Cyborg in training

[Freebird]

I posted on https://heart-valve-surgery.com about my AFib as well, and in response, Adam Pick posted this video about how common AFib is after heart surgery. I found it reassuring.

Johnmarkos I'm in Austin and grateful I'm not near that Zuckerberg hospital -Sheesh! Gotta love our ridiculous healthcare system here in the U.S.

What a reassuring video! Thank you for sharing it! It states that AFib after valve surgery is most always temporary, with 94% of patients not having it after the first 6 weeks following surgery.

Glad to hear things are settling down for you.

 

[Protimenow]

I don't know how it is where you live, but in San Francisco, California, where I have lived most of my adult life, going to the ER means hours of waiting, and it'll ruin your whole day. This experience is a powerful incentive to avoid the ER, unless it's absolutely necessary.

Presumably, if your condition really is life-threatening, they'll get to you right away. I've only been to the ER for things that turned out not to require immediate attention.

But if I call the surgeon's office or my cardiologist's office on Tuesday, and they tell me to go to the ER, I'll go to the ER. But not Zuckerberg San Francisco General (link: vox.com), the closest ER to my home. I guess I'll go to the ER at CPMC Van Ness, where I had my valve replaced.

There are ways to handle the E.R. They seem to prioritize the timing, based on the complaint.

When I had my TIA, I said that I had numbness in my left lower leg and foot. I waited for a long time before they got to me. If I had said 'I think I may have had a stroke,' they'd have seen me a lot sooner.

Similarly, if you go to the E.R. and complain that you're having AFIB, they'll probably put it near the bottom of the line. If you say 'I think I'm having a heart attack' or 'my heart seems like it's beating out of my chest,' they'll see you much sooner.

In November 2018, I went to the E.R. with an obvious issue - my left lower leg was turgid - swollen to the limits that my skin could contain it. This, obviously emergent situation, put my place in line above most of the others.

But, again, if you say the magic words - stroke or heart attack - you'll probably be moved to the front of the line.

 

[Freebird]

We have a BP cuff, a really nice one, and I just used it -- BP 128/73, pulse 70. I'm still noticing some irregular beats, especially when I'm not at rest, but it seems less irregular than yesterday or early this morning.

By the way, my cardiologist recommended I get a Kardia. They're about $100 on Amazon and they allow you to give yourself an EKG. You can email the results to your doctor. Pretty cool stuff. https://www.amazon.com/Alivecor®-Ka...ords=ekg+monitor+kardia&qid=1579465201&sr=8-4

 

[Protimenow]

I have a friend who turned 78 last week. He claims that he's had AFIB since he was six years old. A few months ago, his doctors finally convinced him that he should go on an anticoagulant. He argued that he's had it most of his life, without problems.

They convinced him that, at his age, the best course of treatment is to start an anticoagulant.

 

[Protimenow]

By the way, my cardiologist recommended I get a Kardia. They're about $100 on Amazon and they allow you to give yourself an EKG. You can email the results to your doctor. Pretty cool stuff. https://www.amazon.com/Alivecor®-Ka...ords=ekg+monitor+kardia&qid=1579465201&sr=8-4

Yes, a single lead EKG. This sounds interesting.

Supposedly, some cheap sports watches are supposedly able to do EKGs. I tried one - but it refused to transfer the record to my phone.

If I had money, and was overly concerned with my heart rhythm, I might also try the Kardia.

 

[johnmarkos]

I'm starting to lean into my "Battle Royale" hypothesis: currently, I have a fast, post-op RHR and a slower, natural RHR, which is close to what mine was before surgery. If I so much as move a little bit, it goes into fast mode, but if I sit still for 15-30 seconds, it goes into slow mode. I'll look into the Kardia. I hope that my detailed description of this AFib/fast RHR situation helps others who are at an earlier stage in the process. This forum is certainly helping me: it's reassuring to hear the experience and knowledge of forum members.

I'll check out the Kardia.

 

[pellicle]

I'm taking my pulse manually, using a watch, and counting as well as I can.

its an easy way, don't forget to count the first beat as Zero then 1 2 3 4 ...

 

[pellicle]

If I so much as move a little bit, it goes into fast mode, but if I sit still for 15-30 seconds, it goes into slow mode

I liked to think of it as "retraining" ... the biological system that keeps everything "in balance" (homeostasis) can't be informed about the changes in valves (its not a normal natural process) but it will over time learn and readjust to keep things in balance.

Meanwhile many minor nerves have undoubtedly been severed and so it all takes time. Much of this is autonomic (meaning it does not need your brain) and those systems take time to retrain.

When my HR spiked high (and it was about 120 for most of the time I was in hospital) I sat up in the bed, back straight and breathed in as deep as possible and held it. Usually within 30 seconds it would have a marked reduction in HR (and its good for expanding the lungs too). I hope you have one of these to work with too:

I was given one at the hospital as soon as I got back to the ward.

 

[epstns]

John - You may have a situation that I had prior to valve replacement - mine was called brady/tachycardia. I had a very low RHR, in the upper 40's. Under even moderate exercise load, my heart rate would soar to the mid-160's - and I was 63 at the time, hardly an age when a heart rate in the 160's is expected. This condition, for me, was never diagnosed until surgery. The docs just attributed both the low RHR and my tolerance of a high peak rate to athletic conditioning. Well, I don't think I was in such super shape!

I can't really tell you what happened to my heart rate post-surgery, though. I had so many rate and rhythm issues post-op that I now have a pacemaker and take a daily beta blocker. The pacemaker keeps my heart rate to a minimum of 60 BPM. (I know that my "natural" RHR is still 48 BPM, as that is where it went then one of my pacer leads failed a few years ago.) The beta blocker keeps my heart rate from going too high, and helps to maximize my ejection fraction. My heart rate almost never goes above 145 BPM now, thus limiting me to "power walking" rather than jogging. My knees thank me for it.

Again, although the low RHR. pacemaker and beta blocker sound daunting, and many non-patients might blanche at the thought of any of them, they are really not life issues to me at all. I keep the pressure on my docs to get pacer settings and dosages right, then just get on with my life. These things are more common among valve surgery patients than we think. Maybe there aren't droves of us at the cardio's office, but they have seen enough like us to know how to help.

 

[johnmarkos]

Ended up at the ER after all, for AFlutter and tachycardia.

 

[johnmarkos]

Back from the ER, doing OK, with another medicine to take. Still in AFlutter, but my heart rate has come down, due to the medications they gave me at the ER. I'll follow up with my surgeon and cardiologist as soon as I can.

 

[Freebird]

Back from the ER, doing OK, with another medicine to take. Still in AFlutter, but my heart rate has come down, due to the medications they gave me at the ER. I'll follow up with my surgeon and cardiologist as soon as I can.

Sorry to hear you had to go to the ER but glad you got the help you needed.

 

[pellicle]

Back from the ER, doing OK, ..I'll follow up with my surgeon and cardiologist as soon as I can.

You did the right thing going back in.

Hope it smooths out soon

 

[stephenismycopilot]

Thanks, all! I had an episode of atrial fibrillation yesterday afternoon/evening. When I called the surgeon's office, the PA suggested some more tests tomorrow at my post-op visit, but was reassuring. Apparently, the main risk of Afib is increased risk of stroke, and since I'm already on Warfarin, I'm already mitigating that risk. The Afib resolved on its own before midnight.

Speaking of Warfarin, my father told me that WARFarin contains the abbreviation for Wisconsin Alumni Research Foundation. As my whole family comes from Wisconsin -- converged on Wisconsin in the 19th century, then diverged from it in the 20th -- that pleases me quite a bit.

Wow. I had no idea. I'm from Wisconsin, so that's a fun bit of trivia.

 

[johnmarkos]

This evening, I spoke to another cardiologist from my cardiologist's practice: apparently my ER discharge instructions didn't exactly match what he had instructed last night. I'm supposed to start taking 0.25 mg Digoxin every night, and I'll take 7.5 mg (as opposed to 5 mg) Warfarin every other night, starting tonight. And I'm supposed to double my Carvedilol to 12.5 mg, morning and night. Tomorrow, I'll probably get to talk to my own cardiologist. They're talking about doing cardioversion for my AFlutter, so I need to get my INR above 2 for that.

I'd also feel better about anticoagulation for my valve if it were above 2 -- it was 1.8 last night. Once I get to talk to my cardiologist, I'm going to ask for more documentation of the INR targets.

 

[johnmarkos]

I'm feeling bummed about this whole AFlutter thing. I had surgery to fix a problem, even though I felt fine, and now I have another problem. What's the success rate of cardioversion? From what I've read, it doesn't always work. Then what? More cardioversions? Catheter ablation? What if that doesn't work? I'm a worrier.

The PA at my surgeon's office told me that AFlutter is less likely to spontaneously go back to normal (without cardioversion) than AFib is. Anyone who's had this condition, would you care to weigh in?

On the plus side, it doesn't seem to be holding me back too much. I went for multiple walks today, including one down and up the hill I live on, to the grocery store, and my heart rate didn't get particularly high. It almost seems as though when I exercise, my heart rate moderates itself. From what I've read, there are different ratios in AFlutter, so when I exercise, maybe it's slipping into a higher ratio. Also, when I sleep, my heart rate goes down to my post-surgery RHR, mid-80s.

Tomorrow I talk to my cardiologist -- it's my first post-surgery follow-up appointment. I hope he can offer some more clarity on how this AFlutter will be handled, and I hope I can get past it.

I'd really like to get back to work soon -- I have enough energy to do my job -- so I'm hoping my surgeon will authorize me to work despite my AFlutter. Maybe a couple weeks from now, after my parents go home.

 

[Freebird]

I'm feeling bummed about this whole AFlutter thing. I had surgery to fix a problem, even though I felt fine, and now I have another problem. What's the success rate of cardioversion? From what I've read, it doesn't always work. Then what? More cardioversions? Catheter ablation? What if that doesn't work? I'm a worrier.

The PA at my surgeon's office told me that AFlutter is less likely to spontaneously go back to normal (without cardioversion) than AFib is. Anyone who's had this condition, would you care to weigh in?

On the plus side, it doesn't seem to be holding me back too much. I went for multiple walks today, including one down and up the hill I live on, to the grocery store, and my heart rate didn't get particularly high. It almost seems as though when I exercise, my heart rate moderates itself. From what I've read, there are different ratios in AFlutter, so when I exercise, maybe it's slipping into a higher ratio. Also, when I sleep, my heart rate goes down to my post-surgery RHR, mid-80s.

Tomorrow I talk to my cardiologist -- it's my first post-surgery follow-up appointment. I hope he can offer some more clarity on how this AFlutter will be handled, and I hope I can get past it.

I'd really like to get back to work soon -- I have enough energy to do my job -- so I'm hoping my surgeon will authorize me to work despite my AFlutter. Maybe a couple weeks from now, after my parents go home.

Sorry you're going through this. I hope you'll get some more definitive news from your cardiologist.

 

[johnmarkos]

Sorry you're going through this. I hope you'll get some more definitive news from your cardiologist.

Thanks, @Freebird. My wife says she thinks I seem better, subjectively: that I move more easily than I did immediately post-surgery, and that I'm more active than I was. So maybe I'm just impatient.

 

[Freebird]

Thanks, @Freebird. My wife says she thinks I seem better, subjectively: that I move more easily than I did immediately post-surgery, and that I'm more active than I was. So maybe I'm just impatient.

What are the signs of your aflutter? How is it different from afib?

 

[johnmarkos]

What are the signs of your aflutter? How is it different from afib?

From what I've read, AFlutter is more regular than AFib, which is chaotic. My understanding is that the atria are contracting very fast, like 300 times a minute, and the ventricles are contracting at some ratio to that. When I went to the ER, my pulse was 150 or higher, so I guess my ventricles were contracting at a 2:1 ratio to my atria. When my pulse is 100-something, maybe it's 3:1, and when it's 80-something, maybe 4:1? I'm not sure.

Sometimes, when it's quiet, I can hear double clicks (mechanical valve) for each pulse I feel in my arm, although right now, I'm getting single clicks, probably because of the medicine.