Arterial Fibrillation

[The Charlatan]

I had an aortic valve replacement at a young age and I was told that it wouldn't be a surprise if this developed.

Well I'm nearly 30 now and it seems to have started. I look after myself, not overweight and exercise regularly. Does anyone know how their episodes are set off, and how they remedy them?

Had an episode that gave me a fright last night. Felt like my atria and ventricles were contracting and expanding in unison although one strange thing about my episodes is that I don't really suffer from tachycardia.

Does anyone else suffer from this and care to share their experiences?

 

[Pantherjim.]

I had an aortic valve replacement at a young age and I was told that it wouldn't be a surprise if this developed.

Well I'm nearly 30 now and it seems to have started. I look after myself, not overweight and exercise regularly. Does anyone know how their episodes are set off, and how they remedy them?

Had an episode that gave me a fright last night. Felt like my atria and ventricles were contracting and expanding in unison although one strange thing about my episodes is that I don't really suffer from tachycardia.

Does anyone else suffer from this and care to share their experiences?

Have never suffered from it, but being a former Cardiology Nurse I have certainly treated it.

It's an abnormal heart rhythm caused by a disturbance in your heart's electrical system. It's one of the most common arrhythmias in existence.

Basically your atria (the top chambers of you heart) aren't fully contracting and pushing all the blood down to the ventricles (lower chambers) they're only quivering.

May I ask how long you've had it for? You may be able to get a cardioversion done if you've only had it for a short time. (They put you to sleep and shock you back into normal heart rhythm with a defibrillator)

Get your GP to refer you to a good Cardiologist, and they'll take it from there. Also your GP may need to consider putting you on a medication like wafarin to prevent the formation of blood clots. Unfortunately as the atria aren't contracting fully, there's a chance that the blood remaining in the atria can stagnate and form clots, increasing your risk of having a stroke.

Get a good Cardiologist and you'll be fine.

 

[The Charlatan]

Thanks Jim. I already am on Wafarin because of the replacement valve so the clots shouldn't be too much of an issue.

I haven't had the episodes for long, maybe 3-6 months that I've noticed.

Saw the GP about it. He I think he called mine "paroxysmal" which I think means it's episodic rather than all the time (at least that's how I interpreted it?) and I have a TTE booked in for early February. Hoping for positive results. How effective is cardioversion? Is it periodic treatment or is it meant to fix it permanently?

 

[Pantherjim.]

Thanks Jim. I already am on Wafarin because of the replacement valve so the clots shouldn't be too much of an issue.

I haven't had the episodes for long, maybe 3-6 months that I've noticed.

Saw the GP about it. He I think he called mine "paroxysmal" which I think means it's episodic rather than all the time (at least that's how I interpreted it?) and I have a TTE booked in for early February. Hoping for positive results. How effective is cardioversion? Is it periodic treatment or is it meant to fix it permanently?

If it's paroxsysmal AF (fluctuating from atrial fibrillation to normal heart rhythm and back again) you probably do not need a cardioversion. Cardioversions are mainly indicated for patients who go into AF and stay in it despite having a course of antiarrhythmic therapy (medications to get your heart back into normal sinus rhythm) I'd talk to your GP about antiarrhthmic medications like ammioderone. He/she may not feel comfortable prescribing it and may in fact refer you to a Cardiologist for further opinion if you're not following up with one already.

The Trans Thoracic Echo that you're having in Feb is probably just to check how your new aortic heart valve is functioning.

In my professional opinion you probably need a holter monitor (a little portable device which monitors and records the electrical activity of your heart over the course of 1-2 days) A Cardiologist needs to put one of these on you though.

 

[The Charlatan]

OK.

Wicked Jim, thanks for the advice it's greatly appreciated.

 

[Pantherjim.]

OK.

Wicked Jim, thanks for the advice it's greatly appreciated.

;-) No probs.

 

[The Charlatan]

Thought I'd bump this. Had the TTE done, Cardiologist recommended a Holter Monitor which was fitted.

Turns out it wasn't AF, I have V-Tach & moderate LVH. Cardiologist prescribed Metoprolol in the meantime (despite the fact my blood pressure is already in a healthy range,) getting a second TTE done next week to check Aortic valve function more closely, and then if that is functioning fine they will look to inspect what is causing the VH & V-Tach (no family history of either so most likely not genetically predisposed.)

 

[Pantherjim.]

Sounds like you're on the right track Charlatan.

If You're having runs of V Tach, After your second TTE, The Cardiologist may consider sending you for EPS ( Electrophysiology Studies) To determine if the hearts electrical pathway has any dodgy circuits.

Metoprolol is a beta blocking medication to slow down your heart rate. Although if you're having runs of V Tach I would have considered an anti-arrhythmic medication like sotalol or ammioderone? Anyway your Cardiologist knows what they are doing.

With regards to the Left Ventricular Hypertrophy, after your 2nd TTE ask your Cardiologist what your Left Ventricular Ejection Fraction is.

 

[veggiepatch1959]

Hey The Charlatan. What are the actual symptoms of Atrial Fibrillation?

Last week I had a fluttering feeling in my upper chest with lasted for about 30 seconds then just disappeared. Haven't had it since.

I had a heart attack in early December last year and had a stent installed to repair a minor artery that was 95% blocked. Since then I have been administered Clopidogrel, Aspirin, Metoprolol, Perindopril and Atorvastatin.

 

[The Charlatan]

- Faintness/Lightheadedness
- Palpitations
- Racing heart
- Shortness of breath

This is what caused my GP to originally assume I had AF, especially since I have a history of heart issues and was born with a valvular defect. This has since proven to be something far more serious and potentially fatal. Kind of wishing it was just AF now!

 

[SpaceMonkey]

Funny things, hearts. A friend of mine had a congenital birth defect fixed as a baby, then recently (at 30) started having fainting episodes due to what doctors initially thought was a heart issue so he had a pacemaker fitted, then the episodes continued and it was eventually rediagonised as a form of epilepsy, so hes now on anti-convulsive a as well as having the pacemaker!

 

[The Charlatan]

Funny things, hearts. A friend of mine had a congenital birth defect fixed as a baby, then recently (at 30) started having fainting episodes due to what doctors initially thought was a heart issue so he had a pacemaker fitted, then the episodes continued and it was eventually rediagonised as a form of epilepsy, so hes now on anti-convulsive a as well as having the pacemaker!

This is pretty much where I'm at (the corrected birth defect, and copping symptoms at the same age.) The determination still needs to be made as to whether my replacement valve is faulty or not. These symptoms have only started in the last 12-18 months. Spells of severe lightheadedness and near on fainting, forgetfulness, trouble maintaining a conversation and problems concentrating, exercise intolerance, frightening irregular heartbeats and hospitalisation for episodes that would not correct itself.

It is severely affecting my quality life and I'm miserable as a result. Just want it all to be determined and fixed, but I understand there's a process that has to be undertaken by the doctors to ensure they get the right diagnosis and course of treatment/management.

 

[legend]

Best of luck with it all mate. One tip, keep an eye on your blood sugar levels as Toprol (Metroprolol) can increase insulin resistance by up to 21% according to some reports and I am on it for BP but I also now have type 2 diabetes and I believe Toprol was a major contributing factor.

 

[The Charlatan]

Thanks Legend, I'm pretty sure I read that Metoprolol can also do the exact opposite as well and cause low blood sugar?

 

[The Charlatan]

Sounds like you're on the right track Charlatan.

If You're having runs of V Tach, After your second TTE, The Cardiologist may consider sending you for EPS ( Electrophysiology Studies) To determine if the hearts electrical pathway has any dodgy circuits.

Metoprolol is a beta blocking medication to slow down your heart rate. Although if you're having runs of V Tach I would have considered an anti-arrhythmic medication like sotalol or ammioderone? Anyway your Cardiologist knows what they are doing.

With regards to the Left Ventricular Hypertrophy, after your 2nd TTE ask your Cardiologist what your Left Ventricular Ejection Fraction is.

More info after TTE yesterday Jim:

- Normal sized atria and ventricles;
- Normal systolic function;
- EF is 70%, which is apparently within normal range;
- First TTE showed moderate concentric hypertrophy, however yesterday it only showed mild hypertrophy of the common wall between the ventricles in the LV;
- AV is in perfect working order, no gradient across valve or decreased valve area;
- Aortic root and ascending aorta were moderately dilated on last TTE, are now significantly smaller (still on the larger side of the range though
- Mild mitral regurgitation;
- They didn't mention anything about any diastolic dysfunction, which was noted on the last TTE.

A positive but confusing turn of events I guess. My cardiologist believed the last TTE was poorly conducted as he reviewed the last report felt it was half-arsed. Further to that he had no reason to believe the valve was stenosed purely as there was no murmur present (apparently a significant sign of stenosis,) when he listened to my heart beat. Seems like this TTE confirms his suspicions. He believes the septal hypertrophy could be a sign of a predisposed hypertrophic cardiomyopathy rather than anything linked to the aortic valve.

Am going in for a EP test to see whether they can stir up the arrhythmia again and pinpoint it to see whether I can continue to mange it via pharmaceuticals or whether they can knock it off with ablation. In the meantime he will continue me on the metoprolol as it has reduced my rapid heart rate and the episodes of V-Tach have not continued since taking it.

 

[legend]

Some positive signs there mate. I see everything I do now as preventative maintenance as far as my health goes. I'm almost 42 and my six monthly checkups have been pretty good. If I don't feel right for whatever reason, I'm off to the docs to get it thoroughly checked out!

All the best with with the ongoing treatment/diagnosis.

 

[Pantherjim.]

More info after TTE yesterday Jim:

- Normal sized atria and ventricles;
- Normal systolic function;
- EF is 70%, which is apparently within normal range;
- First TTE showed moderate concentric hypertrophy, however yesterday it only showed mild hypertrophy of the common wall between the ventricles in the LV;
- AV is in perfect working order, no gradient across valve or decreased valve area;
- Aortic root and ascending aorta were moderately dilated on last TTE, are now significantly smaller (still on the larger side of the range though
- Mild mitral regurgitation;
- They didn't mention anything about any diastolic dysfunction, which was noted on the last TTE.

A positive but confusing turn of events I guess. My cardiologist believed the last TTE was poorly conducted as he reviewed the last report felt it was half-arsed. Further to that he had no reason to believe the valve was stenosed purely as there was no murmur present (apparently a significant sign of stenosis,) when he listened to my heart beat. Seems like this TTE confirms his suspicions. He believes the septal hypertrophy could be a sign of a predisposed hypertrophic cardiomyopathy rather than anything linked to the aortic valve.

Am going in for a EP test to see whether they can stir up the arrhythmia again and pinpoint it to see whether I can continue to mange it via pharmaceuticals or whether they can knock it off with ablation. In the meantime he will continue me on the metoprolol as it has reduced my rapid heart rate and the episodes of V-Tach have not continued since taking it.

Awesome result Charlatan.

Was a bit worried about your ejection fraction with the LV hypertrophy, but 70% is excellent.

Hopefully they can do the ablation, then you won't have to be on antiarryhthmic therapy long term.

 

[bileduct]

This is actually a really interesting thread.

 

[The Charlatan]

Another update if you're interested Jim:

Had my EP study done today. Allegedly the electrical pathways around the heart are fine, they tried to irritate the heart and stir up the arrhythmias but the heart wouldn't have it. I have a follow up with the cardiologist next Thursday once he gets the full report from the procedure, but he said in the meantime that he has enough evidence to reason that apart from the small septal hypertrophy, the heart is structurally and electrically fine.

Got off the Metoprolol over a week ago and have been feeling shitloads better since. Apart from the raised heart rates the side effects that plagued me have vaporised. The cardiologist has said that he may recommend me going back on but at 12.5mg twice per day, but will wait until after he has read the full report done by the electrophysiologist.

Don't know what to make of all this... The cardiologist and I both have ample evidence of VT and it would not present itself. Did you often see that happen in your time as a cardiology nurse?

 

[The Charlatan]

Another update:

Cardiologist is now checking alternate rare causes as he has ascertained that there is no structural or electrical damage to the heart.

Have done a 24 hour piss test to be checked for adrenal tumours. If this doesn't show anything I go in for an MRI to check whether I may have a condition that causes a type of fibrosis in the heart (ARVD.)