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Echo and Stress Test for Clogged Arteries?
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Echo and Stress Test for Clogged Arteries?

When I was diagnosed with afib a couple of years ago, I underwent an echo examine and then a year later, a stress test. Both tests came back with my cardiologist saying that my heart was fine (except for the afib problem). Can I also assume that he found no clogged arteries with these tests?

I believe that you addressed this issue before but I can't find it in the archives. I've been told and read where the rule of thumb is if one is in afib for longer than 48 hours, then one should seek medical attention. What is happening in the heart at the 48th hour that is bad? Thank you.

Kev
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Hi KVETT,

1. If you have a negative exercise stress test you probably do not have appreciable coronary artery disease.  I cannot say you don't have it because the test misses about 30% of people who do.  That is why we sometimes add nuclear imaging or echo imaging to the stress test.  If we really think you have CAD and you have symptoms, we sometimes go straight to cardiac cath.

2. I believe that you addressed this issue before but I can't find it in the archives. I've been told and read where the rule of thumb is if one is in afib for longer than 48 hours, then one should seek medical attention. What is happening in the heart at the 48th hour that is bad? Thank you.

This is a complicated question (chapters are written about it) and is difficult to answer briefly.

The magic number of 48 hours has more to do with a study showing that if you are in atrial fibrillation longer than 48 hours, your risk of developing a clot increase.  Therefore, if you have af >48 hours we need to either perform a TEE prior to cardioversion or maintain an INR of 2-3 for at least 3 weeks prior to cardioversion.

Hope this helps and thanks for posting.
13 Comments
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Avatar_n_tn
After 48 hours your risk of a stroke increases. This is a  result of the heart not pumping properly during afib rythym. During afib, the heart does not empty and push the blood through the chambers properly and there is a risk that some of the blood may couagulate(clot) and get released from the heart and cause a stroke. This is why blood thinners are usually prescribed during afib.
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Avatar_n_tn
It will be interesting to see how the doctor responds.  I have Afib, maybe once a year, and have been put on 81mg of asprin and 150mg of Toprol, 50mg at night and 100mg in the morning.  I have been told different things by different doctors.  One doctor told me to wait 6 hours to see if I convert back to normal sinus rhythm.  Another doctor said to come to the ER immediately.  Another said I could wait up to 12 hours.  Next time I go into Afib I will probably wait a few hours then go to the ER but like I said, I will be interested to see how the doctor responds. Good luck.
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Avatar_f_tn
I would like to know how you know if you are in afib?
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Avatar_n_tn
I have paroxysmal atril fibrillation as the episodes come and go with months in between.  (Fingers crossed that it stays that way.)  When I am in Afib my heart rate is around 150 - 170 bpm and the heart beats are chaotic.  When it hits me I know because I get light headed for a split second and then I feel the symptoms.  THis is me.  Others might not feel anything.  The first time I had Afib I was wisked away in an ambulance as I thought I was having a heart attack.  Now, I know what it is and just try to deal with it.  The last one occurred in March of this year and I went to the ER after 7 hours.
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Avatar_n_tn
hello 29 male.. taking atenolol 25 mg twice a day, just got out of hospital...on a 30 day event..asprin they started also.. did normal stress test that was good, echo was good..now they want to do a EP STUDY..ive had a few times tachy but normally in sinas rythem...any suggestions..
thanks
dave
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Avatar_f_tn
Oh, thanks for the info.  As I have read the heart forum in the past and read people's comments about knowing that they were in afib, I have often wondered how they knew they were in it.  I didn't know if you had pain, tachycardia, or if you could just "feel" that the beats were different.  
I wore a 24 hour Holter about 1 1/2 years ago and the Holter machine report printed that a few of my beats may have been afib while I was sleeping, so that made me curious as to how I would know if I ever did go into afib.  
The tech & Dr. never mentioned afib, so I doubt that they agreed with what the machine printed out.

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Avatar_n_tn
I was once in afib for 53 consecutive hours back in 2000. It was really rock and roll time.  I think it was brought about by my fear of going on Sotolol.  In a couple of hours it converted to normal sinus rhythym for virtually all of that time since with a few bouts of paroximal afib.  And it does a "tap dance" occasionally and then calms down. I used to put up with those dreaded PAT's and PVC's frequently and they would drive me crazy.  Then I had an event monitor and it showed some 5,000 PVC's in a 24 hour period.  That's when the Sotolol was prescribed.

For what it is worth, I have come to believe that my underlying cause is high blood pressure that was undiagnosed for years.  I've been on meds for that for several years and it is largely controlled.  I also spend a lot of time on the Air-Dyne.  I am told that my heart is normal but the time I was hospitalized in 1994 showed that it was somewhat enlarged.  This tells me that it was being stressed.  I'm about 62 and in otherwise good health, although I need to lose weight.

I'm on Lipitor for high cholesterol and it is largely controlled but I often wonder if there isn't also some clogging that has been undiagnosed although I am told by all the doctors that my heart is sound and is an "electrical" problem.  About the only way to determine for sure would be to do the invasive catherization and I am agnostic on that for now.  I'll probably continue my current regimen.

Sorry for the long post but I thought this may be of interest to relate my own experiences.
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Avatar_m_tn
I have been in chronic afib for years.  I also have a pacemaker and on coumidan(sic).  My heartbeat does not change as the heartbeat is controlled by the ventricle.  Sometimes when the afib is real bad I notice the fluttering in my chest but it has no affect on my pulse as the ventricle is what you feel in your pulse, not your atrium.  I am also in heart failure with all sorts of other problems but I do not feel you can tell if your are in afib by checking your pulse.
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Avatar_n_tn
I've always found it fairly easy to know if in afib.  It can best be described as an irregular, irregular heart beat.  That is to say it is irregular but there are no cycles or patterns to the hearbeat.  For example, on the old carburetored engines, if the carburetor was not adjusted properly, the engine may "lope", but it would be an up or down number of revolutions per minute.  On the other hand if you would pull one of the spark plug cables the engine would shake, rattle, and roll.  That is pretty close to what being in afib feels like.  Putting the engine under load would reveal that the spark plug was not firing and the engine would smooth out but with one misfiring cylinder.  With afib it is like the heart is "in idle" but the vibration is both uneven and irregular.  When I had it it would literally make my bed shake.  With some chronic afibers they have what is known as "controlled afib" which is under 100 bpm.  Normally, I have a rate in the low 50's; sometimes dipping into the 40's.  

I was watching a program on public television recently and there was much discussion about heart irregularities and some of the recent treatments that looked very promising, using more advanced pacemakers.
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Avatar_n_tn
My nuclear echo studies (Cardiolite and Dobutermine)  MISSED a 95% and 70% blockage. I had symptoms that were dismissed because I was a female. Clinton and I aced our tests but Clinton's doctor were smarter than my Cardiologists and decided to do a heart cath on Bill Clinton which is the Gold standard.  If you are a female...get mad and get mouthy and save your life.  I have permanent damage now.

On A-fib.  I was converted back to NSR within 2 hour of my attack in the ER room.  They listen to me now.
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Avatar_n_tn
What medications are you on? What do you do when you go into one of your episodes? When you go into one of those infrequent episodes, do you know what triggered it?

Kev
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Avatar_n_tn
When I have an episode of Afib I mainly try to relax.  Back in March of this year I had an episode while playing basketball.  I ran down the court two or three times before it hit me.  It was about 7:45pm.  I had someone drive me home where I sat around until around 10pm when, believe it or not, I fell asleep while my heart was beating all erratic.  I woke around 1am to find my heart still at it and decided at that time to go to the ER.  They started an IV and injected me with medication that slowed my heart rate from 160 to 70.  Although it still beat erratic, it was slower which allowed the heart to get back into rythem itself.  I am currently taking 100mg of Toprol XI, 50 at night and 50 in the day.  I also take an 81mg aspirin at night.  The Toprol is to keep both my blood pressure down (I also have an ascending aortic aneurysm) and keep my pulse rate low which they say will contain the Afib episodes.  The trigger for me is usually two things:  Stressful events and/or not getting enough sleep.

Hang in there.  It is scary, no matter how many times you experience it.
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