First episode of AF
Posted , 13 users are following.
Hi everyone I’m 40 years old and few days ago went to a and e with palpitations found to be in fast Af couldn’t get heart rate down for 20 hours. The cardiologist seemed to think it was caused by drinking the night before, I don’t have any medical problems and don’t drink often anybody else heard that this is correct. I’m very scared that this is going to happen again. I’ve not been put in medication and hope to see cardiologist again in few weeks I’ve also been under lots of stress lately could this also be a trigger? Any advice would really help
1 like, 96 replies
li29885 lee06371
Posted
patrick45945 lee06371
Posted
Hey Lee, I was recently diagnosed with new onset A-Fib which resulted in a dangerously elevated heart rate and was hospitalized and put on blood thinners immediately to avoid a stroke which is one of the most serious possible outcomes of A-Fib.
I met met my new cardiologist in the hospital who recommended an electric cardioversion which shocked my heart back to a normal rhythm. My elevated heart rate and blood pressure were restored to normal immediately.
I had a 2 week follow up with the cardiologist today and they did another EKG and am happy to report that it was normal. I am also taking meds for high cholesterol and blood pressure and am now on Pradaxa, a blood thinner, for life.
FWIW, I am a 68 year old male and was diagnosed with an irregular heartbeat many years ago which caused no problems until now.
Since you are 40, it’s a good time to start paying closer attention to your health with regular doctor visits. Welcome to middle age, like it or not. 😉
Do some research on the internet, including helpful forums like this. I think you’ll find that stress and heavy drinking are triggers for A-Fib. Just consider your recent experience a wake up call, followup with your doctor/cardiologist and you’ll be fine. Good luck!👍
ron_08501 patrick45945
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How long between your diagnosis and your op?
patrick45945 ron_08501
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jimjames patrick45945
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Had you been on thinners prior the the electro cardioversion? The protocol is that they shouldn't electro cardiovert after 48 hours from an afib episode unless you have been on thinners for "x" weeks or unless they do a Transesophageal echocardiogram (TEE) just prior to the procedure. It has to do with stroke risk. That weekend thing is absolutely crazy but same thing happened to me. No weekend electro cardioversions so I had to stay in hospital all weekend waiting and therefore needed a TEE. Learned my lesson. Now, I just start popping cardizem to get my rate down and then have the electro cardioversion down as an out patient. Hospitals are the pitts unless you absolutely have to be there.
Jim
patrick45945 jimjames
Posted
They started belly injections of thinners almost immediately after admission and yes, I had the TEE which allowed the procedure after 48 hours.
And yes, hospitals are the pits (people DIE there), especially during a flu epidemic where half the patients have the flu and you’re allergic to flu shots! Needless to say, I kept a low profile, avoided contact as much as possible and was anal about hand sanitizer!😱
And I did discuss with my EP the outpatient option and he was open to that and said it was my decision, but my HR was elevated and didn’t want to delay the procedure and just wanted to “get ‘er done” so I opted to,stay in hospital and be discharged out of aFib.
Next time, if needed, I will go the outpatient route!
Patrick
jimjames patrick45945
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FWIW I always did the ER-right-away route for my first three afib episodes until I spoke to a new doc on the way to the ER who suggested I might pick up some Cardizem instead. It got my heart rate down from close to 200bph to around 100 within an hour or so. I believe it's the same drug they give you in the ER to do the same. Now I have cardizem at home just in case. Also, I'm thinking of changing my cardiovert early strategy of the last 30 plus years. First, I've read that 50% cardiovert naturally within 48 or so hours, so why not wait and see, and second, my last electro cardioversion didn't work however I did cardiovert naturally the next day. So plan moving forward is to control rate with Cardizem at home and give nature a week or so to do its thing.
Jim
patrick45945 jimjames
Posted
I wanted to defer a trip to the ER when first diagnosed as my wife was out of town, but my GP highly recommended going NOW. So into the wheelchair I went and was off to the ER.
I guess the Cardizem is prescribed? Do you use it when in aFib or only to reduce HR? So you get your HR down with Cardizem, but still in aFib for more than 48 hours, what is your plan? How long is it safe to “wait and see”? And do I assume correctly that it’s only safe to “give nature a week or so to do its thing” if you are on blood thinners as clotting and stroke could occur if not?
Patrick
jimjames patrick45945
Posted
Yes, the Cardizem (dilitiazem) is prescribed. It comes in several formulations, including time release. The best to get your HR down fast is the regular tabs, not time release. I take one 60mg tab and wait an hour. By that time my rate is usually down near 100. If not, I would take a second tab. My maintenance is one tab every 6 hours (240mg/day). That keeps my resting pulse 100 or below. I also start a thinner (Xerelto) at the same time I start the dilitiazem. Now I'm 100% safe. My rate is controlled and I'm on a thinner. I could remain like that for weeks, months, years, if I want. But I don't like being in afib so I'm not going to wait too long.
As mentioned, in the past, I'd get electro cardioverted right away. But now, the plan is to wait around a week to see if I naturally convert. If not, then I would choose between electro cardioversion or a rhythm drug.
But going back to your question again, once your HR is controlled and you're on a thinner, in terms of safety there is no reason to get out of afib. In theory, your lifespan would be the same if you remained in afib for life with a controlled HR.
That said, this is how dilitiazem works for ME. In your case, it's possible it wouldn't get your rate down to acceptable levels as quickly as it does mine. But easy enough to test, because it only takes an hour or so. But definitely do it under a doctor's supervision. And have a blood pressure monitor around. When I go into afib my HR shoots up near 200 but my blood pressure dives. When I take the dilitiazem my HR goes down and my bp goes back toward normal. That said, I've heard that some people get a drop in bp from dilitiazem. If that's the case, then it may not be the right drug.
Jim
patrick45945 jimjames
Posted
FWIW, with the exception of the occasional PALPS on my daily bike rides, since the cardioversion and beginning Pradaxa, my BP and HR have been normal *knock on wood*. My last reading: BP 101/73 HR 49.
No doubt cutting back on alcohol, caffeine, sodium and losing a few pounds has helped in this regard. I am finding that behavior modification and lifestyle changes are the most effective methods to adjust to AF.
Patrick
jimjames patrick45945
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Hi Patrick,
Just so there's no confusion, taking Cardizem (dilitiazem) to control heart rate at the onset of an afib attack is not "Pill in Pocket". The dilitiazem just controls rate, not rhythm.
Pill in Pocket is a different drug, Flecanide, and it's a rhythm drug. The concept with pill in pocket is that you take the drug at the onset of afib to throw it back in rhythm. I have never used pill in pocket, so am not that knowledgeable but am looking into it. Personally, I would prefer to stay away from rhythm drugs if I can cardiovert naturally under rate control drugs, but keep in mind that I only have afib attacks maybe once every 5-7 years. If I was having them more often, then Pill in Pocket might make more sense.
Jim
jimjames patrick45945
Posted
Patrick: No doubt cutting back on alcohol, caffeine, sodium and losing a few pounds has helped in this regard. I am finding that behavior modification and lifestyle changes are the most effective methods to adjust to AF.
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You're sounding like Dr. John Mandrola now! Did you get his book yet? He's a big fan of lifestyle mods. Personally, I've had no coffee or caffeine since my last episode, have been watching diet and trying to exercise more.
Jim
patrick45945 jimjames
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Patrick
BJStar3 lee06371
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Alcohol and caffeine can bring afib on. I don't drink but loved my coffee doctor put me on a Mediterranean diet and no alcohol no caffeine! I had a pacemaker put in2 weeks before Christmas this last year.
John5006 lee06371
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Hi Lee,
?I had 2 and half years of palpitations, mostly in the morning about 8 am ish. I tried getting several ecg's done but by the time I got an appointment at my surgery they had stopped. Bang ! outta the blue one day I went into atrial flutter then into full blown AF. Aged 65. Official diagnosis was paroxysmal AF - the consultant stated that I could also be in AF and not know it - that is - I'd have no symptoms at all. From memory now my heart rate locked in at around 160 bpm, I was hospitalised for 6 days whilst all manner of tests were done and despite medication it took over a day to get my heart rate down.
?Look its not the end of the world ........ just the start of a new one. Oh! by the way, I thought I was superman too, super fit at 65, very few ailments during my life - the point is (in my humble non medically trained view) AF is all things to all people and causes and triggers are all things to all people. Look - drinking alcohol, caffeine, binge drinking ( as in being a party animal), food and genetics ( have any members of your family had heart conditions, had AF, had sudden, inexplicable stokes or mini strokes), also stress - can all contribute, individually and collectively to AF. My daughter in her early thirties developed AF during both her pregnancies. Once she was treated, and now since she has stopped breeding no more AF. What happens when she hits 65 is another matter.
?I eventually discovered that my AF kicked off after eating. Long story short - I consulted a nutritionist she helped me identify foods that could aggravate the vagal nerve. Cut out a range of foods, cut back on booze, and I've had no AF since April 2015.
?I would say, if your body has a predisposition to AF then without any lifestyle changes, loose weight, cut back or cut out booze, watch what you eat, when and how much, get more exercise etc. Eat smaller portions, don't eat a large meal late at night it could return. You had a magic warning.
?You may be better off seeing an EP - an electrophysiologist - a person who is a cardiologist with an extra speciality of the electrics of the heart. Think of a car - part mechanical, part electric and today, part computer - well, that's the heart. Then there is the vagal nerve (which is my problem). Its a major nerve of the central nervous system which acts like an information superhighway between the brain, the heart and the digestive system. It also can impact on other organs too.
hope this helps. Good luck.
John
jennissw John5006
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Your post has given me hope - I was fine this morning, palpitations are awful all afternoon. Had some cashew nuts and off it went. Jen
John5006 jennissw
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Hi Jen,
I'll give you a bit of my history first, then you can see where I'm coming from.
I had 2 and half years of palpitations, massive ones, before AF kicked me in the chest. Every time palpitations happened I tried to get to my GP for an ECG but it was never possible to get anything on ECG.
Then out of the blue, one morning in Jan 2010, after a period of time bending over a shredding machine I began to feel unwell. 9 hours later I was in A & E, diagnosed and treatment started for AF.
Many, many months later I began to link food with the onset of an AF event. I also began to learn about the vagal nerve. Then I started to think about my life and my lifestyle.
Naaah! Nothing wrong with me - been fit as a fiddle all my life. More thinking.
Fast rewind to my 30's, around 1985 I had an episode of what today we know as GERD. No action taken except to cut out certain foods, mostly in the salad family. Prior to that I had been diagnosed with gall bladder issues.
Back to Jan 2010. I consulted a Nutritionist and immediately went Gluten, Wheat and Oats free. By a long process over some years I adjusted my diet to embrace cutting out duck and pork. Also Onions, yoghurt, raspberries, runner beans, peas, English pub style real ales, bread, thick gravy non gluten free, some but not all Chinese meals, no hot spicy foods at all, to name but a few items. Nowadays I eat small helpings and start my evening meal around 6 pm and eat very slowly. Dining out is not a problem, either go to a gluten free resturant or to a resturant which has a gluten free menu.
Exercise - not a lot really. I still work driving a tourist bus and am constantly handling suitcases and passengers luggage not much of it less than 15 kgs. So I get reasonable walking lifting and exercising.
I don't know how disciplined you are but I had to keep a food diary. In a way it was easy for me because the first sign I had that I was gonna lurch into AF was bloating - often massive, massive and painful bloating. This would occur as little as 2 hours after digesting a meal to up to 6 hours. Today, this is my first clue, so I may start to bloat in say 2 hours. Then I think back 2 hours or more and analyse what I'd eaten and write it down. Then next time cut it out.
Hope this helps, any questions, ask away.
John