Stroke Prevention Anticoagulation And Left Atrial Appendage
How do we get our CHADS-VASC score?
Oussama Wazni, MD: You can use a calculator such as
gary h: If my ChadVas score were to indicate a stroke risk of say 3% in the next year, does that mean that I have a 30% chance of a stroke in the next decade?
Oussama Wazni, MD: Yes – that is correct.
netmouse: 1. For ChadVas 2, standard of care is an anticoagulant. Do you decide otherwise if no family history, low burden, time without afib , good life style?2. Some EPs no longer consider gender. Is female, 70, score of 2, a reasonable candidate to stop the drug? 3. I had 1 afib event with racing heart 2 years ago. ER tests had very low potassium , history shows it is always in mid-range. Is it possible low potassium caused afib? And/or dehydration from the hot summer and/or an 80 mg corticosteroid shot about a month before? 4. After my 1 event, a 2-week monitor a year ago showed no issues. I am female, age range 65 to 74. No family history or other concerns. I am getting different advice. My EP wants me to stay on anticoagulant as it is standard of care, no data for people like me. 2 EPs say option is to stop, monitor daily with Kardia. Your opinion is?
Oussama Wazni, MD: based on current guidelines you would need to be on a blood thinner. Consider taking a low risk anticoagulant such as eliquiz
Indygirl4: Is it safe to just live with Afib and only take blood thinners?
Melatonin Also Protects Against Heart Rhythm Disturbances
Melatonin is primarily known as a sleep hormone and a powerful antioxidant. According to a new study, melatonin may even improve the condition of rats that have heart rhythm disturbances with an increased risk of heart attack. Melatonins ability to improve the heart function is not related to its antioxidant function, however, and that surprised the scientists behind the study. The new study was presented at an annual meeting for the American Physiological Society in Orlando. Melatonin has several vital functions, but as we age our endogenous production decreases. Not only does this affect our quality of sleep, it also has a negative impact on the heart and the bodys cells.
Heart rhythm disturbances is treated with anti-arrhythmic medication. In earlier studies, melatonin has been shown to have anti-arrhythmic properties, which were believed to be linked to its antioxidant function and ability to neutralize free radicals. In the new study, the researchers looked at the mechanisms by which melatonin supplementation can reduce the risk of heart attacks in rats with arrhythmia. One group of rats was supplemented with 10 mg of melatonin daily for seven days , while the other group got placebo. The scientists measured the electric activity in the rats hearts before, during, and after they had contracted the heart ailment. Also, the scientists measured levels of oxidative stress, which is an imbalance between free radicals and antioxidants.
How Long Does Melatoninlast For Sleep
Disclaimer: This article is for informational purposes only and should not be taken as medical advice.
Weve all had restless nights. Whether tossing and turning is a nightly occurrence or this is the first time youre up counting sheep, youve likely heard of the popular sleep aid melatonin. But what is melatonin, and how long does melatonin last for sleep?
Melatonin is a naturally occurring hormone that can help promote sleepiness, so you fall asleep fast. Many people have turned to melatonin supplements, which are available over the counter, to help them catch some zzzs in a pinch.
Before using melatonin, its essential to understand the potential impacts it can have on your health. Keep reading to learn everything you need to know about using melatonin for sleep.
The Different Types Of Atrial Fibrillation
There are at least five types of AFib that are characterized based on their duration and underlying reasons.
- Paroxysmal fibrillation is when a persons heart returns to normal with or without intervention within a week after its start. Individuals with this type of AFib may experience episodes a few times each year or daily.
- Persistent AFib can be defined as an abnormal rhythm of the heart that lasts more than a week. This variant of atrial fibrillation does not return to normal without treatment.
- Long-standing AFib is a type of atrial fibrillation wherein the heart is continuously in an erratic rhythm, lasting more than twelve months.
- Permanent AFib happens when the disorder lasts indefinitely, with the patient and doctor deciding not to continue its treatment.
- Nonvalvular AFib is the form of AFib that is not caused by an issue with the heart valve.
How Much Should I Take
Because of its ability to promote sleep, melatonin should be taken before bedtime. Doctoroz.com recommends taking 0.3 to 1 milligram of melatonin an hour and a half before bedtime. The website warns that taking too much melatonin — more than 1 milligram — may have an adverse effect and end up disrupting your sleep cycle. Lack of sleep may in turn raise your blood pressure according to the American Heart Association.
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Melatonin In Clinical Trials For Patients With Coronary Heart Disease
Recently, a relevant experimental study found beneficial effects of melatonin in countering oxidative stress in IRI. Clinically, Nrf2, limited oxidative stress that occurred during and after coronary artery bypass grafting . Thirty volunteers undergoing CABG were randomized to receive 10 mg oral melatonin before sleeping at night for 1 month before surgery. In those randomized to melatonin, cellular damages resulting from CABG surgery via theNrf2 pathway were attenuated .
There are several clinical trials underway. The background for these clinical studies is that experimentally induced MI, as studied in rodents, influenced the synthesis, concentration, and receptor expression of endogenous melatonin., In response to experimental MI, melatonin synthesis in the pineal gland increased rapidly, suggesting an important role for endogenous melatonin in post-MI cardioprotection. The day/night pattern of changes in melatonin blood levels, may help to explain the timing of human infarcts. Hypothetically ROS generated during myocardial IRI could influence ischaemia-modified albumin levels as studied in in 27 patients with ST-segment elevation MI undergoing primary angioplasty. Circulating IMA was negatively correlated to melatonin in these patients.
How Does Melatonin Work
Melatonin is produced by the pineal gland of the brain, which transforms serotonin into melatonin when your internal clock sends it the right signal. High melatonin levels cause your blood pressure and body temperature to lower, putting you in the mood for sleep. Additionally, if your body senses that its nighttime and your eyes absorb less light, your body will know to switch from serotonin production to melatonin production.
This is one reason why turning down the lights and practicing proper sleep hygiene before bed is so important. If you keep the lights on, your body may have a harder time producing melatonin, meaning that youre not as prepared for sleep.
Melatonin And Mood Disorders
The biological melanin clock is especially important in the aetiology of seasonal affective disorder in which psychological depression, for which bright light is a very effective treatment. Forty winter depressives were treated for a week with bright light or dawn simulation . Dawn simulation was similarly effective to bright light in the treatment of winter depression. Patients with more severe depression tended to report greater improvement with bright light in such cases, this would outweigh the non-clinical advantages of dawn simulation.
In persons with SAD depressive symptoms in the evening, these are related to abnormal patterns of plasma melatonin which are too high at night. In a 22-day design, 22 patients suffering from a major depression with a seasonal pattern of SAD were given light treatment for 2 weeks on workdays. Therapy to advance the onset of blood melatonin rise improved sleep, alertness, and mood
Sleeplessness & High Blood Pressure
If you are experiencing occasional sleeplessness and have high blood pressure or are taking medication to help manage high blood pressure, you may be wondering which over-the-counter nighttime sleep aid options may be right for you. TYLENOL® PM and SIMPLY SLEEP® both contain the active ingredient diphenhydramine. Read more about diphenhydramine and high blood pressure below. to buy a TYLENOL® PM product.
Melatonin Dosage: How Much To Take
As previously mentioned, some melatonin brands might suggest a dose of 5 to 10 mg per night.
While this is the recommendation, most adults dont need more than 1 to 3 mg of melatonin per night. Its actually ideal to start with a dose of 0.3 mg. Children can also start with a low dose.
Of course, the right melatonin dosage for you may not be the right dose for another person. Finding the right amount is sometimes a matter of trial and error. But typically less is more. So rather than starting at a high dosage and working your way backwards, start low and work your way upwards.
Drugs Sunlight And Low Melatonin
In Dr. Reiters view, the top threats to adequate melatonin production are our level of exposure to bright lights after darkness, and our habit of sleeping only 56 hours a night. The aging process also has an impact , as does the use of drugs like beta blockers and tranquilizers . Together, these things suggest that its a good idea to supplement with melatonin as we get older.
The point about beta blockers is an interesting one given that theyre widely prescribed to lower blood pressure yet it would seem that their effect on melatonin production may actually cause an increase in blood pressure. Ive always considered beta blockers to be among the safest cardiovascular medications available, and an essential therapy for patients whove had a heart attack. But their impact on melatonin production is a wise reminder that even good drugs have side effects. Beta blockers can also cause nightmares and insomnia!
If youre taking a beta blocker for any reason, you need to take a melatonin supplement. Moreover, take your medication in the morning, not before bed as many doctors recommend, when it is most likely to interfere with your natural tendency to produce melatonin.
Melatonin And Cardiac Diseases
Melatonin induces multiple actions in various cardiac pathologies . In this paper, only relevant evidence in myocardial infarction, myocardial ischemia/reperfusion injury and heart failure is included .
Table 1. The effect of melatonin supplementation on cardiac diseases: animal studies.
Table 2. The effect of melatonin supplementation on cardiac diseases: human studies.
Melatonin supplementation protects the heart in several experimental models of myocardial infarction and myocardial I/R injuries . Tan and co-workers were first to demonstrate the beneficial effects of melatonin in isolated rat hearts subjected to cardiac I/R-induced arrhythmias: infusion of melatonin reduces premature ventricular contraction and ventricular fibrillation due to occlusion and reopening of the anterior descending coronary artery . This finding is also reported in other animal models of cardiac arrhythmias , confirming the therapeutic potential for melatonin in reducing the incidence of sudden cardiac death . Additional studies show that short-and long-term melatonin supplementation is cardioprotective in various in vivo and ex vivo myocardial models of I/R injury . In these studies, administration of melatonin before or after ischemia preserves the microstructure of the cardiomyocyte and reduced myocardial I/R injury as indicated by a reduction in myocardial infarct size .
Melatonin Supplements Are Hormone Therapy
Are you taking melatonin? Then you are using hormone therapy. Hormone therapy is a very complicated topic rife with detrimental health consequences when used carelessly. Often, hormone therapy is the easy answer to hormone imbalance and so the layperson, under the guidance of a practitioner or not, will reach for this answer. One common example of hormone therapy is progesterone cream. Melatonin is another.
The popularity of melatonin greatly worries me because hormone therapy should be approached with due caution, wisdom and knowledge. The practitioners whom I most respect use hormone therapy with the most extreme reservation, always preferring to use diet/lifestyle/supplement changes before using hormone therapy only when necessary as a last resort. Why? More often than not, including the case of melatonin, hormone therapy can do more harm than good.
This is the analogy I use when explaining the potential consequences of hormone therapy:
Most of the hormones in the body are governed by negative feedback, which works like your household thermostat. Say you set your thermostat to 72 degrees and the room temperature is 69 degrees. The heater kicks in to warm the room up. When the temperature reaches 72 degrees, the heat shuts off until the temperature drops again.
Administering hormones can actually shut off our bodys hormonal negative feedback loop. Its like heating a room by a space heater and the furnace shuts off because it isnt needed.
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Melatonin And For Early Cognitive Decline
Cognitive impairment inevitably increases with ageing. But when does age-related cognitive decline begin? In healthy educated adults even in their 20s and 30s, certain limited aspects of such decline had already started. Hypertension predisposes to early cognitive decline. The deterioration in mild cognitive declined could be countered by fast-release melatonin 39 mg given at bedtime for up to 3 years. Those treated with melatonin added to their prior medication, often donepezil, performed better in the Mini-Mental State Examination and in the Alzheimer’s disease Assessment Scale. Furthermore, depression scores decreased in melatonin-treated patients, while the quality of sleep and wakefulness also improved. But when does age-related cognitive decline begin? Controversially, the decline in healthy educated adults could start even when they were only in their 20s and 30s. When could melatonin be started to counter this age-related adverse effect? Sensitive testing with a complex video game , using a dataset of 3305 players, showed that age-related slowing began early and not late in life.
Melatonin And Lipid Metabolism
Early experiments showed that treatment with melatonin can improve dyslipidemia . In patients with nonalcoholic fatty liver disease, treatment with melatonin for 14 months significantly reduced levels of triglycerides and LDL cholesterol compared with controls treated with Essentiale . Treatment with melatonin for 2weeks significantly reduced free fatty acids compared with placebo in cigarette smokers . A study on aluminum-induced toxicity in a rat model found that melatonin protected against toxic dyslipidemia by alleviating the aluminum induced increase in total cholesterol, LDL-C, triglycerides, oxidized LDL and apolipoprotein B100 . In unpublished results, we have demonstrated that melatonin administration can improve lipid metabolism and reduce weight. Melatonin treatment reduced body weight, body fat, and waist circumference in obese patients with acanthosis nigricans. We also found that melatonin could decrease LDL and body weight in high-fat diet-induced nonalcoholic fatty liver disease mice. Dyslipidemia is an important risk factor of cardiovascular diseases , and melatonin’s beneficial effects on lipid metabolism may reduce the incidence of cardiovascular diseases.
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Melatonin Affects Cellular Receptors
Ventricular tachycardia and ventricular fibrillation are two types of dangerous, irregular electric activity in the heart that may cause a heart attack. It turned out the melatonin-treated rats had a lower rate of both types of arrhythmia . Also, a particular marker of antioxidant activity was elevated in the rats that got melatonin. However, no link was observed between the presence of oxidative stress and irregular electric activity in the heart.In a previous study, researchers observed that by blocking melatonin-specific receptors in the cells one can disable melatonins anti-arrhythmic effect. In other words, melatonin loses its effects in the cells if there are no receptors to which melatonin can attach. This fact combined with the recent rat study leads the scientists to believe that melatonin has a direct effect on cells, which is positive for the heart rhythm, and that the effect has nothing to do with melatonins role as an antioxidant.
Is Melatonin Safe For Dementia Patients With Afib
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Why Melatonin Is Bad For You
If its all natural, why is melatonin bad for you? my mom asked, when I expressed my concern with this supplement after learning that she takes it on-and-off for her insomnia. Boy, have I got a blog post for you! I replied.
In short, melatonin is a hormone that correlates with sleep cycles and plays beneficial roles in numerous physiological functions. But melatonin supplements are neither a safe, natural nor effective solution to insomnia.
What Are The Side Effects Of Melatonin
Since melatonin is a dietary supplement, its important to understand the potential side effects. The Food and Drug Administration doesnt regulate melatonin the same way they regulate prescriptions, which means that there arent any official guidelines for taking melatonin.
The most common melatonin side effects include:
- Abdominal pain
If youre thinking about using melatonin for sleep, talk to your doctor beforehand to make sure that melatonin is the right sleep aid for you.
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How Is Magnesium An Atrial Fibrillation Cause
Magnesium is an extremely well-researched mineral, and it is vital for the electrical activity in the body- especially for the heart and the brain. Every cell in the body and every single electrical pathway in the body is regulated by magnesium and when this electrical activity gets altered, you can have problems that range from simple irritability to atrial fibrillation to Sudden Death from Heart Failure. When you take a look at the Signs of Magnesium Deficiency, you will see that all of the symptoms have to do with the inability to relax- whether it is muscles, neurons or YOU that can’t relax.
What IS atrial fibrillation anyway? It is the inability of the atrial portion of the heart and its electrical activity to relax. The effects of the atria are somewhat like a Muscle Cramp or a ‘seizure’ of the heart. And muscle cramps and seizures are both related to magnesium deficiency as well!
There are many, many studies showing that the Causes of Muscle Cramps, spasms, tightness, seizures, Heart Palpitations etc. are improved or relieved entirely simply by the administration of magnesium. And atrial fibrillation is no different.