Atrial Fibrillation/Mitral Regurgitation

[Dr. Erik]

I am a 33 year old male. I was diagnosed three weeks ago with Atrial fibillation. I went by ambulance to the ER. I was given Cardizem to slow the Ventricular rate and Coumadin to reduce the risk of stroke. I was sent home still in Atrial Fibrillation. I converted back to sinus rythm shortly after getting home. I was in A-Fib a total of four hours. I followed up with my cardiologist who I have been seeing for PVC's and PAC's. He ordered a stress echo. The results were:  The heart is structurally normal and functioning normally. The only abnormalty is Mild Mitral Regurgitation. He said it was classified as 1+ or mild. He said I should take antibiotics before any invasive procedures. I asked him when I would have to ave my Mitral Valve repaired and he said " we'll talk about it in 60 years". He didn't seem worried about it. Also he took me off of the Coumadin and said to take an Aspirin a day. Unfortunately, I cannot tolerate the Aspirin due to Acid Reflux and upset stomach. MY questions are:
1) Do you think my Doctor is correct about not worrying about my Mild Mitral Regurgitation?

2) If I cannot tolerate the Apirin, should I still be on the Coumadin? I have had no further episodes of A-Fib. I forgot to mention that my Magnesium level was low and I was put on a Magnesium supplement. I had also had two glasses of red wine just before my episode of A-Fib. Any insight would be greatly appreciated!  Thank you in advance.

[CCF-M.D.-CRC]

Dear Erik,
1. In general mild mitral regurgitation is considered a benign condition not requiring any treatment.  The fact that you are developing afib however means that your mitral regurgitation may bear close observation.  If you are having more severe regurgitation that was noted on the echo exam or if the regurgitation changes in intensity this may be causing the afib and would be an indication to consider treatment for the valve earlier rather than later.  I would probably continue with 6month to 1 year echos and discuss the possibility of a transesophageal echo (TEE) with your doctor.

2. This is a clinical judgement and is best left up to your doctor.  I do think that individuals with afib need to be on some form of anticoagulation to decrease the stroke risk.  The wine may have some connection with the afib.  If you continue to have episodes you should consider an atrial fibrillation ablation procedure which can cure this condition.

[debra21784]

Erik,
Iam not a cardiologist, but it sounds to me as if your mitral valve disease may be a little more symptomatic then "mild regurgatation." Usually, the Artial Fib is an indicator that things might need to be re-evaluated.
Have you had a Electrophysilogy study done to reproduce the arrythmia and give a better diagnosis and treatment options for atrial fib?An EP study will also identify the best antiarrythmic agent for you.
When was your last Echo? Was it a TEE or a regular Echo?
You can always get a second opinion about your cardiac status from an arrythmia specialist and a large cardiac practice that has someone who is specialized in valve disease.
Sometimes cardiologist in non-teaching or non-research practices don't pay a great deal of attention to mitral valve prolapse because most of the time it is asymptomatic.
It doesn't sound as if your is .

[debra21784]

Can you direct me to studies done to supprt the use of coumadin in yong patients (age 30-50 ) with atrial fib to prevent stroke?

[LaurieD]

Eric,
I just posted a lengthly post on antiarrhythmic drugs, but let me shorten it by saying that it took a calcium channel blocker <Verapamil long acting> to rid me of the atrial fibrillation. I also have the mitral regurgitation.Ask your doctor about a combination of corgard <beta blocker> and verapamil. It's worked wonders for me and may for you also. Alcohol is a trigger for atrial fibrillation. So is stress, smoking,caffeine, and some other things. I stay away from alcohol as it's caused me to go into a-fib in the past. Good luck let me know how you're doing :)

[Dr. Erik]

Thank you Laurie for the feedback

Laurie-

I think it was the Cardizem (which also is  Calcium channel blocker), that brought me out of A-Fib and has kept me there. I agree with you. I had just drank two glasses of red wine before the episode. I also found out that my Magnesium level was low, which can also cause atrial fibrillation. I have been fine for almost four weeks now. I too avoid alchol now and caffeine. I'm just curious how old you are and how long you've had A-Fib, and if you take Coumadin?

[Dr. Erik]

Debra-

Thank you for the feedback! I have been experiencing brief periods of what I believe was A-Fib for 10 years. They were so few and far between that they never caught it on a Holter or EKG.
I have had numerous Echos over this time and they have never shown Mitral Regurgitation until now. It was a normal echo, not a TEE. As a matter of fact, I had a Stress Echo done about six months ago and it was completely normal and didn't show any Mitral Regurgitation. That's weird, huh? My Mitral Regurgitation must not always be present. Also, I do not have a Mitral Valve Prolapse, Just Mild Regurgitation. The Valve is structurally normal. My Grandmother had Atrial Fibrillaton and my mother has Arial Fibrillation. All their Echos and tests have always been normal. I think that Excessory Pathways( short circuits) must run in the family. Maybe I should consider an Electrophyiological study. I do want to have A TEE and have my Mitral Regurgitation reevaluated by an EP. Thanks again for the input. Any further comments are welcome. Do you suffer from A-Fib or other heart conditions?

[debra21784]

Erik,
My first cardiac symptom was a run of atrial fib that caused me to loose consciuosness. My rate was monitored at 300 beats/min. I had a EP study done that replicated the atrial fib and was placed on Tamborcor and Toporol LX.Additionally,I was also found to have mitral valve prolapse with moderate regurgitation at the time. Within three months I began to experience increased Shortness of breath and profound fatigue as well as the arrythmias.I had a TEE again and was found to have severe regurgitation .A stress echo was unremarkable.I was in heart failure by the time I had the valve repair done and it was only six months after the original symptoms and diagnosis.
My arrythmias continued after surgery and required chemical cardioversion to return to normal sinus.I was also found to have a re-entry pathway that was contributing to the arrythmias.
Two years post-op the arrythmias continued with culminationin a massive stroke from atrial fib.
The long and short of this response is 1. RESEAECH your disorder with top vardiologist in the field.2 Get a EP study done3.Don't be afraid to get a second and even a third opinion, it is your health.4Get an eval for a cardiac ablation to eliminate the re-entry pathway thus decreasing your chances for a stroke.
You can e-mail me at d.***@****
Good luck

[Waterboy]

Hello everyone, my father recently and for the second time was admitted for arrhythmia. The first time was about 5 years ago and now the day of thanksgiving. My father {of 50+ years and in good shape other than a little over weight and on high blood pressure med for about 8 years} is wondering if the bloodpressure med may have caused this rhythm problem. The med he was on contained a water pill i think. I can't remember the name of it,anyway have you folks read the side affects of these poisons! They could cause just about every problem imaginable. His doctor now put him on cardizem {a ccb}Which is highly known to cause heart attack. Have any of you tried to eliminate these drugs through diet? Iknow of a doctor who has great results that way. What do all you think about these stress tests? Again pretty risky in my research findings. Hey they can cause the very things your tring to avoid in the first place, Stroke, Heart attack etc. There has to be a better way! I believe there is and also believe sometimes you have to be medicated i know, I feel for all of you that are, but how long can a persons body tolorate these toxic drugs. I'm on my soap box, let me get back to my question about stress tests. His ekg were great, his xrays of his heart were fine. Just maybe  this was caused by his bp med? Why overhaul the engine if its just the oil that needs changed theory. Or i guess in this case why fidle with something and take the chance of breaking it. Certainly there are many things that can cause it {Arrhythmia}. When the basic tests turn out AOK why are the doctors not convinced or concerned with the list of side affects on meds that could cause these problems or caffeinated products & chemicals like aspartame.  Well maybe one of you folks has some advice about this, anything would help. P.S. Sometimes it seems one test leeds to another and another and another. You start out feeling pretty good for the most part,well you know since an out of rhythm heart beat is not life threatning if caught in time before clotting  starts, but after every test you go through you gradually feel worse and worse, coincidence maybe. Thank you all for your time and may GOD Bless.

[LaurieD]

Eric,
Sorry it took awhile to get back to you. I am 41 years old and my first bout of paroxymal a-fib was about five years ago. This verapamil seems to have halted it. I still do get the PSVT they call it, lots of premature beats, but not as bothersome as they were. Good luck to you and avoid the triggers, there are some good sites on the web if you search for atrial fibrillation you can probably pull them up, they do help you understand the triggers somewhat more. Best of luck and you can email me anytime at ***@****

[debra21784]

Dear Waterboy,
I read your comments about your father's health, Sorry he is ill My main concern however is that you are terribly misinformed about cardiac disease and medications.Never have I heard of blood pressure meds causing cardiac arrythmias. They usually decrease the blood pressure thereby not putting so much stress on the heart to function.Sometimes they even have antiarrythmic properties.(THE BETA BLOCKERS)
Additionally the results of a study done at Boston University were released yesterday in which they studied the effects of vitamins versues statians (Zocor) in assisting in fighting cardiac disease. The vitamins lost.
I for one will cher your father on for getting treatment and making lifestyle changes to improve his cardiac function including medication and diet changes.
There is much info out there on cardiac disease , some helpful and some not so .It appears that you have gotten hold of not so helpful info.

[jenrey7]

Diagnosed 5 years ago with mild atrial fibrilation, echo showed floppy mitral valve not a prolapse and given viskin (pindolol)b/c I had panic like attacks, chest pain and numbness down the left arm. While I don't drink or smoke, I live in a stressful environment.  A question for the experienced user.  If you have low blood pressure 110/55 why would specialist give you med that lowers it further.

2 I have progressively felt cold and depressed  so I started taking a herbal remedy of L/tyrosine and stjohns wort.Throughout my life iv'e taken brufen (NSAID) for joint pain. sounds like a real cocktail I know .Im constantly depressed now, no drive, stomach problems and confusion when stressed, headaches and  allergies.  I have taken myself off all medications now. Anyone else have any similiar problems with beta blockers ? Im not game to stay off for long, although med fraternity appears complacent with valve problems do not consider it serious I believe.

Any thoughts anyone I need some help

[AtFibRookie]

Hi everyone and, let me say it's of great ease to read what others have gone through since my first major AtFib of last Wednesday. It took 1 and 1'2 hours of drug therapy to "convert" - which was something I had been able to do during the other 2 episodes I have experienced without medication. I am home now with a script of 40mg of Sotolol 2x daily as well as a baby aspirin a day. Perhaps someone could share similiar experiences so that I can be reassured that as the doc put it, this is more of a nuisance that any thing more - seems to me, that if yer heart is doing 200 that's gotta be more than a nuisance. All blood work and heart monitoring over the last few days show that everything is normal - no damage to the heart and regular sinus rythym while in the hospital. It looks like I have some mild hyper-tension which we will deal with next week.

A good forum - I have read much and feel for all of us. I'm scared shitless right now, unsure of what the world holds for me at age 47.

Any comments, please post - I'd be more than appreciative!!

Dennis

[arthur]

I am now 54, play soccer avidly and experienced AFib 2 years ago.  That first year was HELL...I was afraid to do anything that might trigger the AFib (I had about a half dozen episodes that first year, each lasting about 10-20 hours, each self-converting). There were times I was actually afraid of getting out of bed (and this from an athlete!). After gathering up as much info as I could (medical libraries, 2 cardios, 1 surgeon, 2 EPs, and the Web), I finally understood what I had (lone AFib), what could be done (drugs, ablations), and settled upon the advice of one EP to get an ablation done, as these PACs and AFib attacks were likely due to a pulmonary vein focus ( a treatable entity with technology developed these past 3-5 years ).  As the first year progressed and I got educated, the fear factor dropped and was replaced by the nuisance factor.  At the end of that year, I had an ablation done which knocked out the focus responsible for the problem.  Since that time I have regained my form on the soccer field and train extensively every other day (running my head off)...with no further episodes other than the occassional PAC due to several other foci which were deemed benign.  So there it is, a trip no one should be required to take, however, it's lemonade and bottoms up!  Get yourself into gear by getting information, and follow it up with a logical and prudent step.  There is nothing you have that isn't treatable...and if all else checks out, it's the fear you need to make lemonade out of.

[Jacobus]

What a marvelous site!  Thanks for all the information shared here!  I had heart surgery three months ago to replace a bad atrial valve, and have been on coumadin ever since.  About a month after surgery I developed PVCs and PACs, and stopped progressing in recovery.  I was eventually put on Amiodarone for one month, and then taken off, in part because of the side effects such as toxicity to the lungs.  Since then I've been taking magnesium which seems to work better than the amiodarone.

[sadeyes]

hi everyone wondering if anyone else is as afraid as me i get what my dr. calls ventricular tachycardia attacks sometimes i can go for weeks without these attacks other times i get two or three a day my pulse raves over 200 at times havent passedout as yet but came close at times the spells last from a couplee mins. to 5hrs.after these attacks i am very tired my dr says they are not harmful just a nuisence he doesant recomend any medication for them says side effects from meds. can be serious please talk to me if anyone else has this problem i am scared to death its driving me crazy  i do not drink or smoke but find if i eat something that upsets my stomache or causes gas this brings the spells on please dont think i am a nut because i am scared to death thank you for your time

[sadeyes]

hi everyone wondering if anyone else is as afraid as me i get what my dr. calls ventricular tachycardia attacks sometimes i can go for weeks without these attacks other times i get two or three a day my pulse raves over 200 at times havent passedout as yet but came close at times the spells last from a couplee mins. to 5hrs.after these attacks i am very tired my dr says they are not harmful just a nuisence he doesant recomend any medication for them says side effects from meds. can be serious please talk to me if anyone else has this problem i am scared to death its driving me crazy  i do not drink or smoke but find if i eat something that upsets my stomache or causes gas this brings the spells on please dont think i am a nut because i am scared to death thank you for your time