Hubby back in a-fib. sigh

SatoriFound · Oct 24, 2024

I know you guys must be sick of me by now.

I didn't drive to the hospital today because I had so many things I had to take care of at home. Hubby usually does these things, so it is my job while he gets well. I felt so guilty already, then I he texted he is back in a-fib. So, I went and pulled up the doctors notes. His most recent ekg states:

"Atrial fibrillation with rapid ventricular response-ST & T wave abnormality, consider inferior ischemia-Abnormal ECG-In automated comparison with ECG of 19-OCT-2024 18:44,-Atrial fibrillation has replaced Junctional rhythm-Vent. rate has increased BY 48
BPM-T wave inversion now evident in Inferior leads-T wave inversion now evident in Lateral leads"

Not being at the hospital I couldn't ask questions. Now I'm freaking out they damaged his heart and he may have ischemia as that is mentioned in the doctor's notes. So, once again they are want to do a Cardio Version. Hubby doesn't want to do what they say because he wants out of the hospital and he worries they will stop the Coumadin again so he is refusing drugs that can't be taken with it. He refused a medication due to that and the doctor came up with something he would agree to, but I feel like I'm on a roller coaster ride that I will never be able to get off of. This is day 11 in the hospital. I know it is the safest place for him, but now I feel like a real jerk for not being there.

He also has small-moderate circumferential pericardial effusion, mediastinal effusion, a periaortic hematoma and bi-lateral pleural effusion. The fluid just won't go away. He is walking and using the spirometer. He is on Lasik... Ugh. I just wanted this to be easy for him. And it seems like he is going to get every complication there is.

And then there is also the issue of flow turbulence in the left main coronary artery, which I googled.

ARGHHHH Yet another thing. If he has to go back into surgery he will be beyond pissed off.

Cause:
The most common reason for turbulent flow in the left main coronary artery after AVR is the altered blood flow pattern around the prosthetic valve, which can create turbulence at the coronary ostium (the opening of the coronary artery) due to its positioning relative to the valve.
Complications:
Significant turbulence can lead to reduced blood flow to the heart muscle, potentially causing ischemia (lack of oxygen) and myocardial infarction (heart attack) in severe cases.
Diagnosis:
This condition is usually diagnosed using transthoracic or transesophageal echocardiography (TEE), which can visualize the blood flow patterns in the coronary arteries.
Management options:
- Monitoring: Close monitoring of the patient's cardiac function after AVR is crucial to detect any signs of coronary compromise.
- Coronary angiography: Further evaluation with coronary angiography may be needed to assess the severity of the flow turbulence and identify any potential coronary artery stenosis.
- Coronary artery bypass grafting (CABG): If the turbulence is severe and causing significant ischemia, a CABG procedure might be necessary to bypass the affected coronary artery.

tjay · Oct 24, 2024

I encountered some of these things right after my surgery as I outlined in my initial response on this thread:
https://www.valvereplacement.org/threads/12-week-update-work-in-process.889789/

- Your husband needs to work with them and follow their advice. They are your best friend and have best interest in mind. For example, if they need to stop coumadin to do certain procedures and/or to offer other drugs for a complication, he should follow along. I did. I trusted them with my care.
Taking a bit longer for INR to come to the range is the least of his concerns right now. It's the other things you are talking about which are much, much more important to deal with at the moment, as follows:

- Effusion around his heart and lung: Let them handle this as they want. For example, if they need to take him to catherterization lab to drain this effusion, or give Lasik, or whatever, and in the process adjust his other meds or coumadin, please do it.

- Turbulence thru Left main coronary: I'm not saying he has a bend in the left main coronary as I did, but it's interesting he's encountering something there as well. Did they not do CT on him (like they did to me even though I wasn't having any issues) to confirm if left main coronary (and others) are connected properly to his aorta? His ascending aorta was also replaced correct?
I don't know why all hospitals don't require a CT scan before discharge for aortic surgery, since I was lucky to have known about the kink/bend in my left main (as it was plugged back into the new aorta during surgery). Mine was probably not causing any turbulence or issue at the time but I benefitted from a CT scan my surgeon did proactively. Ask them if a CT scan would help in his case.

- AFib may be a result of Effusion or these issues he's dealing with. Resolving one may resolve others. If Afib may be going on for too long, cardioversion may be necessary IF they are suggesting it.

Just trust them. In this hour of need, you're already at the right place. Working with them will be helpful so that you don't take any issues home (and then come back later). I know it's really hard after so many days at the hospital but hang in there for a few more. Please provide some family/friends support there if possible.

Once again, hang in there. These issues are not uncommon and do get resolved. In 2-3 weeks, this will be a distant memory. Keep us posted and all the best.

SatoriFound · Oct 25, 2024

tjay said:
I encountered some of these things right after my surgery as I outlined in my initial response on this thread:
https://www.valvereplacement.org/threads/12-week-update-work-in-process.889789/

- Your husband needs to work with them and follow their advice. They are your best friend and have best interest in mind. For example, if they need to stop coumadin to do certain procedures and/or to offer other drugs for a complication, he should follow along. I did. I trusted them with my care.
Taking a bit longer for INR to come to the range is the least of his concerns right now. It's the other things you are talking about which are much, much more important to deal with at the moment, as follows:

- Effusion around his heart and lung: Let them handle this as they want. For example, if they need to take him to catherterization lab to drain this effusion, or give Lasik, or whatever, and in the process adjust his other meds or coumadin, please do it.

- Turbulence thru Left main coronary: I'm not saying he has a bend in the left main coronary as I did, but it's interesting he's encountering something there as well. Did they not do CT on him (like they did to me even though I wasn't having any issues) to confirm if left main coronary (and others) are connected properly to his aorta? His ascending aorta was also replaced correct?
I don't know why all hospitals don't require a CT scan before discharge for aortic surgery, since I was lucky to have known about the kink/bend in my left main (as it was plugged back into the new aorta during surgery). Mine was probably not causing any turbulence or issue at the time but I benefitted from a CT scan my surgeon did proactively. Ask them if a CT scan would help in his case.

- AFib may be a result of Effusion or these issues he's dealing with. Resolving one may resolve others. If Afib may be going on for too long, cardioversion may be necessary IF they are suggesting it.

Just trust them. In this hour of need, you're already at the right place. Working with them will be helpful so that you don't take any issues home (and then come back later). I know it's really hard after so many days at the hospital but hang in there for a few more. Please provide some family/friends support there if possible.

Once again, hang in there. These issues are not uncommon and do get resolved. In 2-3 weeks, this will be a distant memory. Keep us posted and all the best.

They have not done a CT, they have done three echos. According to those reports all the parts and pieces look "normal". What I read says the mechanical valve can cause turbulence, or that there could be a blockage due to plaque coming loose, or damage from surgical staples...

The thing about CardioVersion is it doesn't really fix the problem and it could come back if what is causing it isn't fixed. Ya know? If it is just normal healing and due to fluid/inflammation it seems that those issues should be fixed. I mean, he could get the CardioVersion, it stops the afib, and then an hour later the afib comes back.

pellicle · Oct 26, 2024

SatoriFound said:
I know you guys must be sick of me by now.

pah ... you're an amateur ... you need to take cues from Newarrior or some of the others

On this point:

Not being at the hospital I couldn't ask questions. Now I'm freaking out they damaged his heart and he may have ischemia as that is mentioned in the doctor's notes.

best to just keep calm and not get frantic. I know its tempting to get frantic but (well ...) you can't really do anything about it. If it is then you can't change that and if it isn't there's no point in going off like a frog in a sock at the staff.

on this point:

Hubby doesn't want to do what they say because he wants out of the hospital and he worries they will stop the Coumadin again so he is refusing drugs that can't be taken with it.

this is not sensible, if they take you off warfarin so be it ... its not like taking your off life support or turning off the tap on your scuba tank ... besides, they'll usually start with Heparin.

Its often a bumpy ride on landing ... I hope it smooths out soon.

Best Wishes

SatoriFound · Oct 26, 2024

tjay said:
I encountered some of these things right after my surgery as I outlined in my initial response on this thread:
https://www.valvereplacement.org/threads/12-week-update-work-in-process.889789/

- Your husband needs to work with them and follow their advice. They are your best friend and have best interest in mind. For example, if they need to stop coumadin to do certain procedures and/or to offer other drugs for a complication, he should follow along. I did. I trusted them with my care.
Taking a bit longer for INR to come to the range is the least of his concerns right now. It's the other things you are talking about which are much, much more important to deal with at the moment, as follows:

He was in a better mood yesterday after CardioVerion. He immediately looked better than he had before, his color improved so quickly.

tjay said:
- Effusion around his heart and lung: Let them handle this as they want. For example, if they need to take him to catherterization lab to drain this effusion, or give Lasik, or whatever, and in the process adjust his other meds or coumadin, please do it.

They gave Lasik and another drug I think.

tjay said:
- Turbulence thru Left main coronary: I'm not saying he has a bend in the left main coronary as I did, but it's interesting he's encountering something there as well. Did they not do CT on him (like they did to me even though I wasn't having any issues) to confirm if left main coronary (and others) are connected properly to his aorta? His ascending aorta was also replaced correct?
I don't know why all hospitals don't require a CT scan before discharge for aortic surgery, since I was lucky to have known about the kink/bend in my left main (as it was plugged back into the new aorta during surgery). Mine was probably not causing any turbulence or issue at the time but I benefitted from a CT scan my surgeon did proactively. Ask them if a CT scan would help in his case.

They don't seem to be worried about this and no one has mentioned it. They didn't see any problems in the TEE he had yesterday, but it was limited in scope. Checking for blood clots and things that could contraindicate cardioversion.

tjay said:
- AFib may be a result of Effusion or these issues he's dealing with. Resolving one may resolve others. If Afib may be going on for too long, cardioversion may be necessary IF they are suggesting it.

It is fixed for now!!

tjay said:
Just trust them. In this hour of need, you're already at the right place. Working with them will be helpful so that you don't take any issues home (and then come back later). I know it's really hard after so many days at the hospital but hang in there for a few more. Please provide some family/friends support there if possible.

Once again, hang in there. These issues are not uncommon and do get resolved. In 2-3 weeks, this will be a distant memory. Keep us posted and all the best.

SatoriFound · Oct 26, 2024

pellicle said:
on this point:

this is not sensible, if they take you off warfarin so be it ... its not like taking your off life support or turning off the tap on your scuba tank ... besides, they'll usually start with Heparin.

You and I know this, but he can be stubborn. Anyway, his inr is 2.7 today! They just don't seem to be worried about any of these other things like the turbulent flow in is coronary artery. I want to ask, but damn, I can't be there 24/7 and completely ignore our child during this.

They seem to have forgotten about the anemia, even though his hematocrit is barely over the level they usually transfuse at. They aren't even doing the daily panels for it now. *sigh* His doctor said something about release this weekend, but what if his anemia gets seriously worse and we don't even know because they aren't ordering tests and we are at home? It's not like it is on the upward swing. The last movement his hematocrit and RBC numbers made was to get worse.

Eva · Oct 26, 2024

I’ll share with you what happened to me, hoping you may feel better and have faith your hubby will be fine after all this.
I stayed in the hospital for around 10 days in the ICU. Their reason was there were no rooms available which I believe was a lie! I was in a bad shape but they didn’t want to say. Nurses rushed to me, with concern on their faces, anytime I moved in bed! Doctors kept coming in and out of my room almost every hour of every day. At night, I saw them standing and staring at me from behind the glass windows! I never knew what was going on until I requested copy of the surgery report later.
That was in 2008, before notes were written down on computers. After ten days, I was moved to a regular room for two more days before I was discharged.
But here I am at 73, and I can say I’m functioning very well.
I hope this gives you some comfort and faith.

3mm · Oct 26, 2024

pellicle said:
this is not sensible, if they take you off warfarin so be it ... its not like taking your off life support

I agree with pellicle.

I know this is very hard for both you and your husband. Take a deep breath, hold it for 5 seconds, then exhale slowly. Write down on paper your options together with the pros and cons for each option. Writing these things down helps to remove the panic and fear by replacing them with facts.

For example: Stopping warfarin. Pro: Doctor can use the drug they think is best. Con: May require a few more days in hospital. What are the problems with being in the hospital for a few more days? If the hospital food is lousy, then perhaps you can bypass this issue by bringing in a nice meal 1 evening. If the hospital is noisy, perhaps you can get earplugs or noise cancelling headphones for your husband.

The hospital should have some social workers, clergy, etc., who can help you and your husband talk about these issues. These people can be useful resources to help both of you consider the options and the ramifications of those options.

SatoriFound said:
Not being at the hospital I couldn't ask questions.

Write down your questions and have a nurse pass them on to the appropriate member of the medical team.

pellicle · Oct 26, 2024

3mm said:
Write down your questions and have a nurse pass them on to the appropriate member of the medical team.

@SatoriFound , this is an excellent suggestion.

Not only will that be good at getting answers, writing it down may help you clarify the question in your mind.

Hand in there and be patient (the word was chosen for people who are treated by a doctor for those reasons).

https://pmc.ncbi.nlm.nih.gov/articles/PMC1116090/

Patient comes from the Latin “patiens,” from “patior,” to suffer or bear. The patient, in this language, is truly passive—bearing whatever suffering is necessary and tolerating patiently the interventions of the outside expert. The active patient is a contradiction in terms, and it is the assumption underlying the passivity that is the most dangerous. It is that the user of services will remain passive in sickness, allowing the healthcare professional to take the active part and tell the user what to do.

I know myself that if I'm working on something its better to be able to do it without a fight. If someone wants to fight me on how something should be done I'll usually say "well, saddle up and do it your way" ... no spite in that, just "well you don't want to do it my way, do it yours".

Best Wishes

dornole · Oct 26, 2024

Hang in there. Don’t borrow trouble worrying about tests and notes. Personally I did not look at any of my labs or tests while in hospital. Hubs reviewed and tons of stuff was out of range / sketchy but we both think, we don’t know how to interpret this in these specific circumstances. Hubs always says, he decides if he thinks the doctor is good, then he asks “do they look worried.” And let them call the shots. Trying to rule out stopping warfarin is madness.

If being home is his top priority, he could have skipped this whole project and just died on his couch in a year or whatever - but he’d be home ….. he wants to be home and HEALTHY. My heart really does break for him that it’s taking so long but he doesn’t have much choice. Can you imagine a too early discharge and the havoc and danger that would cause. Better a day late than a day too early.

Take care of yourself as best you can. My FIL is a very cantankerous patient who always wants out and it’s rough on the the family. Many a time have I said “Pop you’re gonna stay here till you’re safe to go home. And I’m getting myself some coffee.”

You guys are in my prayers.

SatoriFound · Oct 27, 2024

3mm said:
I agree with pellicle.

I know this is very hard for both you and your husband. Take a deep breath, hold it for 5 seconds, then exhale slowly. Write down on paper your options together with the pros and cons for each option. Writing these things down helps to remove the panic and fear by replacing them with facts.

For example: Stopping warfarin. Pro: Doctor can use the drug they think is best. Con: May require a few more days in hospital. What are the problems with being in the hospital for a few more days? If the hospital food is lousy, then perhaps you can bypass this issue by bringing in a nice meal 1 evening. If the hospital is noisy, perhaps you can get earplugs or noise cancelling headphones for your husband.

The hospital should have some social workers, clergy, etc., who can help you and your husband talk about these issues. These people can be useful resources to help both of you consider the options and the ramifications of those options.

Write down your questions and have a nurse pass them on to the appropriate member of the medical team.

When he gets in these moods it is impossible to talk sense with him. The doctor worked something out with him, and it was fine. Overnight his heparin wasn't being delivered properly due to where they placed the new IV line. It was right at the bend of the elbow and was occluded for most of the night. The nurse in the morning stated they heard the alarms. Well why the heck didn't they DO something about it. Every freaking half an hour or more that alarm was going off. His numbers from the next day showed it too. They did nothing about it until I made it clear I was unhappy about how they weren't even trying to make sure he could get some rest. The time your body does the most healing is while in a certain stage of sleep. If he isn't able to get there how is he supposed to heal??? Anyway, it is all ok. Hubby got to come home yesterday. He was getting worried he wouldn't be able to make it to early voting, but we successfully went and voted today and that made him very happy.

Anyway, he believes he had an afib episode this morning. It lasted for a few hours and then stopped. He was watching the readings from his smart ring. His heart rate didn't go above 130 though, so I don't think we need to worry too much. If it had gone up to 160 like before I would be making sure his doctors were aware. As it is, I will probably send a quick message to his care team through MyChart.

SatoriFound · Oct 27, 2024

Eva said:
I’ll share with you what happened to me, hoping you may feel better and have faith your hubby will be fine after all this.
I stayed in the hospital for around 10 days in the ICU. Their reason was there were no rooms available which I believe was a lie! I was in a bad shape but they didn’t want to say. Nurses rushed to me, with concern on their faces, anytime I moved in bed! Doctors kept coming in and out of my room almost every hour of every day. At night, I saw them standing and staring at me from behind the glass windows! I never knew what was going on until I requested copy of the surgery report later.
That was in 2008, before notes were written down on computers. After ten days, I was moved to a regular room for two more days before I was discharged.
But here I am at 73, and I can say I’m functioning very well.
I hope this gives you some comfort and faith.

I almost think it was better before you could read all the labs and doctors notes almost immediately online. LOL In iCU the notes and labs showed up almost as soon as they got them, but once he moved to recovery they wouldn't release them until the next day.

SatoriFound · Oct 27, 2024

pellicle said:
@SatoriFound , this is an excellent suggestion.

Not only will that be good at getting answers, writing it down may help you clarify the question in your mind.

Hand in there and be patient (the word was chosen for people who are treated by a doctor for those reasons).

https://pmc.ncbi.nlm.nih.gov/articles/PMC1116090/

Patient comes from the Latin “patiens,” from “patior,” to suffer or bear. The patient, in this language, is truly passive—bearing whatever suffering is necessary and tolerating patiently the interventions of the outside expert. The active patient is a contradiction in terms, and it is the assumption underlying the passivity that is the most dangerous. It is that the user of services will remain passive in sickness, allowing the healthcare professional to take the active part and tell the user what to do.

I know myself that if I'm working on something its better to be able to do it without a fight. If someone wants to fight me on how something should be done I'll usually say "well, saddle up and do it your way" ... no spite in that, just "well you don't want to do it my way, do it yours".

Best Wishes

I wish I had this advice so much earlier, the writing down my questions. LOL Hubby is home and hopefully doesn't end up readmitted.

pellicle · Oct 27, 2024

SatoriFound said:
LOL Hubby is home and hopefully doesn't end up readmitted.

Great news

Fingers crossed.

SatoriFound · Oct 27, 2024

pellicle said:
Great news

Fingers crossed.

Yes, we are crossing our fingers that his hematocrit hasn't gone down on tomorrow's blood draw.

pellicle · Oct 27, 2024

SatoriFound said:
... that his hematocrit hasn't gone down on tomorrow's blood draw.

surely this would be a good time to watch an old Wesley Snipes movie from 1998 ;-)

Lisa from LJ · Oct 27, 2024

Glad you're home! Are you making sure he gets plenty of iron, preferably through his diet and not pills, as they can cause constipation? I had a single unit transfused during surgery and was still anemic when I left the hospital. Spinach, beef, salmon, beans, almonds, oats, and more will help with anemia. It takes some time to build back red cells.

dornole · Oct 27, 2024

So glad to read that he is home. Def send a note with the afib / tachycardia episode they need all info for care. I had probably a dozen of those episodes prior to surgery and noted how long they lasted. I verified it was afib with a Kardia that I purchased which the doc said is usually pretty accurate.

Congrats on making it home, hope the patient has more patience now.

SatoriFound · Oct 28, 2024

pellicle said:
surely this would be a good time to watch an old Wesley Snipes movie from 1998 ;-)

LOL His inr went up to 2.9!! I was wondering when he got a nose bleed at Costco if maybe the number was too high. It was no big deal and stopped super quick. It seemed quicker than the nose bleeds I have seen him get in the past. So, they halved his dosage for tonight and have him set up for another test on Thursday.

SatoriFound · Oct 28, 2024

pellicle said:
surely this would be a good time to watch an old Wesley Snipes movie from 1998 ;-)

dornole said:
So glad to read that he is home. Def send a note with the afib / tachycardia episode they need all info for care. I had probably a dozen of those episodes prior to surgery and noted how long they lasted. I verified it was afib with a Kardia that I purchased which the doc said is usually pretty accurate.

Congrats on making it home, hope the patient has more patience now.

We just ordered the Kardia Mobile device so he can do home ekgs. We ordered the 6 lead, so hopefully that helps to waylay his fears, plus we can send any info we get from it to his doctor. We also ordered the new Samsung Galaxy Ultra watch that monitors heartrate. I know, we went overboard. We don't do Apple, so went with Galaxy because we have Samsung Galaxy phones.

When we went to get his blood drawn today to test his hemoglobin/hematocrit/RBC numbers he realized he still had a device on from his stay. A little chunky square thing on his chest. We decided since we were at the medical center to walk over to the recovery ward he had been in and ask if he could take it off. They laughed and said take that sucker off! heehee He got dressed before he was even released and was just waiting to leave, so no one noticed it was still there. It was some kind of heartrate telemetry, even though he had the monitor you wear on too while at the hospital...

Hubby back in a-fib. *sigh*

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Hubby back in a-fib. sigh