Digoxin

[discobeat]

I am 43, and have been diagnosed with cronic a-fib for eight years.  Cardioversion didn't work and I didn't push alternitives because I really didn't have symptoms.  I was put on digoxin to lower my heart rate, and I immediatly found myself running long distance for the first time in my life.  I was taken off when a holter showed four second pauses during sleep.  My excersise tolerance has decreased gradually since being taken off the digixon. My questions are:

A) The doctor's feel there isn't enough study to safely put me back on digoxin long term, so they won't.  Is there a safe or similer drug which might let me exercise again.  I've never been told that I have any other electrical problems other than the cronic a-fib.

b) I never had symptoms until four months ago.  When I walk (or try to run) it feels like a little lump forms in the center of my chest, sometime getting sharper with continued excercise. If I keep walking it dulls somewhat, but it feels like a lag in getting going. Doctors did full workups two years ago, and found no blockages. Is angina from arythmias common?  and I imagine its not as dangerous as angina from blockages.


c) If I were to come to CCF for a exam, how does someone organize that?  After my records are sent down, does a nurse work up the schedule and try to fit everthing into a condensed time period, or would I have to plan on making the drive from Buffalo once a week until the initial work-up is completed?

Thanks for your help

[Cleveland Clinic]

disco,

Tbanks for the post.

A) The doctor's feel there isn't enough study to safely put me back on digoxin long term, so they won't. Is there a safe or similer drug which might let me exercise again. I've never been told that I have any other electrical problems other than the cronic a-fib.

I find it interesing that you got so much bang out of your digoxin. Digoxin is usually a subpar agent for heart rate control while exercising. With respect to the fib, dig is a fairly unique medication. The other altenatives for rate control really are beta and calcium channel blockers. You are pretty young, without any other significant risk, I would probably have you look into ablation therapies which can be curative.

b) I never had symptoms until four months ago. When I walk (or try to run) it feels like a little lump forms in the center of my chest, sometime getting sharper with continued excercise. If I keep walking it dulls somewhat, but it feels like a lag in getting going. Doctors did full workups two years ago, and found no blockages. Is angina from arythmias common? and I imagine its not as dangerous as angina from blockages.

A few people have pretty bad symptoms from their fibrillation. Most dont, especially with an otherwise normal cardiac evaluation.  


c) If I were to come to CCF for a exam, how does someone organize that? After my records are sent down, does a nurse work up the schedule and try to fit everthing into a condensed time period, or would I have to plan on making the drive from Buffalo once a week until the initial work-up is completed?

We have a specialized center for atrial fibrillation at the Cleveland Clinic which is simply outstanding. Most of the time, you can have your records sent, so you wont have to make frequent trips to the clinic.

You can call the Heart Center Resource and Information Center Nurse at 216/445-9288 or toll-free 866/289-6911. Phone calls are answered between 8:30 am to 4:00 pm on regular business days. Ask for appointments or information on the center for atrial fibrillation.


good luck

[discobeat]

The Digoxin didn't do anything for rate control, my rate was always high.  When I ran with the holter on, the doctor thought that 190 - 210 bpm with afib wasn't a problem, because they weren't "real" beats. The dig increased my exercise tolorance, and helped me lose weight, or at least gave me increased energy to stay more active.  I was taken off when my rate went too low.

If the digoxin was only a placebo effect, then I can put it out of my head and try to get back to some level of activity.

Thanks for letting me know about the AFib center, I'll try and follow up with them.

[B_Johnson]

You should be on some degree of anticoagulation too.  Especially if this is a chronic problem.

Digoxin has very limited indications in this day and age, especially as a first line agent.

[cristabelle]

Hello,
I have had bouts of A-fib years ago, and my Dr. tried me out on Digoxin, which lasted about 2 weeks.  I had very bad heart "pauses".  After consulting with another cardio and an uncle at Duke Hospital/University, they both agreed that there are MUCH better heart meds. out there.  I have found Inderal and Toprol XL to be much more effective.  I have not had any bouts of A-fib for almost 10 years.  My echos and heart dimensions have actually improved!  
I'm not a physician, and would always encourage one to recieve the hearty counsel of their physician.  This has just been my experience.

cristabelle