We can slow an elevated heart rate through several methods. Beta blockers work by blocking receptors that normally accelerate the heart rate. Digoxin, derived from digitalis, slows the AV node to reduce the ventricular rate. Calcium channel blockers like verapamil and diltiazem slow conduction through the AV node. Amiodarone can be used intravenously for acute rate control. An interesting connection is that a persistently elevated heart rate over time can lead to tachycardia-induced cardiomyopathy, where the heart muscle becomes fatigued and dilated. However, slowing the heart rate through medications can reverse this condition and improve heart function.
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Thinning the blood reduces the risk of stroke in atrial fibrillation patients. Blood clots form through the coagulation of platelets and fibrin. Anticoagulant medications work by inhibiting parts of the coagulation cascade. Aspirin and clopidogrel inhibit platelets while warfarin, heparin and NOACs act on coagulation factors. The CHA2DS2-VASc and HAS-BLED scores help determine anticoagulation treatment based on stroke and bleeding risks. In the acute setting, heparin and clexane are used to thin blood. Long-term, warfarin and newer NOACs are options. NOACs are convenient as they don't require monitoring but have limitations in patients with kidney issues. Of interest, a left atrial appendage occlusion device can prevent clots forming in some patients who cannot take blood thinners.
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The use of blood thinners carries risks, such as an increased risk of bleeding, including hemorrhagic stroke and gastrointestinal bleeding. However, there are potential benefits in certain situations. For example, blood thinners can be beneficial for preventing clot formation during long-distance travel, reducing the risk of pulmonary embolism. Additionally, the increased propensity to bleed caused by blood thinners can sometimes lead to early detection of bowel cancer. Screening tests for blood in the stool can detect abnormalities related to bowel problems, including the early stages of cancer. It is advisable for individuals on blood thinners to consider undergoing regular fecal occult blood tests to monitor for gut abnormalities. Carrying a list of medications, especially for those on blood thinners, is important in case of emergencies, as it can provide crucial information to treating doctors and potentially save lives.
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