Archive | March 2015


Approximately four percent of the U.S. population has either intermittent or permanent Afib. In people over the age of 60, the incidence rises to about nine percent.

AFib is caused by abnormal electrical impulses in the atria, which are the upper chambers of the heart. The result is a rapid and irregular pumping of blood through the atria. These chambers fibrillate, or quiver, rapidly.


Part 3 Engine of the heart-AFIB and RVR

After reviewing the anatomy and physiology of the human heart and seeing how it functions with the lungs, and blood for carrying oxygen and dispensing carbon dioxide from other areas of the human body to ending spot the lungs in exhaling, now lets learn how cardiac disease effects the heart to function in doing this process.  Today lets talk about atrial fibrillation and Rapid Ventricular Rate/Response.

Some people in the US have this cardiac condition called Atrial Fibrillation where some with this condition even experience Rapid Ventricular Rate or Response with it.

Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body.

During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart causing your pulse to be irregular. We know now how the blood flows through the heart but due to the irregularity of the atriums which is not allowing the chambers to fill up to the maximal level they normally did when they didn’t have Atrial Fibrillation is decreasing the cardiac output (blood volume) from the left ventricle to be decreased.   This means the heart and all other tissuesaren’t getting the regular amount of oxygen they got when they were in a regular normal rhythm.  Atrial fibrillation symptoms often include heart palpitations, shortness of breath and weakness.  Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications. Some people refer to AF as a quivering heart.  What happens here is primarily the ventricles take over.   With the atriums quivering and the ventricles going at their rate this causes an irregular heart rate HR.  Another problem with an irregular heart rate is this allows blood to pool in the heart putting the patient at risk for clot formation.  As this HR gets more irregular it puts the patient at a higher risk of allowing the clot to break off inside the heart now flowing freely in the blood stream.  If it reaches the lungs and stays there a pulmonary thrombus can occur causing breathing difficulties; if it bypasses the lungs the next place it goes to is the brain putting the person at risk for a stroke and if it reaches back to the heart the patient can have a heart attack.  This why you commonly see patients with atrial fibrillation on the med Coumadin or some form of anticoagulant drug to prevent clots from occurring.

An estimated 2.7 million Americans are living with Afib.

Episodes of atrial fibrillation can come and go, or you may develop atrial fibrillation that doesn’t go away and may require treatment. Although atrial fibrillation itself usually isn’t life-threatening, it is a serious medical condition that sometimes requires emergency treatment. It can lead to complications. Atrial fibrillation may lead to blood clots forming in the heart that may circulate to other organs and lead to blocked blood flow (ischemia) to even stroke/heart attack to pulmonary thrombus as stated earlier.

Treatments for atrial fibrillation may include medications like anticoagulants primarily=usually Coumadin,  antiplatelets= aspirin (platelets are responsible for clotting in our bloodstream) with and other interventions to try to alter the heart’s electrical system such as cardioversion-shocking the heart at low level voltage, more common in newly diagnosed afib. in hope to knock the afib into a regular rhythm called normal sinus rhythm (the best rhythm to be in).

Various studies have reported that electrical cardioversion is over 90 percent effective in converting to a normal sinus rhythm though many people revert back into afib shortly thereafter. Success has been shown to be enhanced when patients are on an antiarrhythmic drug beforehand, which helps prevent reverting back to atrial fibrillation.

Success depends on the size of the left atrium as well as how long the patient has been in afib. Patients with a very large left atrium, one greater than 5 cm, or who have been in constant afib for a year or two, may find that electrical cardioversion is not effective in converting to or maintaining a normal sinus rhythm.

Following a successful electrical cardioversion, the goal is to maintain a normal sinus rhythm, which only happens with about 20–30 percent of patients within the first year if they are not on antiarrhythmic drugs for rhythm control. Overall, the likelihood is quite high that you will revert back into atrial fibrillation, regardless of whether you stay on rhythm control drugs.

When the ventricles beat too rapidly they don’t fill completely with blood from the atria. As a result, they cannot efficiently pump blood out to meet the needs of the body. This can ultimately lead to heart failure in time if not treated.  Just like us running from NY to California most will end up not being able to do it just like the heart can’t run in atrial fibrillation in a high heart rate for a long time,  it also will give out going into failure.  The heart can only compensate in atrial fibrillation in a rapid high heart rate for so long.

A cardiac condition called Rapid Ventricular Rate or Response which is seen sometimes with Atrial Fibrillation which is the heart is overloaded.  Our heart beats lub dub which is first the atriums opening and closing (lub) and than the ventricles opening and closing (dub).  When the heart gets overworked and tries to compensate the atriums can give up and just allow the ventricles to take over to beat which affects the heart and all other tissues to get proper amount of blood with oxygen in time.  Since you loose the atriums (the upper chambers of the heart) and they don’t fill up with the amount of blood volume like they use to.  You loose a lot of blood volume(RBC’s); what the heart pumps out in the left ventricle to our tissues with oxygen get’s decreased in what we call your cardiac output=the volume of oxygenated blood pumped out of the left ventricle.  Well with atrial fibrillation this gets compensated.  In time if this is not repaired the blood goes backwards in how the heart pumps the blood.  It is regurgitating blood back in the heart back in the pulmonary vein back to the lungs putting fluid in the lungs even going further back into the Rt side of the heart and the superior vena cava and even further depending how long this hasn’t been treated.  Heart failure is set up, if not already.

Heart failure as a result of Atrial Fibrillation with RVR is most common in those who already have another type of heart disease like CAD (Coronary Heart Disease, CHF, etc…).

RVR can cause chest pains and make conditions like congestive heart failure worse.   RVR is simply having a high heart rate with the ventricles only pumping.  The HR can be like 140 or 160.  You need to get to an ER to be treated immediately.  This is where you would be started on a IV drip like Cardizem to bring the HR down to get you in controlled atrial fibrillation or some type of medication in bringing the HR down.  HR meaning the heart rate.

There are 2 types of atrial fibrillations controlled and uncontrolled.  If you are seen every 6 months or sooner with atrial fibrillation keeping your pulse under 100, which is controlled atrial fibrillation that is effective in treating it.

If you are with a pulse over 100 your in Uncontrolled Atrial Fibrillation and need your cardiologist to evaluate what needs to be done to bring the pulse under 100 so that it is less stressful for your heart to beat.  Than would be ideal under 100 as opposed to over 100.  It your over 100 higher odds you could go into RVR or just another rhythm more complicated than atrial fibrillation.  The more stressed out your heart is in doing its function the higher the odds your heart will go into problems.  So keep the pulse under 100 if you have afib and if not get checked out by your cardiologist or any doctor now not 2 mths or 2 weeks from now.

Always check with your doctor when you question anything medical about your self but at any time if you feel chest pain, chest discomfort, headache, palpatations, dizziness, shortness of breath or difficulty breathing call your doctor and be resting in hopes that the symptoms decrease to disappear.

If you have chronic atrial fibrillation you can live a completely normal life only with keeping the pulse under 100 and following up with your cardiologist as he/she orders.



“Blood is the fluid of life, transporting oxygen from the lungs to body tissue and carbon dioxide from body tissue to the lungs. Blood is the fluid of growth.”

The Franklin Institute

Part 2 The heart is the engine of the human body.

Lets review the anatomy of the heart, our bodies oxygen is the food to our tissues in keeping them alive through our red blood cells (RBC’s) that carry the O2 to the tissues through a heart and lungs working properly.  The heart in pumping and the lungs in inspiration/expiration (one organ cannot live without the other).                                                                                                                                                              There has to be a systemic way we allow this to work and this is through the heart, lungs, and RBC’s (3 systems that connect with each other). The heart = right side deals with more C02 blood than 02 blood which is blood returning to the heart to get more 02 going first via the Rt. side of the heart to the pulmonary artery, each of which carries blood to the lungs for 02 and C02 exchange to occur. This is for getting more 02 in our RBC’s with allowing them to release C02 at the lungs bases and then return to the left side of the heart.  On the left side of the heart this is blood to be sent through both Lt. chambers (Lt. atria first  and then the Lt. ventricle) of the heart to our blood stream to utilize the new 02 in our RBC’s that they intially obtained at our lungs going now to our body tissues. This is a 24hr/7days a week job for our red blood cells, lungs and heart in functioning to keep the human body alive.

In simpler terms this is how it works: The blood that needs to be refreshed with more 02 always which takes place by the blood in our body entering the right (Rt.) atrium coming from a vessel that brings back mainly carbon dioxide in the blood from the toes and the brain that was previously oxygenated blood that mainly was used up by the tissues and those RBC’s returning on the right side of the heart need to be reoxygenated with higher levels of oxygen.  For the RBC’s to deliver 02 again to tissues in redoing this process all over again it goes through a pathway=our circulatory system.  When the red blood cells need more oxygen it first goes to the Rt. atrium & fills up to its max level in that chamber to going to the Rt Ventricle than through the pulmonary artery to the lungs to get more 02.  Simultaneously while the Right side of the heart does this the left (Lt.) atrium is filling up to its max level than goes to the Lt. Ventricle and out the Aorta to the arteries throughout the body to carry 02 to our tissues through the RBC’s carrying the 02.   Ending line when the Rt. atrium is ready to drop its blood max level into the Rt. ventricle the Lt side does the same thing.  The difference is the 02 and C02 content in Rt and Lt side of the heart (Right side is more C02 in the RBC’S whereas the Left side has more 02 content in the RBCs/blood.                                                                                                               For the blood to get to the atriums to the ventricles they have valves; they open between the chambers simultaneously (the tricuspid valve on the right side and mitral valve on the left side) dropping the blood to the lower chambers of the heart happens simultaneously but only the Rt. side ends up going to the lungs through a pulmonary artery to get more oxygen to send the highly oxygenated blood to the L (left) side of the heart. The job the Rt. side of the heart does this, it just goes from the Rt. side of the heart to our lungs and back to the heart on the Lt. side through the pulmonary veins to the L atrium than the Lt Ventricle going to the aorta this blood gets sent throughout the body; so the path or distance for the Rt. side of the heart to do its function is a short distance = it gets your used up oxygen in the red blood cells (that are high in carbon dioxide) to get more oxygen by going through the Rt. side of the heart sending them to the lungs where they get more O2 and then they are sent back to the Lt. side of the heart.   This is the Rt. side of the heart’s function and explains why the heart muscle on that side of the heart is smaller than the Lt. side.  Now let us look at what the Lt. side of the heart, in what blood it delivers to our tissues with our red blood cells (RBC’s).   The RBC’s reoxygenated that leave the lungs and are sent via the pulmonary vein to the Lt. side of the heart, reaching the Lt. atrium, thus carries a high 02 level in the RBC’s (this blood just came directly from the lungs where O2 and CO2 exchange for the RBC’s took place).  Next the RBC’s go to the Lt. ventricle to our Aorta that sends this high oxygen level of RBC’s out to all our tissues as food to prevent starvation of the tissues.   Again, when the valves open between the chambers of the heart and allowing this blood to fill up in the lower chambers called the Rt. and Lt. ventricles it is simultaneously done.   Also including the valves that open and close in the heart the pulmonary artery and the aorta or the tricuspid valve and mitral valve are simultaneous as well.  The ventricle sending RBC’s out to our circulatory system high in O2 to be utilized by our body tissues is the Lt. Ventrilcle. To do this job takes more effort as opposed to the Rt. side of the heart and that is why the Lt side of the heart has a bigger muscle mass (more of a work out for that side of the heart).

So the way it works with both sides of the heart is the Rt. side sends blood of highly carbon dioxide blood (RBC’s) to the lungs to get re-oxygenated through 2 vessels from the Rt. side of the heart to the lungs that sends this re-oxygenated blood in the RBC’s through 2 vessels.  On the Rt side of the heart you have the Superior Vena Cava which enters the C02 blood into the right atrium and the 2 pulmonary arteries that send that blood from the Rt Ventricle to the lungs to get the 0xygen from them.  Than this blood goes to the Lt. side of the heart  sends this highly oxygenated blood now throughout the top and bottom of the Lt. side of the heart through 2 vessels which are the pulmonary veins dumping the blood in the Lt atrium down into the Lt ventricle and out the aorta that sends this blood throughout our body tissues.  When this oxygen is used all up from the RBC’s dispensing it out to tissues the C02 is taken back from the tissues by RBC’s that replace it with O2 through breathing;   this process starts all over again with these RBC’s returning to the right side of the heart reaching the lungs to get more oxygen to be sent out by the left side of the heart to go out to all our tissues. Ending line the right side of the heart is for higher levels of carbon dioxide in the blood (used up oxygenated blood) to get more oxygen through our RBC’s whereas the left side of the heart sends higher levels of O2 throughout the body all the way to the toes through the RBC’s (a harder job on the left side of the heart=muscle mass of the left side of the heart works out more than the right making the left side of the heart a bigger muscle vs the right side).

Now knowing the anatomy and physiology of the heart let’s now understand more about a cardiac disease RVR=Rapid Ventricular Rate and Atrial Fibrillation and more regarding how they develop and in how it effects the engine of the body, being the heart, and the lungs=the transmission of the body. Like a car if the engine is affected in time the transmission gets affected and if not repaired by the mechanic the car engine will die with the transmission. Same effect with the human engine=the heart. If the heart is affected in time it will effect the lungs and if not repaired the heart will die and so will the lungs with the rest of the body.

Tomorrow Part 2 on Rapid Ventricular Rate and A Fib in how it affects the heart in functioning but how it can be treated to live a fairly normal life.


From the moment it begins beating until the moment it stops, the human heart works tirelessly. In an average lifetime*, the heart beats more than two and a half billion times, without ever pausing to rest. Like a pumping machine, the heart provides the power needed for life.

The Heart

Part 1 The heart is the engine of the human body.

Let us first understand how the heart functions.  For starters think of a car, without the engine the car won’t move unless pushed in neutral but the engine is still not working at all. Well, the body can’t work at all if the heart isn’t working=dead. Right? We can’t live without the heart but more importantly you can’t function actively and productively with one that is diseased and not being cared for or just severely diseased. We need to take good care of our bodies especially if diseased already, that includes your heart especially (the organ the allows the human body to live).

Looking at the anatomy and physiology of the heart it will help you understand in how it functions with how cardiac disease affects it. For starters the heart is like the engine of the human body based on its characteristics.  This organ is  just like a car in that the human body would not function without its engine.

The heart’s anatomy,  in this organ you have chambers (2 on the top called atriums and 2 on the bottom called ventricles), 4 chambers to be exact (sort of like a 4 cylinder car). It also has valves which allows our blood to go in and out of the chambers and vessels of the heart. That is what makes blood move throughout the circulatory system starting from the heart down the abdomen to the arms, than the legs/feet back up to the brain to the heart again. These valves are located before the entrance of the blood entering the heart on right upper chamber, between the upper and lower chambers (atriums & ventricles), at the beginning of arteries and veins involved in moving blood throughout the heart and to or from the lungs to do one major function in keeping all tissue alive in exchanging oxygen and carbon dioxide from the tissues. Lastly, in our veins the legs have valves to push blood back up to the heart because this blood that had high oxygen cells carried by our red blood cells are not filled with mostly oxygen but with carbon dioxide. When this blood is pushed up in the legs through the veins by valves allowing the blood to return to the heart with more carbon dioxide in the blood this is done to allow the blood to get to the lungs for more oxygen and carbon dioxide to be released (like oil/gas entering the car first in the tank and used throughout the engine and leaves the muffler out the tail pipe (the car’s lungs). Oxygen is our gas to the body tissues; without it we couldn’t survive but to get it we have to breath to allow oxygen and carbon dioxide to go in and out of our red blood cells at the bases of the lungs.  This is where the red blood cells pass by in the circulatory system for this transfer of O2 and CO2 to take place. For this to take place it is when we breath; which is allowing 02 in the body to our tissues by the red blood cell that carries 02 to our tissues and tissues releasing carbon dioxide (end product of oxygen used in tissues) transferred over to our red blood cells carried back to the lungs in where the carbon dioxide is released from the cell and removed through the lungs on expiration.

  • First take our blood, in particular our red blood cells are the cells that carry oxygen and carbon dioxide throughout our body; the body without enough oxygen in the body tissues=cellular starvation. We can’t survive without oxygen sent to our tissues=food to our tissues (Ex. poor circulation to any tissue of the body = pain and if not resolved it will go into necrosis = death of the tissue, like in a diabetic that has poor circulation to the toes/foot that has pain/numbness and unresolved = necrosis to amputation.  So your blood, in particular the red blood cells, need to transport oxygen (O2) to and take carbon dioxide (CO2) from our tissues in the body and refill up with more 02 and release C02 (O2 used up by our tissues) which takes place at the lungs. This process is done constantly in the body to feed our tissues O2 (by the red blood cells-RBC’s picking up 02 upon inhalation) with tissues releasing CO2 which is picked up by the RBC’s at all tissues of our body and they take that CO2 to the lungs in releasing it from our body completely via exhaling. This whole process is only done due to the heart beating allowing the blood to circulate and recirculate throughout the body and allowing this O2/C02 process from the lungs to even take place by pumping RBC’s throughout the body through the circulatory system (just like the engine of a car in how the engine works to allow fuels, oils to circulate throughout the engine and other areas of the car to allow the car overall to function but for it to happen the engine has to be on pumping the transmission and oil throughout its system to allow these oils to be utilizes.   When the gas gets low we refill it up at the gas station with more car gas.  For the human body we fill up by breathing allowing the gas we need to run on, being oxygen, but at the sametime allowing the toxic gas out of our body being what we call carbon dioxide via expiration.  Turn in tomorrow for Part 2 of this article on the anatomy and physiology of the heart and to prepare for Monday’s article on  Rapid Ventricular Rate and Atrial Fibrillation with how both affect the heart in its function.


“Factors that influence selection of treatment for genital warts include wart size, wart number, anatomic site of the wart, wart morphology, patient preference, cost of treatment, convenience, adverse effects, and provider experience”

Centers for Disease Control and Prevention

What are genital warts?

Genital warts (or condylomata acuminata, venereal warts, anal warts and anogenital warts)

Genital warts affect both men and women and can occur at any age.  Most patients with genital warts are between the ages of 17-33 years. Genital warts are highly contagious. There is high risk of getting the infection from a single sexual contact with someone who has genital warts.

In children younger than three years of age, genital warts are thought to be transmitted by nonsexual methods such as direct manual contact. Nevertheless, the presence of genital warts in children should raise the suspicion for sexual abuse.

Up to 20% of people with genital warts will have other sexually transmitted diseases (STDs).

Most genital warts are caused by two specific types of the virus (HPV-6 and -11), and these HPV types are considered “low risk,” meaning they have a low cancer-causing potential. Other HPV types are known causes of premalignant changes and cervical cancers in women. HPV16, one of the “high-risk” types, is responsible for about 50% of cervical cancers. HPV types 16, 18, 31, and 45 are other known “high risk” virus types. High-risk HPV types are also referred to as oncogenic HPV types. HPV is believed to cause 100% of cases of cervical cancer..

Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area.

Most genital warts are caused by two specific types of the virus (HPV-6 and -11), and these HPV types are considered “low risk,” meaning they have a low cancer-causing potential. Other HPV types are known causes of premalignant changes and cervical cancers in women. HPV16, one of the “high-risk” types, is responsible for about 50% of cervical cancers. HPV types 16, 18, 31, and 45 are other known “high risk” virus types. High-risk HPV types are also referred to as oncogenic HPV types. HPV is believed to cause 100% of cases of cervical cancer.

  1.  The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur, during which there is no evidence of infection. Genital warts are indirectly associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners, and having sex at an early age.The size may range from less than one millimeter (1 mm = 0.039 inches) across to several square centimeters (1 cm = 0.39 inches) when many warts join together. Rarely, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.) There may be a history of previous or concurrent sexually transmitted diseases (STDs).In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Sometimes lesions may be hidden by hair or in the inner aspect of the uncircumcised foreskin in males.Diagnosis is often based on findings from the history and appearance of the genital warts. Magnification of the area (colposcopy) using a scope may be necessary to see the lesions. In females, a colposcope may be used to look for lesions in the vaginal canal and on the cervix. A biopsy can be performed if the lesion appears unusual or recurs after treatment. Because genital warts essentially have no symptoms other than their appearance, there is little need for home treatment. It is important, however, to recognize that the warts exist. Be careful to prevent transmission to a sexual partner.Treatment: #1 before even getting genital herpes and stick to it is PREVENTION!! Never get them.Cryotherapy: This technique freezes the wart using liquid nitrogen or a “cryoprobe.” It is an excellent first-line treatment because response rates are high with few side effects.Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. Of note, the resulting smoke plume may be infectious.2.) Surgery in some cases removing the warts.4.) With your health care practitioner DON’T FORGET FOLLOW UP, a must. -Complete the necessary treatment as outlined by your health care practitioner.
  2. There is also alternative treatments 1.) Types of medical creams prescribed and even OTC.
  3. Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV-induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume.
  4. There is no single effective cure for removal of genital warts. A number of treatment options exist; however, no treatment is 100% effective in eliminating warts and preventing them from coming back in all patients. It also is not possible to eliminate infection with human papillomavirus once it has occurred. Genital warts may go away on their own in about 10% to 20% of people over a period of three to four months.
  5. Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.
  6. Take the necessary precautions to prevent trauma to the area, which can result in bleeding.
  7. Special laboratory tests can also be used to confirm the presence of HPV infection.
  8. A routine Pap smear should always be done in order to look for evidence of HPV infection and abnormal cells on the cervix.
  9. Sometimes, lesions are only visible with an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the area of suspicion for about 5-10 minutes. Infected areas will turn white.
  10. In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of the vaginal canal, cervix, and anorectal area.
  11. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.
  12. Warts in more than one area are common.
  13. Men and women with genital warts will often complain of painless bumps, itching, and discharge.
  14. Signs or genital warts: First know although genital warts are painless, they may be bothersome because of their location, size, or due to itching.
  15. Generally, about two-thirds of people who have sexual contact with a partner who has genital warts develop them within three months.
  16. Common warts are not the same as genital warts and are caused by different HPV types that  infect the skin.
  17. Some types of HPVs use cervical or anal cancer, and vaccines are available to protect against the most dangerous types. Other HPV types cause genital warts, which can be raised,  and flat.


“The timing of flu is very unpredictable and can vary in different parts of the country and from season to season. However, seasonal flu activity can begin as early as October and continue to occur as late as May. Flu activity most commonly peaks in the U.S. between December and February.”

CDC Centers for Disease Control and Prevention (“What should you know for the 2014-2015 influenza season”.