing on my SVT? Also, how difficult is it to pin point the electrical malfunction during the ablation procedure?
Dr_Walid_Saliba: there are some forms of svt associated with valve prolapse.
Diamond: I have had 2 episodes but converted back after med. from ER. Had Stress EKG and Echo. No Holter Monitor - should this be done?
Dr_Walid_Saliba: Yes - it would be recommended to do a holter monitor.
stevemc: when is it time to go to the hospital? How High BPM, BP, Pain
Dr_Walid_Saliba: it depends on the symptoms, how much symptoms you are having at the time of the episode.
CHAUMONT: I had a stress test and went into SVT. I am on cardizem180mg. It seems to manage the problem, but sometimes feel a "flutter". My cardiologist said that I would need the ablation if meds do not work. Could he not increase the dose? I have heard some awful stories about the 3 hour ablation procedure. and am hesitant to have it done.
Dr_Walid_Saliba: Yes - the medication can be increased but this carries with it potential side effects such as decrease in blood pressure and dizziness. An increase in dose may not control the symptoms. If not satisfied by medical therapy an ablation for SVT is easily performed with a high success rate. You heard awful stories about the ablation but you may want to hear about the wonderful stories of other patients who have had success.
CHAUMONT: Is shortness of breath a problem after the ablation procedure for SVT?
Dr_Walid_Saliba: It needs to be evaluated because some specific conditions need to be ruled out - see your cardiologist
Calculus: When is an ICD recommended and what are different settings used for?
Dr_Walid_Saliba: ICD is recommended when your risk of having dangerous arrhythmias is identified. This is usually the case if you have significant weakness in the pumping function of your heart or any genetic diseases with sudden death in the family.
efpat: I have a question about meds post CRT-D implant. I am lucky to be a hyper-responder. Two post implant echos showed almost complete reverse remodeling including improved EF from 25 to 50+. My pre-implant QRS duration was 175. Has there been any discussion of attempting to reduce or eliminate medication in patients with my results? I am on carvidelol, Atacand and spironolactone.
Dr_Walid_Saliba: This should be done through your heart failure specialist with careful follow up of heart function and symptoms.
autumn: Is it safe for a person with ARVD and an ICD to go skydiving? Autumn
Dr_Walid_Saliba: It is not recommended to go high impact sports because of the potential occurrence of ventricular arrhythmias.
JBD: Any restrictions on exercise if you have atrial fib?
Dr_Walid_Saliba: The restrictions on exercise is dictated by how controlled your heart rate is during afib. We recommend that you take medications to control the heart rate during exercise as atrial fibrillation usually increases your heart rate out of proportion to the activity.
catu96: If you have PVC's and you are exercising (HR above 100) and a PVC happens. How is that different from Ventricular tachycardia?
Dr_Walid_Saliba: The pvcs are isolated single beats. VT is a series of pvcs occurring fast together.
catu96: I am new to all this. I failed a cardiolite stress test. Impression was "demonstrated repeated runs of multifocal ventricular tachycardia, lasting anywhere from 3-5 beats at peak exercise" I had a catheterizaton the next day; the cardiologist stated my heart was structurally sound. No blockage. . I was then taken off my diuretic for High blood pressure and continued on linsinopril 40mg. They added atenolol 25mg. After seeing my GP DR. he informed me I had cardiomyopathy (which my cardiologist states I do Not have). I was so stressed from this. Later in the week I went to the hospital where I was admitted with Atrial Fib. I was taken off all meds by my cardiologist and placed on Sotalol 2x daily at 80mg each. Plus baby aspirin 1x daily. Could the AFib be a result of stress? Should I be more concerned about the VT that was reported or Afib? Is this medicine the best approach?
Dr_Walid_Saliba: We would need to look at those rhythm strips as well as the echocardiogram to determine if indeed you have cardiomyopathy. You need to be seen by an electrophysiologist.
lahmeh: I have been diagnosed with atrial tachycardia, mitral regurgitation and arrhythmia. I'm a 37 year old female. My cardiologist put me on nadolol and sent me on my way. This medication does control my heart from racing but I'm wondering if it's more serious and maybe I should have more testing and get a second opinion. What are your thoughts? Thank you.
Dr_Walid_Saliba: You should get a second opinion regarding the severity of regurgitation. The arrhythmia that you are describing is not life threatening and symptomatic treatment is advised.
This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians.
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15 Ways to Be Happy When You Feel Unhappy
Sometimes when you feel unhappy it can seem like the feeling will never go away. You may feel trapped in negative thoughts and it can be hard to imagine life any other way. You may also get down on yourself for feeling sad, like something is wrong with you.
But feeling down doesn't mean that there is something wrong with you or that you are weak, unlovable or broken. It just means you have some feelings right now that are difficult or overwhelming for you. It's normal for you to have periods of feeling sad and periods of feeling happy. Everyone goes through ups and downs with their feelings and it doesn't mean you are defective. The following are some helpful tips and thing to remember when you have sad feelings. Reminding yourself of these things can help you keep perspective on your feelings and hopefully lift you out of the negative thoughts.
- Know that your emotions are not permanent. For most of us, emotions can be like a rollercoaster - they go up and they go down. Sometimes they are smooth and straight, and sometimes they twist and turn. Rarely do they ever stay in the same position for long. It is normal to be sad sometimes and to be happy others. It's all a normal part of life.
- Spend time with friends – social connection is one of the strongest ways to get out of a funk. Being alone can cause you to get stuck in your negative emotions. Isolation can lead to more distress. Engaging in the world around you with friends can help you feel connected and loved.
- Do things you enjoy. By spending time doing something you enjoy, it can help you feel more fulfilled and help you feel that you have more purpose in your life. Feeling fulfilled and connecting with your purpose can help reduce negative thoughts.
- Try to figure out what your emotional triggers are. Do you know what sets you off when feel down? It can be helpful to notice when you are set off on the emotional rollercoaster. Try to notice who were you with, what were you doing, what were you thinking? Paying attention to these things can help you avoid some of those situations in the future. If you can minimize your exposure to the things that trigger negative feelings for you, you may feel better.
- Avoid drugs and alcohol – sad or negative feelings can be amplified by drugs or alcohol and make a situation seem worse than it actually is.
- Avoid caffeine – caffeine can increase nervousness and make you feel more jittery or anxious. It can also make it harder for you to sleep, which can make negative feelings worse. Keep in mind that caffeine isn't only in coffee, it's also in a number of soft drinks.
- Practice gratitude -appreciate the things that you do have. When you are feeling down it can be hard to see the beauty or joy in things, but these are just the moments when you need that joy and beauty the most. Here are more tips on how to be grateful.
- When you are feeling sad, think about someone who cares about you and what they would say to you to help you feel better. Maybe it was a teacher you had in grade school, or maybe it's a family relative – imagine them being compassionate and encouraging towards you when you are feeling down. What would they say to help you feel better? Now that you've thought of it, tell it to yourself.
- Learn to manage your negative thoughts. You can do this in a number of different ways. The next numbers 10 - 13 are some suggestions on how to manage your negative thoughts.
- Notice when a negative thought comes up. Don't judge it or judge yourself for having the thought, just notice that it's there. As quickly as it arises, think that it can float away. Think of your thoughts as coming as going, just like the clouds in the sky. You can't hold onto a cloud or grab it. If you do, it will just evaporate. Clouds float away, just like your thoughts. Your thoughts are ever changing, like the clouds in the sky.
- See if it helps to replace a negative thought with the opposite thought. For example, if you think "I will never find a job and will always be unhappy" replace it with the thought "I will find a job and find happiness". Keep doing this over and over when the negative thought comes up.
- Stop yourself from thinking in extremes – such as "I should" or "I must". This type of extreme thinking is unrealistic and impossible to live up to. It sets up an unrealistic expectation that you cannot live up to and can be a set up for failure. More on thinking in extremes here.
- Stop thinking "it's all my fault". Challenge yourself and challenge that thought when it comes up. You can challenge it by asking yourself, "Is it really my fault? Was this situation totally within my control?" If it was within your control, then think what you can do differently next time. If it wasn't within your control, give yourself a break! Remember that it's okay, and that everyone makes mistakes. Life isn't about the mistakes we make. Life is s all about how we recover from those mistakes and that is what really defines us.
- Life is not perfect. Understand that we all make mistakes, it is normal. That's why there are erasers on pencils, for our mistakes! No one is perfect. Get that? No one. Don't try to be perfect because it's impossible.
- Forgive yourself and give yourself permission to not be perfect. You can learn how to do things differently from situations that didn't work out. Instead of beating yourself up in your mind, just tell yourself that it's normal to make mistakes and that it's okay.
Everyone goes through feeling up and feeling down. Usually these feelings can last from a couple of hours to a few days. If you notice that you are feeling down for more than just a few days, you may want to talk to a mental health professional and seek out some help. It is often necessary to try many different things before you can find a way to feel better. Know that there is hope and feelings do change. It is possible to reduce the negative thoughts you are having, and you can change the way you think. Also, there are people who are willing to listen to you and help you. You are not alone, and often times change is possible.
Written by Victoria Marano, LCSW
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Remarks by Mrs. Celina Cossa
On The Occasion of the Award Ceremony of the Africa Prize For Leadership for the Sustainable End of Hunger
New York, October 3, 1998
Mr. Chairperson, Excellencies, Ladies and Gentlemen,
One day the true history of mankind will be written, and it will be a history of struggle and sacrifice, of war and peace, of failure and success.
It will be a history of the efforts and sweat of anonymous men and women associated with organizations such as the General Union of Cooperatives of Maputo.
It will be a history of the efforts and support of anonymous men and women associated with numerous non governmental organizations such as The Hunger Project.
It will be a history of men and women from different countries and continents that together have grabbed the moment and built a better world than the one in which they were living.
Mr. Chairperson, Excellencies, Ladies and Gentlemen,
We grew up with the indignity of the colonial system in which everything: land, education, knowledge, means of production, was owned by the settlers. We grew up in a society in which social, racial, religious and gender discrimination was the dominant regime.
It is against all these odds that we struggled. And our form of struggle was through production. Since we did not command technology, we committed ourselves to training and literacy. By producing, we learned. By learning, we produced more and we produced better. And so we freed ourselves from the complexes of the past.
We engaged the struggle through the most vulnerable sector of the society - women and children that comprise the majority of the population. It is for the emancipation and dignity of women and for the secure future of our children that we develop our work in the General Union of Cooperatives of Maputo.
Whereas a woman's technical capacity grows through training and literacy, it is through production that she recognizes her role in the transformation of society. She is no more a passive component but a participatory component of the community, opening the way to social stability based on mutual respect and personal achievement, human dignity and self reliance.
Gender issues have always been a high priority in our organization, so we have involved ourselves in the problems of women, of maternity, of the health and education of children, the value of the family and the cohesion of the social group. Thus the mother can participate with greater dedication and security in productive activities.
For the next generation, besides the stability of family life created by mothers, it is the access to our schools, from kindergarten to the secondary and intermediate technical levels, and some even to university level that insure that our movement will continue.
Economical and social sustainability is based on principles and tools that have been evolving through a process of continuous systematic evaluation of results and discussions with the members of the associated cooperatives.
We are not dealing with a finished model of rural intervention, nor does it seem to be replicable. Our own perception continues to evolve and today we are quite far from our starting point.
We will carry on working together and will continue to do everything possible to improve ourselves and view the future with serenity and optimism. This is the challenge that we the cooperative members face, in order that future generations do not recall in us an image of poverty, of disease, of hunger, an image that for so long represented our continent, but that we wish only to be a souvenir of the past.
Mr. Chairperson, Excellencies, Ladies and Gentlemen,
It is with great emotion that I am present at this ceremony. I am only able to be here today because of the enormous effort and participation of thousands of women, who have allowed us to reach the stage in which we find ourselves presently.
Allow me to refer here to the Government of my country that has always supported us, thus participating in the accomplishments we have attained so far.
I consider that the prize awarded to me is in fact a prize to the General Union of Cooperatives of Maputo, to all the women members, and to the people of Mozambique.
Above all, this Prize and this ceremony demand that we continue on the path in which we are engaged, certain that we are not alone, that we will continue to enjoy the support of all our friends and of the Government of Mozambique. We will not deceive you.
Thank you The Hunger Project.


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List Price: $25.95Publisher: TextstreamBinding: Cloth Text Pages: 222Size: 6.50" wide x 9.25" long x 1.00" tall Weight: 1.100Language: English
"Any book that weaves together allusions to both Julian of Norwich and Biddy Early is worth checking out! Add in a dash of mystery, Celtic romance, and wry Irish humor, and the result is this engaging novel from Lillian Lewis,All Shall Be Well." —Carl McColman, author ofThe Big Book of Christian Mysticismand366 CeltMorgan Kenny is many things, but she is definitely not a psychic. As she flies across the ocean to Ireland to bury her eccentric Aunt Mary, she has no idea that her last link to the old world is about to lead her straight into an intriguing Irish murder mystery. Even so, as Morgan's plane settles into its cruising altitude, she is overcome with a feeling that her Aunt Mary is attempting to contact her with an important message. After Morgan deplanes, she receives a telegram that informs her that her aunt has already been buried. Perplexed by the strange unfolding of events, Morgan silently wonders who has taken care of the final details, since she is the last remaining relative in the family. As she begins a fruitless search to find her aunt's burial site and the family's ancestral home, Morgan is flooded with memories and voices of the dead who tell her she needs to mine old ways in order to claim her inheritance. Morgan must break the cipher, but not without the help of a teenager, a fourteenth-century English saint, and a handsome archeologist. In this compelling tale rich with history and culture, an American woman embarks on an Irish adventure in which she will learn more about her ancestors and herself than she ever could have imagined.
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The records were requested under public records laws by news organizations over two years ago, when Palin was running for Vice President.
Alaska preparing to release 24,000 pages of Palin emails.
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For More Information
Center for International Education at (585) 389-2371
Nazareth College's Center for International Education proudly hosts 20 student leaders from Angola, Liberia, Mozambique, Sierra Leone, and Sudan from June 26 – July 28, 2011 as part of the 2011 Study of the U.S. Institute for Pluralism, a program that allows international students to immerse themselves in the political, economic, and cultural aspects of American society. Nazareth is one of only a few colleges and universities nationwide hosting summer institutes sponsored by the Academy for Education Development in Washington, D.C. and funded by a grant from the U.S. Department of State's Bureau of Education and Cultural Affairs. The bureau seeks to increase mutual understanding between the United States and other countries through a range of academic and professional exchanges.
The students were selected through a careful screening process by the Department of State. While at Nazareth, they will study U.S. culture, politics, business, and the process of service learning. Students in the Study of the U.S. Institute for Pluralism are among 30,000 individuals who participate in these programs each year. From classroom lectures on race relations to field trips to Niagara Falls, the program strives to help participants develop their own insights about this country.
"It creates new leadership, especially in countries not as friendly with the United States – which are not hard to find," explains George Eisen, executive director of Nazareth's Center for International Education and associate vice president for academic affairs. "It's cultural immersion, not just an academic immersion. We feel that's the best way to provide the full American experience."
Founded in 1924, Nazareth College is a coeducational college with undergraduate and graduate studies in the liberal arts and sciences and professional programs in health and human services, education, and management. The College is located on 150 scenic acres near Rochester, New York, and currently enrolls approximately 2,000 undergraduate and 1,000 graduate students. Nazareth has a strong commitment to experience-based learning and civic engagement. In the past decade, Nazareth has produced 18 Fulbright recipients and two Pickering Foreign Affairs Fellowships.
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View more: International, Global Experience, CIE


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ComicsDC is for information and events relating to cartoons and comics (including comic books, comic strips, political cartoons, animation and caricature) in Washington, DC and its environs (including counties such as Arlington, Alexandria, Fairfax, Prince George's, and Montgomery.) Press releases including store events are welcomed - email email@example.com.
Saturday, March 28, 2009
Hagen exhibit
I went last night and met David and his family including his wife and inlaws who were all from England and fun to talk with. The exhibit is in 2 rooms of a real-estate firm, but that works surprisingly well. There's a variety of works including paintings of robots, odd animals and baseball players from a 1966 card set as well as some prints. I bought a cartoony portrait of S*p*rm*n. Go check it out!
1 comment:
- David Hagen said...
It was great seeing you, Mike!
Thanks to you and all the others who came and made it a "super" night!
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- News
- Weather
- Sports
- Community
- Features
- Programming
- Station Info
- Featured on 4
Sunday, December 30, 2012 - 5:32pm
EL PASO — Police were looking for a couple involved in a shooting outside a central El Paso bar.
A man was shot several times in the parking lot of the Dollhouse Bar on Trowbridge and East Paisano the morning of November 4.
The shooter was seen leaving with a woman in a red 4-door car.
The pair was Hispanic. Both have tattoo sleeves on both arms.
If you recognize the couple or have any information about the shooting, call Crime Stoppers at 566-TIPS.


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NWRPCA Conferences: Gather, Learn, ConnectThe cornerstones of NWRPCA's educational offerings are our three annual conferences: the Fall and Spring Primary Care conferences, and the Western Migrant Stream Forum.
Each conference brings together experts and learners (the categories are by no means mutually exclusive) to share knowledge and resources and to energize each other in the quest for continual growth and improvement in all aspects of the CMHC world.
In each conference section, you will find information on the upcoming event as well as materials and highlights from the previous event.
Do you have ideas for future conferences? We want to hear from you: please email comments and suggestions to Eva McGinnis, Education and Training Manager, emcginnis at nwrpca.org.


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Kalib is a smart and handsome teen who enjoys playing sports, cooking and spending time with family. This easygoing young man who gets along well with other kids also enjoys playing outside, playing video games, going on outings and rebuilding electronics. Kalib can fix almost anything if given the proper time and tools as he works well with his hands and likes to tinker. He hopes to become an engineer or pilot when he grows up. Kalib really wants a permanent family. This adoptive family will need to support his need for ongoing therapy and tutoring.
For more information on Kalib, or on adoption, click here for a link to www.wednesdayschildga.com or call 1-877-210-KIDS (5437).
WTTG FOX 5 & myfoxdc5151 Wisconsin Ave. NWWashington, DC 20016Main Number: (202) 244-5151Newsroom: (202) firstname.lastname@example.com


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