Thread: Atrial fibrillation

Originally Posted by mikm

I'm curious to know if anybody has any experience with AF? I've had two episodes since the first in August and the experts still have me popping beta blockers and warfarin like there is no tomorrow. Scared the cr@p out of a fit and otherwise healthy 34 year old when it decided to fire up the first time...
Cheers,
Mick

Yep. And I've even been jump-started with the paddles once. But it sounds to me like you're getting over-medicated. It sounds to me that you are experiencing what is called "episodic AF". I am not a doctor. As you would know, the reason for the warfarin is to stop you from getting a stroke. Well, there are other problems with warfarin. Let's put it this way, it's not a good drug for woodworkers, since we tend to see a bit of blood now and then.

And if you are not experiencing the AF regularly, that means that your sinus rhythm is OK....normal...and you don't need to prevent a stroke. You are only vulnerable when the blood might be pooling, during an AF episode.

The beta-blocker strategy is an interesting one. I've read heaps about this stuff, and it's not the only way to go. If it's working well, then great, and you will only experience slight side effects from the blockers, notably, huffing and puffing when exerting. My experience was that it actually made things worse. I'm on nothing at all right now and have only occasionally had an episode. I have some digoxin in my drawer, and I have instructions from the cardiologist that go like this:

1.Move into a position where you can rest quietly
2. Take 2 x 0.25 tablets of Digoxin and continue to rest
3. If, after 6 hours AF is persisting, take 1 x 0.25mg of Digoxin
4. If , after 12 hours AF is still presting, you can either:
-come into hospital, especially if you were taking Digoxin already)
OR
-take another 0.25 of Digoxin
5. IF AF is present after 24 hours, then you should go to hospital

IF YOU DEVELOP CHEST PAIN OR FEEL DISTRESSED, COME TO HOSPITAL IMMEDIATELY

I've followed these instructions on, I think, 3 occasions, and it's gone away, not to return for usually about 6 months. All people are different, but the bad news is, that once you've got it, you're likely to experience it again.

The good news is, it's not life-threatening in and of itself. Some people live a very long life indeed with it, and in the end it's not what gets 'em.

Why not ask your quack about this? I can give you the name and whereabouts of my own cardio guy, who is terrific....just PM me, and I can do that for you. But your own person should be able to advise based upon what I've typed above.

Don't worry. It's just an electrical problem, so you want to solve it without the use of sledge hammers and plastic explosives.

Good luck. Get a carotid scan to make sure that your arteries are OK, and just accept it gracefully. I too am a fit and healthy person, and you may take some consolation from the fact that AF often strikes people who have been long-distance runners, and elite athletes. I was a runner and a cycler of great distances, and a mountain climber.

All the best, Mick.

Michael

Thanks for your thoughts, Michael. I have been told I have some dodgy electrics in an otherwise healthy heart. The also tell me that yes, I am very likely to get it again, and no, it's not likely to kill me (although it took quite a while for me to find that out). It's just a major pain in the butt.

I am in the last two of six weeks on warfarin since I was cardioverted - SOP with cardioversion. I was in the process of weaning off the beta-blockers from the first episode when it sturck again, so they have wacked me back on them again. I am fairly confident that my cardiologist is making the right call on the medication, given my particular symptoms and risk factors. For instance, according to good ol' wikipedia, digoxin is reputed to increase the force of contraction of the heart - my heart often really beats hard with a normal rate and rhythm, so any more and it would jump out of my chest. So, I suspect the medication is probably on the money, I'm just b1tching about it since I can't have a beer and have to time when I eat while I'm on the drugs.

For those that havent heard of it, cardioversion is kind of fun. Very similar to the movies where someone lubes up the paddles, yells "Clear!" and a stiff jumps around on a stretcher. To revert AF, they stick conductive pads on the front and back of your chest, hook you up to a machine, press the go button and step back. The hardware decides the correct timing within your heart beat and then gives you a belt to shock the heart back into normal sinus rhythm. The patient is under a general, but I was awoken from my sheep count on the last one by every muscle in my upper body contracting and all the air getting squeezed out of my lungs . I have no recollection of the first one, though.

I am told if I go back into AF 'too often' (this hasn't really been clearly defined, but I suspect the number is four, + or -1 in my case), I will be advised to have RF ablation. Two procedures are supposed to give me an 80% chance of cure. Probe(s) are inserted into the femoral artery, fed up to the heart and used to deliver rafio frequency energy to stratecigally burn sections of the heart muscle. The intention is to create scar tissue to remove the unwanted electrical pathways which cause the rapid erratic heart beat. The first time the ambos arrived, my resting heart rate was peaking at 220 bpm .

One thing I have found quite frustrating with this business is that with the exception of the cardiologist, no-one is prepared to give an opinion on anything or to provide any useful advise at all. Because these idiots (medicos at the emergency department) are so hamstrung by their all-consuming fear of being sued, not one of them has the plums to say anything except "Oooh, its your heart. If you notice any symptoms, go straight to hospital, or you could DIE!!!!" One of the indicators of AF is stress. With nothing but that useless advice for the first two months (untill I could get in to see a private cardiologist) I was panicking with every pectoral twinge. Nurse-on-call was just as bad, they would always tell me to go straigt to the emergency department, preferably by ambulance. I would dutifully do as I was told and go in, only to waste my time and their resources watching a nice sinus rhythm on the ECG for 12 to 24 hours.

Apologies for the rant, but its still slightly frustrating...
I still need to get the sentiments of

just accept it gracefully. I too am a fit and healthy person, and you may take some consolation from the fact that AF often strikes people who have been long-distance runners, and elite athletes. I was a runner and a cycler of great distances, and a mountain climber.

a bit firmer in the grey matter.

Originally Posted by mikm

Thanks for your thoughts, Michael. I have been told I have some dodgy electrics in an otherwise healthy heart. The also tell me that yes, I am very likely to get it again, and no, it's not likely to kill me (although it took quite a while for me to find that out). It's just a major pain in the butt.

I am in the last two of six weeks on warfarin since I was cardioverted - SOP with cardioversion. I was in the process of weaning off the beta-blockers from the first episode when it sturck again, so they have wacked me back on them again. I am fairly confident that my cardiologist is making the right call on the medication, given my particular symptoms and risk factors. For instance, according to good ol' wikipedia, digoxin is reputed to increase the force of contraction of the heart - my heart often really beats hard with a normal rate and rhythm, so any more and it would jump out of my chest. So, I suspect the medication is probably on the money, I'm just b1tching about it since I can't have a beer and have to time when I eat while I'm on the drugs.

For those that havent heard of it, cardioversion is kind of fun. Very similar to the movies where someone lubes up the paddles, yells "Clear!" and a stiff jumps around on a stretcher. To revert AF, they stick conductive pads on the front and back of your chest, hook you up to a machine, press the go button and step back. The hardware decides the correct timing within your heart beat and then gives you a belt to shock the heart back into normal sinus rhythm. The patient is under a general, but I was awoken from my sheep count on the last one by every muscle in my upper body contracting and all the air getting squeezed out of my lungs . I have no recollection of the first one, though.

I am told if I go back into AF 'too often' (this hasn't really been clearly defined, but I suspect the number is four, + or -1 in my case), I will be advised to have RF ablation. Two procedures are supposed to give me an 80% chance of cure. Probe(s) are inserted into the femoral artery, fed up to the heart and used to deliver rafio frequency energy to stratecigally burn sections of the heart muscle. The intention is to create scar tissue to remove the unwanted electrical pathways which cause the rapid erratic heart beat. The first time the ambos arrived, my resting heart rate was peaking at 220 bpm .

One thing I have found quite frustrating with this business is that with the exception of the cardiologist, no-one is prepared to give an opinion on anything or to provide any useful advise at all. Because these idiots (medicos at the emergency department) are so hamstrung by their all-consuming fear of being sued, not one of them has the plums to say anything except "Oooh, its your heart. If you notice any symptoms, go straight to hospital, or you could DIE!!!!" One of the indicators of AF is stress. With nothing but that useless advice for the first two months (untill I could get in to see a private cardiologist) I was panicking with every pectoral twinge. Nurse-on-call was just as bad, they would always tell me to go straigt to the emergency department, preferably by ambulance. I would dutifully do as I was told and go in, only to waste my time and their resources watching a nice sinus rhythm on the ECG for 12 to 24 hours.

Apologies for the rant, but its still slightly frustrating...
I still need to get the sentiments of a bit firmer in the grey matter.

Sounds like you are on the proverbial case. It is a major pain, but it's better than some other things that befall people. The stress angle is an interesting one. My first episode came after having got the flu while flying around the country on a very stressful business trip. I had a nose that was dripping like a tap, not a good look in a business setting....so I got some over-the -counter medication at the Sydney airport. It certainly dried up my nose, but that's what set off the AF. Turned out the stuff had atropine in it.

Since all that stuff happened, it's been about 3 years. I changed jobs as it turned out, and focused in on my woodworking. I live a pretty peaceful life now and I never have to wear a suit. Funny how the heart thing has faded out.

I hope you make whatever adjustments to your lifestyle that you might need to make. This could just be a "sign" for you. If it's just something that a medico-sparky can get under the bonnet and fix, well...be grateful that you live in an advanced country. Imagine having AF and living in someplace like Af-bloody-ghanistan!?

All the best, and may your heartbeat be regular.

Michael

Thanks mate.

...should that have been "May the sinus rhythm be with you"?...

Mick, About 15 years ago I started to have mini bllackouts ,only lasted for a couple of seconds. I thought they were caused by stress as I was in the process of selling my buisness and retireing. When they still occured after retirement it was about time to do something about it. To cut a long story short I had Atrial Fibulation and Venticular tachycardia combined,hence miniuum blood flow to the brain which caused the blackouts.
Early medication I was perscribed was AMIODRONE ,they bloody near killed me, warfarin also had a bad effect on me ,arms ,hands and legs bled at the slightest touch.
Employed a new cardioligist, a few tests (can't rember them all ,now 7 years ago) new medication was perscribed ,2 - 100mg Tamborcor daily, and 1/2 a solprin to keep the blood flowing.
I enjoy a we glasses of wine and a whiskey (don't tell my Doc) without any effects on the medication.
Mick many people have AF, don't worry over it enjoy life.
all the best Nine Fingers.

Worst feeling I've ever experienced. Was treated with Amiodrone and the wooblies stopped. Continued on medication for about a month then the doc weaned me off. No Warfarin was prescribed and I've had no problems since.

Friend has dicky electrical circutry and had an ablation done but has to be careful with strenuous activity and is on medication.

The Warfarin bit is new to me. Seems like overkill.

Thanks, NF. I seem to remember VT is much more of a worry than AF, so having them combined must be a bit of a handful.

Originally Posted by artme

The Warfarin bit is new to me. Seems like overkill.

Nah, it's all good. Rat poison is standard procedure after cardioversion puts you back in sinus rhythm. Blood can pool and clot in the bottom of the atria (particularly the left atrium, I think) during AF as they dont contract properly, presenting a stroke hazard once you get back into sinus and have complete emptying of the chambers. To counteract that, they thin you out for four to six weeks just to make sure there are no clots floating around.

My 38 year old son has this problem and has been paddled 6 or 7 times to get him back into sync.
His doctor after a lot of questioning worked out that his was caused by having ice cold drinks. The coldness of the drink passing the heart was causing it to go out of sync. Since that he has been careful with the temperature of his drinks and on the couple of occassions that he has had it recently he has had cold drinks. He has been on warfarin as well and goes to a specialist regularly. Luckily his medical insurance with his employer picks up the tab.

I also had it 5 weeks ago after a heart bypass operation but they have fixed it with medication. Apparently it is quite common after these ops

I read this post in fascination. This must be a frightening ailment to live with and I wish you all the best in getting on top of it.
Happy New Year.

CHADS Squared (CHADS^2) indication for warfarin...

C - cardiac failure
H - Hypertenion
A - Age > 75
D - Diabetes
S - Previous stroke/TIA

1 point for each, 2 point for stroke

3 point = life is better with warfarin
2 point = depends, aspirin or warfarin
1 point = life is better with aspirin


Interesting stuff...
34 and otherwise healthy... scores you... zero.

Of course always depends on individual, life style and other illnesses.


More random stuff...

I think it's around 50% of episodes people won't know they're in AF even though they are risk of stroke. Therefore, not feeling it is not a reason to stop medication.

VT is bad. Shock that one.

Thanks, Prozac.
As previously mentioned, the first episode scared the bejeezus out of me, but I just find myself irritated by it now. Funny what you get used to.

Originally Posted by BozInOz

34 and otherwise healthy... scores you... zero.

Boz, don't get me started!
I have mentioned exactly the same thing to every doctor or cardiologist involved and it just falls on deaf ears. The medical system in this country seems almost paralysed with fear of litigation. "It doesn’t matter if we can treat it with a band-aid, you're getting eight stitches and a skin graft, just in case you decide to sue".

My background is science and engineering where we usually trust most information found in textbooks and peer reviewed journals. It seems bizarre to me that information commonly held to be reliable fact such as CHADS is routinely ignored in favour of (possibly) excessive caution.



Having moaned about all that, sucking down warfarin for a month or two is not that arduous a task in the interests of avoiding death, even if the risk was very small.