Atril Fibrillation

[luisa]

My 74 yr. old Dad is presently diagnosed w/Atril Fibrillation. He is on Blood Pressure meds.---Norvasc(5mg), Metoprolol(50mg),& Cozaar(50mg).
His BP is under control.  These past 2 months he has been sedentary because he had fallen 4 times due to an unstable gait & not able to hold his weight.  He says that his legs wobble/shake & then he sits.
In 1996 he had mennigitis.  Since then he has had an unsteady gait and occasional headaches when he feels cold air or drafts.
In 1997 he was again hospitalized because his potassium was depleted.  They gave him the needed potassium thru his veins ( I remember my dad commenting how it burned & that he felt his heart couldn't take it anymore).  The doctor then gave the remaining needed potassium by liquid drink.
In 1998 he had a minor stroke (one centimeter brain hemmorage). He was on coumadin (blood thinner) at the time of the stroke.  His Doctor was preparing him for electrocardioversion. He was immediately taken off the coumadin. Now we are in a "Catch 22".
My dad is gradually getting worse in being mobile or moving.  He has no pain, eats & sleeps well, however, is afraid to walk more than necessary.  He is using his walker & hopes that soon he may leave it without fearing that he will lose his balance and fail again.
I would like to know what other specific things the doctor may need to investigate or "rule-out" next?
Thank you for your knowledge & time.
His daughter,
Ms. D

[Cleveland Clinic, MD]

The stroke was probably due to the coumadin and not the afib so his doctor was right to stop the coumadin.  He could remain in afib but the doctor could also try a TEE and cardioversion to try to get him back in sinus rhythm.  Preventing additional falls is vital so make sure his house is "fall-proof" and he has a bedside commode for night-time toilet needs.

[Gunter]

I thought we afib types take Coumadin to prevent strokes - please explain how and under what conditions Coumadin can cause strokes.

Thanks again!

[Cleveland Clinic, MD]

There are two types of strokes - embolic (due to blood clot) and hemorrhagic ( due to bleeding).  Coumadin decreases the risk of embolic but also increases the risk of hemorrhagic - particularly in the elderly.

[EdMac]

at 65 and on Coumadin due to A-Fib what is the preferred manner in dealing with the posible blood clots ?

Thanks, enjoy your site.

[Cleveland Clinic, MD]

Coumadin is recommended for individuals older than 65 with afib and no contrindications to the medication.  For younger individuals with only afib and no other heart problems aspirin alone may be OK.

[Gunter]

PLease explain why Coumadin is recommended for folks over 65 with afib, while aspirin will do for younger folks. What are the pros and cons?

Thanks.

[Cleveland Clinic, MD]

This is kind of beyond the scope of this forum.  Suffice it to say the risk of stroke is higher in elderly and thus more powerful protection is needed.

[luisa]

Dr. CCF, thank you for your reply.  My dad had the TEE before coumadin was introduced.  I am wondering if his electrolytes are affected.  If so, could this attribute to his weak legs that can not support him? (they give-out unexpectedly)  This is most troubling.
He has always been a strong man (muscular type--some of it is hereditary & the rest is from a lifetime of physical labor). If I may make an analogy---it's like he has an "electrical short" somewhere.
What should we have tested or look for next?
Thank you...

[Cleveland Clinic, MD]

Coumadin won't affect electrolytes.  I would see about enrolling him in a exercise rehab program.

[luisa]

I will look into the exercise rehab.program.  What could affect electrolytes?  Do you think a cardiologist that specializes in eletrophysiology should be the next doctor visit?
Thank you

[Cleveland Clinic, MD]

Many things can affect the electrolytes.  Yes, an EP doc would be a good idea.

[Nic (Luisa's Brother)]

My father had 3 spinal taps in 10 days during his 12 day hospital stay for menningitis (meningitis).  He claims that this weakened his legs somehow.  Is this possible whether likely or not?  His legs tire easily when used.  Is this common with afib?

[Cleveland Clinic, MD]

Afib can cause fatigue but usually not leg weakness.  The other questions can be answered in the neurology forum.

[patricia]

My boyfriend was just diognoised with afib.  He is 46 years old and cycles and swims, he is basically very healthy, although under a large amount of stress lately.  He feels the afib is stress induced.  He waited 5 days before going to the doctor.  They are giving him blood thinners and coumadin.  He is very leary of all of the drugs he is taking.  He feels that they should just shock his heart and put it back into rythme.  He was told that they don't want to do that for three weeks because if there are iny blood clots in his system, it could be dangerous.  Pl;ease explain why they just can't shock his heart back into its normal rythme?

[vicki]

Hi, I am a 40 year old female and was diagnosed with AF yesterday..I have been having these episodes for a long time and finally went to the ER yesterday...They first gave me 2 nitro pills and they did very litte for the pain and nothing for the racing heart...after doing an EKG, they discovered I had no "P's", whatever that means, they administered cardizem and my heart rate went back to normal, but I still have an irregular heart beat...they sent me home with orders to take one aspirin a day and 1 cardizem CD daily...I also have to go in for a stress test and halter...I am very scared and wonder what causes this and what my future looks like, ANY HELP, COMMENTS OR ADVICE WOULD BE VERY HELPFUL!!!!  Please respond!!  Thank-you...

[Raygen Pyle]

I am 66 years old and have atrial fibrillation and have had it for about 8 years.  I would to know about RF Ablation to correct my atrial fibrillation.

[Mrs. R.]

Friend has a blood clot at the base of the brain which is hemmoraging, due to incurable infection in her body.   What are the changes of removing this clot?

[Coy Haney]

My wife had a stroke 17 mo. ago, caused by A/F her complete right side was effected, she is now on TAMBERCOR, We have heard so much  about the deadly drug, I would like to know <HOW DEADLY IS IT, She takes 100mg A.M. & 100mg. P.M. and what is the true side effects of it.
Would like a reply;
Mr. C.

[Ron]

I had a knee replacement in November and during admittance to PT, they discoveredan irregular heart beat aka Atrial Fibrillation. I was admitted to the CCU for 7 days where I had no PT to speak of. They administered Coumadin, Lanoxin, Verapamil for the AF.
    
    PT was done for 10 weeks of 3X per week, both land and aquatics. Neither has made me recover or given me my range of motion that should have been accomplished.
    
    My knee flexion is 90 degrees, leg extension is -10 degrees which makes me limp occassionally due to stiffness. Stairs are also a problem. Knee is always swelled from 1" - 2 1/2" more than the good knee.
    
    My question is, is there any data that shows COUMADIN having a effect on swelling and retarding the healing process ? I have learned from others that it does affect the knee.
    
    Any similar cases ?

[Bob M.]

I have afib (one episode)and have been on Tambocor and Toprol for several months. I take half of a Toprol tablet in the morning and Tamborcor twice a day.

I do feel very tired late in the day and have a bit of dizziness when I turn my head to either side quickly.

Can you tell me about other side effects of these drugs? Is constipation one of them?

Also, if I am symptom-free for an extended period of time, what is the likelihood that my heart specialist will reduce the dosage or eliminate one of these drugs?

[Sonny C]

I started with Atrial Fibulation on Jan 27 1998. I had Cardioversion and then a pacemaker on Feb 3 1998. Have been on many different drugs since then, curently on Betapace. Nothing seems to help, still continue to have Atrial fibilation, every one to three weeks. All the betablocker drugs that have been tried have left me very fatigued and tire very easily. At the normal doses of these drugs I have Angina, but when the dosages were cut back the angina would be less of a problem. Before and during, the periods of atrial fibulation, I have dizziness, extreme fatigue, periods of sweating, after I am left Fatigued for varieing periods from a few hours to a couple of days. When Atrial fib is suspected due to symptoms mentioned above, I increase my Betapace dosage, sometimes I catch the atrial fibulation before it becomes a problem. You may ask why not stay on the higher dosage, it was tried early on and still I had A Fib every week or so. After consulting with my heart doctor,I have been on the reduced dosage and increased as needed. Note as I stated before, I had other problems when on higher dosages of drugs containing betablockers, and these problems come back when I increase my betapace to control my A Fib.

[Barbara Driver]

I am a 52 year old female who has had two serious bouts of a 'racing heart' where I was admitted to the local hospital who gave me a general anaesthetic which corrected my heart back into it's normal rhythm without recourse to shock treatment.

I was diagnoised as having Superaventricular Tachycardia.

I was put on Tamborcor (Flecainide) - two 100mg tablets per day -by my heart specialist in June 1996.

I was given the options of continuing with the Taborcor medication or an operation involving 'Catheter Ablation' of my probable AVNRT pathway but was told that there were risks which if the operation was not successful could result in me having to have a pace maker for life.

My two questions are:

1) Is it safe to be on Tamborcor twice a day for the rest of my life & if so what are the likely long term side effects?

2) With medical advances is the 'Catheter Ablation' operation getting safer to the point where this is a better option to taking Tamborcor for the rest of my life?