Antibiotics: Furosemide

Atrial septal defect is an abnormality of the upper chambers of the heart (atria) where the wall between the right and left atria does not close completely. In general the defect is a hole in the wall (septum) between the top two chambers of the heart (atria). Arial septal defects occur in 4 percent to 10 percent of all children born with congenital heart disease. As a group, atrial septal defects are detected in 1 child per 1500 live births. Smaller atrial septal defects may close on their own during infancy or early childhood. The health effects of holes that remain open often don't show up until last age — usually by age 40. Many people don't realize they have an atrial septal defect until then. Sometimes a doctor detects an atrial septal defect during a newborn exam, or during a routine exam later in life. Large and long-standing atrial septal defects can damage the heart and lungs. An who has had an undetected atrial septal defect for decades may have a shortened life span from heart failure or high blood pressure in the lungs. For children with very small ASDs, the ASD closes on its own about 90% of the time. However, most other ASDs must be closed. People with some types of heart defects, including certain rarer forms of ASD, are at greater risk of developing bacterial endocarditis, an infection of the inner surface of the heart.

The term "atrial septal defect" usually refers to holes in the atria resulting from a lack of atrial septal tissue, rather than those related to a condition called patent foramen ovale (PFO). Symptoms usually have manifested by age 30. Infants with larger atrial septal defects may have poor appetite and not grow as they should. Infants may have signs of heart failure or arrhythmias. Congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome. A genetic counselor can predict the approximate odds that any future children will have one. An atrial septal defect allows oxygen-rich (red) blood to pass from the left atrium, through the opening in the septum, and then mix with oxygen-poor (blue) blood in the right atrium. Complete closure occurs in most individuals. In 25-30% of normal hearts, however, a probe can be passed from the right atrium to the left atrium via the foramen ovale and ostium secundum.

The person also could develop heart or blood vessel damage and be at increased risk of having a stroke or getting a heart infection. Congenital heart defects of significance occur in approximately 8 in 1000 live births. Surgical closure of the defect is recommended if the atrial septal defect is large or if symptoms occur. Anticoagulants, often called blood thinners, can help reduce the chances of developing a blood clot and having a stroke. Anti-coagulants include warfarin (Coumadin) and anti-platelet agents such as aspirin. Keep the heartbeat regular. Examples include beta-blockers (Lopressor, Inderal) and digoxin (Lanoxin). Prophylactic (preventive) antibiotics should be given prior to dental procedures to reduce the risk of developing infective endocarditis. Embolization (dislodgement of thrombi) normally go to the lung and cause pulmonary emboli. In an individual with ASD, these emboli can potentially enter the arterial system. In most cases, atrial septal defects can't be prevented. Consider talking with a genetic counselor before getting pregnant.

Treatment for Atrial Septal Defect Tips

1. Surgical closure of an ASD involves opening up at least one atrium and closing the defect with a patch under direct visualization.

2. Embolization (dislodgement of thrombi) normally go to the lung and cause pulmonary emboli.

3. Keep the heartbeat regular. Examples include beta-blockers (Lopressor, Inderal) and digoxin (Lanoxin).

4. Increase the strength of the heart's contractions. Examples include digoxin (Lanoxin).

5. Decrease the amount of fluid in circulation. Doing so reduces the volume of blood that must be pumped. These medications, called diuretics, include furosemide (Lasix).

6.Prophylactic (preventive) antibiotics should be given prior to dental procedures to reduce the risk of developing infective endocarditis.

Sleeping Medication - A Fast and Easy Overview

You keep hearing of so many new and different sleeping medications in the market. Each one is touting its benefits and superiority over others. You want to make sense of all that information so you'll know how to talk to your doctor or get one over the counter.

Firstly, here's how sleeping medications are broadly grouped based on the sleeping problem being treated.

Sleeping medication to help you fall asleep
Sleeping medication to help you stay asleep
Sleeping medication to help you when you can't sleep and are depressed at the same time

Next, you then need to know the 4 classes of sleeping medication that fall under the groups above. They are:

1. The "Z" Drugs:

They are the newest, most talked about and most expensive class of drugs used today. This class of sleeping medication is the non-benzodiazepines or "Non-Benzos" and sometimes called the ''Z'' drugs. They are popularly used because they achieve comparable efficacy with lesser side effects compared to the older generation of drugs i.e. the benzodiazepines.

Lunesta (eszopiclone)
Sonata (zaleplon)
Ambien (zolpidem)
Rozerem (ramelteon), the newest kid on the block


However, all of this sleep medication may cause severe allergic reaction, facial swelling and complex sleep-related behaviors such as sleep-driving and preparing and eating food while asleep. Bizarre sleep-walking has caught much attention of the public. In one of these cases a patient woke with a paintbrush in her hand after painting the front door to her house. Another case involved a woman who gained 23 kilograms over seven months while taking zolpidem. "It was only when she was discovered in front of an open refrigerator while asleep that the problem was resolved," according to the report.

All the non-benzodiazepines can be used to help you fall asleep. Lunesta and Ambien CR (extended release) can additionally help you stay asleep.

2. The "Benzos":

Benzodiazepines are the oldest class of sleeping medication and formerly the most commonly used treatment for insomnia. Due to the issues of inappropriate use (abuse), dependence, side effects such as memory or movement impairments, and next-day "hangover", these sleeping medications are now prescribed with greater caution. This explains why the "non-benzos" are today's favored and first line treatment of insomnia.

Dalmane (flurazepam)
Doral (quazepam)
Halcion (triazolam)
Prosom (estazolam)
Restoril (temazepam)


Even so, benzodiazepines remain a viable treatment option as some practitioners feel they offer better value than the newer more expensive non-benzodiazepines. As it is, proprietary or "branded" drugs like Dalmane and Restoril, sell in generic versions for only 30 to 50 cents each.

''We tend to use the old benzodiazepines,'' one medical practitioner explained. ''They appear to be as effective as some of the newer ones, and they're infinitely less expensive.''

Halcion (triazolam) is popularly used to help you fall asleep while Restoril (temazepam) and estazolam (a benzodiazepine derivative) are used to help you stay asleep.

3. The Antidepressants

You would have heard of antidepressants being used for their sedative side effects to treat insomnia.

Desyrel (trazodone)
Elavil (amitriptyline)
Sinequan (doxepin)


In fact, the inexpensive antidepressant trazodone is the most commonly prescribed sleep medication for the treatment of insomnia in the United States (NIH conference 2005). Yet, the FDA has not approved it officially for insomnia treatment. This is possibly due to lack of long-term studies. As with all antidepressants, there is an inherent small but significant risk of suicidal thoughts or worsening of depression.

Antidepressants i.e. Pamelor (nortriptyline), Desyrel (trazodone), amitriptyline are drugs that help you when you can't sleep and are depressed at the same time.

4. The "Over-the-counter" Sleeping Medication

The main ingredient of over-the-counter sleeping medication is an antihistamine. Antihistamines are mainly used to treat allergies. There are 2 types of antihistamine compounds i.e. doxylamine and diphenhydramine. Again, it is their sedative side effects that make you sleepy.

Unisom (Doxylamine compound)
Sleepinal (Doxylamine compound)
Benadryl (Diphenhydramine compound)
Nytol (Diphenhydramine compound)
Sominex (Diphenhydramine compound)

It must be noted that other popular brands like Tylenol PM and Advil PM combine the antihistamine with the painkillers acetaminophen and ibuprofen respectively. You may be taking on additional risks with painkillers you don't need. Generally, while these OTC sleeping medications can have a mildly positive effect on short-term insomnia, the infamous next-day drowsiness can be common and severe. Not to mention tolerance to the sleep medication can easily develop in just a few days.

LASTLY, just be mindful of this fact: Sleeping medication is usually used for short periods of time (7-10 days, maximum 2 weeks). This is because they may lose their effectiveness over time. Don't use more or longer than you need to. Insomnia or sleeplessness is usually a symptom of an underlying problem.

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