Palpitations.

[David W]

I just wanted to ask about everyone about their experience of palpitations post op. For the last week (it's only been just over 2 weeks post op) I get these bloody palpitations that really give me the heebie jeebies. Is anyone else still experiencing this? Does this calm down with time? Any info as always is greatly appreciated.

D

 

[Paleowoman]

Hi David,

During the first few weeks after AVR I had a few palpitations and also what seemed like missed beats. I contacted the cardiologist and they did a 24hr ECG monitor which showed it was normal, and normal to have a few 'funny' beats. Probably because of the heart being handled ? It's if you get the kind of paplitations which are like atrial fibrillation that it's something to be very concerned about. Best to see your GP or cardiologist just to check.

The other thing I found was that in the first few months after AVR I was very much more aware of my heart beat, and that's becasue the valve was 'better' than my bicuspid valve and the leaflets closing nice and properly, so louder in my chest so I was therefore more aware of any irregularities. Night time especially when the heart is naturally slower and the beats seemed very much more strong and pronounced, when I missed one or got a couple of fast ones it felt like my heart was 'jumping' ! Nothing was wrong though. Btw, the flow murmur from my new valve is very loud to doctors, but normal, so it's no wonder. An amusing anecdote here: one night last year I had real palpitations reaching upper 100s for several hours (turned out to be due to some antibiotics I was on that I'm sensitive to) and 111 sent me to A&E - the consultant who saw me said I had a "stonking murmur". Of course "stonking" is not a medical term but a UK informal and originally military term, but when I wrote that on the forum it had an amusing result.

 

[yotphix]

Heebie Jeebies for certain. I remember that I was told to come in if they lasted more than a day. One night they started up at around 8 pm, and by about 4 in the morning, unable to sleep because they were so powerfully wierd, I suddenly wondered whether 'a day' was 8 hours like a work day? Maybe 12 hours, like the part of a day which isn't night? Or did they really intend for me to sit at home with two caged rabbits having a fight to the death inside my ribcage for 24 straight hours? I emailed my surgeon, and he simply said, come in to emerg, and tell them to page me if they aren't gone by lunch time. By 10 am they were gone. That was the worst bout, and there was one other similar. The rest ranged from single 'missed beats' or 'flipflops' to 5, 10, 30 minute bouts. They had all stopped well befor 6 months passed (I remember because I didn't experience them while on holiday at 6 months). Mostly they were gone within a few weeks though.

 

[Paleowoman]

Love the analogy of the two caged rabbits having a fight yotphix !

 

[pellicle]

I used to get them for some time, but curiously there hasn't been a memorable instance for some time (that could just be because I'm used to it??)

Last one (that i recall) was back before mobile phones were common and I was cycling the 17km home. I just sat there on the side of the road (at night) waiting for it to subside. I think it took 20 min. Then I mounted up and cycled home.

 

[David W]

Thanks for your info guys. It's not like my palpitations are constant, they are just every now and then and they last for maybe 10 seconds. I guess I'm just unsure
If it's normal or something I need to go and ask my GP about just to make sure. I know it's early doors for me post op, but when it happens it doesn't half give you a kick up the arse and then I'm sitting up in my chair like a meerkat. I'll maybe give till the end of this week and if it remains I'll just go and have a chat with the quack. I have my follow up appointment with the surgeon on the 20th, so not long to go.

 

[MrsBray]

I'm 19 months post-op, and I still herky-jerk every time something "different" happens. I distinctly remember about 4 weeks post-op I skipped a beat. The adrenaline hit my system so fast, I caught my breath, and it was over. I just had a conversation with my husband about palpitations, and realized I haven't felt any in quite some time. I must be almost healed!

 

[almost_hectic]

Thanks for your info guys. It's not like my palpitations are constant, they are just every now and then and they last for maybe 10 seconds. I guess I'm just unsure
If it's normal or something I need to go and ask my GP about just to make sure. I know it's early doors for me post op, but when it happens it doesn't half give you a kick up the arse and then I'm sitting up in my chair like a meerkat. I'll maybe give till the end of this week and if it remains I'll just go and have a chat with the quack. I have my follow up appointment with the surgeon on the 20th, so not long to go.

Let us know what your surgeon says. I'm two months out and skip a beat every now and then. But I've always had that experience before surgery so to me it's normal. I think for myself it actually happens less often since surgery. Although when it does, it's more noticeable. From what I've come to understand, prior to surgery your heart is enclosed in a fluid filled sac, the pericardium. It's a protective barrier protecting the heart holding it steady and acts like a shock absorber insulating the heart from bumps and blows. During surgery that sac is cut open to access the heart. Most all surgeons leave this open when they're done to prevent complications from surgery. So after surgery you no longer have that barrier around the heart, so the sensation of a good hard flub or beat out of synch can be felt that much more. I've read mixed information on the healing of the pericardial sac and wether or not it returns to its normal function over time.

 

[David W]

Let us know what your surgeon says. I'm two months out and skip a beat every now and then. But I've always had that experience before surgery so to me it's normal. I think for myself it actually happens less often since surgery. Although when it does, it's more noticeable. From what I've come to understand, prior to surgery your heart is enclosed in a fluid filled sac, the pericardium. It's a protective barrier protecting the heart holding it steady and acts like a shock absorber insulating the heart from bumps and blows. During surgery that sac is cut open to access the heart. Most all surgeons leave this open when they're done to prevent complications from surgery. So after surgery you no longer have that barrier around the heart, so the sensation of a good hard flub or beat out of synch can be felt that much more. I've read mixed information on the healing of the pericardial sac and wether or not it returns to its normal function over time.

Thanks AH. That's interesting re the pericardium. I didn't know that. I will have a gander and research further. I guess I need to monitor this over time and will have a full debrief with my doctor next week.

 

[David W]

I'm 19 months post-op, and I still herky-jerk every time something "different" happens. I distinctly remember about 4 weeks post-op I skipped a beat. The adrenaline hit my system so fast, I caught my breath, and it was over. I just had a conversation with my husband about palpitations, and realized I haven't felt any in quite some time. I must be almost healed!

Glad to hear things have settled down for you Mrs Bray.

 

[David W]

Hi David,

During the first few weeks after AVR I had a few palpitations and also what seemed like missed beats. I contacted the cardiologist and they did a 24hr ECG monitor which showed it was normal, and normal to have a few 'funny' beats. Probably because of the heart being handled ? It's if you get the kind of paplitations which are like atrial fibrillation that it's something to be very concerned about. Best to see your GP or cardiologist just to check.

The other thing I found was that in the first few months after AVR I was very much more aware of my heart beat, and that's becasue the valve was 'better' than my bicuspid valve and the leaflets closing nice and properly, so louder in my chest so I was therefore more aware of any irregularities. Night time especially when the heart is naturally slower and the beats seemed very much more strong and pronounced, when I missed one or got a couple of fast ones it felt like my heart was 'jumping' ! Nothing was wrong though. Btw, the flow murmur from my new valve is very loud to doctors, but normal, so it's no wonder. An amusing anecdote here: one night last year I had real palpitations reaching upper 100s for several hours (turned out to be due to some antibiotics I was on that I'm sensitive to) and 111 sent me to A&E - the consultant who saw me said I had a "stonking murmur". Of course "stonking" is not a medical term but a UK informal and originally military term, but when I wrote that on the forum it had an amusing result.

Stonking is such a great word that is under used Anne.

 

[Zoltania]

I went to the ED a week after returning home from surgery because I was having a lot of what felt like skipped beats. They turned out to be PVCs and PACs. The ED staff called the CV surgeon on duty, who said that those were normal in my situation. Later my own surgeon said that the heart is "irritable" after surgery, and my cardiologist said that it's OK for the heartbeat to be "regularly irregular." What they worry about is a disorganized rhythm such as atrial fibrillation or atrial flutter. I wish I had known all this before I was discharged from the hospital; it would have saved me a scare and an ED visit. All the printed information I got from the hospital said to call if I experienced an irregular heartbeat, and when I called I was told to come in. Over time the frequency of my PVCs/PACs has been decreasing, so maybe my heart is feeling less irritable now.

Interestingly, it turns out (maybe most of you already know this) that what feels like skipped beats is actually early beats. The first beat is normal. Then an early one occurs, but the heart has not yet had time to refill with blood, so the beat is almost imperceptible and you think you've skipped it.

 

[pellicle]

Hi

Thanks for your info guys. It's not like my palpitations are constant, they are just every now and then and they last for maybe 10 seconds

mine were irregular, unpredictable and could last 5 beats or 15 minutes ... but ask for sure ... even if you totally believed us, always ask.

 

[Midpack]

Interestingly, it turns out (maybe most of you already know this) that what feels like skipped beats is actually early beats. The first beat is normal. Then an early one occurs, but the heart has not yet had time to refill with blood, so the beat is almost imperceptible and you think you've skipped it.

And the next normal beat is usually stronger than usual, as a result of some compensatory effect. In my case, i know i have a PVC/PAC not so much because of the "pause", but mostly from the next louder beat. Anyway, isolated extrasystoles in an structurally normal heart, as i have been told, are not something to worry about. And the more anxious you get about them, the more you have!

 

[Zoltania]

Anyway, isolated extrasystoles in an structurally normal heart, as i have been told, are not something to worry about. And the more anxious you get about them, the more you have!

That seems to be the Catch-22 of having, or having had, a heart condition. We're often told, "Listen to your body" but it's hard to trust what you "hear" when you aren't sure you can trust your heart.

 

[pellicle]

That seems to be the Catch-22 of having, or having had, a heart condition. We're often told, "Listen to your body" but it's hard to trust what you "hear" when you aren't sure you can trust your heart.

well, its like listening to anyone else ... you know there are some things which they say that are reliable, some things which are going to be flatout wrong, and others which need verification.

I sometimes think people suffer from the metaphor of "the heart" being about your emotions and "listen to your heart" being about the muscle in our chest which simply pumps blood. I trust my heat ... it beats reliably and without it I'd be dead in about 3 minutes. It has had some faulty components, which have been replaced and now its all working great.

 

[almost_hectic]

If anyone is like me and has dealt with palpitations (PVCs, PACs) over the long term. One thing I've found through research that helps me quite a bit and others have told me so as well, is Magnesium. Magnesium is essential to most of the body's nerve and muscle functions. Magnesium if often called natures calcium channel blocker because it works in very much the same way when your body has enough of it. It enhances electrical conductivity in nerve impulses, relaxes muscle tissue, and even lowers blood pressure by widening arteries. Most people at any given time are magnesium deficient. Magnesium from natural sources is best but it can be difficult to get enough. Especially considering the foods high in magnesium are leafy greens, if you're on Coumadin this gets difficult. That's where supplements become the way to go. Before taking my advice ask your doctor, but it's likely that most doctors dismiss its benefits, while others will confirm it and encourage giving it a try. So long as it's not counter productive to any other treatment they might have you on, so please ask before swallowing a bunch of Mg pills. Do a bit of research and you can find tons of info on this topic. Here's one quick excerpt

Calcium channel blockers, or calcium antagonists, are so named because they block calcium from going into blood vessel and heart cells. This helps to relax and widen artery walls. They are used in the treatment of conditions such as hypertension, migraine headaches, arrhythmias and certain other circulatory problems.

 

[MethodAir]

Taurine and magnesium work synergistically, as calcium channel blockers that can aid palpitations, afib etc. Check out this link from a MD who had AVR:

http://www.drjanson.com/djhl-html/2010/news-2010-03.html Taurine and hypertension
Ever since my heart surgery in 2003 to replace a congenitally defective aortic valve (you can read about this in the newsletter of April, 2003), I have had rare episodes of atrial fibrillation lasting for a few hours, perhaps once a year, but this unusually cool winter altered my exercise schedule and immune function, and the arrhythmia recurred several times a week for about two months (and occasionally several times a day), and was causing fatigue and general discomfort.
I have known about the value of the amino acid L-taurine in treating arrhythmias for some time, and often take it as a supplement. With some further research, I came across an article suggesting much higher doses of taurine for managing atrial fibrillation and other arrhythmias, and I decided to try this treatment along with other supplements.
The atrium (specifically, the sinus node) is where the regular heartbeat is initiated, and if the atrium is not beating normally, as in fibrillation, the ventricular rhythm is thrown off. In many cases (as in mine) there are periods of rapid heart rate and palpitations. If the atrium does not beat, about 30 percent less blood gets into the ventricle for pumping to the muscles, impairing exercise capacity and causing shortness of breath.
I have treated a number of patients with atrial fibrillation with taurine and magnesium, including intravenous doses. After reading this new report on taurine, I increased my oral dose to 9 to 15 grams per day, and treated myself with intravenous taurine and magnesium (along with vitamin C and B complex vitamins) and several EDTA chelation solutions. In addition, I took high doses of magnesium orally, and now my heart rhythm is back to normal. After this, I went back and reviewed several articles on taurine.
In 1987, researchers reported on a study of 19 young patients with borderline hypertension. They administered 6000 mg of taurine orally daily for 7 days in a double-blind, placebo-controlled trial. The taurine-treated group had an average drop in systolic blood pressure (the first, higher number) of 9 points. Their diastolic pressure (the lower number) dropped by 4 points. The placebo group had just a 2.7 drop in systolic pressure (the power of placebo) and a 1.2 point drop in diastolic pressure. (Fujita, T., et al. Effects of increased adrenomedullary activity and taurine in young patients with borderline hypertension. Circulation. 75(3):525-532, 1987.)
This research confirmed what had been noted in previous studies in rats. The researchers also noted that stress hormones were reduced by taurine treatment in humans, just as they were in rats. The baseline plasma epinephrine level (Adrenalin) was higher in the hypertensive patients than in normals, and it dropped significantly with the active treatment.
Young patients are often treated with medication for hypertension, and they are told they need to be on the drugs for the rest of their lives, but lifestyle changes and supplements can almost always totally eliminate the need for these treatments. (Many of the patients do not take their medications because of side effects, but they are not taught the proper diet, exercise, and supplement programs that might help (coenzyme Q10, magnesium, omega-3 oils, hawthorn), and they often do not tell their doctors that they are not taking the drugs.)
Taurine and congestive heart failure

Taurine is also beneficial in the management of congestive heart failure (CHF). In CHF, the heart muscle is too weak to pump out as much blood as it needs to, resulting in fluid congestion in the tissues. CHF has a variety of causes. In a double-blind study of 14 patients published in 1985, half were treated with taurine along with conventional treatment, and half were given placebo. (Azuma, J, Therapeutic effect of taurine in congestive heart failure: A double-blind crossover trial. Clinical Cardiology. 8(5):276-82, 1985.)
Those subjects on the taurine were clinically improved and ventricular function was enhanced. None of the patients on the active treatment worsened during the treatment, but four of those on placebo deteriorated. During taurine administration, no side effects were noted.
Taurine and congestive heart failure 2

In 1983, researchers studied 24 patients with CHF in another double-blind trial using 4000 mg of taurine per day. They were evaluated by clinical signs and symptoms as well as the New York Heart Association functional classification, a common standard for monitoring CHF. (Azuma, J., et al. Therapy of congestive heart failure with orally administered taurine. Clin Ther 5(4):398-408, 1983.)
After eight weeks, 19 of the 24 patients on taurine were improved. Of the 15 patients on taurine who were classified as NYHA class III or IV at the start of the study, 13 were designated as class II at the end of the 8 weeks. This was a highly significant improvement from relatively serious CHF to only mild impairment, and very unusual with single nutrient treatment, although coenzyme Q10 offers similar benefits.
Taurine and arrhythmias

In a study of rat hearts, researchers compared treatment with taurine to hearts that were subjected to the same low-oxygen stresses but not treated. Taurine protected the tissue from ventricular fibrillation (much more serious than atrial fibrillation). The incidence of ventricular fibrillation was reduced from 86 percent in the control hearts to just 16 percent in the hearts that were treated with taurine throughout the stress period. (Chahine R, Feng J, Protective effects of taurine against reperfusion-induced arrhythmias in isolated ischemic rat heart. Arzneimittelforschung 1998 Apr;48(4):360-4).
The researchers also evaluated the effect of taurine on indicators of lipid peroxidation, which corresponded to heart muscle damage. The indicator molecule, malondialdehyde, was significantly reduced with the taurine treatment. In addition, taurine decreased the frequency of ventricular premature beats and rapid heart rates, acting both as a free radical scavenger and a membrane stabilizer. Both of these effects strongly suggest its value in treatment of arrhythmias.
Taurine and arrhythmias2

In a report of case studies, researchers presented a hypothesis for how taurine might work for elimination of cardiac arrhythmias. They included in their subjects those with a variety of arrhythmias, including premature beats, atrial fibrillation, and pauses. They treated with either taurine, or a combination of taurine with another amino acid, L-arginine. (Eby G, Halcomb WW, Elimination of cardiac arrhythmias using oral taurine with l-arginine with case histories: Hypothesis for nitric oxide stabilization of the sinus node. Med Hypotheses. 2006;67(5):1200-4.)
This report is on only three subjects (with premature atrial contractions (PACs), premature ventricular contractions (PVCs), atrial fibrillation (AF), and tachycardia (rapid heart rate), and palpitations), but the results were striking and in accord with the theoretical information already available in laboratory, animal, and some human studies. They treated the patients with 10 to 20 grams of taurine per day and found a 50 percent reduction in PACs and elimination of PVCs, but not pauses.
When they added 4 to 6 grams of arginine per day, the PACs were eliminated as well as all pauses. In the patient with heavy palpitations and AF, 95 percent of symptoms were eliminated by taking 4 grams of taurine three times per day, and the remaining symptoms disappeared with the addition of one gram of arginine with each dose. They noted that fish oils can provide similar benefits.
Tachycardia and palpitations can be exhausting and uncomfortable, and can disrupt sleep. As a result of these reports, I started taking 3-4 grams of taurine three to four times a day. I also gave myself 100 mg of taurine with magnesium intravenously several times a week. This all occurred over a 10 week period, and I was able to eliminate all of my arrhythmias. I am now down to a maintenance dose of six grams of taurine orally per day. I never needed to add the arginine, but as a precursor of nitric oxide it is a valuable treatment in itself.
One case such as my own does not constitute research, but my experience is worth noting, as taurine is a safe nutrient produced in the body, with no reports of toxicity. It is possible that my symptoms simply disappeared with improvement in the weather, or the elimination of a virus (a relatively mild attack of herpes zoster that seemed to coincide with the onset of the AF, and for which I added much higher doses of vitamin C to my IV treatments).
The physicians that I saw did not suggest any relationship with stress (cold weather) or the virus, and all of the tests and monitors offered no solutions. I was told only that the abnormal sinus function would get worse over time, and they wanted to treat me with a drug but could not because they either lower blood pressure (mine is already very low) or heart rate (mine is already at 44 beats per minute). Fortunately, I have found a solution that might help other patients also.
Doughnut makers force political firing

The New York Times relayed an Associated Press report of a doctor who was head of the Panama City Health Department forced out of his job for posting signs critical of junk food and doughnuts (NYT, August 17, 2009). The signs said: Sweet Tea=Liquid Sugar; Hamburger= Spare Tire; French Fries=Thunder Thighs; and Doughnuts=Diabetes.
Dr. Jason Newsom also made a direct attack, “America Dies on Dunkin’.” A county commissioner who owns a Dunkin’ Doughnuts, and two lawyers who own franchises threatened to sue. His bosses made him remove the anti-fried dough rants and forced him to resign, even though everything he said was true! He has reapplied for his job.

 

[almost_hectic]

Wow, that's really interesting. Albeit a bit complex as far as what to do with all that information... The body can amazingly correct itself so often if given the right circumstances (diet, supplements, exercise). I wish the medical community were a bigger advocate for that approach instead of just pushing meds.

 

[MethodAir]

I wish the medical community were a bigger advocate for that approach instead of just pushing meds.

Yea...walking into a cardiologists' office can be like walking into a minefield. Sometimes it pays to trust your gut instinct.