What Is Atrial Fibrillation?

This type of irregular heartbeat affects millions of Americans. Understanding the causes and symptoms of atrial fibrillation can help you manage the condition and prevent additional complications.

By Chris Iliades, MD

Medically reviewed by Lindsey Marcellin, MD, MPH

Atrial fibrillation is a condition that affects millions of Americans. This type of irregular heart rhythm, also known as an arrhythmia, is the most common serious irregular heartbeat, especially in people over 60.

Your heart's rhythm is normally controlled by a structure in the upper part of your heart called the sinoatrial node. This node sends an electrical signal to the rest of your heart that keeps your heart beating at about 60 to 100 beats a minute. This is known as your normal sinus rhythm.

In atrial fibrillation, the sinoatrial node does not direct the heartbeat. Rather, it causes heartbeats to start from many locations in upper chambers of the heart, or the atria. "These irregular heartbeats all over the atria cause the upper part of the heart to quiver like a bag of worms," says Danya L. Dinwoodey, MD, a cardiologist at the Lahey Clinic in Burlington, Mass.

The term atrial fibrillation refers to the quivering, or fibrillation, of the upper parts of the heart. It can cause your heart to beat very quickly and inefficiently, which can be dangerous.

Causes of Atrial Fibrillation

The cause of atrial fibrillation can vary from person to person, and sometimes it’s difficult to determine. In many cases, there is a combination of causes. "The most common causes are high blood pressure or an abnormal heart valve," explains Dr. Dinwoodey.

Other causes of atrial fibrillation include:

Coronary artery disease (the clogging of the arteries of the heart that may cause a heart attack)

Heart failure

Heart defects you are born with

Pericarditis (an infection of the lining of the sac that surrounds the heart)

An overactive thyroid gland

Risk Factors for Atrial Fibrillation

The biggest risk factor for atrial fibrillation is age. The condition occurs more often in people over 60, and the risk for developing it increases as you get older.

Other common risk factors include:

Obesity

Diabetes

Sleep apnea

Lung disease

Family history of atrial fibrillation

Heavy use of alcohol

Symptoms of Atrial Fibrillation

Not everyone who has atrial fibrillation experiences symptoms. “Some people are very aware of their symptoms and can tell right away when an episode of atrial fibrillation starts and stops," Dinwoodey says. “Other people may not notice any symptoms. For people who have symptoms, the most common ones are decreased tolerance for exercise and feeling a flutter in the chest.”

Other symptoms of atrial fibrillation may include:

Shortness of breath

Dizziness

Chest pain

Tiredness

There are two different types of atrial fibrillation, and the frequency of symptoms varies with each type. Paroxysmal atrial fibrillation begins suddenly and often stops on its own. Persistent atrial fibrillation lasts for more than a week, and while it may stop on its own, it frequently requires treatment. Both types may become permanent over time.

If you believe that you are at risk for atrial fibrillation or if you think you’ve experienced an irregular heartbeat, make an appointment to get evaluated by your doctor. Atrial fibrillation can lead to serious problems and additional complications over time. Fortunately, there are many types of treatment that can help keep this condition under control.

Phases of Alzheimer's Disease

Experts have found that most Alzheimer’s patients go through seven stages of disease progression. The duration and symptoms might vary, but the general decline of Alzheimer's remains the same.


1. No Impairment

Individuals at this stage show no marked decline in their cognitive function. No memory problems show up on a regular basis.

2. Very Mild Impairment

Forgetfulness begins. The patient begins to forget names and small details, like where they put their glasses or if they took their medication that morning.

3. Mild Decline

At this point, family and friends begin to notice the symptoms. Losing things is more common, and the patient might begin having performance issues at work.

4. Moderate Decline

The problems are now clear in medical interviews. The patient begins forgetting personal history, recent events, and how to handle complex tasks, such as planning dinner or paying bills. They could begin acting withdrawn or subdued in social situations.

5. Moderately Severe Decline

While the patient may remember their own name and the names of those important to them, they begin to forget basic information, such as the current date, time, or season. Day-to-day tasks like cooking may no longer be safe.

6. Severe Decline

Now, the patient needs more help with basic activities like dressing and using the toilet. They might also experience behavioral changes, such as feeling suspicious or experiencing hallucinations. Someone at this stage might engage in repetitive behaviors or wander away, only to become confused and lost.

7. Very Severe Decline

In this final stage, the patient may lose the ability to speak coherently. They may need help with general hygiene, and may eventually lose muscle coordination and the ability to control movement. Their muscles typically grow rigid, the reflexes become unpredictable, and eventually even swallowing could become impaired.


Caring for a loved one with Alzheimer’s can be exhausting and frustrating, but you don’t have to go it alone. There are many services that can help, such as adult day care and in-home care services.

Daily Health for You

What Makes Good Cholesterol Go Bad?

Researchers have discovered how specific proteins in the blood transform HDL cholesterol (the good kind) into LDL Cholesterol (the bad kind). Here's how it works, plus ways to amp up your good cholesterol levels through diet and exercise.

By Jaimie Dalessio, Senior Editor

High Cholesterol Management

THURSDAY, Feb. 23, 2012 — Blame it on a tiny, banana-shaped protein molecule called CETP, which stands for cholesteryl ester transfer protein.

Research from the U.S. Department of Energy (DOE)’s Lawrence Berkeley National Laboratory (Berkeley Lab) has revealed how CETP turns good cholesterol (high density lipoproteins, or HDL) into bad cholesterol (low density lipoproteins, LDL).

Lipoproteins are substances that carry cholesterol throughout the body. LDLs do so in a way that can clog arteries — blocking blood flow, and potentially causing heart disease or stroke. Hence the “bad” label. HDLs, on the other hand, carry cholesterol out of the bloodstream and into the liver, where it’s excreted. That way, it doesn’t build up in the arteries.

It turns out that CETP molecules transfer cholesterol from those good HDLs to bad LDLs via a tunnel that runs through its center.

The findings, published in the journal Nature Chemical Biology, could lead to more efficient ways of preventing the development of heart disease. “Our model identifies new interfaces of CETP that interact with HDL and LDL and delineates the mechanism by which the transfer of cholesterol takes place,” says Gang Ren, PhD, of Berkeley Lab’s Molecular Foundry, who led the study. “This is an important step toward the rational design of next generation CETP inhibitors for treating cardiovascular disease.”

In the meantime, here are some changes you can make today to help boost your HDL cholesterol levels.

Simple Ways to Improve Good Cholesterol

Follow the three F’s of food: Fatty fish, fiber, and fats (the healthy kind). Adding salmon or mackerel to your diet a few times a week can help raise your HDL levels. Soluble fiber found in fruits, vegetables, nuts, and grains can do the same. Finally, by switching to healthier fat such as that in olive, canola, and flaxseed oils, you eliminate saturated fat, which increases bad cholesterol and lowers good cholesterol.

Work out. It doesn’t take much. Hitting the gym or the pavement for just a half an hour on most days of the week is enough to get your heart pumping and improve your HDL cholesterol levels.

Limit your alcohol intake. While research has shown alcohol can raise your HDL levels, don’t get carried away with the “It’s good for me” mantra. It’s only beneficial if you consume it in moderation — only one drink a day for women and two for men.

Longer-term goals include quitting smoking (it can raise HDL cholesterol a few points) and losing weight, which should be easier to do if you’re already eating heart-healthy foods and exercising.

Signs That A Senior Is Becoming Dehydrated

Written By:  Susan K. Ross

There are three different types of dehydration that can occur and each has different signs and symptoms. There are different ways to treat each of these types of dehydration and they can sometimes occur together. When caring for the elderly, it is very important to look for these signs and symptoms. It becomes crucial when the elderly person suffers from a condition that:

• Makes it difficult for them to communicate
• Makes it difficult for them to obtain what they need on their own
• Makes it difficult for them to understand what is going on around them
• Puts them at risk for medical complications even without dehydration (i.e. diabetes, anorexia, renal failure, or other diseases)

The first type of dehydration, isotonic, occurs when there are equal amounts of water and sodium lost from the body. The most common reason for this type of dehydration is illness which results in prolonged vomiting or excessive diarrhea. Other causes include fasting, internal bleeding or use of suctioning (this occurs in patients who are already medically compromised. Individuals with isotonic dehydration may experience thirst, dizziness, weakness, a drop in blood pressure, a drop in body temperature, changes in the tongue, and rapid weight loss. There are not typically mental changes that occur with this type of dehydration. Most patients remain alert and oriented and are usually aware that they need hydration.

Hypernatremia, or hypertonic dehydration, is usually seen in both children and the elderly. It occurs when there is a greater loss of water than sodium. It is typically caused by a fever and the cause of the fever must be determined and addressed before adequate hydration can occur. Providing hydration can be a challenge because water begins to evaporate through the lungs and skin more quickly than hydration can be provided. While the most common cause is fever related to an illness, it can also be seen in patients who have cognitive problems and do not recognize the feeling of thirst, those who have problems swallowing because of a stroke or other illness, or those who are unable to care for themselves and cannot physically obtain water. The onset of dementia can be gradual in nature and caregivers may not realize that an individual is not drinking enough until they begin to exhibit signs or dehydration.

Hypotonic dehydration, or hyponatremia, results when the amount of sodium in the system is less than the amount of water. Symptoms can include muscle cramps, headaches, personality changes, nausea, vomiting, anorexia, impaired taste, and seizures. If left untreated, it can cause the person to lapse into a coma. Hyponatremia is often associated with renal failure, compulsive water drinking because of a psychiatric condition, or prolonged use of diuretics.

By knowing the risk factors for dehydration in the elderly, cases can be prevented. When signs and symptoms are spotted early, treatment can begin quickly. If you suspect that someone is suffering from dehydration, seek medical treatment as quickly as possible.

Osteoarthritis Pain Relief on the Go

If you need osteoarthritis pain relief, whether it's in your hip, knee, hand, or neck, try these exercises to ease what hurts. Changing positions and doing some light stretching can help.

By Madeline Vann, MPH

Medically reviewed by Lindsey Marcellin, MD, MPH

 

Finding osteoarthritis pain relief during your day is not that difficult: The key is not sitting or standing in one position for too long. Shifting positions and doing light stretching provides some osteoarthritis pain relief, whether your hips, hands, or neck trouble you.

 

People with arthritis have to be creative problem solvers. One question you should ask as you go through your day is, what can I change about my environment to get some osteoarthritis pain relief? For example, consider the grocery store, a place that everyone has to go several times a week and where you may, on occasion, be forced into long lines.

 

“A lot of stores have driving carts that people can use,” recommends Karen C. Smith, an occupational therapist and practice associate at the American Occupational Therapy Association in Bethesda, Md. If you prefer to be in motion or don’t trust your in-store driving abilities, here are some other ideas for osteoarthritis pain relief while you shop:

 

Use the cart for support. You can lean on the cart and, when standing, you can use one of the lower bars to put one foot up for a minute or so, and then the other. “Changing your weight from side to side takes some stress off your back,” says Smith.

Pick the right time of day. You may want to shop at times when the store is less crowded. If you don’t know when this is, talk to the store manager. Another option is to let store personnel know you have arthritis and ask for permission to use the quick checkout lanes.

Get help. Ask for help with products that are heavy, such as big bags of dog food, or are too high up for you to reach comfortably.

You can apply these kinds of tips to any environment in which you need osteoarthritis pain relief.

Osteoarthritis Pain Relief: Take Five

Whether on the job or on the go, staying in one position can increase your discomfort. When you are out and about, or even at work, you may be limited in how much movement you can get in your day.

“Any prolonged position is going to make you stiff. Take breaks and move around. Even wiggling can be of some assistance,” says Smith. “You need to lubricate those joints.”

Osteoarthritis Pain Relief: On Long Car or Plane Trips

If you are going on a long drive, take frequent breaks. Get out of the car and walk around a bit. Sitting on a heated seat pad can bring some osteoarthritis pain relief (try this as well if you put in long days at a desk job).

Learn seated exercises if you are going to be confined for a long time:

Stretch out your legs instead of sitting with them bent.

Lift straightened legs up one at a time as much as you can, using thigh muscles.

When your feet are flat on the floor, try lifting your toes, hold for about 10 seconds and then put them back down.

Gently twist your upper body from side to side to exercise the spine.

Osteoarthritis Pain Relief: In the Office

Stand up to exercise your hips: Pulling each knee up to your chest and rolling it around a bit will ease hip pain.

Try this simple stretch for osteoarthritis neck pain relief:

• Pull your chin down and back, as if to make a double chin.
• While your chin is tucked in, turn your head to look over your right shoulders and then your left.
• Again while your chin is tucked in and you are facing forward, lean your head over as if to touch one ear to the same-side shoulder.  Slowly come back to center and then lean the other way.  Note:  Each ear does not have to actually touch your shoulder.
• Learn finger and hand stretches or carry a soft ball that you can use to exercise your grip.

The goal of all these suggestions is to practice range-of-motion exercises.  "Any motion that your body can normally make is a motion that you should let it do," says Smith.  By including this strategy for some light stretching into your daily routine, you can stay active despite osteoarthritis.

Coping with Stress Incontinence

Episodes of urine leakage can affect your home and work life, but there are ways to overcome the challenges.

A sneeze. A cough. A laugh. Moving too quickly. Lifting too much weight. Any of these can trigger stress incontinence, causing a person to uncontrollably leak a small amount of urine.

And since these triggers are all things that occur regularly throughout life, people with stress incontinence can find it very difficult to maintain a normal work and social life. This is particularly true of women, for whom stress incontinence is the most common form of urinary incontinence.

Stress incontinence does not have to force you to withdraw from work, friends, and family, however. There are ways to protect yourself from urine leakage, and ways to communicate your problem to co-workers, friends, and loved ones.

Stress Incontinence and Work

Researchers have found that urinary incontinence can affect your work life, especially if you are suffering from severe incontinence. A recent study revealed that two out of every five women with incontinence had leaked urine on the job during the previous month. That same study revealed that women with severe incontinence said they had trouble concentrating, performing physical activities, maintaining their self-confidence, and completing tasks.

There are ways to avoid embarrassment from stress incontinence while on the job. They include:

• Using absorbent pads or undergarments to protect against leaking. Be sure the pads contain odor-controlling material.
• Limiting your physical activity to avoid placing stress on your bladder.
• Taking frequent bathroom breaks to keep your bladder empty.
• Strengthening your bladder control by performing Kegel exercises at home.

You must discuss your stress incontinence problem with your employer, particularly if it is severe. Otherwise, you might face criticism for poor concentration or taking too many breaks. And keep in mind that the Occupational Safety and Health Administration has ruled that employers cannot place unreasonable restrictions on employees’ use of toilet facilities, especially if the employee is suffering from a medical condition.

Stress Incontinence and Social Life

 

So much of life involves physical activity that can cause stress incontinence. At least half of women who exercise regularly are at risk for developing stress incontinence, and athletes in high-impact sports are more likely to report stress incontinence symptoms than those participating in low-impact sports.

Sports that can increase pressure on the bladder, and make stress incontinence more likely, include:

• Martial arts like judo or karate.
• Team sports like basketball or volleyball.
• Horseback riding.
• Body building with heavy weights.
• Track and field.

On the other hand, there are a number of sports that carry little risk of stress incontinence, including:

• Bicycling.
• Swimming.
• Rowing.
• Walking.
• Low-impact aerobics.
• Activities in which at least one foot is on the floor at all times.

Social activities that lead to stress on the bladder, like very active dancing, should be avoided unless you're wearing absorbent pads.  When attending a social event, you might want to limit your fluid intake and go to the bathroom just before leaving for the occasion.  Dark clothing also can help you mask any inadvertent leaking.  Finally, don't be afraid to talk about your problem with friends and loved ones.  They will accept what you tell them with understanding and good humor.

By Dennis Thompson Jr.  Medically reviewed by Pat F. Bass III, MD, MPH

Overcoming Caregiver Burnout

Written By : Mark Jordan

Home caregivers are under a great deal of stress, there is no denying. But, along with this it is the ultimate way to show your love. These two types of feelings converge to cause many problems. The daily schedule of care giving, especially for an elderly parent, can cause burnout pretty quickly. You may go from being a person who is concerned and motivated to one who is pessimistic and resentful. Farther down the road you may hit physical exhaustion from the extra work and stress. There is simply too much work and not enough help much of the time. Getting to the burnout stage may cause depression and anxiety. But your love for the person can also then cause guilt.

How Do You Identify The Symptoms Of Care Giver Burnout?

The burnout you may suffer can manifest itself in a variety of ways. It can creep up on you before you even realize what has happened. Do you have one or more of these symptoms?

1. Is your weight fluctuating more than normal? Perhaps you are using food to comfort yourself or withdrawing from food due to a lost appetite.

2. Are you more irritable and having trouble controlling it? This may spill over to the way you treat other family members.

3. Have you quit doing the things in life that used to make you happy such as hobbies or visiting people?

4. Are you experiencing extreme feelings of being overwhelmed with guilt? Sometimes this can even lead to wanting to hurt your self due to the powerful feelings of this stress.

5. How are you sleeping? You may have a change in your habits that you can't seem to break due to feelings of worry and stress. This can mean too little or too much sleep. It goes both ways.

6. Physical Exhaustion. Are you experiencing new pains in joints or your body? How about headaches? This can be from care giver burnout.

Why Does Care Giver Burnout And Guilt Occur?

The physical burnout you suffer may simply be because you have no time to take care of yourself. You may not only have the elderly person to take care of but you may have children and a spouse too, all demanding some time.

Think of the role reversal that may be taking place as well. You now find yourself taking care of a loved one who once was healthy, self-efficient and could communicate with you better. It is difficult to now see this person as something different. You may encounter an identity crisis as you are now the care giver of a parent or friend who once was your equal, or who may have taken care of you in the past.

Home care giving becomes so stressful at times and so burdensome that the extra burden on your time and money makes it unfathomable and difficult to manage. It sometimes seems like everything happens at once and there is little or no good and steady help.

As well the new demands on your physical and mental heath take its toll rather quickly. You may feel you aren't doing all that you can and so are hard on yourself. This is usually just the result of feeling overly responsible.

What Should You Do To Prevent Burnout?

First off you have to be realistic about your loved ones situation and condition. You need to realize from the beginning that you can't do it on your own. Talk to friends and family about the situation to see if they have ideas. They may have gone through already what you are going through.

Set some specific goals for yourself and set schedules in caring for your loved one. Make an effort to enlist the help of others if for no other reason than to get an hour of free time to take a breath or get some exercise. Put this time on a written schedule so you have a clear picture of this new life of yours. On this schedule you should also put things to do that you enjoy such as taking a bath, phoning a friend or catching up on a hobby.

Read and research all you can on your loved ones condition so you have the knowledge to make better decisions. You can only do so much and don't rule out institutional care, or a visiting nurse, if necessary. Seek backup care such as home health care agencies or adult day cares.

Make sure you take physical care of yourself. You will be under more physical stress than usual so this means you should get the necessary exercise, eat well and take vitamins if you can. Support groups for some comradeship are a big help. The last thing you want to feel is alone. Help may be just a question away or at the end of a short phone call.

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