Prevention of embolic events during cardioversion

1. Both electric and pharmacologic cardioversion carry a risk of embolic events, including stroke. Patients with persistent atrial fibrillation of unknown duration or more than 48 hours duration should be treated with anticoagulants for three weeks before either pharmacologic or DC cardioversion is attempted. Anticoagulation should be continued for four weeks after cardioversion. The International Standardized Ratio (INR) should be maintained between 2.0 and 3.0.

2. Transesophageal echocardiography may be used to exclude the presence of thrombus in the atria of patients being considered for cardioversion. A negative transesophageal echocardiogram does not obviate the need for at least a short course of warfarin (Coumadin) therapy after cardioversion.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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