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Old 03-16-2015, 02:40 PM   #61
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Welcome to the Afib club Alan. Doesn't that make you feel better?

I've had a couple more events of it aside from the first. In the first I was having shortness of breath, rapid HR, and since I had a stethoscope by then I could tell from the sound of the heart that this was NOT a normal heartbeat. DW drove me to the ER and they did a cardioversion (electric shock) and sent me home ~45 minutes later. I got a mild rebuke for having DW drive me instead of calling an ambulance even though the latter takes more time. I asked if I could take some of the drug they gave me home and they just laughed. The drug put me to sleep in less than five minutes. They said it was in the same class as what Michael Jackson was taking and that no sane doc would use that as a sleep aid. Anyway....

The second time I could feel it - same symptoms - and when I was putting on a shirt to go to the ER it just reverted back to normal rhythm by itself. I let the doc's office know about it but they never called back so I guess that's a "normal" event.

ronboyd is correct. From what I've read about it and talked with the docs about it the threat is not from the Afib. Hardly anyone dies from that. The big threat is from stroke caused by the Afib - blood pools in the upper ventricles some of it may clot because it isn't moving through the heart. When the clot breaks loose it causes a blockage whenever it comes upon a restriction that it cannot pass through.

Needless to say I am very careful to take the prescribed meds on schedule and am almost fanatic about the gym routine and schedule. Never thought I'd be a gym rat but when the incentive is powerful enough....

BTW, I took a copy of the gym workout and BP/HR readings to the cardiologist and he was almost astonished - "Nobody ever does that!" was his comment.
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Old 03-16-2015, 02:43 PM   #62
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You do know that you should not have driven yourself if you suspected a heart problem, don't you? Oh, the embarrassment of waking up in the hospital... Best case scenario that is.
I know but it was either that or an ambulance as DW can't drive at night.
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Old 03-16-2015, 02:53 PM   #63
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Nice one Walt. Are the meds you take blood thinners, and how often do you take them?
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Old 03-16-2015, 03:13 PM   #64
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Nice one Walt. Are the meds you take blood thinners, and how often do you take them?
I'm on two at the moment, one for the stents installed last July and that was supposed to stop one year later. The Afib may change that so I'll have to see. That one is Clopidogrel (Plavix).

The other one started after the first event of Afib is Apixaban (Eliquis). Each one is once pill a day, I take one in the morning and one in the evening but the bottle doesn't say when, just once a day. My regular physician (internist) prescribed it.

The cardiologist raised an eyebrow at the latter since apparently being somewhat new it hasn't been fully tested for compatibility with Plavix. However, he said that "since it is clearly working for you I'd let it be". By that time it had been ~three weeks since the first event of Afib. The usual alternative is Wafarin (Coumadin) but that requires a lot of monitoring (blood tests) to make sure the dosage remains correct. Apparently with that one the correct dosage can be a moving target making it somewhat of a pita to use.

Sigh. So for now what they're using is working so I guess all is good....
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Measuring blood pressure and heart rate
Old 03-16-2015, 03:15 PM   #65
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Measuring blood pressure and heart rate

Thanks for sharing this Alan, puts all the normal discussion here into perspective. Hope this was just a one-time thing and all will be fine going forward.

I was getting dizzy awhile back. Turns out it was caffeine for me. I stopped drinking more than 12 ounces of coke and no more dizziness.
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Old 03-16-2015, 03:28 PM   #66
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Thanks for the details Walt. Both the Docs mentioned Coumadin and we know several family members and friends on that and understand how tricky it is initially to get the levels right. Given that we plan on leaving here 2nd or 3rd week in April for several months I'm really hoping not to have to face this prospect until we get back.
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Old 03-16-2015, 03:36 PM   #67
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Thanks for the details Walt. Both the Docs mentioned Coumadin and we know several family members and friends on that and understand how tricky it is initially to get the levels right. Given that we plan on leaving here 2nd or 3rd week in April for several months I'm really hoping not to have to face this prospect until we get back.
This is not something you want to hear but (talk to your doc first of course) but I think I'd put that anticoagulant on the front burner. Especially if you have a second event of Afib.

Having a stroke can make all other plans vanish in one day.
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Old 03-16-2015, 03:42 PM   #68
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Thanks for the details Walt. Both the Docs mentioned Coumadin and we know several family members and friends on that and understand how tricky it is initially to get the levels right. Given that we plan on leaving here 2nd or 3rd week in April for several months I'm really hoping not to have to face this prospect until we get back.
I have been on warfarin (Coumadin) for fifteen years and rarely need to adjust the dosage. And, even then, it is very minor... a half tablet a week up or down.

The upside is that I use an office visit to run the test rather than do the testing myself. That way I get a "physical exam" every 8 weeks. My copay is $10 and the warfarin is another $6.00 (3-month supply) at Walmart.

I am very skeptical of these "new" drugs for blood thinning... even if only to be curious about who's paying for all that TV advertising. Both my PCP and my cardiologist have recommended against them for me personally.
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Old 03-16-2015, 06:33 PM   #69
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another asymptomatic Afib'r here. Happens mostly when I exercise intensely. I found it looking back @ my heart monitor records from my workouts and have had it for at least 4 years.

The only scary part for me was when they put me on a Holter monitor to capture an event. I captured one and uploaded it to the service. They looked at the result and called an ambulance to take me to emergency room because there were a couple of beats that looked like Vtach (apparently Very serious).

So I am in my biking gear and they have me lie on the floor and hook me up to monitor, IV, etc. while my wife and kids are standing around.

In the end nothing to worry about - now cardiologist is just watching it.


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Old 03-16-2015, 06:54 PM   #70
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another asymptomatic Afib'r here. Happens mostly when I exercise intensely. I found it looking back @ my heart monitor records from my workouts and have had it for at least 4 years.

The only scary part for me was when they put me on a Holter monitor to capture an event. I captured one and uploaded it to the service. They looked at the result and called an ambulance to take me to emergency room because there were a couple of beats that looked like Vtach (apparently Very serious).

So I am in my biking gear and they have me lie on the floor and hook me up to monitor, IV, etc. while my wife and kids are standing around.

In the end nothing to worry about - now cardiologist is just watching it.


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Encouraging - thanks. A few things I will put into place after doing some reading today, and seeing the feedback here.

1) Don't panic. This was my first instance of Afib and it corrected itself. Worrying excessively is going to increase the chances of it happening again

2) Cut back on the real heavy aerobic exercise and do more yoga type exercise. Controlled breathing is good.

3) Cut out or greatly reduce caffeine and alcohol. I often have 3 drinks in an evening, and while DW drinks no caffeinated drinks after lunch I don't hold back.

4) Keep control of weight and BP (both are in range currently)

5) Drink plenty of fluids to stay hydrated
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Old 03-16-2015, 07:11 PM   #71
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Alan,
Glad to hear you will be evaluated by a cardiologist. Be sure to mention that, although infrequent, occasionally your heart rate will drop to 35 or 36. I think that's a significant piece of medical history. In addition to a EKG, I would predict the cardiologist may order an echocardiogram to look for any abnormal heart valve leakage (regurgitation), wall motion abnormalities, heart chamber size, or existing blood clot (thrombus) in the atrial heart chamber. If he/she thinks your history is reliable in that you only had brief episodes of arrhythmia, he may decide to forego any anticoagulant and instead place you on an antiarrhythmic to keep your heart in a normal sinus rhythm. Don't fret about getting a electrical cardioversion -- they only reserve that for people who are symptomatic or who fail chemical cardioversion. Let us know how your appointment on the 25th goes.
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Old 03-16-2015, 07:42 PM   #72
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Alan,
Glad to hear you will be evaluated by a cardiologist. Be sure to mention that, although infrequent, occasionally your heart rate will drop to 35 or 36. I think that's a significant piece of medical history. In addition to a EKG, I would predict the cardiologist may order an echocardiogram to look for any abnormal heart valve leakage (regurgitation), wall motion abnormalities, heart chamber size, or existing blood clot (thrombus) in the atrial heart chamber. If he/she thinks your history is reliable in that you only had brief episodes of arrhythmia, he may decide to forego any anticoagulant and instead place you on an antiarrhythmic to keep your heart in a normal sinus rhythm. Don't fret about getting a electrical cardioversion -- they only reserve that for people who are symptomatic or who fail chemical cardioversion. Let us know how your appointment on the 25th goes.
Good point, I will tell him about the occasional low heart rates in the 30's. And thank you for the reassurances. I did have stress test with a cardiologist in 2008 when my HR was 39 on the EKG during my annual physical at work, but I've not had an echocardiogram before.
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Old 03-16-2015, 07:58 PM   #73
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but I've not had an echocardiogram before.
Yeah, I forgot about the echocardiograms. I had two types. The first was the Transesophageal Echocardiogram (TEE) where they stick a tube down your throat to look at the back side of the heart. I didn't like that at all... even though I was under general anesthesia. A year later, I had a normal (regular?) one with the jelly all over the chest. and then a year or so later another one (The regular kind) to compare it to the first. It has not been suggested since.

The issue here, if I understand it correctly, is that with a rapid heart rate your heart like all other muscles can increase in size. This expansion causes the valves to not seal properly.
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Old 03-17-2015, 06:57 AM   #74
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You guys start a monitoring thread and then switch the topic to a bunch of scary S*it.
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BTW, I took a copy of the gym workout and BP/HR readings to the cardiologist and he was almost astonished - "Nobody ever does that!" was his comment.
I have found that the machines in the gym I go to don't read accurately any more... so telling my cardiologist those numbers would be worthless. I would have to test other meters to see if they'd measure accurately. My Omron seems to be reasonably correct.

A couple years ago @ 51 I experienced a couple of intense light headed spells that were very short lived in the middle of a day when sitting. Two days later while checking into a hotel (business trip), I experienced the same thing but also lost my vision for a short period. When it happened, I noted to the hotel clerk that "something is not right" and she responded with "do you want me to call an ambulance?" I said no... the feeling went away, and I checked in and went to my room. The morning of the second day after checking in, I got up early and ws waiting for some people on a coach in the hotel lobby when I had the feeling again. I blacked out twice, the second time I remember having to sit back up as I had slumped over. I flew home that morning and had DW pick me up from the airport and went to the ER (emergency room... not early retirement ).

I'll skip some of the details.. When the episodes were not happening... I felt fine. I was admitted and was passing all the tests. They were about to send me home, but one test was taken late so they kept me overnight so he could read it in the morning. That night I have 3 more light headed episodes... the constantly monitored EKG did not alarm. After the second one I gave them the gory details of it and the nurse looked back through the electronic records. She found it, the signals on the top of the heart were just fine... but every now and then the signals on the bottom vanished.

So they fitted me with shiny new pacemaker (I think it was shiny and new) that paces conditionally. I did not like the idea at all when they first told me that I was getting one.
Limitations...
  1. Will not let my heart rate go below 50 -- doc does not want to be called in the middle of the night by ER thinking I have arrhythmia.
  2. Will not let my heart rate go above 150 -- limit of the tracking of this pacemaker... advantage of this pacemaker is that I can still get MRIs.
  3. EMI Issues, such as cannot work on a car under the hood while running -- need to keep away from ignition system or other high EMI sources. Note that I spend most of my career working in high EMI projects.
  4. Many HR meters don't read accurately when the pacemaker is pacing. Omron seems fine, machines at the gym just don't work reliably.
Orders from the cardiologist on exercise... whatever you were doing before... keep on doing it. If the strap from the backpack bothers you (where it crosses the pacemaker)... just get a pad to cover it. I can still push DW when hiking even with the 150bpm limitation.

Alan... hope all goes well. Hopefully the resulting treatment will not be too limiting.

ER's @53 ... this month. Now that it is warming up... time to get hiking!
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Old 03-17-2015, 07:08 AM   #75
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wow bingybear - that sounds scary. Glad they caught it and that it didn't get you on the flight home!

I just got the "no HR over 150" recommendation - not due to a pacemaker but to an aortic aneurysm. Apparently the higher the HR, the higher the blood pressure (I have naturally low BP) so they want me to avoid that. It meant no more bike racing but other than that 150 isn't big limiter for most exercise. Enjoy your hiking!


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Old 03-17-2015, 07:27 AM   #76
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I just got the "no HR over 150" recommendation - not due to a pacemaker but to an aortic aneurysm.
Mine is a pacemaker limitation. The cardiologist noted I would have to really convince him that allowing a higher heart rate in exchange for not getting MRIs for the rest of my life was worth it. He expects that there will be a PM that is MRI compliant before the time I need to get mine changed. When I push it at the gym... I do hit the 150 limit... but I'm running at about 160-175% of DW calorie burn rate or so when I do it.

It was more scary when I found out what it was and that the escape mechanism was not robust (would not reliably restart). Just lucky I guess.
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Old 03-17-2015, 05:01 PM   #77
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I have found that the machines in the gym I go to don't read accurately any more... so telling my cardiologist those numbers would be worthless. I would have to test other meters to see if they'd measure accurately. My Omron seems to be reasonably correct.
Oh, I'm not relying on the HR readouts from the gym equipment, these are the hand-written records that I keep from the old-fashioned BP cuff and stethoscope kit that I bought at Walgreens.

Alan:
If they ever do have to do a cardioversion it wasn't anything to get too worried about, at least according to the ER doc. The equipment looks intimidating. In addition to the other wiring they attach to you, there are a couple of big "paddles" that look like they're going to do a shock as if to restart the heart as shown on TV, but these stick on. (BTW, they keep those things in the freezer - at least that's what it felt like when they went on.) The doc said I might have some muscle soreness in the chest afterward because of the sudden contraction but I did not experience that.

And of course I was "out" when it actually happened so have no memory of it.
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Old 03-17-2015, 05:13 PM   #78
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Oh, I'm not relying on the HR readouts from the gym equipment, these are the hand-written records that I keep from the old-fashioned BP cuff and stethoscope kit that I bought at Walgreens.
.
The exercise machines were quite accurate before pacemaker. From my understanding the pacemaker can screw up many of the electronically sensed HR monitors... not just exercise machines. When I first got my pacemaker, I had issues with it going into distress mode. As the exercise machines did not report HR correctly, I just approximated it using a finger on the neck and just guessing the time factor. This worked well for what it was. They use a stress test to figure out what tweaks needed to be done with the pacemaker. It was going into distress and beating between 70 and 80bpm when it should have been in the 130-140 range.
hmmm... sounds like a project.
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Old 03-17-2015, 07:42 PM   #79
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Alan:
If they ever do have to do a cardioversion it wasn't anything to get too worried about, at least according to the ER doc. The equipment looks intimidating. In addition to the other wiring they attach to you, there are a couple of big "paddles" that look like they're going to do a shock as if to restart the heart as shown on TV, but these stick on. (BTW, they keep those things in the freezer - at least that's what it felt like when they went on.) The doc said I might have some muscle soreness in the chest afterward because of the sudden contraction but I did not experience that.
Yeah, I was under general anesthesia when they did mine. The only negative result that I had was similar to a bad sunburn on a square section of my chest and back.

Unfortunately, they had discovered my A. Fib. well after it had become permanent -- probably two or more years -- so the cardioversion was simply a waste of time... well, it probably made a yacht payment.

It did, however, put me back in Sinus Rhythm for about two hours.

Nevertheless, that was fifteen years ago. I am sure medicine has advanced somewhat since then. <chuckle>
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Old 03-17-2015, 08:17 PM   #80
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Alan - sorry to hear you've gone through this scary stuff.

DH has afib when he's under a lot of stress. He quit a job because of the stress and pressure - he landed in the ER twice from afib attacks after blame-game meetings. The first response was to put him on coumadin but he resisted - and after discussion with the cardiologist it was agreed that he didn't need it. Basically, he hasn't had any incidents since he reduced coffee intake dramatically and reduced stress dramatically. He got the all clear from the cardiologist that these changes seemed to do the trick.

He said it was VERY scary. I found out about both ER visits after the fact (GRRRR) and both times he drove himself (double GRRRR... he should have called me!!!) It's been 5 years since this all happened and his annual checks continue to be fine.
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