24 year old with Vagally Mediated AFIB just got the flu at the same time!!!!

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Hi.  I have AFIB about once every 1-1/2 years, and yesterday, I got the flu and vomited which triggered an attack.

My doctor says I need to go to the ER no later than 7 P.M. tonight, as this will be before the 24 hour period.  

I feel soooo bad.  What can they do for me at the ER being that I have the flu, nauseous and haven't eaten all day?

I took a Rythomol at 4 A.M. but vomited 1 1/2 hours after that.

Miserable.......................but i guess I have to follow the Dr.'s orders and get to the ER soon.

Any advice??????

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  • Posted

    Hi. I assume your doctor wants you in the hospital within 24 hours so you can be safely electro cardioverted?

    You should know two things. First, the majority of afib episodes resolve by themselves within 48 hours, so rushing to electro cardiovert within that window doesn't often allow the body to cardiovert naturally. Second, if you don't naturally cardiovert within the "safe" window, you can still have an electro cardioversion as long as they perform a TEE (Transesophageal echocardiography) right before it. TEE is simple and relatively non invasive procedure that looks for clots and can be performed while your under anathesia just prior to electro cardioversion. I've had 3 electro cardioversions and all three were preceded by a TEE.

    I don't know your history, nor am I a doctor, but I can tell you my strategy if I go into afib again. Since my rate goes very high, I take a drug to lower the rate called dilitiazem (cardizem). I have it at home so I don't need to contact my doctor to call in an rx. I also start taking a blood thinner Xerelto since I'm not on it full time. Then I plan on waiting at least a week to see if I go back into normal sinus rhythm naturally. If not, then I will consider electro cardioversion with a TEE right before.

    I would speak to your doctor and discuss the concept of giving your body at least a few more days to convert by itself. If he brings up the "safety window" for electro cardioversion, you then bring up having a TEE. Afib can be a real problem, but over treating, or treating too soon can also be a problem.

    Jim

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    • Posted

      Jim,

      I really appreciated all of your advice.  I have never heard of a TEE before, and that is extremely important information to know!!!!

      Also, I am thrilled to learn of a pill that can slow down your heart rate as mine goes to almost 200 and I get extremely short of breath and exhausted. 

      Also, it is great to know that you don’t have to be on a blood thinner all of the time but can just take it when you go into AFib. How long do you take it after an episode?

      My doctor wants me to have an ablation because of my age, but I only get an attack once a year or so.  

      By the time I got to the ER that night, I was actually in sinus Tachycardia...never had before ....It was not too high, and they attributed to dehydration from the stomach flu.  

      I am so appreciative that you took the time to provide me with such useful information.  I think it will be extremely useful to me in the future!  I hope you do well with yours too!   Thanks again, Jim.

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    • Posted

      Happy to hear you were not in afib.

      I'll start by saying that if I were in your position and only had afib episodes once a year, no way I would opt for ablation at this point. As to thinners, it depends somewhat on your Chad Score as well. Mine is 2 and arguably I could be on thinners or not. I decided not to and my cardiologist thinks it's a reasonable decision. You mentioned age as part of the decison. I'm 71, how old are you?

      Our situations are similar in the sense that we have distinct afib episodes and at least a year apart. My strategy again requires a couple of things. First, I have an rx of Dilitiazem (cardizem) 60mg tabs at home. When I go into afib my HR is close to 200 but the Dilitizem brings it down to around 100 usually within the hour which is faster than I could get taken care of in the ER. If it doesn't, I can take a second pill an hour or so later. At the same time I monitor my bp which tends to go very low in afib and comes back to normal with the dilitiazem. I also take a thinner Xerelto for protection and continue it for a month after I cardiovert. Once my HR goes down, my current strategy is to simply wait a week or so to see if it will cardiovert naturally. If not, then I would probably have a TEE and electro cardiovert as an outpatient.

      Lately, I added one more item to my strategy. I got a Kardia Mobile afib monitor. If you had one, you would have known before you called your doctor (and went to the hospital) that you were not in afib. The Kardia Mobile is what told me I naturally cardioverted after my last afib episode. Without it I would have not known because the Cardizem was keeping my heart rate normal and I had benign PACs which are very difficult to tell apart from afib.

      I can't recommend you follow my strategy, however it might be something you could discuss with your doctor and preferably a cardiologist. You could also discuss it with an EP, however as a group they tend to favor ablation.

      I have nothing against ablation and if I was going in and out of afib very frequently like many here, I would probably seriously consider it. But that's not what is going on with either of us.

      Hope your're doing better with the flu. I came down with it a few weeks after my afib episode. Not a lot of fun. Gotta keep hydrated!

      Jim

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    • Posted

      Hi Jim,

      Thanks again for your reply! 

      I think the EP wants to do an ablation because I am 24, and he feels things will just progress with age.

      I have vagally mediated AFib which I first triggered when I drank cold milk at age 15. 

      Since then, it seems to hit me every year to year and a half. 

      I would love to take something to slow down my heart rate when it happens, and I’ll have to check with the doctor to see what he says.  I can’t take certain things with vagally mediated AFib, but I’ll look into it.

      Again, thanks for all of the great information, and here’s to us not ever having AFib again!  Cheers!

      Matt

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    • Posted

      Hi Matt,

      I have the same trigger, drinking a cold beverage. Once it was soft ice cream.

      "Vagally mediated" is a good guess, but just that. An alternative explanation given to me

      by a well known cardilogist is that since the esophagus passes right by the heart, the

      cold liquid could have drectly thrown the heart out of rhythm and not via the vagal nervel. Personally, I'll go with the vagal nerve theory but it really doesn't matter much in terms of treatment.

      I had my first episode also at a relatively young age, in my early 40's. The "gets worse with age" thing never translated to me as my episodes remained far apart. I think also what they are talking about is older age, like where I'm at at 71. There is absolutely no reason to think that at age 24, your afib will get worse within the next 20 years. In fact, there's a better logic is that within the next 20 years they will have better procedures than the current ablation.

      Again, EP love to ablate. It's what they do. My Ep suggested ablation before he even took a full history! My cardiologist said, well, that's what Eps do! I asked the cardiologist when he recommends ablation. His answer was only if the patient requests it! That says a lot.

      My take is that the only reason to ablate now is if you're having very frequent episodes and that you don't tolerate rhythm or rate drugs very well.

      Dilitiazem (cardizem) is pretty standard. It's the same drug they give you IV at the ER when you show up with a high heart rate.

      Instead (or in addition)  to discussing with your EP, you mgiht want to consult with a cardiolgist. I find they have a more balanced overview of the situation.

      Jim

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