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How to Read ACLS Rhythm Strips

Within medicine, knowledge is power. The more you are aware of what is going
on with a patient, the quicker you will be to react to any potential change or
problem that may soon develop. Thankfully, our ability to help others has been
greatly improved by the technology we use to monitor patients. Effectively using
this information however requires understanding what it shows us.

ACLS, or advanced cardiovascular life support refers to a series of interventions
that are targeted to address several life-threatening conditions as well as medical
emergencies. In addition to being a means to determine the best way to save a
person’s life, it is also a form of certification that can be obtained, as well as a
central part of any nursing or doctor’s education. As a result, being able to
effectively read ACLS rhythm strips is not only necessary to continue with your
education, but to also save the lives of future patients. Lets take a moment to
review how to read ACLS rhythm strips.


Reading ACLS

The Basics

ACLS Rhythm Strips on EKG paper presents a way to measure heart rate that,
with the right understanding, can provide a great deal of information. Split into
5X5 grids, the horizontal boxes each refer to 0.04 seconds with a full 5 boxes
being 0.20 seconds. Using this information you can calculate the basic heart rate
as well as the heart rhythm regularity.

Identifying Different Patterns And Conditions

Beyond understanding the basics, the most important thing to understand are the
various patterns that can result from a myriad of potentially life threatening
conditions. For example, there are a range of pulseless rhythms including
pulseless ventricular tachycardia, ventricular fibrillation, pulseless electrical
activity, and asystole. In addition to pulseless conditions, there are also
bradyarrhythmias including 1st degree block, 2nd Degree AV block type 1, 2nd
Degree AV block type 2, and complete heart block, as well as tachyarrhythmias
including supraventricular tachycardia (SVT), atrial flutter, atrial fibrillation, and
even more. The only way that you can read an ACLS rhythm strip is to know
what these conditions are and what they look like. The more familiar you are
with this information, the quicker your response will be and the more lifesaving
services you will be able to provide before it is too late.

Expanding Through Experience

Simply put, the more experience you have practicing the better you will be at
successfully reading ACLS rhythm strips. One thing you should consider is
searching for online aids that create a variety of conditions for you to test your
knowledge in. Along with being fantastic study aids, these websites will also help
you to improve your response time, giving you the edge you need in a high-
stress and rewarding career. Until then, the best thing you can do is to
understand the basics and build your understanding through experience.

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EKG testing information for nurses

Because medicine is adopting the most advanced technologies and is an ever-changing science they continue education is very important for nurses. As changes in treatments and therapies are adopted and new medical information is gained through research and clinical studies, nurses need to continue update their medical knowledge.

Female nurse at a desk working in a modern office

EKG testing is an area important for the generalist nurse as well as for those employed in cardiology departments. For this reason all nurses would need to regularly upgrade their knowledge on the ECG testing.


By taking the course on EKG testing here at at, each nurse will be able at the end of the program to:


· Describe the normal cardiac physiology and anatomy.

· Name and discuss the heart’s important anatomical structures that relate to EKG.

· Perform satisfactorily on an objective EKG examination.

· Identify normal EKG waveform, measure and analyze each segment and wave.

· Recognize the most dangerous arrhythmias that could be dangerous to a person.

· Identify cardiac medication and their uses.

· Know the two most frequently used treatments for heart arrhythmias.

· Interpret correctly the basic arrhythmias by using a step-by step

Among the benefits for taking the EKG course at are:

· Increased trust from colleagues and physicians in monitoring the patients.

· Increased levels of competence in caring for your patient.

By learning the matNurse-online-courseerial presented in the EKG course at nurses will master the various ways of understanding and reading an EKG strip. Nurses can also get 11 contact hours with this online clinical telemetry course.


The course has the purpose to provide licensed nurses information on how to provide care for patients in a clinical telemetry setting and how to interpret EKG readings. The training program was designed for all licensed nurses, with a focus on specific telemetry areas such as basic telemetry hospital units, surgery, ICU, endoscopy, special procedures, and interventional radiology.


Here are some highlights of the material presented in the EKG course:


Each wave on the EKG is related to electrical impulses. When these electrical impulses stimulate the heart muscles, blood is ejected from a chamber of the heart.


The basic facts about heart function are the following:

1. The inside and outside of the heart cell membrane are bathed in fluid.

2. This fluid is made up of an electrolyte solution that is carrying positive and negative ions.

3. Between ions of opposite polarity will flow an electrical current.

4. The extracellular fluid is mostly positive when cells are at rest. That means that no electrical current will flow.

5. Current will flow when the cell membrane is stimulated.

6. At all times positive ions of K go in and out freely.

7. The positive ions of K are limited to the outside of the cell.

8. The negative chargers inside the cell and diffusion gradient change attract positive ions of NA to enter cell’s interior.

The EKG course will also refresh the information about the electrical conduction system of the heart. This system includes the intermodal atrial conduction tracts, sinoatrial node, atrioventicular node, interatrial conduction tract, bundle of HIS, Purkinje network, and the right and left bundle branches. The bundle of HIS and the AV node from the heart’s AV junction. The Purkinje network, the right and left bundle branches, and the bundle of HIS are also called the HIS-Purkinje ventricles system. The sole function of the heart’s electrical conduction system is to transmit electrical impulses from the SA node to the ventricles and atria.


The course will also refresh the nurses’ knowledge about the electrical basis of the EKG. The electrocardiogram uses electrodes attached to the skin in order to provide a graphic record of the magnitude and direction of the heart’s electrical activity generated by the depolarization and re-polarization of the ventricles and atria. This graphic record can be used for evaluating if the heard presents a normal EKG or for interpretation of arrhythmias.


The EKG paper shows time intervals as well as the measurements of each block on the paper. By counting blocks up and down on the EKG paper it is possible to make a fairly accurate measurement of a patient’s heart rate. Amplitude of the electrical activity of the heart as well as time sequences is recorded on the EKG paper. Other measurements on the EKG paper used in diagnosis of heart conditions are the P Wave, the QRS Complex, the T Wave, the U Wave, and the EKG Leads. All these aspects are detailed discussed in our course.


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Sudden Cardiac Death in Young People

So young-football-cardiac-deathdid you hear about this in the news-

a 16 year-old kid collapses and dies on the football field during Friday night’s game

… and you wonder… “How could this happen?”

Sudden cardiac death (SCD) is usually associated with physical activity like sports. This, many times, causes us to ponder how “healthy” exercise really is. And, yes, exercise has been shown to be a trigger for MI and sudden cardiac death, but routine exercise actually protects against it.

Sudden cardiac death is rare in people under 35 years old, but it does occur and here’s why.

Over 60% of SCD’s are caused by a heart abnormality that leads to ventricular fibrillation (the uncontrolled quivering of the ventricles of the heart).

Specifically, there are several abnormalities that can occur.

  • Hypertrophic cardiomyopathy: This is the most common cause of SCD in people under 30 years old and in athletes. In hypertrophic cardiomyopathy the heart muscle becomes thick, making it harder to pump blood. The normal alignment of heart muscle cells is disrupted and the heart’s electrical functions do not all work properly.   It often goes undetected and has no symptoms until the SCD occurs.
  • Coronary artery and heart muscle abnormalities: Sometimes the coronary arteries or heart muscle form incorrectly in utero.   This may cause the arteries to become compressed during exercise, blocking blood flow to large portions of the heart muscle. Some of the more subtle abnormalities may not cause any symptoms. They remain undetected and allow full athletic development, then suddenly cause death during exercise.
  • Long QT syndrome: This is rare, genetic issue. In this condition, ventricular repolarization is delayed leaving the heart in a depolarized state and open for stimuli. This increases the risk of episodes of Torsades de Pointes- a type of polymorphic ventricular tachycardia that cannot sustain a pulse.
    torsades de pointes rhythm

    Torsades de Pointes

  • Previously unknown congenital heart disease
  • Brugada syndrome: An genetic disease that causes electrical issues in the heart leading to ventricular fibrillation.
  • Heart muscle inflammation/irritation from illness, viruses
  • Commitio cordis: This involves no abnormalities… just bad timing. It occurs usually during sports when the chest is forcefully struck with an object (i.e. football, hockey puck, etc) at just the wrong time, causing the heart to go into ventricular fibrillation or ventricular tachycardia.

Red flags for sudden cardiac death risk- symptoms to watch for that may indicate an underlying problem:

  • Unexplained fainting- syncopal episodes or palpitations, chest pain during physical activity
  • Family history of sudden cardiac death


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How Do Heart Valves Work?

Have you ever wondered how heart valves work?

The best way to look at them is that they act like doors.

They close to keep blood from flowing back into the area it came from and open at just the right time to allow the blood to move forward into the next area. Each valve is made up of flaps or cusps that, when working properly, open and close together to create a tight seal.

Anatomy of heart

The heart valves are basically a way to keep the blood flowing efficiently in the right direction.  There are 4 valves in the heart. Two are between the heart and its surrounding major vessels and the other two are between the chambers of the heart. The pulmonic valve lies between the right ventricle and the pulmonary artery. It opens to allow blood from the right ventricle into the pulmonary artery and closes to prevent that blood from flowing back into the right ventricle. The aortic valve is between the left ventricle and the aorta. It opens to allow blood into the aorta and closes to prevent that blood from flowing back into the left ventricle. The tricuspid lies between the right atrium and right ventricle and the mitral valve between the left atrium and ventricle- both of these open to allow blood to flow from the atria to the ventricles below and close to prevent that blood from traveling back up into the atria when the ventricles pump the blood to the vessels. When the atria squeeze, the tricuspid and bicuspid are open to allow the blood to flow from the atria to the ventricles. When the ventricles squeeze, the aortic and pulmonic valves open to allow the blood from the ventricles in and the mitral and tricuspid are closed to prevent the blood from the ventricles from going back up into the atria.


There are several issues that can occur with the heart valves. The most common are stenosis, regurgitation, and prolapse.

Stenosis: This refers to a valve not opening properly. This occurs because the valve thickens, stiffens or some of the cusps may be fused together. The thickening/stiffening mainly is caused by advanced age- where the cusps develop calcifications over time.  People can also be born with stenosis or it can be causes from rheumatic heart disease.  Cusps fused together are usually something that a person is born with. Because the stenosis causes the valve’s opening to be smaller than usual, the heart has to work harder to get blood through. Aortic stenosis, specifically, causes the left ventricle to thicken and enlarge, eventually weakening it.

Regurgitation: Unlike stenosis, regurgitation occurs when the valve doesn’t close properly, allowing blood to backflow into the area it just came from. It also allows blood to go into the area ahead before it is needed. This, in turn, can cause the heart to work harder in general. Several things can cause regurgitation including, high blood pressure, infection, and coronary artery disease.

• Prolapse: This issue mainly affects the mitral valve. Another term used for this is “floppy valve syndrome”.  With prolapse, the two cusps of the mitral valve do not close or seal evenly or properly.  It is caused by tumor-like collagen growths on the cusps. It usually only occurs in 2-3% of the population and can be genetic. The effects it has on the heart are similar to that of regurgitation. Many times this condition is harmless and needs no intervention.

In many cases, valve issues cause no significant symptoms and, sometimes, people do not even know they have them. However, if a valve issue becomes prominent enough to cause symptoms and problems, the main two remedies are either surgical repair or surgical replacement.

Related article: Henry Kissinger’s Heart Valve Replacement Surgery

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Young People Get Arrhythmias Too?

SVT (Supraventricular Tachycardia) in Young Patients

It is rare for young people experience cardiac arrhythmias, but it does occur.  Many times it comes about in their late teens or twenties when they are most active with sports, activities, etc.  This is the issue that young athlete Rhett Lindholm had.

Rhett dealt with SVT for years.

Rhett dealt with SVT for years.

There are two main types tachyarrythmias found in young people: AV Nodal Re-entrant Tachycardia (AVNRT) and Wolff-Parkinson-White (WPW).


AV Nodal Re-entrant Tachycardia

In cardiac conduction system, the AV node is the gateway, the traffic cop, in the electrical pathway between the atria and ventricles.  It controls what signals get through and how fast.  In AVNRT, an extra electrical pathway forms and allows an electrical signal to travel backwards through the AV node at the same time.  This causes another heartbeat.  The two pathways create a continuous electrical signal in a circular pattern called “re-entry”.  The extra pathway that forms comes from tissue that behaves very much like the AV node.  It is geographically located in the right atrium close to the AV node.

This arrhythmia can cause heart rates 160-220 beats per minute.    AVNRT is most common in women.  In fact, 75% of the AVNRT cases occur in females.  It also is most common in the 20’s and 30’s.  Symptoms of AVNRT include syncope or near syncope, faint feeling, lightheadedness, and palpitations.

AVNRT appears on the EKG as a narrow QRS complex tachycardia.  The retrograde (re-entry) conduction occurs at the same time as the ventricles beat.  Therefore, its P wave will often be hidden by the QRS complex.  AVRT11

Treatments for AV Nodal Re-entrant Tachycardia usually focus on any action that can transiently block the AV node like vagus nerve stimulation techniques including carotid sinus massage and valsalva maneuver.  Medications like adenosine, B- blockers, and Ca-channel blockers and procedures like electrical cardioversion and ablation are also sometimes used.


Wolff-Parkinson-White Syndrome

Unlike AVNRT where the extra electrical pathway occurs at or near the AV node, in WPW it is directly from the atria to the ventricles.  These extra pathways cause the signal to get to the ventricles too fast and the signal is then sent back to the atria creating another electrical loop.

Patients that have the extra electrical pathways that occur in Wolff-Parkinson-White syndrome are born with them.  This syndrome affects patients of all ages, including infants.  However, symptoms often first occur in their teens and 20’s.   Patients with WPW are also more likely to develop other arrhythmias later in life like atrial fibrillation and ventricular tachycardia.

Wolff-Parkinson-White syndrome symptoms include dizziness, syncope, and palpitations.  Patients with WPW can also fatigue easily with exercise.  WPW can be easily fixed with a procedure called ablation.


The full source article for Lindholm’s heart condition can be found at

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Healthy Living to prevent Heart Attack

Healthy Living as a Strategy for Heart Attack Prevention

There has been an unprecedented rise in the occurrence of heart attacks or cardiac conditions among many people across the globe. Heart attack symptoms range widely from mild, heartburn-like chest pain/pressure to intense, crushing, elephant-sitting-on-your-chest pressure.  When people experience this it is imperative to any medical center where tests are run to figure out whether there is possibility of a cardiac arrest.ekg-color-against-heart-attack

Once in a medical facility, an EKG (Electrocardiogram), a non- invasive test that determines the electrical signals of individuals’ hearts will be done. Presently, an EKG test takes only about fifteen minutes to give the results. However, when the test shows that a patient does not have signs of a heart attack; several other diagnostic examinations are done. This can take a period of thirty six hours to find out the cause of the chest pain.

Regardless of heart attacks being a common phenomenon, it is great news that it is also preventable. Sometimes it is inherited and other times it is mainly due to the lifestyles that people have adopted. Since a standard of living is subject to change, choosing a healthy way of life is vital for the well being of the heart. Below are steps people can take toward implementing a healthy living style focused on having a fit heart.

1. Assessing risk of having cardiac disease

Assessing individuals’ chances of having the condition is the first step in preventing its occurrence. Making contact with a cardiovascular doctor facilitates this as he or she can evaluate risks depending on hereditary risk factors. Relying on the results, individuals will either consider making changes to their lifestyle or find ways of improving their heart health.

2. Quitting smoking and alcohol consumption

Alcohol and cigarettes are among the highest risk factors for developing cardiac diseases. People who consume these drugs are six times more likely to develop heart problems as opposed to their counterparts who do not use them. Continued use of the same increases the rate of heart attack occurrence. Hence, avoiding for non users and quitting for users is necessary.

3. Eating healthy

Eating healthy foods such as fruits, vegetables, lean proteins and whole grains provides the body with vitality against cardiac conditions and diseases. Individuals also should avoid taking foods with high levels of cholesterol and salt, processed food, and “junk foods”. It is important that before anyone purchases food from grocery stores, a look at the label will help in making a wise choice on what to buy.

4. Maintaining a healthy body weight

Maintaining a healthy body weight is essential in reducing individuals’ risks of having heart attack. It is evident that majority of people with excessive pounds are the prime candidates of cardiac related conditions. Apart from eating healthy, engaging in aerobic exercise also facilitates a decreased risk.

5. Avoiding stress

Everyone has to endure stress that comes from their daily encounters. However, individuals ought to develop mechanisms to dealing with stress so as to make sure it does not take a toll on them. Speaking to a friend or counselor may go a long way in helping avoid suffering a heart attack.


6. Carefully handling diabetes and high blood pressure

People suffering from these diseases are highly susceptible to experiencing heart attacks. Proper management of these conditions by taking prescribed dosages and living healthy places patients in a better position to evade any occurrences of cardiac failures.

Working on these guidelines is will help individuals take a closer step toward healthy living. Individuals ought to be alert so that any chest pain is not ignored.

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Bundle Branch Blocks. How dangerous are they?

When we sit in a doctor’s office, we tend to hear a lot of medical terminology that we may not understand. This can be especially frightening when we are in the cardiologist’s office.  One of the terms we might hear is “bundle branch block”.

What is a bundle branch block?

  • A bundle branch block is a heart condition wherein there is a delay bundlebranchblockalong the electrical pathway that makes the heart beat.
  • A blockage along this pathway can happen on either the right side or the left side of the heart.
  • These obstacles can make it more difficult for the heart to effectively pump blood through the circulatory system.

What are the causes of a bundle branch block?

The underlying causes for these bundle branch blocks can differ, depending on whether you have one on the right or left side.

Left bundle branch blocks are more often caused by some variation of heart disease:

  • Congestive heart failure
  • Cardiomyopathy (stiffened, thickened, or weakened heart tissue)
  • Hypertension (high blood pressure)
  • Heart disease

Right bundle branch blocks can have a larger range of causes:

  • Congenital defect (an abnormality that is present at birth)
  • Myocardial infarction (heart attack)
  • Myocarditis (bacterial or viral infection of the heart)
  • Hypertension (high blood pressure)
  • Scar tissue due to previous surgeries of the heart
  • Pulmonary embolism (a blood clot located in the lungs)


What are the effects – how dangerous are they?


It can be difficult to give a proper diagnosis with just this one piece of information.  Sometimes your doctor will perform additional tests in order to give them a better picture of what is happening.


  • If there are no other symptoms, the risks of this particular condition are small.
  • It mostly depends on the underlying causes of the block.
  • If the block is caused by a serious heart condition such as a heart attack, that can be more concerning.
  • If the block is caused by a manageable condition such as high blood pressure, then it can be less concerning.
  • Your doctor will keep watch because if you also develop a bundle branch block in the opposite side, he will most likely want to put in a pacemaker in order to regulate the electrical impulses.


When you do hear these frightening terms, remain calm and make sure to get all the information you can from your doctor.  They will help you navigate the management options for your particular situation.

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Congestive Heart Failure- How Serious Is It?

        About 5.7 million people in the United States have heart failure, and the number is growing.  About 50% of people die within 5 years of getting the diagnosis. It contributed to about 280,000 deaths in 2008.  Occurs more in men, African-Americans, and people age 65 an older.  Actually, CHF is the #1 reason for hospital stays in that age group.

 heart       Pathophysiology:  Congestive heart failure (CHF) is a condition in which the heart can’t pump enough blood throughout the body.  The heart can’t fill with enough blood or pump with enough force, or both.  Heart failure develops over time as the pumping action of the heart grows weaker. It can affect the left, right, or both sides of the heart. Most cases involve the left side where the heart can’t pump enough blood to the rest of the body. With right-sided failure, the heart can’t effectively pump blood to the lungs

Causes:  Any condition that damages heart muscle can lead to heart failure. The three leading causes are coronary artery disease (leads to heart attacks), hypertension, and diabetes.  Other causes include cardiomyopathy, diseases of the heart valves, arrhythmias (including atrial fibrillation), congenital heart defects, cancer treatments like chemotherapy and radiation, thyroid disorders, HIV/AIDS, alcohol abuse, and illicit drug abuse (i.e. cocaine).

clutch chestSigns and symptoms:  These depend on the side of the heart affected.  The inability of the heart to pump properly causes blood to back up into where it came from (right side—blood backs up into the vena cava, left side—the lungs) and insufficient blood flow to where it is supposed to go (right side—the lungs, left side—the rest of the body including the coronary arteries and the kidneys).  Right-sided heart failure includes peripheral edema, ascites (fluid accumulation in the abdominal cavity), enlarged liver, juglar vein distension, weight gain, and frequent urination.  Left-sided heart failure includes pulmonary edema (fluid in the lungs), cough at night, shortness of breath with exertion, orthopnea (shortness of breath depending on a person’s body position), and fatigue.

Treatments:  If possible, treat the underlying cause of the heart failure, for example, coronary artery bypass graft surgery (CABG) or valve surgery.  Lifestyle changes like a low salt diet, weighing oneself daily, restricting the amount of fluid intake, and exercise will also help manage this condition.

Medications:  The following medications are used to treat CHF:  diuretics—to reduce fluid buildup therefore reducing preload (the amount of fluid going into the heart), ACE inhibitors—to lower blood pressure and decrease afterload (the amount of pressure the heart muscle has to work against to pump out the blood), Beta-blockers—to lower heart rate and blood pressure to decrease afterload, and Digoxin—to allow heart to beat stronger and pump blood more efficiently which increases cardiac output (the amount of blood the heart is able to pump out with each squeeze).  If the above do not work and the CHF worsens, heart transplant or mechanical heart pump may need to be considered.




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Afib – The Sometimes Silent Killer

peverley_photoWhat is afib?


Afib, short for atrial fibrillation, is a cardiac arrhythmia originating in the atria of the heart.   It occurs when the atria, the top chambers of the heart, quiver or “fibrillate” instead of squeezing and pumping normally.  80% of the blood in the atria usually passively falls into the ventricles when the bicuspid and tricuspid valves open.   But because, in afib, the atria quiver and don’t squeeze, the blood does not get that extra push it usually would with the atrial squeeze.  This is referred to as loss of the “atrial kick”.



What are the symptoms?

Many times atrial fibrillation has no symptoms at all and it is incidentally picked up when a routine EKG is performed.   This is how hockey player Dallas Stars’ center Rich Peverly found his afib recently.  Atrial fib shows up on the EKG as an irregular heartbeat with fibrillating lines and waves where the P waves should be.  It can be a slow rate or a fast rate depending on how frequently the ventricles respond to the stimuli given off by the atria.  If they respond more frequently, the rate can become very fast and turn into atrial fibrillation with rapid ventricular response of afib with RVR.  Depending on how fast the rate is, the condition can become serious and need a medical intervention.  Other symptoms of atrial fibrillation: heart palpitations or “fluttering”, dizziness, faintness, syncope or passing out, and chest pain.  If someone goes on with untreated afib for a long time they may begin to show other symptoms like shortness of breath, inability to perform activities they usually could due to fatigue, and lower extremity swelling.

What are the causes?

There are several cardiovascular diseases and/or conditions that atrial fibrillation is linked to and associated with, including:  high blood pressure, coronary artery disease, mitral valve issues, pericarditis, congenital heart disease, previous heart surgery.  Some lung diseases are linked also, including pneumonia, lung cancer, pulmonary embolism, and sarcoidosis.  Atrial fib has also been linked to hyperthyroidism and family history of afib.

What are the complications?

Several complications can arrive from atrial fib.  The first being the heart rate fluctuation and irritability discussed earlier.  It also causes turbulence of the blood inside the heart’s atria.  The body sees this turbulence as almost like an injury and sends platelets there.  This accumulation of platelets causes clots to form in the atria.  These clots then get pumped through the heart and can get sent to the lung causing what’s called a pulmonary embolus or the brain causing a stroke.  Another complication of atrial fib, if left untreated for a long time can lead to congestive heart failure- this causes the symptoms mentioned earlier including the swelling, shortness of breath, activity intolerance, etc.

How is it treated?

Atrial fibrillation is a manageable condition, depending on the case, as each person is different.  As far as management, there are a number of medications to help control the heart rate and even the rhythm.  These include drug classes like Beta-blockers, calcium-channel blockers, and cardiac glycosides.  A person with chronic atrial fib may also be put on a form of anticoagulant like Coumadin, Plavix, Aspirin, or Lovenox to help keep their blood from clotting too easily in order to prevent stroke or pulmonary embolus.  Another way to treat and sometimes get rid of afib is to use cardioversion.  Cardioversion can be done electrically using a machine the mildly shocks the heart back into a normal rhythm using its sinus node instead of the atria to pace the heart and send the signals (this is how Rich Peverly treated his) or it can be done chemically using medications that do the same thing.

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