Atrial Flutter & Stroke

So am I Sarah, and I had this debate with my GP after recovery from the stroke. Clinically I understand that for prescription of anti coagulants you need to score 2 or more on the CHADs risk assessment, I scored only 1, (over 65); this would have equated to a 2/3% risk, small, but in my case not small enough.

Having been to the US recently and spoken to someone who found themselves in a similar situation, they were immediately prescribed anti coagulants. The real debate in the UK, is whether the risk is tolerable; I also suspect the cost of medication comes into the equation somewhere. The other consideration if anti coagulants are prescribed, is the risk of a bleed, especially if NOACs rather than Warfarin are taken.

Sherpa Al

Hi Sherpa Al,

Based on my experience, and reading such forums as this over the last 8 years, and seeing how people describe their diagnosis and treatment I'm surprised that more people aren't on the receiving end of a stroke.

I was 65 when AF hit (in Jan 2010). 

I was diagnosed and treatment started in 9 hrs of onset.

I'd had 2 and half years of palpitations prior to AF hitting me.

?My GP had me admitted to A & E and I was kept in hospital for 6 days during which time all manner of tests were done, the most notable were a) Electrocardiogram and b) Echocardiogram. There were a shed load of others which I cannot now recall.

The 'Echo' was the little beauty. It showed the left Atria had been damaged at the time AF hit..

?When I was first admitted to A & E I was in Atrial flutter, which later converted itself to Atrial fibrillation. At/in those moments the left Atria was damaged. The damage will never reverse. 

?In the AF process it is the left atria which will be the source of activity which will, likely as not, cause a stroke - if you are lucky it'll be minor - if you are not - you'll be dead. (Most AF strokes are more fatal than strokes from other causes for some reason).

?I was put on Warfarin immediately, and for life ! ( also other drugs).

?So, what I'm saying this Chads system is a part - and a very crude part - of the diagnostic process. In itself its meaningless. The major criteria to determine the risk of a stroke is the 'Echo' which will look at the state of the components of the heart. That is the determinant for anticoagulants.

?AF history is littered with athletes, and others, who regard themselves as fit,  in their 30's and 40's, who are diagnosed with AF and who merit a zero on the chads score. But they get a stroke, in some cases they die. The Chads system is little more use than a labelling system. Unless you find out if the Atria are damaged ( or ventricles for that matter) its all a waste of time and money. 

?The next most important thing is the 'Electro' - which tells the state of the hearts electrical activity.

To conclude, thanks to the brilliant attention to detail I received by the NHS, and thanks to advice received about lifestyle and diet changes, I'm AF free, my last AF event was in April 2015. I don't regard myself as cured but at least my heart hasn't been BBQ'd via ablation or anything more sinister and intrusive. whether it stays like that is another matter.

Best regards for the New Year to all.

John

Thanks for your reply Maxine50. It sounds like you're in the UK, and you also had no anti-coagulants prescribed prior to your stroke, is that correct?

Glad to hear that the NHS responded so quickly and so well, and that you are now free of AFib.

Sherpa Al

Hi,

Yes initially I was on warfarin prior and after the ablation for a short while.

Since I had the stroke I have been on warfarin as a blood thinner, my INR is currently 2.5 which is the best it can be.

Yes I am in the UK.

Regards Ken.

Hi jx41870, I have had acid reflux and bloating/belching on and off for nearly ten years. After diagnosis of atrial flutter, and also after my ablation I was still getting palpitations, which I usually found to be when I was full of wind, and regularly at night.

I consulted a nutritionist and discovered an intolerance to dairy products. Having gone dairy free now for around three months, I have reduced the wind and belching by a good 90%, and this in turn has similarly reduced heart palpitations. Many people talk about the connect between stomach and heart, I concur, manage the stomach, and reduce the instances of palpitations.

I miss cheese but in turn have found some other tasty foods I wouldn’t otherwise have tried.

Hope that helps.

Best Wishes, Sherpa Al

 

Hi Sherpa Al, 

Its me again, just scrolled on through the other comments on your thread and have come to this one. In my earlier comment I mentioned about diet.

?Well, when I read your comment to jx41870, I thought I was reading something I'd written myself. Some 9 to 12 months after my AF diagnosis I discovered that my AF events seemed to occur after eating. I too visited a nutritionist and was advised to go, gluten, wheat and oats free. I have since widened the dietary exclusions. As a matter of interest I can eat hard cheese, like Edam or cheddar, but not soft cheeses, like Brie. But then also, I can eat Strawberries and cream but not Raspberries and cream .... weird !

?It seems all to be linked to the vagal nerve - an information superhighway between the brain and other organs, significantly the heart and digestive system.

I reckon pretty much as you - calm the digestive system, calm the vagal nerve and calm the heart !

?Back to the Ashes on TV.

John

Hello John,

Seems we're getting a bit of a going over again at the MCG, I hope that isn't causing you any palpitations. I say this only half in jest as the one thing that gets me palpitating, is watching Leicester Tigers on TV, especially if they are also getting a bit of a going over; but strangely not a problem at Welford Road.

I read your comments about atria damage with interest. As a precaution after my first episode April 2016, I had an echocardiogram before I went hiking in the Himalayas October 2016; it showed slightly dilated atria, which, it stated, might predispose one to rhythm disturbance, but nothing to worry about, you're good to  go my GP said.

My second episode was Day 2 of our hike, at 3,000m and with a tough day ahead. I still associated this with my stomach, struggled through the day and then rested for a couple of days before curtailing the hike and returning to sea level(ish).

So, perhaps there was a message in that echo that wasn't fully heeded or interpreted, it still makes me wonder.

Hope the Ashes watching has not been too painful!

Best Wishes

Sherpa Al

Hi Sherpa Al,

No, the cricket hasn't done me any damage, but Christmas dinner did as I've been pretty crook today .... roast duck leading to digestive issues today!

I've lived most of my life in Australia, even though I was born in Cambridge. Hold dual citizenship. So the easiest way around the loyalty business is when I am in Oz I support England and when I am here I support Oz😀.

Now living in Cornwall.

Hope 2018 sees progress with your AF.

John

Thank you John, and at least the weather in Melbourne is something to write home about, as opposed to the cricket.

I plan to get back on the bike in 2018 as the weather here improves, and am reasonably hopeful I have the AF under control. As mentioned the palpitations tend to occur as a consequence of the stomach, and not any physical exertion, certainly since the ablation, fingers crossed!

Best Wishes

Allan