Question for you old pros - episodes of noticably slower heart rate

[Ross]

I'm telling ya, that range is too narrow. Be happy if it's between 2 and 4. Amio will screw you up big time if taking for longer then necessary. Not just your lungs, but liver and who knows what all else. Also, it takes up to 6 months to leave your body. That being said, your not really out of the ordinary. Most all of us went through a period of afib. For me, it was 6 weeks after surgery and lasted for 2 solid days then stopped.

 

[ARGreenMN]

So Afib must be more common than what my cardiologist said. He said it only happens in about 10% of those w/ this surgery... Either way, it's comforting to know you and others have had it and survived! It was scary! And I hope it doesn't come back!

I certainly won't take Amiodarone longer than necessary. And to be honest, some of the side effects listed are a little concerning. Like sexual performance issues (I know, I know, what is sex...). But there's some other ones too I'm not excited about - blurred vision, drowsiness, have to stay out of the sun, etc., etc... You're right - the sheet says "...it is only to be used when other meds have not worked" and when "heartbeat problems may be life-threatining". And he acknowledged all that, as well as the side effects. I got the impression he didn't wanna mess around with the other stuff 'cause my rate was getting pretty high. The nurse said if it got much higher, there were gonna be a lot more people in my room - so maybe it was bordering on life-threating? I'm seeing him again in the morning, so I'll ask if he thinks I could switch to one of the lower-impact ones or something.

On the INR range, I'm gonna ask my surgeon when I see him in a couple wks why he's got my range is so tight (and so low). I think he explained it in the hospital, but I forgot (was still a little woozy).

 

[kfay]

Don't drive yourself crazy about the whole Amiodarone thing as long as you know it is going to be short term. Several of us, me included, had surgeons who routinely put their patients on it as soon as they are out of surgery just to try and keep something like this from happening. I was supposed to be on it for 3 months and asked to stop it around the 2 month mark. Glad you went and got yourself checked out.

Kim

 

[Luckyguy17]

ARGreen,

Sorry to hear about your little setback & bump in the road, needing a visit to ER...better safe than sorry for sure and hopefully they will be able to estabilize you quickly.

Suspected that Ross knew something we did not (temporary setbacks) to a fuller healing process, from his note yesterday..

So far so good for me, probably overdid it a wee bit yesterday, as could not get enough of living, but last night took an OTC sleeping pill and actually got my 1st night of 8 hours of continuous sleep since surgery and Instinct (Ross) told me to tak it easy today and am doing so, so thanks Ross for the reminder that we ain't healed yet, with a ways to go.

So now lots more sitting an resting for me today, as am now over the excitement of being home and running about (smile) and will better pace myself, especially after hearing of AR's little bout as he seemed so indestructible. (smile)...guess we are human huh AR?

My beta blocker dose is set as 2 x 25mg per day or 50 Metoprolol total, daily so mine is half your dose AR.

My 5mg of Coumadin daily has gotten my INR to 1.6 as of Saturday, but surgeon mentioned the target is 2.5 - 3. INR for next 3 months...so likely blood tests tomorrow, to check INR and likely increase in Coumadin dose I suspect,o good on BP vitals and heart rate and likely no need for pain killers till the day the staples come out late this week.

VR is a complex surgery and gues this is a wake up call that drugs help with rehab, but can actually produce unknown risks as we are all built differently

AR, betcha your are just itching to tee off those big drives as lost into the woods huh (smile)...a couple more months away, jsut in time for late summer

Gil

 

[Guest]

Glad you are ok, I had atrial flutter at about 3 weeks, they put me on Flecanaide along with the beta blocker. It is a scary feeling when you are going through it, I put up with mine for about 8 hours. They told me if the flecanaide had not worked, they were going to zap my heart back into rhythm. Glad I and you missed out on that!

Some of the members are on the new drug multaq for their afib. Maybe ask him about that one??? Rest easy, you have plenty of new life to swing at a couple of golf balls. :wink2:

 

[buncle]

I was 1 week out of the hospital and went into a-fib. Just like you-back to the hospital.They put me on the amiodarone too. It did the job and was of it in a week.I think it is alot more common than 10%
from what my dr. and the nurses said.They said "no big deal" yea well I was in a-fib not them! I hear of people that have all the time-I couldnt stand up when I had it.I dont know how some
can live with it? Maybe affects different people differently.Once it stopped it didnt come back for me. You will get staightened out.

 

[Jeanie]

I am glad you went to the ER. I agree you were definitely overdoing it, but that is nice that you felt so good you thought you could! That also is good that they plan only to have you on the Amiodarone for no more than 3 months; that is what they told me too.

I hope this is not TMI - too much information, and am not a doctor of course, but just in case this is useful though, here is my story. I has been discharged after surgery with Amiodarone and Metoprolol, (and the anti-coag of course) and after a couple of weeks, I became so freaked out about the possible side effects I went off of the Amiodarone, prematurely. I then had A-Fib, had to go back to hospital first week of Feb for cardioversion, and went back on the Amiodarone. The good part is, this time both the surgeon and the cardiologist explained to me that the process of surgery itself causes some communication problems within the heart's own pacing system and that it usually gets sorted out within a few months. They reassured me that the really bad side effects become a concern if the patient takes the Amio for an extended period of time. They did check my liver and thyroid blood values in mid March. (Unfortunately, the thyroid issues can occur even with short term use, so make sure Docs are checking your thyroid status regularly.) I was told that the Amiodarone was for prevention of further arrythmias and that the Metoprolol was to keep heart rate from being too fast.

They had said they'd get me off the Amio ASAP and they did. My surgery was Jan 14. I was told it was OK to stop the Amiodarone at end of March (I had had an echo March 16). I had been concerned over really low BPs during the cardiac rehab exercise process, discussed that with the cardiologist via her nurse, and got the OK to taper off of Metroprolol second week of May. You've probably already Googled Metoprolol and found that you must not stop it abruptly?

My BPs have remained in normal range since getting off both drugs, but my heart rate is a tad fast on any exertion (resting is OK 66 - 78) but any exertion puts it into 84 - 90 zone. I hope that will improve, and if I recall correctly, that is probably due to my having left ventricle enlargement. I had found out through my research on Metoprolol side effects that it is known to disrupt sleep patterns, and inhibit the body's production of melatonin. I am thrilled to be off of the Metoprolol though, because I am sleeping better.

The main danger of too much of the beta blocker is 'bradycardia' or unusually slow heartbeat. So, if you continue to notice slower heart rate than ideal, that would be something to discuss with your Doctor.

Edited to add, electrolytes being out of optimal range can trigger arrythmias too, so if you recently (as I imagine you did) got CBC, electrolytes done, get a copy of that report, and ask Doctor when they are going to check those again. They may already know, from having monitored you while you were in for the surgery and now for the Afib, whether you have any trends out of range. For example, if your potassium gets too low that can be an arrythmia trigger, same with magnesium. Too much potassium is a bad thing too, so might be a good idea to have Docs tell you how many milligrams of potassium you should be consuming per day.

 

[ARGreenMN]

More on afib

More on afib

Thanks for the encouragement guys. Hey, before I forget - I just realized it doesn't show up in here. My name is Andy. ARGreenMN is my standard "moniker" - Andy R. Green from Minnesota (MN). Lol, thought I'd explain that, so you can call me Andy if ya want instead of AR, or ARGreen. But if ya like AR better, go for it!

Anywho - I just talked to a veteran nurse who was very helpful with all this too. She said she thinks it's a lot higher than 10% too - she remembers a LOT of aorta valve folks getting it over the years. And she said not to worry - when afib is caused by a new valve, it usually goes away and doesn't come back. That was after she scared the crap outta me before she knew I had just had a valve replaced - started telling me horror stories about once you get it, it comes back, becomes chronic, etc... Then when she knew I just had a valve - she said, oh, well that's it - that's a different story. So I feel a little better....

Yea Gil, I guess I was feeling a little too bullet-proof. I'll cool my jets again for a while. It's just so hard, like you say, you wanna start living your new life asap now that you're blessed to have it. But we gotta be smart!

Well, I've got a headache, so am gonna go to sleep. Here's to hoping no more afib tonight! Still ticking away at about 75 bpm right now, so am hopeful I'm passed that afib stuff. Later guys!

 

[Jeanie]

Andy, I am so glad you checked in, while I was writing my magnum opus above, LOL. 75 for a heart rate seems very good! I hope you get some sleep, and be sure to take naps when you get back home. Surgery is a major stressor to the body, and sleep is necessary for bodily repair and maintenance. Even if you have trouble sleeping, just resting in recliner or bed can be therapeutic, IMO.

 

[Ross]

People with aortic valves experience much less afib then those that have mitral replacements. For many with mitral replacement, afib usually stays. That's just observation from 9 years of being here. It may or may not be scientifically correct.

I wish I could say I was like you guys and had near textbook surgery, but that wasn't the case for me. Heck I'd still be in the hospital for another 1.5 months or so. I didn't feel at all reved up and ready to go when I got out. I've watched a lot of people get out and feel they had to push themselves, sometimes much too far, much to fast, and suffer the consequences. Neither of you need to go backsliding now. Accept that this is a long slow process of healing and don't push too hard.

 

[RunMartin]

I've watched a lot of people get out and feel they had to push themselves, sometimes much too far, much to fast, and suffer the consequences. Neither of you need to go backsliding now. Accept that this is a long slow process of healing and don't push too hard.

I have to agree with this. I have just recently been to my first rehab class (after 15 weeks due to delays because of the irregular heart beats) and have found that what I thought was taking it easy was much more than I should have been doing. I have been following the new guidelines given at rehab for the last few days and feel much better for it. I wish I had been to this class much earlier as I am sure I would be feeling much better now.

 

[Woodbutcher]

An inr range of 1.8 - 2.2 is bonkers ? Very low for a mech valve and very tight too ? When on Earth are Doctors going to get on the same song sheet ? I'd guess your range should be 2.0-3.0 or even 2.5-3.5 but, if like me, once you settle into the whole Warfarin thing and understand it a little then you'll be happy with anything from 2.0 to 4.0 ?
I'm obviously no Doctor but from my understanding your range is not workable or even safe, so question it ?

 

[Ross]

I'm obviously no Doctor but from my understanding your range is not workable or even safe, so question it ?

I question it too, but there are a couple of Doctors claiming INR doesn't need to be as high as previously thought.

That doesn't excuse the very narrow window though. That just shows the doctors lack of understanding how Coumadin works.

 

[ARGreenMN]

Inr

Inr

Thanks for the concern about the low/tight range (1.8-2.2). I'm trying to get a better understanding why, and am keeping a close eye on it, and so are they here at the hospital (yep - back in once again - more irregular beats when got released last night). My understanding so far, having asked at least 3 docs so far, in addition to my surgeon who gave me that range, is that the reason for the lower INR has to do with the new generation of mechanical valves. The one I got (St. Judes Regent) apparently tolerates lower INRs. I'm gonna get a better understanding of why that is when I talk to the surgeon again in a week or so. I don't know yet why the range is so tight for me, but so far (while it's still really early) I haven't had much problem keeping it in or close to that range. I've been 2.5, 2.5, 2.2 and 2.1 (and just had it read again a few min ago but don't have results yet). Maybe I'm just naive (wouldn't be first time!) but so far I feel ok about having a tight range. I figure it's just a target, so might as well have a small target - that way if/when I miss, maybe I'll stay closer to the 'ideal' number (2.0) than if the range was wider. Because of putting me on Amiodarone they lowered my Coumadin from 5 mg to 4 mg yesterday in anticipation the Amiodarone will tend to increase my INR. I'll keep ya posted as I find out more.

 

[ARGreenMN]

Oh, and another cardiologist yesterday told me he thinks it's more like 30% - 50% of patients w/ arota valve replacements who have a-fib while recovering. Not 10% like my primary cardiologist told me. I was afraid I was going back into afib last night (which is why I came back in) because I was having the same symptoms as before - heart rate in the 40's, and more frequent/sustained irregular beats. But made it through the night w/o going into a-fib and my rate is back up to about 60 now. They keep telling me it's just a fairly 'normal' (for 30% anyway) part of the healing process - scar tissue/swelling around heart causing temporary interference w/ electrical signals. Hope so (that it's temporary)! Oh, and on the amiodarone - they've got me on 400mg / day for a week, cutting it in half to 200 mg/day for another week or two after that, then cutting it in half again, before (hopefully) weining me off it totally withing 3 mo. or so (if not sooner). They're monitoring my thyroid twice a day - and so far no issues... Keeping my fingers crossed...

 

[Ross]

Wish that Amio wasn't in the cards. It's going to screw your INR up for some time to come. Outside of that, your INR's are PERFECT. I honestly don't think they have enough data to establish that lower INR's with newer valves is safe. The difference between 1.8 and 2.0 is a mere 2 to 3 seconds time before the blood begins to clot. Not significant in other words.

 

[Ross]

Just remember this, It's better to be too high, then too low. You can replace blood cells, but you cannot replace brain cells.

 

[Woodbutcher]

I think you may be confusing your range and your target ? Your target will normaly be mid way between your range ? So if your range is 1.8 - 2.2 then your targer is 2.0, just as if your range was 1.5 - 2.5 your target would also be 2.0. The range is your comfort zone around your target if you like, and the bigger that zone the easier your Warfarin management. When you go out of that zone then your dose will be messed with, inside the zone it wont be. It's a good thing that Doctors think the new generation of valves can work with a lower inr but I'll still be happier at the higher end of my own range. Having had a few nasty bicycle crashes with lots of blood and been nearly knocked out by my surfboard a couple times whilst on Warfarin, not to mention my huge tooth extraction with nearly no blood, all the while with an inr between 2.5 - 3.5, better safe than sorry I recon. In this range I now know that I can do pretty much anything I used to do before I started taking the drug and that goes for eating and drinking what I like too.
Sounds like you have some added complications to work through to be too worried about all this range stuff right now, I'm sure lots of it will be chalked down to teathing problems to due course. I hope you get the problems ironed out soon.

 

[Luckyguy17]

Andy,

Just for comparison and fact that Ross, indicates that being higher in range is better than lower in range
my surgeon's INR range target was 2.5-3.0 and I am on bio aortic valve and mech mitral ring
Hit INR 2.5 at Anti coag clinic yesterday, after about 7 days of 5mg daily dose of Coumadin
blood doctor preferred to leave 5mg Coumadin dose as is and recommends blood tests next tuesday (so confirming Ross's theory of higher better than lower)
maybe Coumadin dose gets adjusted next week if my INR is much higher than 3.

Believe my INR started at about 1.2 before Coumadin dosing began, several days ago.

Gil

 

[ARGreenMN]

Gil, your experiences are similar to mine. Was 1.2 and 1.3 while in hospital. A few days later, at my first post hospital INR test (about a week after surgery) I was at 2.5. And that was while on 5 mg, although I think they might have given me one "starter" dose of 10 mg on the first day (can't remember).

And you're all absolutely right (which my cardiologist confirmed today too) - much better to err on the high side! So I'll be happy anywhere between 2.0 & 2.5. Would start getting nervous if under 2.0. And won't be too worried, but will probably start getting a little concerned if it gets up to 3 or over.

Got released again this afternoon. They continue to be convinced the a-fib and other irregular beats are fairly normal while recovering, and nothing to be too concerned about (easy for them to say!). They took me off the Metropol though - since my main complaint has been the episodes of slowwwwww beats (in the 40s). There's enough "slow-down" in Amiodarone (probably mis-spelled both drugs - still getting used to them) that they figure I'll be ok w/o the Metropol. We'll see ...