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Heart Disease (Expert Forum)
APCs/Posture Dependence?
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APCs/Posture Dependence?
by arthur, Dec 10, 1999 12:00AM
I have been an active amateur soccer player for 30+ years (I am 52) and suffered a paroxysmal atrial fib about 6 months ago after (and during) a very physical game. It cleared up by itself in about 17 hrs (diagnosed in the ER as AF). After seeing a cardiologist with a follow-up stress echo, everything looked normal (with the exception of some minor APCs considered benign). During the past 6 months the APCs have increased in duration (sometimes coming at 3-6 per minute) and several more AF bouts occurred (lasting 4-17 hrs). My normal heart rate is about 40-45 during the day.
Several interesting symptoms and observations have not been adequately explained by the two cardiologists I am now seeing:
(1) the APCs disappear when I assume a horizontal position (on my back, front, or side) and reappear when I regain a vertical position (to me this suggests a physical reason for the arrythmia)
(2) the AF is triggered only when I play soccer or excercise with other people (stress)...I can and do excercise on my own, quite vigorously (3-5 miles jogging, sprinting, for about 1 hour) and have never gotten an AF.
(3) related or not, I have been experiencing a pressure at the base of my throat, a feeling of stuffiness in my ears, and a slightly raspy throat by the end of the day...these symptoms began a few weeks before the first AF 6 months ago. In my estimation they are not a product of an imagination made vivid by my arrythmia experiences.
(4) last but not least, there is definitely a flutter/tremor sensation in my chest, wherein the heart beats normally but feels as though there is an extra set of vibrations following each stroke. These "vibrations" vary in strength and seem to portent the onset of APCs.
There it is. This enigmatic arythmia is preventing me from pursuing my greatest love, playing competitive soccer. Can you please take a stab at addressing points 1-4?
Thanks,
Arthur
Several interesting symptoms and observations have not been adequately explained by the two cardiologists I am now seeing:
(1) the APCs disappear when I assume a horizontal position (on my back, front, or side) and reappear when I regain a vertical position (to me this suggests a physical reason for the arrythmia)
(2) the AF is triggered only when I play soccer or excercise with other people (stress)...I can and do excercise on my own, quite vigorously (3-5 miles jogging, sprinting, for about 1 hour) and have never gotten an AF.
(3) related or not, I have been experiencing a pressure at the base of my throat, a feeling of stuffiness in my ears, and a slightly raspy throat by the end of the day...these symptoms began a few weeks before the first AF 6 months ago. In my estimation they are not a product of an imagination made vivid by my arrythmia experiences.
(4) last but not least, there is definitely a flutter/tremor sensation in my chest, wherein the heart beats normally but feels as though there is an extra set of vibrations following each stroke. These "vibrations" vary in strength and seem to portent the onset of APCs.
There it is. This enigmatic arythmia is preventing me from pursuing my greatest love, playing competitive soccer. Can you please take a stab at addressing points 1-4?
Thanks,
Arthur
Doctor's Answer
by CCF CARDIO MD - DLB, Dec 10, 1999 12:00AM
The reason your two cardiologists have not been able to answer your questions is because there is no answer. Your body position is unlikely to truly be related to your arrhythmia. Exercise and adrenaline are known to trigger certain arrhythmias. The throat and ear conditions are unrelated. You have paroxysmal atrial fibrillation, and since it really bothers you, you may benefit from medication to try to prevent it.
The arrythmia may have nothing to do with body position, but body position definitely affects the arrythmia...the reason may be beyond the scope of your experience or training (or for that matter, anyone's experience or training).
The pressure at the base of my throat is real and is beyond the normal "skipped beat" sometimes felt in that location. It is constant. One cardiologist has suggested the possible involvement of an esophagitis or tumor, and this possibility is being investigated.
Now that you're likely upset with me, perhaps you could address point 4...ie, the clear sensation of tremor/vibration felt throughout the chest. This is not normal and has gradually increased in intensity and duration over these past few months. It seems exacerbated by exercise. At times I feel as if AF has settled in, but when I check, I find a normal rythym (with some APCs) seemingly unassociated with the mystery thumping.
-Arthur
I too have some type of lump in the throat feeling. I have also developed PVC's that vary with positions.
The ear pressure thing seems to be related to Cerebral Spinal Fluid pressure/flow.
By the way, my episodes are neurologically mediated.
The postural dependence is definite, and fortunately in my case, the APCs do disappear in any horizontal position. I have undergone an endoscopy to check out possible esophageal involvement, and some minor reflux/irritation was noted. I've been taking Prevacid (proton pump inhibitor) and the symptoms of Globus hystericus (lump in throat) have diminished somewhat, along with heartburn, and it appears, along with the "vibrations" I have felt...coincidentally, the APC production has diminished.
With time (perhaps months, as such irritation is slow to heal) I am hopeful that the APC problem will be "cured". In fact, I am now sure that the APC frequency is directly related to the "vibrations" felt, and that these "vibrations" are the result of an irritated esophagus. It doesn't take a brain surgeon or a rocket scientist to figure out that a pulsating esophagus sitting up against the atrium will likely have some arrhythmic effect (in contrast to the many comments made by the MDs at this site, there is ample evidence in the literature dating back to the 70's of esophageal dysmotility causing a variety of arrythmias). I suspect that my atrium sensitivity to such dysmotility is excarcerbated by over-training (intense exercise for many years) which has resulted in both an enlarged heart and a over-reactive atrium/pulmonary vein junction.
I believe that I am suffering from two problems (reflux and sensitized atrium) which result in one symptom: APCs which turn into PAF at a high pulse rate... It's perplexing that when a problem emerges that crosses specialist boundaries (heart v gastroenterological) that it tends to be dismissed by either specialist. It looks like when this happens you need to do a lot of your own research.
-Arthur