Atrial Flutter

[RobThatsMe]

Hi Gang,

This has been one of those weeks!

Last Monday evening, (while out of town on business), a felt a weird feeling come over me while at dinner. When I went back to my hotel, I felt my pulse and noticed it was extremely fast. I figured I would relax and see if I felt better in the morning. Morning came, and I didn't feel any better, so I went to a local medical clinic that our office uses. The GP there ran an EKG and verified that I had an Atrial Flutter. I also told him that I just started taking Zyrtec and Flonase 3 days earlier and asked if this could be caused by a drug interaction with my Beta Blocker. He didn't know, and called a local cardiologist group that the clinic is affiliated with. He came back and informed me that I would be getting a call from them very soon, and that I should see the cardiologist that afternoon. He provided me with a copy of his report and my EKG.

I waited for the call.... and waited..... and waited!! No Call...
So, I called my cardiologist office, and faxed him a copy of my EKG.
MY doctor immediately called me back. Told me to seek help ASAP, that I needed a cadioversion, and that he did not know of any doctors in the small town I was in. He advised that I could see a local doctor, but that I would be better off if I could see him, or at least get to a larger city with good medical facilities.

I told him that I thought I could drive back to Nashville. He said he would setup the appointment at the hospital for first thing in the morning for a cardioversion. He also advised me to take an additional dose, 50 Mg, of my Atenolol beta blocker when I got home. Well, I got home, check my BP and pulse.. whew.... 90/67 and my pulse was 152 YIKES! I figured the last thing I want to do is lower my BP even lower than it was already... but also realized that the beta blocker also slows the heart rate.... so.. I took 1/2 a pill.

I also read some in the internet about some things you can do to put your heart back in rhythm. coughing, gagging, stressfully holding your breath. I tried a these a few times prior to going to bed, still worried about getting paddled/shocked in the morning at the hospital.

Well.. I woke up.. and I was back to a normal pattern. BP was 121/72 and pulse was 64. My wife and I still went to the hospital for the appointment. The nurse was all ready to sedate me for the cardioversion, I told her that I didn't need it. She doubted me, and ran an EKG... She looked so surprised that I was back to normal stating that this just doesn't happen often maybe 1 out of 10 come out of atrial flutter on their own. I was in flutter for over 36 hours.

My doctor wanted me to stay for awhile under observation, and did some blood workups as well. He also wanted me to continue on my additional dose of the beta blocker. I then told him that I only took 1/2 of what he recommended. I also voiced concern over changing my dose when in fact they don't even know what the cause was. I am to have a follow-up visit with him in 2 weeks.

Here is my concern. Again the medical community cannot explain the cause of my issue, yet want to change doses of medication. I would prefer to stay on my regular regiment of meds.. see if this happens again... and try to isolate the problem should it occur again.

I am checking my BP and Pulse twice a day.. and so far it is real good and I feel great.

I had one of the most stressful few days of my life over the weekend prior to tis occurring, and I was also on the new allergy meds. It could have been a combination of this that was the culprit and see no real need to adjust meds.
What are your thoughts?

Also, I might mention that is was a real good thing that I was already on Coumadin and Aspirin. Without those, I had a great risk of clotting and a stroke. Also, I had to change my cardiologist recently, and prior to this incident, I saw him for the first time just 6 weeks earlier. At this visit, the first thing he wanted to do after reviewing my meds was change my dose for my aspirin from 325 to 80 mg. I am aware of some of the current news validating this, however, my vascular and heart surgeons and my other cardiologist all reviewed this and in my case they recommended that I stay on the 325 mg.

I get so concerned, mad even, at doctors that just want to go in and make changes to meds without a good foundation. My mom got so sick from doctors making so many adjustments to her meds that the interactions almost killed her.

Whew... guess I vented allot.. anyway.. Any comments or suggestions on my actions or view regarding increasing my dose of the beta blocker?

Thanks,
Rob

 

[hensylee]

Rob - what a shock! That is so scary. I can only try to imagine your feelings when you were 152. Cardioversion was certainly indicated with your pulse that high. Could it be that the drive home calmed you down an got you back in proper rhythm. Going home is always comforting.

I agree with you that doctors screw us around. My brother, bless his heart, is living proof of the messups of some doctors. That's why we ALL must be our own teachers - find out all we can for our own good.

From time to time we have a discussion about 'shall I consider myself normal now or still worry'. Whatever each person's decision, I do think we need to be mindful of our hearts and how it reacts to things. Congratulations to you on making your own decisions. We can do that, from time to time, you know.

It is such good news that you are settled down again. Blessins - Ann

 

[LUVMyBirman]

They call him Dr. Rob!

They call him Dr. Rob!

Hi Rob,

Happy to hear you are back in sinus. I would place a bet on your allergy meds. See if you can back off...or try something else.

"Think" I may have had a few epsiodes of threatened A-Flutter. Kind of what you described with a funny feeling in the pit of your stomach. I could feel my heart speed up for a second, skip and back to normal. Once I used the head between the legs and cough. It was gone a quick as it came. I know it can be scary.

Wishing you all the best! Please keep us posted. Will you be in CO this fall?

 

[Susan BAV]

Hey Rob -

That sounds like a rough time!

I had a-fib after surgery and it was really rough, 198 bpm. I could hardly get my breath. The local doctors kept telling me to go straight to the local emergency room but my husband and I have strong misgivings about the local hospital so I wouldn't go. I was finally rehospitalized up in L.A. where I'd had the surgery and they put me on Sotalol for three months, which stopped the a-fib, but I believe the medication may have caused a painful problem in my leg joints, which is still resolving these several months later.

Anyway, this may or may not help you but I recall that the first time I went into a-fib was when I first got home from the hospital, one week post-op, and I sat down and drank a glass of white grape juice. I didn't realize it was a-fib and thought it was some kind of blood sugar problem. (Later a hospital tech said that the fruit juice could have been a trigger and that there may be many triggers. At that point she had me take several deep breaths and I hopped right back into a-fib.) After the first episode of a-fib, however, it resolved overnight but kept coming back every day for a week until I went back into the hospital (as I mentioned above). At that point, the cardiologist found out that I had been drinking coffee and he STRONGLY condemned that joyful pasttime. My husband turned into the caffiene police and we are strictly on decaf at home now. I do sneak out and have an espresso nearly every day (which doesn't have nearly the caffiene) and it doesn't seem to bother me as long as that is all the caffiene I have in a day.

But, sadly, last week my husband's grandmother passed away and we were back in Colorado with family for the memorial service and I had a lot of coffee while staying with family and I had a lot of arrythmic episodes. I believe it may have been from the coffee.

Oh, one more thing, the cardiologist massaged my (jugular?) while I was in a-fib and that slowed the bpm down. I do not know, however, if that is something a person can safely do on their own.

 

[Raverlaw]

Rob,

That must have been a little scary for you. My money's on the allergy meds ir you haven't had these episodes before. A combo of stress and the meds, plus maybe a little coffee?

Susan, I bet it was your carotid artery that the cardio massaged. I haven't had any of these type of episodes (knock on wood ) but I'm sure they're not fun to deal with.

And Rob, I agree 100% that if you haven't had any problems until now, your meds shouldn't be changed until they have a pretty good idea of what happened to cause the a-flutter in the first place.

 

[tobagotwo]

Rob, I also agree that medication shouldn't be changed on whimsy or on a single episode, even one as scary as yours. Atrial flutter is equated to atrial fibrillation everywhere I can find it, so I'm assuming you're referring to afib.

I used to have that a lot before surgery, and had one whole night of it the second night after surgery. It gives you that sick, sinking feeling in your stomach, like twanging a bad nerve, and an absolute feeling of impending doom. I shared its company many evenings, but never had it for more than six hours. That must have been a real head trip for you.

I don't envy you that experience. It's good to hear that you converted to NSR youself before they could take all the credit for it, and start bossing you around.

One thought: a number of people have had good rhythm remediation results with magnesium supplements, which can be bought over the counter very inexpensively. If your doctor isn't adverse to it, you might consider giving it a try as an added buffer against afib. I take it myself. At worst, it's at least as good as a rabbit's foot.

Susan, you are full of beans! Coffee beans, that is: unless you've found a source for decaf espresso. Espresso has much more caffeine in it than the same amount of regular coffee. In my twenties, a friend and I actually got high on it once, drinking it to stay awake working third shift.

Best wishes,

 

[Susan BAV]

Beans, beans, the musical fruit...

Bob - I should have been more clear on that (previous) statement. Ounce per ounce, espresso obviously has more caffiene. One shot of espresso, however, has less caffiene than a cup of coffee. I meant to imply a comparison of serving against serving.

 

[Susan BAV]

Oh, and also, the cardiologist had me receive several (three or four maybe?) magnesium IV's too, while I was hospitalized for the a-fib.

 

[Nancy]

Rob-

I looked up Zyrtec and this is a list of side affects:

Fast or irregular heartbeat; fever; abdominal or stomach pain; burning; chills; clay-colored stools or dark urine; cough; diarrhea; difficulty swallowing; dizziness; fast heartbeat; fever; headache; hives; itching; prickly sensations; puffiness or swelling of the eyelids or around the eyes, face, lips or tongue ; redness of skin; seizures ; shortness of breath; skin rash; swelling; tightness in chest; tingling; unusual tiredness or weakness; wheezing

Sorry you had those symptoms.

Joe has frequent afib or aflutter, not as bad as they were, though. And the rate is coming down when he does get it.

I would bet that the Zyrtec did it, combined with any stress you might have had.

I think you did exactly the right thing..

 

[Turkey Hunter]

Meds...........

Meds...........

Your new meds and your constantly changing time zone have a continual effect on your heart rhythm.

The allergy meds may have been OK last year....but with each year your body changes and reacts differently to each med you are on.

Just my oppinion...my dear friend.

God has touched you with pulling you from the arrhythmia prior to the cardioversion. Thank God. That is scary, I have been there and have no desire to return to that. I have experienced unsustained V-Tach as well as A-Fib. Anytime your heart beats at an abnormal rate or rythm.........it sucks and (I know I know it) we feel it when it happens !! I have been extreamly "aware" of my heart beat since my surgery..........is this normal??

Anyhow, God bless Rob !

Just so you know, my daughters' prayer that night was for your heart to "beep normal" !! You have been in my families thoughts and prayers since this episode!!

God Bless Rob.

Ben

 

[tobagotwo]

Wow! That Zyrtec sure is some fine stuff. With all those possible side effects, I hope it does a great job of relieving allergies.

It does sound like the Zyrtec is the culprit, hitting you as it did in combination with other med changes. Nancy made another good call. You may also have been tired or anxious that day, which would make it worse. Stress really seems to figure heavily in afib.

Don't forget to consider the magnesium as well.

Susan, I shouldn't be drinking coffee either. And yet I do...

I cut down to one cup at home before work (the good stuff - A&P), because everyone likes to go get coffee in the morning at work.

I can't stand the decaf stuff they have at work, so I've been doing half-and-half with the decaf and the regular. It's a social requirement, I guess. Anyway, I notice I rarely finish it before it goes cold. I often wonder if the cleaning crew gets splashed when they empty my wastebasket. They must expect that from people by now, wouldn't you think?

Best wishes,

 

[Ross]

Sure would be nice to know if something in particular caused it. Glad it's abated.

Friend of mine has been having all sorts of trouble with Afib. He went to the Doc the other day for simple INR draw and ended up getting an ambulance ride to the hopsital for cardioversion. He was in afib and didn't know it!

 

[Rain]

I hope you're spending a nice long weekend on your boat.. relaxing.

I hope you're spending a nice long weekend on your boat.. relaxing.

WOW! Rob, that?s scary stuff!! I lived with atrial fib and racing out of control heart rate for many, many years. Scary! Only word for it. It doesn?t race fast like it used to, mostly just very irregular now. But back in those days when it would race out of control... I would actually start sweating, get a dizzy feeling, tight chest and couldn?t breath! I don?t remember anything about my stomach feeling funny... it was my chest. It would feel like my whole chest (and body) was just quivering. I thank God quite often that I lived through those years. Thank God YOU got over it and didn?t have to get shocked. You know more about this stuff than I do, but I sure wouldn?t mess with my meds... other than kicking out the bad one. I gotta tell ya tho, Rob... I know from living with it for so many years, and my cardio has confirmed it... stress is BAD news. I still live with cronic a-fib. The meds I take make it a lot easier to deal with... But when I?m stressed out... I can really feel my heart get more out of control. There?s a nurse where I exercise three days a week, she has to take my heart rate on my chest to get a true reading, the finger thingie won?t work on me because of the a-fib, it jumps all over the place. Anyway she can always tell when I?m stressed. Once in a while she?ll say to me..... ?okay, Lorraine, what?s got ya stressed out??. So my advice would be lose the stress! I know that?s impossible... but I know it?s a big factor. Do your best, that?s all ya can do. Think happy, positive thoughts at every opportunity and spend lots of time at the lake.

Without anyone ever telling me in the old days, I did discover that coughing helped when my heart was being weird... must be sort of an instinct kind of thing... I also always wanted to be near cool air... I couldn?t breath and started to feel dizzy. Scary... so happy you?re over it and hope you never go back. Stress, Rob.. I?m tellin ya.. that has more to do with it than you want to admit. Of course if you get all stressed out and go cry in one or two too many beers... then you?re in REAL trouble. To much caffeine, alcohol or even a smoke filled room will really mess with my heart too.

You know what Janie?s gonna say if she ever gets here.... she swears magnesium keeps her heart in line. I've been meaning to get some of that... but I just hate to mess with my meds. If nothing else.. there's the INR issue. Grrrrr..... I can't stand having health issues. Ignoring them doesn't make them go away though... I proved that with living through the above. My cardio says that's why I'm in constant a-fib.

My very best wishes to you, Rob. Hopefully it's the last you'll see of it.

 

[Gemma]

Hi Rob,
Sorry to hear about your scary experience. My boyfriend Jim had what we thought at first was atrial flutter (found out later from his GP - the hospital didn't explain - that it was supra-ventricular tachychardia, fast (165bpm) but regular - that seems to be the difference) a month post-op. Started with a feeling of "butterflies" in his stomach and progressed to a fast heart rate.
Although it was the first incident, his cardio stuck him on sotalol (Susan, we have since discovered aching legs can be a side-effect of the sotalol), saw him 4 weeks later and that's it until November. I've often wondered how they know if it would happen again, or if it's just cheaper to keep him on the sotalol indefinitely regardless of any potential side effects. He had maybe 3 or 4 brief spurts of a few fast beats in the few weeks after the SVT in January, and none since. His problem now is his slow heart rate at rest - causes some ectopic beats (PVCs?) - during and after exercise it's fine, just happens when he's been sitting for 1/2 an hour or more, or is asleep. His GP's answer? Take more sotalol!!! So, Jim decided not to take more but change the time he has his second dose from 8pm to 9.30pm. This seems to make it less noticeable, but it still happens to some extent. Everybody reacts differently to all kinds of meds - it's a bit of a try it and see approach really which isn't ideal!
The other thing about Jim's SVT experience though is that I strongly believe stress had a big part to play in it. For a start, he'd spent 3-4 hours in the January sales 2 days previously, then gone to a motorbike sale and walked around for several hours there too the next day. The day it actually started up, he'd been heaving bits of engine around. This was a vast increase in activity in a short amount of time. Then in hospital nobody explained what was going on, they just freaked him out even more and stopping his heart with some drugs 3 times while he was awake to no avail really didn't help. Then he stayed in hospital over night whilst on a 24-hour amioderone drip (which eventually slowed his heart rate and he got back into sinus rhythm after about 6 hours), and was given cup after cup of tea. Next morning, the nurse comes along and explains what can cause arrhythmias - stress (like being rushed into hospital and not told what's going on), too much alcohol (hello, he's on warfarin so can't drink that much!!!) and caffeine (hmmm, so why the 10 cups of tea?). Of course now he's switched to decaf.
Sorry, this seems to have turned into my own rant rather than offering any insight. But I think maybe when the doctors don't really have a definite answer, you might do what you feel is best regarding meds. Maybe see how it goes for a while and if you DO have any problems try their solution? This has worked for Jim so far with regards to his sotalol dosage - he doesn't want to take more at all!
Gemma.

 

[RobThatsMe]

Hi Everyone,

Thank you so much for your replies! I was away over the weekend, and so far so good. No more episodes. I think that a combinations of factors... yup.. all the stars were aligned, caused my atrial flutter. Hmm... let's see... Lots of stress... new meds... caffeine, ( not to mention one of those new power drinks the day before), and a few drinks over the weekend... Yikes! Anyway, I feel fine today!

Helen, than you for your positive words.

Gina, I'm not sure about CO this fall. My mother-in-law is still battling lung cancer, and at the moment it is hard to make any long range plans.

Susan, Thanks... I am watching all my caffeine intake now. Only drinking 2 cups of 1/2 and 1/2 a day.

Bill, I think you are on the mark.. I had all the makings for a serious combo of trouble. Time to eliminate some of them!

Bob H. and Gemma, I am taking your advice and holding the line on any changes to my meds unless they can provide me with a sound reason to make a change. A base line needs to be established to find the root cause of the event prior to making corrective action.

Nancy, Your message made me put those meds away... At least for now. I took Zytec last year with no problems... But things / bodies do change. I'll rule out the other issues, then if my allergies startup again, I may try 1/2 dose for a few days... lay off it, then start it again for a few more days..etc.

Rain and Janie... Stress.... Stresss... me? hahahaha! Whew... if you only new... This has been a real stressful time for me, and yes... I need to shake it off. Life is good... and don't sweat the small stuff... I really need to drill that into my head!

Ben, I am so glad I called you while driving back home with my heart in A-Flutter. You helped calm me down some, and after hearing that you came out of it on your on gave me hope. Please tell your daughter thanks for all her prayers, I said a few myself, and practiced a few of those exercises prior to going to bed the night before my scheduled cardioversion. Prayers work, they helped me through my initial surgery! I had to smile when I did wake up the next morning and realized that I was back in normal pattern. I smiled, and said.. yup.. Ben can do it... So can I ! hehehehe..

Again, thanks everyone. Hopefully this was a one time experience. Perhaps even a wake up call to myself. I was beginning to feel like I was back to normal and that my heart surgery never happened. Guess we all just have to face up that our lives have changed, and that we must make some adjustments to accommodate this change in life style. Still... Live is to be lived.. so.. Enjoy!

Best wishes and good health to all,
Rob

 

[Turkey Hunter]

Rob.............

Rob.............

Alayna made a "homemade" card for you.
We will send it. She was so worried..............She and the boy said extra prayers that night. (As well as I and Cindy did)

God Bless you and Cristi.

Great to hear all is well.

Love ya man.

Ben

 

[hensylee]

That's good news Rob. can't have our pin-up boy having troubles. Thanks for telling us. Me 'n Miss Janie were worried - And Ben - and Nancy - and Ross and Sue -and - well, you know.