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Re: 9 week PVA update

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> SB

>

> I wasn't aware that PAC's could be felt by taking your pulse.

Cleveland

> thought they were PVC's

> Thor

Thor,

Absolutely you can feel PACs in your pulse. As far as I know, just

by taking your pulse you can't tell the difference between a PAC and

a PVC, someone correct me if I'm wrong.

I have also seen people in here ask if PVCs felt stronger than PACs

when you feel them in your chest/throat/pulse, and other people say

their docs have said no, you can't tell them apart that way. I have

never gotten around to asking my doc about that.

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Trudy:

My wife & I went out to dinner with a physician & his wife last evening. (in

addition to being friends, he is also our F.P. Dr.) He told me what you feel

when taking a wrist pulse is your ventricles, not your atria's. According to

www/a-fib.com website, " when a Dr. or nurse takes your pulse, he/she is

counting contractions of your ventricles " . Dr. G further stated atria

contractions are almost impossible to detect if you're in AF or a tachycardia

NSR, even with a stethoscope. (he actually said you can't hear them, but maybe

some Drs/nurses can)

Maybe you feel you can tell the difference in your chest, but I don't think it's

possible from a wrist pulse, as all you are feeling is the ventricle

contraction.

Any other opinions out there ?

Thor

Re: 9 week PVA update

> SB

>

> I wasn't aware that PAC's could be felt by taking your pulse.

Cleveland

> thought they were PVC's

> Thor

Thor,

Absolutely you can feel PACs in your pulse. As far as I know, just

by taking your pulse you can't tell the difference between a PAC and

a PVC, someone correct me if I'm wrong.

I have also seen people in here ask if PVCs felt stronger than PACs

when you feel them in your chest/throat/pulse, and other people say

their docs have said no, you can't tell them apart that way. I have

never gotten around to asking my doc about that.

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> Trudy:

>

> My wife & I went out to dinner with a physician & his wife last

evening. (in addition to being friends, he is also our F.P. Dr.) He

told me what you feel when taking a wrist pulse is your ventricles,

not your atria's.

Thor, I think we are actually in agreement. When I say I believe one

can detect PACs in the pulse, I mean the " pause " is detected, not

that I think I can feel the actual premature beat.

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Trudy

But PAC's are Premature Atril Contractions (unless there is some other PAC I'm

not aware of) and as such, can't be felt by taking your pulse, since you can't

detect atril contractions of any sort via the wrist. If you feel a pause, it's a

ventricle pause. It can't be anything else, 'cause you can't feel anything else

by wrist. (after a PVC, the ventricle pauses to fill up since the premature

contraction came too soon - at least that's my understanding) Any arrhythmia

felt by wrist is ventricle in nature, regardless of what it is. I'm not saying

your not having PAC's & PVC's, but just that you can't detect PAC's by pulse

rate. (BTW, I'm not suggesting you can't tell by PR if you're in AF, I certainly

could, but it was the goofy ventricle rate that was the tip-off)

If anyone out there thinks I've got this wrong, feel free to correct me.

Thor

Re: 9 week PVA update

> Trudy:

>

> My wife & I went out to dinner with a physician & his wife last

evening. (in addition to being friends, he is also our F.P. Dr.) He

told me what you feel when taking a wrist pulse is your ventricles,

not your atria's.

Thor, I think we are actually in agreement. When I say I believe one

can detect PACs in the pulse, I mean the " pause " is detected, not

that I think I can feel the actual premature beat.

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

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In a message dated 18/04/2004 20:45:02 GMT Standard Time,

tk_wascow@... writes: <snip

My wife & I went out to dinner with a physician & his wife last evening. (in

addition to being friends, he is also our F.P. Dr.) He told me what you feel

when taking a wrist pulse is your ventricles, not your atria's. >snip

Maybe you feel you can tell the difference in your chest, but I don't think

it's possible from a wrist pulse, as all you are feeling is the ventricle

contraction.

===========

That is very interesting Thor, as I could never work out how my chest

sometimes feels like I have an army marching on it and yet my wrist pulse is

steady

and regular, and at a reasonable rate. If the wrist pulse is ventricular

beats , this would mean the only accurate pulseometers for A- fibbers would be

those that have a band around the chest or the event monitor or holter monitor?

Haze

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> Trudy

>

> But PAC's ... can't be felt by taking your pulse, since you can't

detect atril contractions of any sort via the wrist. If you feel a

pause, it's a ventricle pause. ...> If anyone out there thinks I've

got this wrong, feel free to correct me.

> Thor

Again (and I am getting tired - no more discussion of this from me

after this) the atria drive the ventricles, so a pacs can be

reflected in a pause in the pulse.

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Thor,

http://www.columbiasurgery.org/divisions/cardiac/dm_tachycardia.html

" PACs or extra beats often cause irregular heart rhythms. PACs start

in the upper chambers of the heart. A beat occurs early, causing the

heart to beat before the next regular heartbeat. If you've ever felt

your heart " skip a beat " , it was probably from a PAC. The heart

doesn't really skip a beat. Instead an extra beat comes sooner than

normal. Then there's a pause that causes the next beat to be more

forceful. "

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> Trudy

>

> But PAC's are Premature Atril Contractions (unless there is some other

> PAC I'm not aware of) and as such, can't be felt by taking your pulse,

> since you can't detect atril contractions of any sort via the wrist.

> If you feel a pause, it's a ventricle pause. It can't be anything

> else, 'cause you can't feel anything else by wrist. (after a PVC, the

> ventricle pauses to fill up since the premature contraction came too

> soon - at least that's my understanding)

Thor, Trudy is correct, a PAC will result in the ventricles beating out

of time - so the result of a PAC can be still felt as a pause (or an

early beat). Distinguishing between a PAC and a PVC by feeling your

pulse is not possible, they both result in a ventricular contraction out

of time.

Some PACs (but I believe the minority) are blocked by the AV node and

don't get transmitted down to the ventricles but the outcome is still

the same - the next ventricular contraction is out of time.

So yes, you are feeling pauses/or extra contractions in the ventricles

when you take your pulse at the wrist or neck but that is not enough

information to say whether the origin was a PAC or a PVC (or the AV node

or a re-entrant circuit)

--

D

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> So yes, you are feeling pauses/or extra contractions in the

ventricles

> when you take your pulse at the wrist or neck but that is not enough

> information to say whether the origin was a PAC or a PVC (or the AV

node

> or a re-entrant circuit)

> --

> D

..........................

I agree. I've been having PVentricleC's/PAtrialC's for many years.

I've had two EP's tell me that the only way to tell for sure what

kind of beats they are is to be hooked up to an EKG machine while

they're happening.

One also told me that PAC's can be a precursor to AFIB.

P <MI>

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> So yes, you are feeling pauses/or extra contractions in the

ventricles

> when you take your pulse at the wrist or neck but that is not enough

> information to say whether the origin was a PAC or a PVC (or the AV

node

> or a re-entrant circuit)

> --

> D

..........................

I agree. I've been having PVentricleC's/PAtrialC's for many years.

I've had two EP's tell me that the only way to tell for sure what

kind of beats they are is to be hooked up to an EKG machine while

they're happening.

One also told me that PAC's can be a precursor to AFIB.

P <MI>

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That was a coincidence !

I had just come off the Polar website after looking at Sports heart rate

monitors , when I read your mail and looked at your very interesting readouts

from your Polar s810!

I have been using only a blood pressure monitor that gives a pulse per

minute readout and have decided to look at the Sports HR Monitors, as I have

more

ectopics at present than anything, and feel 'missed' beats which is

actually, as others said, early beats and longer spaces (to put it in layman's

terms

, lol) than Afib.

I found your info clarifying and reassuring, thanks :)

I must admit I'm tempted to purchase a Sports Heart Rate Monitor if only to

see as much as your readouts give from your Polar s810.

Even though they show only ventricular contractions, they enable you to see

visually, (as shown with your links to your ECG -like readings), when other

events are occuring elsewhere in the heart.

Great links to your 'events' readouts , fascinating!

Although Sports Heart rate monitors have been discussed thoroughly, so I do

not frustrate anyone, lol, heres a UK link for Cardiosport Heart monitors

and one for Polar.

_http://www.heartratemonitor.co.uk/cardiosport.html_

(http://www.heartratemonitor.co.uk/cardiosport.html)

_http://www.polarusa.com/consumer/default.asp_

(http://www.polarusa.com/consumer/default.asp)

Haze :)

In a message dated 19/04/2004 03:42:49 GMT Standard Time,

james@... writes:

Sports heart rate monitors (even top of the range ones) that have a

strap around the chest only measure ventricular rate. The top end

models will give an accurate measure of your ventricular rate in AF and

will show ectopics preceding and event but will still not distinguish

between PACs and PVCs. The atria doesn't really beat when it's in AF so

the concept of an atrial rate is a little spurious. You'll read

anything from 300-600bpm for the atria but the reality is that there is

a chaotic quiver rather than anything that can be called a beat. What's

important is that your ventricles keep on beating :)

If you are feeling a steady regular pulse at your wrist I think it's

very unlikely you are in AF.

this is what AF looks like on my heart rate monitor (Polar s810)...

http://james.dialsolutions.com/public/AF(bpm).gif

(the pulse at my wrist/neck feels very much like the graph looks - very

irregular pulses and very irregular intensity)

here's the start of an AF with some pauses before hand

htp://james.dialsolutions.com/public/AFstart(bpm).gif

and here's some ectopics (no idea of it they are PACs or PVCs)

http://james.dialsolutions.com/public/ectopics.gif

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P said:

<<One also told me that PAC's can be a precursor to AFIB.>> In my case

they definitely are as I look back over the rather exhaustive log I have

kept for several years. When the prematures start appearing, AF often

follows within hours, many times minutes. Too often to say it is a

coincidence, though I have not analyzed it statistically.

- OU alum in MI

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> That is very interesting Thor, as I could never work out how my chest

> sometimes feels like I have an army marching on it and yet my wrist pulse is

steady

> and regular, and at a reasonable rate. If the wrist pulse is ventricular

> beats , this would mean the only accurate pulseometers for A- fibbers would

be

> those that have a band around the chest or the event monitor or holter

monitor?

> Haze

>

Hi Haze,

Sports heart rate monitors (even top of the range ones) that have a

strap around the chest only measure ventricular rate. The top end

models will give an accurate measure of your ventricular rate in AF and

will show ectopics preceding and event but will still not distinguish

between PACs and PVCs. The atria doesn't really beat when it's in AF so

the concept of an atrial rate is a little spurious. You'll read

anything from 300-600bpm for the atria but the reality is that there is

a chaotic quiver rather than anything that can be called a beat. What's

important is that your ventricles keep on beating :)

If you are feeling a steady regular pulse at your wrist I think it's

very unlikely you are in AF.

this is what AF looks like on my heart rate monitor (Polar s810)...

http://james.dialsolutions.com/public/AF(bpm).gif

(the pulse at my wrist/neck feels very much like the graph looks - very

irregular pulses and very irregular intensity)

here's the start of an AF with some pauses before hand

http://james.dialsolutions.com/public/AFstart(bpm).gif

and here's some ectopics (no idea of it they are PACs or PVCs)

http://james.dialsolutions.com/public/ectopics.gif

--

D

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> , fascinating!

> Although Sports Heart rate monitors have been discussed thoroughly, so I do

> not frustrate anyone, lol, heres a UK link for Cardiosport Heart monitors

> and one for Polar.

> _http://www.heartratemonitor.co.uk/cardiosport.html_

> (http://www.heartratemonitor.co.uk/cardiosport.html)

> _http://www.polarusa.com/consumer/default.asp_

> (http://www.polarusa.com/consumer/default.asp)

> Haze :)

Hi Haze, I can recommend the uk site - it's where I bought my watch from

and they gave me great service. Unfortunately it's only the top end

watches which record R-R intervals (the time between ventricular beats)

many of the watches - even those that link to a computer often only

record averages over certain periods- whilst these may still be useful

they wont record the beat to beat fluctuations seen in AF. (I'm sure

it's just a money making scam from the watch producers - the only

overhead will be the amount for memory in the watch, the lower end

models will still have to pick out R-R intervals to calculate averages)

The R-R interval provides enough data for my cardiologist to be

interested in the print outs.

If you want to browse a few more of my events point your browser at this

directory

http://james.dialsolutions.com/public/

I should throw in a word of warning that the watch is nowhere near as

good as an ECG. The data sometimes has a fair amount of noise in it and

interpreting some data is often tricky. The PC software has some error

correction functions but it's designed for NSR so it's best to not use

it. I use ECG gel on my watch strap which greatly reduces the noise on

the output but doesn't eliminate it.

I wouldn't want you to spend some money and worry that your heart was

dropping a lot of beats only to discover later that it's the chest strap

that's not recording every beat :)

--

D

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> , fascinating!

> Although Sports Heart rate monitors have been discussed thoroughly, so I do

> not frustrate anyone, lol, heres a UK link for Cardiosport Heart monitors

> and one for Polar.

> _http://www.heartratemonitor.co.uk/cardiosport.html_

> (http://www.heartratemonitor.co.uk/cardiosport.html)

> _http://www.polarusa.com/consumer/default.asp_

> (http://www.polarusa.com/consumer/default.asp)

> Haze :)

Hi Haze, I can recommend the uk site - it's where I bought my watch from

and they gave me great service. Unfortunately it's only the top end

watches which record R-R intervals (the time between ventricular beats)

many of the watches - even those that link to a computer often only

record averages over certain periods- whilst these may still be useful

they wont record the beat to beat fluctuations seen in AF. (I'm sure

it's just a money making scam from the watch producers - the only

overhead will be the amount for memory in the watch, the lower end

models will still have to pick out R-R intervals to calculate averages)

The R-R interval provides enough data for my cardiologist to be

interested in the print outs.

If you want to browse a few more of my events point your browser at this

directory

http://james.dialsolutions.com/public/

I should throw in a word of warning that the watch is nowhere near as

good as an ECG. The data sometimes has a fair amount of noise in it and

interpreting some data is often tricky. The PC software has some error

correction functions but it's designed for NSR so it's best to not use

it. I use ECG gel on my watch strap which greatly reduces the noise on

the output but doesn't eliminate it.

I wouldn't want you to spend some money and worry that your heart was

dropping a lot of beats only to discover later that it's the chest strap

that's not recording every beat :)

--

D

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I guess I was taking the discussion too literally as to what " feeling " a PAC

meant. Didn't mean to ruffle any feathers out there.

, my whole point was you can't distinguish a PAC by wrist pulse &

apparently you agree. It could be either.

End of discussion on my end.

Thor

Re: Re: 9 week PVA update

Snip - Distinguishing between a PAC and a PVC by feeling your

pulse is not possible, they both result in a ventricular contraction out

of time.

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I guess I was taking the discussion too literally as to what " feeling " a PAC

meant. Didn't mean to ruffle any feathers out there.

, my whole point was you can't distinguish a PAC by wrist pulse &

apparently you agree. It could be either.

End of discussion on my end.

Thor

Re: Re: 9 week PVA update

Snip - Distinguishing between a PAC and a PVC by feeling your

pulse is not possible, they both result in a ventricular contraction out

of time.

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>

>

> I guess I was taking the discussion too literally as to

what " feeling " a PAC meant. Didn't mean to ruffle any feathers out

there.

>

> , my whole point was you can't distinguish a PAC by wrist

pulse & apparently you agree. It could be either.

>

> End of discussion on my end.

>

> Thor

>

> Re: Re: 9 week PVA update

>

> Snip - Distinguishing between a PAC and a PVC by feeling your

> pulse is not possible, they both result in a ventricular

contraction out

> of time.

Now I need to revisit this. I just got back from an appointment with

my new cardiologist. Those of you who have seem my previous wailings

know I am having trouble finding a cardiologist here in RI whom I

feel comfortable with.

He told me two things I'd like a sanity check on:

1. I asked him about the THUMPs I have been feeling a few times a

day in my chest, and remarked that some people thought the force

meant they were PVCs (vs. PACs) but that what I had heard was that it

was impossible to distinguish them without an EKG. He says that's

wrong, that the THUMPs are PVCs. What's the word on this people, has

anyone else asked their cardiologists about this?

2. My old California cardiologist said I should not be on coumadin,

since I was doing well at that point, and I was 59. I was happy not

to be on it, since my Mom had had a bad hemorrhage on it. However,

if every few months I had some hours of afib or multiple ectopics a

minute, she had me come into the office for an ekg and a little

talk. When I asked her why, she said if the situations were long

enough, she'd want to put me on coumadin, but not cardiovert me

because her belief was that I'd always snap back into sinus by myself.

The new cardio says that because I have lone afib, my chance of a

clot is no greater than someone's without afib, regardless of how

long or how frequently I am in afib, so he was not going to put me on

coumadin ever until I reached 65.

This is a scary difference - is he right? If not, I run a clot risk,

esp. with things acting up.

Do I wish I could find a good cardiologist. I may drive up to Boston

at some point, esp. if things don't get good and solidly better.

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>

>

> I guess I was taking the discussion too literally as to

what " feeling " a PAC meant. Didn't mean to ruffle any feathers out

there.

>

> , my whole point was you can't distinguish a PAC by wrist

pulse & apparently you agree. It could be either.

>

> End of discussion on my end.

>

> Thor

>

> Re: Re: 9 week PVA update

>

> Snip - Distinguishing between a PAC and a PVC by feeling your

> pulse is not possible, they both result in a ventricular

contraction out

> of time.

Now I need to revisit this. I just got back from an appointment with

my new cardiologist. Those of you who have seem my previous wailings

know I am having trouble finding a cardiologist here in RI whom I

feel comfortable with.

He told me two things I'd like a sanity check on:

1. I asked him about the THUMPs I have been feeling a few times a

day in my chest, and remarked that some people thought the force

meant they were PVCs (vs. PACs) but that what I had heard was that it

was impossible to distinguish them without an EKG. He says that's

wrong, that the THUMPs are PVCs. What's the word on this people, has

anyone else asked their cardiologists about this?

2. My old California cardiologist said I should not be on coumadin,

since I was doing well at that point, and I was 59. I was happy not

to be on it, since my Mom had had a bad hemorrhage on it. However,

if every few months I had some hours of afib or multiple ectopics a

minute, she had me come into the office for an ekg and a little

talk. When I asked her why, she said if the situations were long

enough, she'd want to put me on coumadin, but not cardiovert me

because her belief was that I'd always snap back into sinus by myself.

The new cardio says that because I have lone afib, my chance of a

clot is no greater than someone's without afib, regardless of how

long or how frequently I am in afib, so he was not going to put me on

coumadin ever until I reached 65.

This is a scary difference - is he right? If not, I run a clot risk,

esp. with things acting up.

Do I wish I could find a good cardiologist. I may drive up to Boston

at some point, esp. if things don't get good and solidly better.

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> 1. I asked him about the THUMPs I have been feeling a few times a

> day in my chest, and remarked that some people thought the force

> meant they were PVCs (vs. PACs) but that what I had heard was that it

> was impossible to distinguish them without an EKG. He says that's

> wrong, that the THUMPs are PVCs. What's the word on this people, has

> anyone else asked their cardiologists about this?

I'm afraid I have to disagree with your new cardiologist on this Trudy -

I suspect an awful lot of us will testify to feeling these thumps

immediately before we go into AF - if we are to believe recent research

the majority of these ectopics originate in the pulmonary veins (which

will make them PACs). (and a PVC triggering AF would imply some

retrograde conduction)

I've shown many of my watch recordings to my cardiologist which indicate

ectopic beats but not there origin and have been told an ECG would be

the way to find out - not quite the same as asking him the question

directly but surely he would have said 'well if you feel the ectopic

it's a PVC if you don't it's a PAC'

I just did a quick web search and found this..

http://home.earthlink.net/~avdoc/infocntr/htrhythm/hrapbs.htm

> 2. [sNIP]

> The new cardio says that because I have lone afib, my chance of a

> clot is no greater than someone's without afib, regardless of how

> long or how frequently I am in afib, so he was not going to put me on

> coumadin ever until I reached 65.

>

> This is a scary difference - is he right? If not, I run a clot risk,

> esp. with things acting up.

I know this a sticky subject for many but this information seems to be

in line with a lot of research I've read. You are in charge Trudy, if

you are not happy with this decision further research and discussion

with your doctor is in order until you are comfortable with whatever

route you take.

I've made my views clear on many occasions here so I will try to resist

any replies to any 'better safe than sorry' responses that you get.

As ever I'm not a doctor and nothing in this message should be taken as

medical advice but it felt like I crossed a line when I wrote this

reply so I'm sticking this in :)

--

D

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> 1. I asked him about the THUMPs I have been feeling a few times a

> day in my chest, and remarked that some people thought the force

> meant they were PVCs (vs. PACs) but that what I had heard was that it

> was impossible to distinguish them without an EKG. He says that's

> wrong, that the THUMPs are PVCs. What's the word on this people, has

> anyone else asked their cardiologists about this?

I'm afraid I have to disagree with your new cardiologist on this Trudy -

I suspect an awful lot of us will testify to feeling these thumps

immediately before we go into AF - if we are to believe recent research

the majority of these ectopics originate in the pulmonary veins (which

will make them PACs). (and a PVC triggering AF would imply some

retrograde conduction)

I've shown many of my watch recordings to my cardiologist which indicate

ectopic beats but not there origin and have been told an ECG would be

the way to find out - not quite the same as asking him the question

directly but surely he would have said 'well if you feel the ectopic

it's a PVC if you don't it's a PAC'

I just did a quick web search and found this..

http://home.earthlink.net/~avdoc/infocntr/htrhythm/hrapbs.htm

> 2. [sNIP]

> The new cardio says that because I have lone afib, my chance of a

> clot is no greater than someone's without afib, regardless of how

> long or how frequently I am in afib, so he was not going to put me on

> coumadin ever until I reached 65.

>

> This is a scary difference - is he right? If not, I run a clot risk,

> esp. with things acting up.

I know this a sticky subject for many but this information seems to be

in line with a lot of research I've read. You are in charge Trudy, if

you are not happy with this decision further research and discussion

with your doctor is in order until you are comfortable with whatever

route you take.

I've made my views clear on many occasions here so I will try to resist

any replies to any 'better safe than sorry' responses that you get.

As ever I'm not a doctor and nothing in this message should be taken as

medical advice but it felt like I crossed a line when I wrote this

reply so I'm sticking this in :)

--

D

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, when you said:

I know this a sticky subject for many but this information seems to be

in line with a lot of research I've read.

I wasn't sure if by " this information is in line with research " you

meant the take coumadin advice or not take coumadin advice :-)

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, when you said:

I know this a sticky subject for many but this information seems to be

in line with a lot of research I've read.

I wasn't sure if by " this information is in line with research " you

meant the take coumadin advice or not take coumadin advice :-)

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In a message dated 4/19/04 5:01:16 PM Eastern Daylight Time, trudyjh@...

writes:

> Do I wish I could find a good cardiologist. I may drive up to Boston

> at some point, esp. if things don't get good and solidly better.

>

>

Trudy, who are you seeing in RI?

Rich O

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> , when you said:

>

> I know this a sticky subject for many but this information seems to be

> in line with a lot of research I've read.

>

> I wasn't sure if by " this information is in line with research " you

> meant the take coumadin advice or not take coumadin advice :-)

>

I meant that lone AFers under 65 with no other risk factors are at such a

low stroke risk that coumadin is not indicated :)

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