Atrial Fibrillation

[DavidMac]

Things were going well until today. During my physio program at the hospital I experienced palpitations for the third time since post op. They decided to do an ECG and said I had an irregular rythm = Atrial Fibrillation.

They have increased by Betaloc and said to see my Cardio on Monday. Apparently its normal. But it didn't feel that way this morning, quite demotivating.

What are the solutions? They said they will see if my rythm kicks back by itself, otherwise they will prescribe some drugs to sort it out. Anyone know the drill to sort AF out and what to watch out for?
Cheers


P.S. I passed on the addres of this site to my Cardio Physio crew this morning. Spreading the good message!

 

[Ross]

It seems to be rather normal for some. I don't have the good stuff on it, so I'll leave it to those who've been there to supply the info. Don't worry, alot of people have problems with it.

 

[Les]

Hi David,
I'm almost eight years post-op from my second AVR and I have been on Atenolol and Digoxin ever since my first AVR almost ten years ago. Many of us experience what we call "pre-beats" where the heart rhythm tends to feel like it "skips" a beat or two which can be regulated fairly well with medication, such as the ones I swallow daily. Some of us, myself included, have had experiences with afib, and I still do if I push a little too hard while running. My cardio finds it interesting that I'll slip in and out of afib so quickly, but there's no fix......I just live with the fact and adjust accordingly. I've had to increase my dosage of Atenolol over the years as our livers get so efficient in processing drugs that it takes more to keep me on an "even keel". Big picture....it's something I have to live with....the key word here...LIVE. I hope you are one of the fortunates who get this rhythm problem resolved with no future occurences! Best wishes!
___________________
Les AVR '93 / '95

 

[Nancy]

I hesitated to give this link because there is so much data that might not apply to you, but here is just about everything you wanted to know about AF, and some things you never wanted to know. It's from the American Heart Association. Look at the section EPIDEMIOLOGY a couple pf paragraphs down and it mentions that AF is a self-limiting condition in a lot of heart surgeries.

http://circ.ahajournals.org/cgi/content/full/93/6/1262

My husband has AF and has had it for many years. He got a pacemaker to control the bradycardia aspects of it which were causing him to faint, and his rapid heart rate is mostly controlled with Lanoxin. However his heart rate is probably higher than most in spite of medication. There is a limit to how much Lanoxin one can be given. But my husband has several serious heart situations which you don't have. It is a condition that can be controlled several ways, with medication, with cardioversion, and with surgery, in some cases.

Most of it caused by heart surgery will improve with time. You may be given medications and if you are not on Coumadin, you might also be put on that to prevent clot formation.

Your card will tailor the treatment according to your own particular situation.

Best wishes. You have lots, and lots of company with this.

 

[ALCapshaw2]

G'day Mate,

A-Fib is fairly common in the first couple of months following any kind of Heart Surgery. I had a couple of episodes after Bypass Surgery and three episodes after my AVR. Cardiologists seem to characterize this as being the 'common cold' of heart conditions.

While still in the hospital following my AVR, I went into A-Fib and the nurse followed their Digoxin protocol with 3 injections. At that point she sent me back to the CCU. By the time I arrived at CCU, they said I was perfectly normal and wondered why I had been sent back. Elapsed time was 3 hours.

Around 6 weeks post op, I had another A-fib event and went to the ER where they did the usual heart enzyme tests and 3 hour observation while on a heart monitor. Sure enough, after 3 hours on the gurney, I converted to normal sinus rhythm and they sent me home.

A third A-Fib event occured a couple of days later, late in the evening. I called my PCP and we agreed to take an extra dose of Toprol XL 25mg (Low Dose Beta Blocker) and see what happened. I was cautioned to go to the ER if it got worse or did not resolve in a day or two. True to form, I converted to normal sinus rhythm after 3 hours. I've not had any more events.

I continue to take 25 mg of Toprol XL to prevent PVC and PAC which do seem to reoccur if I stop. Some cardiologists caution that 100 mg is the 'minimum theraputic dose' but 25 mg works for me and without it I have experienced PVC's and PAC's. YMMV.

'AL'

 

[pillarpaul]

David,

How far out was your surgery? Les is right, this is the "common cold" to cardiologists. I got a-fib 12 days post-op. I felt like a word that I can't use in the forum that starts with "s". My heart rate was over 200 beats per minute. I was adminsitered an IV drip of a drug called amiodarone (pretty heavy duty) and returned to normal sinus rhythm in three hours. I am on drugs now to prevent it from happening again. I was told both by my primary care physician and my cardiologist that every day I don't get it again will reduce my chances of ever getting it. It really is quite common for a couple of episodes post open heart surgery. You might ask your doc about taking digoxin preventatively. It seems to be safe and more effective than beta blockers when a-fib is due to surgery.

Also, Nancy's right about the American Heart Association having great info. I don't know if her link was the same I found, but I went to their web site then typed in atrial fibrillation and read several articles for the next two hours. You'll learn everything and more there.

Best of luck.

Paul

 

[JimL]

David,

Digoxin (lanoxin) is good stuff, with fewer side effects; I took it for over a year after surgery.

Amoidarone (cordarone) will work well for a while, but its side effects can be rather severe, and stay with you a long time. Be cautious about this one.

Magnesium is very safe as a maintenance drug to keep the heart beating regularly. Many take 500 mg a day -- magnesium gluconate, I get mine from a store here called GNC.

You need to have it checked out for your own peace of mind, and in case it is severe enough to warrant special treatment. Otherwise, consider getting a prescription for lanoxin, and try out the magnesium.

Hope this helps.

 

[sylviayasgur]

hi david!
i'm sorry to hear that you have to deal with afib. joey had a few bouts with afib presurgery andwas on sotolol (betapace) preventatively. (he was even cardioverted once). it really did the job, until he had his surgery and went into afib 4 days post op.
the sotolol did nothing. so they put him on amiodarone.
although everyone herewill tell you that it is really strong stuff, it does the trick. he is in the process of slowly weaning himself off of it, but is having trouble as he gets to the point of eliminating it altogether.
i think the side effects are awful (lung problems, eye problems, among others) but if monitored really closely, it can be a wonderful drug for treating afib.
on the other hand, my father has a st. jude's valve and is in chronic afib. he takes coumadin and is fine with it. it does not impede in his lifestyle.
so, you have choices here. there are numerous choices that you might want to look into before jumping into amiodarone.
discuss these with your cardio and please let us know what happens.
be well, sylvia

 

[DavidMac]

Yet again I am utterly amazed by the kind advice from you all. I can't quite believe what a wealth of info and support I have found. Thank you all very much.

So, here is the update. My AFib seems to be mild and intermittent. My beat was around 100 which is low right? Last night I went back to sinus and have been normal since. So it seems to come and go. It only happened 3 times, so I am hoping its a passing fad. I see my Cardio on Monday. I think he might say see how you go with increased Betaloc to help control it. I will ask him about the other solutions you have mentioned too.

I am confident it will clear up and not cause me any long term problems.

Thanks guys!

 

[bvdr]

Flecanide (Tamborcar)

Flecanide (Tamborcar)

Hi David,

I am still in the waiting room but I have had atrial fib quite a few times and am on Flecainide and Cardiazem to keep me in sinus rhythm. My cardio says its because my left atrium in very enlarged. I imagine the swelling after surgery has about the same effect. Flecainide has a bad reputation and even had a nasty book written about it but the problems were when it was used for a different purpose than what we are talking about here.
If you get put on it don't panic. I know several other people on it and it has certainly helped. I hope you are feeling well and having a good day..............Betty(bvdr)

 

[Dave Mendenhall]

I had atrial fib pre - surgery and none post op. I did have a rhythm slow down (low 40's) while catching up on sleep about 4 days post op while still in the Hospital (Eastern Maine Medical Center - Bangor). A train of white uniforms entered the room and attached me to an external pacemaker.

Now I had taken a sleeping pill, 5mg. valium and a pain pill. I was deep in slumberland and I felt the meds had something to do with the slow down. I was on Beta blockers and other meds as well. The Dr's decided to have an intenal pacemaker inserted in the next few days. I told them to just let the heart shake of this surgical trauma and I was sure I'd be fine. It was a Mexican stand off.

I over rode the external pace maker in 2-3 hours (defaulted at 70 bpm). They finally agreed after four days that the pace maker wasn't needed. I am on Amiodarone 200mg once a day instead to regulate heart rhythm.

I'm five weeks post op and plan to return to work after Memorial week end. The Sternum healing was my most difficult challenge as I have trouble sleeping on my back. I don't need to now and am OK to cough and snort without dropping to my knees.

Cheers
Dave Mendenhall 57 y/o
Mitral/St. Jude's #33
EMMC
Bangor, ME
4/17/03 surgery

 

[ALCapshaw2]

Dave -

I suspect most people have trouble sleeping on their back in a horizontal position. Two often recommended solutions are to sleep in a recliner or to get a Body Pillow to lay against. Another option is a wedge shaped pillow or foam support which is often recommended for patients with Acid Reflux disease.

Good luck getting some restful sleep!

'AL'

 

[shana23]

Hi David,
Well I had the same thing happen and had to do a cardioconversion...wasn't bad as they put me to sleep.I'm now on medication for the next 6 months and then they will see if I can come off of it.Lets hope so.Don't worry your in good hands and your doctor will beable to take care of it.All my best,Shana

 

[EVELYN]

Good Morning, Dave


Everyone here is right on about the afib. My husband, Tyce, went into afib one month prior to his avr surgery last June...He was admitted and put on amiodarone while in icu and converted back to nsr naturally. He had surgery, went back into afib post op and was put back on the amiodarone for about 6 months. He was weaned off last November and everything has been fine since. As everyone here has said, it is a wonderful, but watchful drug. He did have a lung test and eye tests during this period and our eye guy saw deposits of it in his eyes..........luckily he was able to get off it rather quickly post surgery. Our surgeon also said it was the heart tell you it was mad for being so disturbed----no one at our hospital or our cardio seemed too worried about it, thank goodness.

Hope that's a help---got to run.

Evelyn

 

[Dave Mendenhall]

Amioderone

Amioderone


Good news is that my surgeon told me last week that he would probably take me off Amioderone this month (that's 2 months of therapy only). Yes the side effects are very alarming to me...the one that stood out the most was clumsiness, now I have an excuse! I was also given the green light to go back to work.
Dave Mendenhall
Mitral valve
4/17/03
Maine

 

[shana23]

Great news lucky you!!!!My doctors said I'll have to be on Amidarone for at least another 6 months my fib was so bad.Glad to hear that someone is coming off of it.So far I haven't had so many side effects only alittle "morning sickness" every once and awhile and a cough doc said I'll just have to live with it.So happy for you,Shana

 

[Dave Mendenhall]

Thanks for your encouragement Shanna, although I'm now having trouble to get the Coumadin regulated. I just got back with a 8+ test and Vitamin 'K' shot. I was 1.4 last Friaday and my dosage was boosted, now I am off the charts as the test machine tops out at 8!

 

[ALCapshaw2]

GOOD GRIEF Dave ...

WHO is managing your Coumadin?

Did they use the 10% protocol?

(If your INR is high, reduce the WEEKLY dose by 10%,
If your INR is low, increase the WEEKLY dose by 10%,
spread over 7 days.

Most likely, you will NEVER get your INR under control
if the dosage is juggled wildly around!

FWIW, Coumadin Clinics often (typically?) do better
than most Doc's at managing Coumadin levels.

You may want to visit the Coumadin Forum
and / or e-mail Al Ludwick who manages a
Coumadin Clinic and monitors / contributes to
the Coumadin Forum here on VR.com

'AL'

 

[pillarpaul]

Dave,

Don't get too discouraged. After my a-fib I read 1.1, 1.3 and then 7.3. It is hard to get your INR stabilized when you first get on Coumadin. Shortly after my "bleed-out" score of 7.3 I stabilized and scored a 2.5 every week for four weeks (perfect for a-fib whihc is 2.0-3.0). Our bodies metabolize drugs differently and a correct dosage can't just be "predicted".

Shana and Dave, as for the amiodarone, I have been on it almost two months. Because I had a VERY SEVERE case of a-fib I was put on this "overkill" drug to prevenet more episodes. About 80-85% of all people on it never get a side effect, especially if you are not on it longer than six months. I will be off it by then although it does have a 45-day half-life. Just let your doc know if you think you may be having a side effect from it like fatigue or breathing problems.

Paul

 

[Dave Mendenhall]

Coumadin regulation

Coumadin regulation

I think you are absolutely right, as far as, GP's and thier experience. My Dr. (small town clinic) is sending me to the regional hospital for tests and opinions today.

I'm not all that upset, I'm breathing fresh coastal Maine air and am not experiencing difficulties.

We'll get it sorted out. Thanks for the support folks.

P.S. I sent this web site to my Cardiac Surgeon {hi Jim} and encouraged him to pass this on to his patients.

Dave Mendenhall
Castine, Maine
Mitral 4/17/03