A-Fib Problem

[Cooker]

Posted this earlier as a reply and it ended up in post op. Thought this might be a better place. Sorry for the repetition--I'm a new


Hi and Merry Christmas!

Wanted to know more about A-Fib. I have been tracking mine on my calender and it has been happening about once a month. I sometimes convert in 30 minutes and sometimes it takes 12 hours. Last night was 12 hours with head aches, upper jaw pain (like sinus) and very little sleep. This only happens at night??? I am on Toprol XL 100mg up from 50mgs last month. I was in the hospital Jan 05 with A-Fib that would not convert without alittle help. Truth be known that bout was most likely chemically induced . That has not been the case since. Right before I converted this
morning I thought I was going to faint and had to lay down on the floor. That passed and I converted by the time I could get off the floor.

Enough rambling. Here are my questions.
1. any danger in this, stroke etc?
2. I had been constipated and took a strong laxative about 30 minutes before it started. Could this have brought this on?
3. Is this something I should contact my cardio about or just deal with it?
My next visit is in May for a echo stress.
4. My cardio doc wants me off caffeine. I have not been able to do this as of yet. I have read several things on the net that say caffeine will "not" cause A-Fib. Any ideas on this?

I understand many of you have this after your OHS. I hope my OHS/AVR will not increase this problem. Thanks for your input and support.

Cooker

 

[RCB]

See post in Post-surg

Maybe the Great Santa, Ross will fix this if we have been good all year

 

[FredH]

A-fib Probles

A-fib Probles

I have had an a-fib problem since my surgery in 2000. After a rough start I have kept it under complete control with meds. After trying several meds I settled on Tambocor 150mg twice daily. In the last 3 years I have gone into a-fib only once. I forgot to take my afternoon dose 2 days in a row and that was the cause. I had to be converted and everything has been ok since. Ok to answer you question yes there is a significant risk of stroke when you go into a-fib. As soon as you go into a-fib you should start taking coumadin or you can get blood clots and then when you come out of a-fib they can be pushed up to the brain and cause a stroke. You should be at the very least be on aspirin all the time and have coumadin ready to take if you go into a-fib. From what I understand coumadin with greatly reduce the chance of a stroke. Last time I went into a-fib the ER doctor said I was for sure not in a-fib and did not need to take coumadin. I then went for 3 days without coumadin until I visited my Doctor and he said the other doc was wrong and I was in a-fib as I had told him. I then started on coumadin but by that time I had a clot in my heart. I had to wait two weeks to dissolve the clot before I could be converted. If you haven't tried all the possible drugs to control it I would pursue that ASAP. The Tambocor has worked well for me. Good Luck

Fred

 

[ALCapshaw2]

By all means, if you are going into and out of A-Fib, you need to be on Coumadin to prevent possible clot formation.

Out of curiosity, how do you know you are in A-Fib? The usual way to confirm that is with an EKG.

Many of us had intermittent A-Fib that could come and go for several weeks following surgery.

For reasons I will skip over, I started having PAC's which I correlated with consumption of CHOCOLATE (i.e. CAFFEINE) which is probably why your doctor wants you OFF caffeine.

After a while, the PAC's turned into A-Fib and my cardiologist switched me from Toprol XL to Sotalol (generic form of BetaPace) which specifically targets A-Fib. I've not had any more problems with A-Fib.

You really need to discuss your A-Fib issues with your cardiologist ASAP and get a proper treatment protocol established. IF he suggests Amiodarone, I STRONGLY recommend you ask that he exhause ALL other options first.

There has been considerable discussion of the SERIOUS side effects of prolonged use of amiodarone (do a SEARCH for amiodarone or get a copy of the information sheet for that drug). Amiodarone is the SLEDGE HAMMER of anti-arrhythmic medications, to be used as a LAST RESORT ONLY.

'AL Capshaw'

 

[Cooker]

Confused

Confused



Thanks for the input. I called my doc and his first question was if I had had to much to drink....holiday and all that. He did not want to increase my Toprol, said it would make me tired and would not solve the problem. If it continues he said he would put me in the hospital and start Amiodarone.

I was a drinker and I guess that was a logical question but it kind of made me mad sinse I thought he under stood that was no longer part of the equation. Then I was suprised about having to go in the hospital for Amiodarone. If this is happening about once a month and I am not on any blood thinner and he is taking a wait and see attitude I wonder if I should think about looking for another cardio?? I plan to talk with my pcp and get his thoughts.

I guess I rambling. I know I am confused, scared and a bit pissed off!

Cooker

 

[tobagotwo]

If you're not allergic to aspirin, and your doctor has no reason for you not to take aspirin, it certainly would not hurt to take the 81mg aspirins commonly available over-the-counter on a daily basis. If they are coated, you might want to take two, as at least one study has shown that the coated ones are less effective on many people. They are absorbed less effectively in the colon, rather than the stomach. One standard aspirin is 325mg (about 5 grains), so two, 81mg aspirins at 162 gms still equal less than half a regular aspirin.

Be sure to let your doctor and cardiologist know you are taking it, especially if you are prescribed Coumadin or Plavix at some point.

When it comes time for your surgery, ask about getting the MAZE procedure, which is the most successful surgical approach to atrial fibrillation. It might help you.

I concur with Al Capshaw on the subject of amiodorone. While it can be effective, there are also many other effective treatments available. Amiodorone has a high level of side effects, and it takes six months for the residue to leave your body. It is intended to be an emergency or last-ditch drug, but is being used more commonly now. I believe that is mostly out of laziness, by doctors who don't want to take the time to try out other, less toxic prescriptions on their patients. Frequently, it takes several tries to find the medicine that works best for an individual. Some doctors may feel it makes them look like they don't know what they're doing when the first couple of prescriptions fail to work. Others may just not want to take the time for the repeat visits. Regardless, the drug is not intended to be the first approach to anything.

The laxative is not likely to have caused it. You might consider one of the daily capsules or mixes, perhaps with psillium husks, as they should help you to avoid that issue.

Caffeine can definitely be associated with palpitations and other heartbeat irregularities, especially if you are prone to them anyway. It commonly increases the heartbeat along with other central nervous system activity. Physical activity can lessen the effect. Nicotine is also associated with heartbeat irregularities. If you smoke, be aware that the combination of nicotine and caffeine is doubly hard an your heart, as you increase its beat while constricting the blood vessels at the same time.

Best wishes,

 

[Cooker]

Caffeine can definitely be associated with palpitations and other heartbeat irregularities, especially if you are prone to them anyway. It commonly increases the heartbeat along with other central nervous system activity. Physical activity can lessen the effect. Nicotine is also associated with heartbeat irregularities. If you smoke, be aware that the combination of nicotine and caffeine is doubly hard an your heart, as you increase its beat while constricting the blood vessels at the same time.

Best wishes,

Bob,

Thanks for your reply. My cardio told me to get off of caffeine a year ago but all I did was switch to decaf tea and half and half coffee (when I have it) and I am a chocoholic (sp?). I do not smoke now but I am addicted to nicotine gum. With the prospect of Amiodarone I guess it is time that I tow the line and resign to the fact that I am not bullitt proof
Oh, I forgot sodas. hate decaf cola.

No booze...
No coffee....
No nicotine....
No choc. candy....

Any other habits I should give up???

Cooker

 

[aussigal]

I am pre-surgery and get spells of these too, so you are not alone...


This is where I am up to with mine...

I currently am on 50mg Metoprolol twice a day and 1 Coversyl-plus and have 250mcg of Digoxin to add to the cocktail... ...

I am going back to see the Cardio next week cos I havent noticed much decrease in these unless of course these events have increased and the pills have cut half them out ...spose thats where your lil chart would be useful to counteract the sieve-like brain of mine!...

The metoprolol also makes me dopey, but I take that as a positive as it keeps me slowed-down, instead of racing around .

 

[tobagotwo]

I don't have afib, for which I'm grateful. But I have made an effort to cut down on caffeine, because I consumed a lot of it, and it sometimes affected my heart before the surgery. I hate decaf coffee. I'm not thrilled with decaf colas, either.

I do all right with root beer and the new carbonated fruit juices (not the flavored water stuff). The coffee's a tough one, so I usually go for half-and-half at work too, because it cuts that metallic flavor in the decaf coffee. Can't be perfect, I guess. If you can get away with it every time, without starting up the afib, it's fair play. If you can't, you have to find a different way to start the day. Ground rules are simple.

I used to smoke, too. Nicotine is a real tough one. It's an alkaloid that has chemical receptors very similar to one of the B vitamins. After you've smoked for a while, your system starts to crank out chemicals that seek nicotine's chemical signature, just like the chemicals it sends out for the real B vitamins. That's part of the craving. It takes a while for your body's chemistry to catch on, and stop manufacturing the matching seeker chemicals. Until then, it can feel like those receptors are screaming through your veins, ransacking your system for any shred of leftover nicotine.

Getting off the nicotine gum is a decision only you can make. It's certainly better than nicotine and smoke, but you know it's not enough for a heart problem, particularly when recovery time comes around.

You've made some tough choices. And people don't always make it any easier, such as the doctor's remark. But those are choices you've made for yourself, so you control them, not the doctor. Because of what you've already done, I know you can continue to make those decisions, and make them stick for your own benefit.

We'll be around.

Best wishes,

 

[aussigal]

So I have a question for you, BOB ...

Do you think B Vitamins would be benficial to an ex-smoker or one who is desperately trying to quit..is there some more info on this?

 

[Sagebrush]

a-fib last Wednesday

a-fib last Wednesday

Well I have been wanting to post about this too. I have been having these episodes for about the last three years and didn't know what they were just knew it was weird feeling but my doctor could never catch it on the holter. They would only last for about 5 to 10 seconds and go away. I am already on coumadin and asprin 81mg. Well last Wednesday it started up and won't go away. I ended up going to the er because I had never had this last this long. So they converted me with drugs and it was really strange when it did convert. I had had a mountain dew the night before(I try to limit my mt dew to once a week). I am partially blaming the caffeen and because of the holidays I haven't been going to Curves like I usually do. I have to say that excercising deffently helps. So the er cardio says that these will probably come more often. He didn't put me any rythem meds but might if I have another episode.....so what has been other peoples experiences with this. Will it happen more and more.....did you have to go on drugs for this???

 

[tobagotwo]

Atrial fibrillation is more common with mitral problems and mitral surgery than aortic, although it can happen with either. It's unpredictable, and can go for long periods without showing up, or can pop up repeatedly in a short span of time - and then go into hibernation again. The fact that yours responded to the drug therapy is promising. You may have "spells" of afib, but there is nothing that indicates it will necessarily become more prevalent for you. If it does, you will likely be successful in having drugs control it for you.

Exercise helps most arrhythmias generally, and does seem to help counteract caffeine's tendency to drum up rhythm misadventures.

For arrhythmias, the best supplements I am aware of are magnesium and fish oil. There are people on this forum who have had excellent results from magnesium supplements on this site, and have even been able to get off of anti-arrhythmia dugs with it (in conjunction with their doctors, of course). Fish oil is actually recognized by the medical establishment as having a beneficial effect on heart rate and rhythm. Fish oils are something of a mild anticoagulant, though, so if you're on Coumadin, check Al Lodwick's site to see if it is a problem. If you're on Plavix, check with your doctor.

However, like everything else, neither of these works for everyone, and afib is an especially obnoxious customer.

Reasonable amounts of B vitamins, and especially folic acid might very well be helpful to someone who recently quit smoking, although I can't prove it. I did use them. However, they are inexpensive and they won't hurt, so you figure the balance sheet.

I take a number of supplements (including those), but I am not religious about it. The base for them is a low-dose, very inclusive multivitamin. I take a low-dose B supplement, which has just 50 mg or 50 mcg of each B vitamin, as appropriate. High doses don't seem to have a measurable benefit, and too much of some B vitamins can create toxic build-ups in the system, even though they are water-based. I take extra folic acid, though.

I take trivalvent chromium nicotinic (enhances insulin efficiency), polycosinol and pantethine (lipid balance), nattozime (reduces free fibrin to reduce possibility of accidental blood clots - not for people on Coumadin or Plavix), and zinc.

I also use a number of antioxidants, such as lycopene, blueberry leaves, hawthorne, lutien, bilberry, alpha lipoic acid, and selenium. Also Vitamin E with mixed tocopherols and tocotrienols. I don't take more than 200 IU of E daily, by the way, as it's been associated with heart-related mortality in studies, although no one has apparently figured out why.

However, there are some antioxidant supplements, such as astaxanthin and beta carotene that are not recommended for those who smoke or have only recently quit, as they can reportedly actually raise the rate of cancer when used while the body is still responding to the effects of smoking. Fortunately, a few years after quitting they will have the the same effect they do in non-smokers.

I don't take CoEnzyme Q10 (CoQ10), as I am on a prescription beta blocker (atenolol), and it is reputed to not play well with beta blockers. In fact, I have at least one unopened bottle of CoQ10 capsules, if anyone wants it.

I don't take large doses of any of these things. They're supplements, not staples or medicine. And I often just skip them on weekends (all this week so far, in fact), to give my body a break and some time to cleanup any excess that might have accumulated.

Best wishes,

 

[RCB]

Recent fish oil studies

Recent fish oil studies

Show that fish oil may increase AF in some people. Where is was thought
to protect against deadly arrhythmias, studies have shown that it may increase more benign AF attacks. The jury is hung on this case.

 

[aussigal]

Gee Thanks BOB for that informative post...

I had been taking the fish oil and magnesium because I had continually read and heard of their positive effects. There is something about the magnesium that you hve to take a certan kind I recall because one sort is pretty much useless ...better go look it up and see...

I also came across a really informative web-site for A-fib...I shall go find the link to share...


didnt come very prepared today did I... ...

 

[tobagotwo]

RCB, here are somne recent articles from Medpage Today... https://www.medpagetoday.com/search.cfm

Omega-3 Protects Against Harmful Heart Rate Changes (This is a Medpage Teaching Brief in the Cardiovascular Arrhythmias subsection, by Neil Osterweil, Senior Associate Editor, MedPage Today, Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine, from December 15, 2005. https://www.medpagetoday.com/Cardiology/Arrhythmias/tb1/2340

AHA: Fish Oil Plus Statin Reduces Coronary Events https://www.medpagetoday.com/Cardiology/Dyslipidemia/tb1/2168

Dietary Soy and Fish Oil Work Quickly to Improve Cardiac Function https://www.medpagetoday.com/PrimaryCare/DietNutrition/tb1/866

I did find one potentially negative article on its use with defibrillator patients, where a 200-patient trial concluded it "may increase the risk of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with defibrillators." However, it also points out that "Previous trials have shown that dietary changes or supplements to increase omega-3 PUFA intake resulted in a reduced risk of sudden death" Fish Oil Supplements May Be Risky to Defibrillator https://www.medpagetoday.com/Cardiology/Arrhythmias/tb1/1201

However, articles are generally heavily weighted toward the positive with fish oils, due to their Omega 3 content.

Best wishes,

 

[RCB]

another view

another view

http://www.nutraingredients.com/news/ng.asp?id=62299-fish-oil-heart-arrhythmia[/urlarrhythmia


http://www.pcrm.org/news/archive050616.html


I not sure where the science is going to lead us, but there appears to be a difference of opinion. I have never heard from anyone in the AF community
that felt fish oil made a difference for them. It has not made a difference for me.

 

[tobagotwo]

Both of those citations are specific retellings of the one negative study I quoted earlier, about the 200 vtach/vfib patients with implanted defibrillators. They are not separate research studies, so they do not add to its scientific weight.

That study stands apart from others in its findings, and for that reason, I am concerned with what makes it different, and if there's something in the study setup that obviated the results that others had. It might be a question of degree: perhaps when one is to the point of requiring a defibrillator, things like fish oil are no longer effective at all.

I entirely agree about atrial fibrillation as a type being resistant to many prescription fixes, much less supplements. There are many kinds of arrhythmias, and fish oil (its omega 3 content actually, also found in vegetable oils like primrose or flax) can be helpful for some arrhythmias and palpitations. Accepted studies also say it reduces fatal cardiac events, particularly in those who've had previous heart attacks.

But nothing, certainly including fish oil, is a panacea for afib - or in this one study, vfib. A stubborn case of afib is very difficult to treat, and some cases like yours defy intervention completely.

The same is true of magnesium. It helps some people. When it does, it may remove a prescription drug from someone's cabinet, which is a worthwhile endeavor. But as I have said, these are supplements, not medicines, and even the medicines don't work for everyone.

Best wishes,

 

[bvdr]

Well I have been wanting to post about this too. I have been having these episodes for about the last three years and didn't know what they were just knew it was weird feeling but my doctor could never catch it on the holter. They would only last for about 5 to 10 seconds and go away. I am already on coumadin and asprin 81mg. Well last Wednesday it started up and won't go away. I ended up going to the er because I had never had this last this long. So they converted me with drugs and it was really strange when it did convert. I had had a mountain dew the night before(I try to limit my mt dew to once a week). I am partially blaming the caffeen and because of the holidays I haven't been going to Curves like I usually do. I have to say that excercising deffently helps. So the er cardio says that these will probably come more often. He didn't put me any rythem meds but might if I have another episode.....so what has been other peoples experiences with this. Will it happen more and more.....did you have to go on drugs for this???

My experience with A-fib started similar to yours. At first the episodes were short and spaced apart by sometimes months. When they started coming more frequently and lasted much longer I finally went to get it checked out and documented. The first time I was cardioverted and placed on digoxin and cardiazem. That didn't work well and within a week or so I was also put on verapamil. That didn't work for very long (maybe a week or so) and then I was put on flecainide. During the work-up for atrial fib my rheumatic heart disease was discovered and I entered the world of valve disorders.

Now it is a few years later and I think my flecainide dose is about the maximum allowed. I take a total of 400mg a day and I still have some episodes of a-fib. My doctors say it is only a matter of time until it will become my permament rhythm. I guess drugs only work for so long.

 

[Cooker]

A-Fib Again

A-Fib Again

Well it happened again . No reason, no booze, no caffeine!!! I have been perfect as far as doing what my cardio doc says. He is starting me on a very low dose of Amiodarone and will slowly reduce the Toprol XL. I know this is a bad drug with many side effects but I guess I need to go with what he says for the time being. He said there is a 90% plus chance this will solve the problem. He also said he was almost 100% sure that the A-Fib was not connected to my valve problem.

Wonder if this means I can have chocolate again!!!

 

[tobagotwo]

What's life without a little chocolate now and then?

Even if the new prescriptions don't do the trick, I don't think that giving up everything entirely is a really good answer.

Nicotine is a vasoconstrictor, narrowing your veins and making your heart work harder. If you are aiming for one big win in lifestyle, the removal of nicotine would top the list.

Best wishes,