Is This Atrial Fibrilation or something else?

[ASaxon]

I posted this earlier:

Had an echocardiogram two years ago with borderline measurements for wall thickness (IVSd=1.1cm, LVs=1.2cm), Left Ventricle Diastolic Diameter (LVd=5.9cm), Left Atrium Systolic Diameter (LAs=4.5cm), an Ejection Fraction of 67% with no mention of mitral valve regurgitation.

Had a follow up echocardiogram one year ago with the following results: Mild to Moderate wall thickness (IVSd=1.4cm, LVs=1.6cm), mild Left Ventricle Diastolic Diameter (LVd=6.2cm), Left Atrium Systolic Diameter (LAs=5.2cm), an Ejection Fraction of 71% with the following mitral valve analysis.

Mitral Valve ? Normal anatomy and motion with normal peak flow velocity without stenosis, prolapse or vegetation. There is mild mitral regurgitation seen at peak elocity of 4.2 m/sec going back approximately half way to the superior left atrial border occupying no more than 10-20% of the left atrial volume on the color flow map.

No doctor has ever been able to hear any murmur or abnormal sound with a stethoscope. My doctor tells me that this may be because I?m so big (6?1?, 300+ lbs) as this can make it difficult to hear faint abnormal heart sounds.

I also had an echo about two and a half years ago that showed mitral valve regurgitation with an atrium of 4.5cm but I don?t have the results and that?s all I remember.

Here?s my question:

I just started exercising and loosing weight again after four months of taking it easy. Prior to quitting exercise I was occasionally experiencing a fluttering sensation in my upper back or chest. It?s really hard to explain but it?s as if you?re really nervous and your muscles in your back are quivering because of the tension.

I went to my cardio doc and he did a bunch of monitoring tests such as a 24-hour holter and an event recorder and I know I got one of these fluttering sensations on the event recorder. The doctor said it was a normal sinus rhythm and didn?t detect any atrial flutter.

1. I know that being a large person can make ECG voltages appear lower (more fat to go through) than in a thin person so could it be that atrial flutter would be more difficult to see in a large person? I question this myself as atrial flutter only appears on an ECG when there?s no P wave so if there?s a detectible P wave it can?t be atrial flutter.

2. Could be a beat generated from somewhere else on the atrium and thus would not show as affecting the main atrial electrical signal but would appear in conjunction with it (a normal P wave)?

After I stopped exercising four months ago this fluttering sensation went away and I had not had any of it for four months. I recently started exercising about a week ago and now the fluttering sensation is back. If I?m near my beta-blocker dose (25mg Q.D.) the fluttering will tend to go away. My pulse rate during the fluttering is around 90 - 100 BPM when at rest and my normal pulse around 60 to 70 at rest.

Here?s my theory.

I have recurring mitral valve regurgitation (by echo) which only appears at certain times when my blood pressure is higher (anxiety) or if it has been high recently (exercising). When I?m not exercising for a period of time and my blood pressure is controlled the regurgitation goes away which would in turn cause my atrium to get smaller (as evidenced by my first echo). This would cause my atrium to shrink down (a bit) and bring me ba

When I?m exercising my blood pressure rises enough to cause the valve to regurgitate. If I exercise long, or hard, enough the atrium begins to expand and could stay that way for a while which not only could cause continued regurgitation due to the enlarged atrium but also potentially is causing the fluttering sensation.

Any opinions on this theory?

 

[Nancy]

Well, I would guess if the Holter monitor results indicate that things are OK, then it's probably true. They usually pick up the most unusual rhythms, especialy since you mentioned that you had one of those spells while hooked up.

My husband has atrial flutter, atrial fibrillation and other strange rhythms from time to time.

His heart rate goes way up above 100, say about 116-120 when he's in aflutter or afib.

His cardiologists even sometimes cannot tell by listening if he's in aflutter or afib, he needs an EKG to determine which it is.

His cardiologist said that not all fast heart rates are abnormal. People can and do have normal high heart rates. They will come back down again, after stress or exercise is over.

The afib or flutter last for a long time and do not come down easily.

 

[ASaxon]

Thanks for the reply...

I?ve been doing research on this and no longer think that it?s AFib or AFlut. From what I can tell it?s pretty easy to detect these two conditions on ECG and since I know I had caught more than one of these symptoms on my Holter and Event Recorder and my doctor didn?t see any problem I guess it?s something else.

 

[Tony]

What type of exercise are you doing?

Could your symptoms be specific to the type of exercise?

Would alternative exercise produce the same symptoms?
Have you tried working out on an elliptical or a treadmill where your legs are doing the work?

Perhaps these questions will lead to further discussion.

Good luck!

 

[ASaxon]

I?m beginning to think that it?s really in my back. Yesterday after having a day of this quivering sensation I started having back aches and one sharper ache right in the spot in my upper back where this quivering could have been coming from. I?m just going to keep a careful watch on it and see what happens. Today I don't have it and a few days ago I was doing some lifting so I guess it could be related. Drives me nuts though!!!