Atrial Fibrillation

[axel_knutt]

Just fishing for anyone who has it, or knows anything about it. I was rushed to A&E, and spent Monday afternoon in Resus with the consultant trying to get my heart rate down from 200+bpm. I've been complaining of chest pain and palpitations after exercise for 30 years now, but it's taken until two days ago for them to stop telling me it's just anxiety. "This is not anxiety" said the paramedic, "and you don't look anxious either". The ambulance crew wanted to know what drugs I am on. When I told them none, they asked what diagnosis I'd been given. They were astonished when I told them "anxiety".

My heart lapped up the first dose of adenosine, said yum yum and asked for more. So they doubled the dose, and this time my heart stopped, only to restart again at 200bpm. While they were preparing me for a cardioversion, it stopped by itself after a total of 19 hours (is this a typical duration?). They had warned me that the adenosine would make me feel like death warmed up (quite literally) while my heart was stopped, but afterwards I just said "Is that it, I feel worse than that after a bike ride!" I then pulled out my mobile and played the consultant a recording of my HRM with me sat in the armchair. My heart was stopping for up to four seconds at a time, longer than on the adenosine:

"If that's what your heart's been doing, and you're feeling dizzy as well, then it's serious."
"But they never take me seriously."
"Well, now you been admitted to Resus as an emergency, and they will do by the time I've written to them."

In August 2010 I had a similar episode which lasted for 9 hours, but I didn't call for any help because I knew if it stopped before anyone arrived I'd just get told it's anxiety again. When I told a GP that my heart had been racing for 9 hours and that I couldn't stand without fainting I didn't get a "good" or "bad" or anything, she just looked as if I'd told her I'd been for a joy ride in a martians flying saucer.

My resting heart rate was 45 up until Sunday evening, now it's anything from 65-80 so I'm just wondering whether it'll come back down. When I mentioned it to the doctor he said 83 is normal:

"Mine's usually 45"
"70 to 80 is normal"
"Not for me it isn't"
"It's normal"

I still don't think they're listening.........

[Mark1978]

Sounds like you've got a malpractice case on your hands there...

[eileithyia]

Well a friend of mine has been treated for AF this year, last year he found he was riding at very lower power output for his racing HR, indeed having his HRM for a couple of early season time trials meant he saw his Hr do some very bizarre fluctuations with some very high readings, though not had the problems for as long as you have with palpitations etc.

He has since been cardioverted to correct it.

[cycloret]

I assume you've already Googled for information about AF, if not there's lots of out there that's informative.

The atria are mini pumps feeding their respective larger ventricles, with the left side usually being the more important. In AF the pumping action of the atrium is lost, so the heart is less efficient. Most people will feel loss of energy if in AF though not all. Things are worse if the heart rate is very rapid because the heart is too busy contracting with not enough time to allow for proper filling. Drugs such as digitalis partially block the over-stimulation of the ventricles by the atrium.

Ideally you want to be back in sinus rhythm but you might have an ectopic focus of excitation in the atrium perhaps with an abnormal pathway which needs treatment. You need to be refereed to a cardiology unit if not already.

Recently I had an eye condition and was reassured by an optician that all was well but info on the web indicated otherwise and that I should see an ophthalmic surgeon which I did. I'm currently recovering from an operation I had last Friday.

[patricktaylor]

... You need to be refereed to a cardiology unit if not already ...

I agree. You should be referred for a proper diagnosis ASP. By the sound of it, that is what is now being arranged.

[Tigger]

"This is not anxiety" said the paramedic, "and you don't look anxious either". The ambulance crew wanted to know what drugs I am on. When I told them none, they asked what diagnosis I'd been given. They were astonished when I told them "anxiety".

While they were preparing me for a cardioversion, it stopped by itself after a total of 19 hours (is this a typical duration?).

I then pulled out my mobile and played the consultant a recording of my HRM with me sat in the armchair. My heart was stopping for up to four seconds at a time, longer than on the adenosine:

"If that's what your heart's been doing, and you're feeling dizzy as well, then it's serious."

In August 2010 I had a similar episode which lasted for 9 hours, but I didn't call for any help...

My resting heart rate was 45 up until Sunday evening, now it's anything from 65-80 so I'm just wondering whether it'll come back down. When I mentioned it to the doctor he said 83 is normal:

I still don't think they're listening.........

Hi Axel, sorry to hear you have had a bad time with the medical profession. You won't be alone in that of course But I strongly recommend you read up on AF as much as you can so that YOU are in charge of your own health care.
Suggest you start here: http://www.patient.co.uk/health/Atrial-Fibrillation.htm
You will see there are 3 types of AF - and yours may be 'paroxysmal' ie it comes and goes so it can be hard to 'catch' on record - there is no typical duration - minutes/ hours/ days/ weeks! To get the chest pain/ palpitations after the exercise is interesting so needs following up, as already mentioned.

I was surprised that you were given adenosine as it's not usually the drug of choice for cardioversion but they may have been treating you for SVT (Supra Ventricular Tachycardia = fast heart rate which originates above the ventricles) at the time. http://www.patient.co.uk/health/Suprave ... ardia-(SVT).htm

Regarding your HRM recording - it sounds like your heart is dropping beats rather than 'stopping'. At a slow resting heart rate of 45 (= ok if you are a fit person) then one dropped beat could cause a 4 second gap. But impossible to say without seeing an ECG (electrocardiogram = electrical activity of the heart) Also your increased resting heart rate is surprising - not sure what that could be down to. You are right to point out what is normal for you - other people's norms are irrelevant! I do hope you have been put on the list for a 24hr (or preferably longer) 'tape' = a non-stop ECG recording.

I hope you get the follow up soon but please do not hesitate to call 999 if you get the rapid heart rate again or chest pain or feel dizzy doing normal activities - paramedics will always take it seriously. At the very least they can take an ECG recording and compare it with previous ones (try to keep a copy!)

[sevenhills]

"Mine's usually 45"
"70 to 80 is normal"
"Not for me it isn't"
"It's normal"

I still don't think they're listening.........

I checked mine when I was in bed the other day and it measured high fourties a few times, but I think 50s is around normal for me. Although after food and when not still it can quite often be 70+
I have a wrist monitor that does the blood presure too, thinking about getting a watch type soon. My pulse is quite low too, around 110/65

[Tigger]

Drugs such as digitalis partially block the over-stimulation of the ventricles by the atrium.

Ideally you want to be back in sinus rhythm but you might have an ectopic focus of excitation in the atrium perhaps with an abnormal pathway which needs treatment. You need to be refereed to a cardiology unit if not already.

Recently I had an eye condition and was reassured by an optician that all was well but info on the web indicated otherwise and that I should see an ophthalmic surgeon which I did. I'm currently recovering from an operation I had last Friday.

Sorry cycloret, need to pull you up on some of what you say. (This is a site full of extremely pedantic forumites after all...!)

The atria do not stimulate the ventricles, as such. The wall of the right atrium contains a small area called the sino-atrial node which is the inbuilt pacemaker of the heart. When the SA node sends out an electrical signal, the atria contract (to fill the ventricles), and the signal travels along a pathway to the atrio-ventricular node, which sits between the atria and ventricles (funnily enough, given the name!). From here, the signal moves through specific pathways to spread across the ventricles so that the muscle fibres contract in unison, more or less.

Yes, in AF there can be multiple foci of areas with pacemaker activity. But often it is not possible to get AF back into normal sinus rhythm (= a regular heart beat between 60 and 100 beats per minute) so GPs juggle with medication to try to get the best result (not too fast, not too slow, good cardiac output = person can carry on with normal life) with the least side effects! Also to reduce the risk of stroke from AF (hence warfarin or aspirin, usually).

Digitalis (aka digoxin - in nature found in foxgloves which is why the flowers are poisonous - slows down the electrical conduction at the AV node, giving the ventricles more time to accept blood from the atria) is not normally the drug of choice these days. Beta blockers and calcium channel blockers have taken its place.

You are absolutely right that you should learn about conditions affecting you and challenge medics (or any professional for that matter), who are but human, and therefore err.

[Tigger]

My pulse is quite low too, around 110/65

That would be your blood pressure. 110/65 is normal. Though it does depend how old you are! And how you define normal
Perhaps I should say 110/65 is healthy, as many circulation related ills are caused by high blood pressure.

It's good to know what's normal for you, so that if you are ill you can tell paramedics/ doctors that it's not normal for you (if they are listening). But it's not a peeing competition ok!?

[sevenhills]

That would be your blood pressure. 110/65 is normal. Though it does depend how old you are! And how you define normal
Perhaps I should say 110/65 is healthy, as many circulation related ills are caused by high blood pressure.

It's good to know what's normal for you, so that if you are ill you can tell paramedics/ doctors that it's not normal for you (if they are listening). But it's not a peeing competition ok!?

Yes, BP, searching online it says that for blood presure - the lower the better. So long as it does not cause any problems. I have always suffered occasional cramp, but perhaps that is normal.

[georgew]

Drugs such as digitalis partially block the over-stimulation of the ventricles by the atrium.



You are absolutely right that you should learn about conditions affecting you and challenge medics (or any professional for that matter), who are but human, and therefore err.

I'll say.
Having had a pain in my chest while cycling which rapidly became worse I went along to my GP ( in fact a Locum who was a trainee GP, as to see my own would take up to three weeks). I explained that I'd already had a stroke, had a dreadful family history of cardiac problems and was in my seventies so I was a little worried. The GP told me to arrange with the receptionist to have an ECG and that she would arrange an appointment for me at the local Hospital. So it was that I found myself competing with those awaiting treatment for ingrowing toenails for an appointment with the nurse and I was given one for three days later. The weekend before my hospital appointment I had a heart attack and was admitted as an emergency. Following a stent being fitted I was discharged but told that I had lost a quarter of a major heart muscle. Had it been treated as an emergency in the first place, the Consultant said that no damage would have resulted.
No more keeping up with the group for me following this so I'm a little peeved to say the least.

[axel_knutt]

they may have been treating you for SVT

your increased resting heart rate is surprising

I do hope you have been put on the list for a 24hr (or preferably longer) 'tape'

an ECG recording and compare it with previous ones (try to keep a copy!)

The paramedic provisionally marked down SVT on his worksheet, but Resus diagnosed AF.

As of today my RHR is 46 laid in bed, but still 75 sat upright (Usual: 45&49).

In summer 2011 an orthopaedic doc suggested a portable ecg, and told me to ask the GP for one. GP response:"Oh, only rich surgeries use those....". I mentioned this again to a cardiologist two months ago and again the idea was dismissed with a scoff and a wave of the hand.

I have a couple of runs of ECG that the paramedic left on the coffee table showing HR 193....216.

I've been getting increased incidence of Ocular migraines lately, which have also been dismissed. But Dr Google is beginning to find links between Ocular Migraine >> Atrial Septum Aeurysm >> Atrial Fibrillation

[sevenhills]

I have a couple of runs of ECG that the paramedic left on the coffee table showing HR 193....216.

I've been getting increased incidence of Ocular migraines lately, which have also been dismissed. But Dr Google is beginning to find links between Ocular Migraine >> Atrial Septum Aeurysm >> Atrial Fibrillation

193-216, I would be asking some very serious questions if that was my heart/pulse rate. I fact I would probably just go at AE.

[patricktaylor]

I have a couple of runs of ECG ... HR 193....216 ...

193-216, I would be asking some very serious questions if that was my heart/pulse rate. I fact I would probably just go at AE.

Yes. Down to casualty and insist on seeing a cardiologist. Expert diagnosis required. Insist. Tell them you've been fainting.

[axel_knutt]

I fact I would probably just go at AE.

And here's me thinking that's where I've just come from....