atrial fibrillation due to lung infection

Posted By  CCF CARDIO MD - MTR on March 10, 1998 at 15:21:17:

In Reply to: atrial fibrillation due to lung infection posted by Lynne Jarvis on March 03, 1998 at 10:32:50:

: My father entered the hospital with an A-fib attack on 1/24.  His heart was stabilized with IV meds and oral Lenoxin.  On 2/9, he returned to the ER with a severe lung infection, was treated with Biaxin, sent home and returned later that day with another A-fib attack.  IV meds did not resolve the problem and so he was given a 24 hr. dose of blood thinners and electrical cardioversion.  Two physicians agreed that the probable cause of my father's A-fib was the lung infection and that his heart is in perfect condition.  My father was prescribed 0.125mg Lanoxin, Norpace 200mg (was taken off these meds on 3/1), Flowvent 440mcg daily.  On 2/27, my father noticed more A-fib and had to have two paddle jolts to stabilize his heart.  Cardarone was prescribed for a period of two weeks, at which time my dad will be further evaluated by the cardiologist.  Up to three weeks ago, my father enjoyed exceptional health for a 75 yr. old man.  He walks 2 miles/day (always has), lifted weights and used a cardioglide machine.  For the past 40 yrs., he has followed exercise and nutritional programs to suit his age and need.  I recently have come across studies on Magnesium deficiency and cardiac arrhythmias.  My father lives in a warm climate and just retired from a high stress job (it is my understanding that exercise, prespiration, stress and age can deplete Mg levels).  Do you have an opinion on Mg depletion/supplementation and atrial fibrillation in an otherwise healthy heart?  Any input you might offer would be greatly appreciated, as my father is anxious to resume his previous life style and looks forward to being "med free".  Thank you,  Lynne  

[CCF Cardio MD - MTR]

Dear Lynne, thank you for your question.  Your father sounds debilitated by the recurrent
afib attacks and I hope to provide some insight into his condition.  Afib is caused by
many conditions: valvular heart disease, high blood pressure, hyperthyroidism, infections
(like pneumonia), after open-heart surgery, and structural heart disease.  If your father
had pneumonia, that certainly could have caused afib but I wonder if he had an echocardiogram
to evaluate the heart and valve function - this test is commonly done when afib is diagnosed
to rule out structural heart disease.  Normally, the sinus node in the right atrium
initiates each heartbeat in synchronous fashion.  With afib, there is rapid, chaotic
electrical activity of the atrium which causes the heart to beat fast and irregularly as
the rapid atrial impulses are conducted to the ventricles.  Patients become symptomatic
with palpitations, shortness of breath, and fatigue when afib develops.  Infections cause
afib by increasing catecholamine levels in the blood which are stress hormones that
proliferate to help combat infection.  Unless the underlying cause is dealt with, afib
can be hard to suppress.  With afib, we have two goals.  First, we control the heart rate
with drugs like lanoxin, beta blockers, or calcium channel blockers to decrease symptoms.
Second, we thin the blood to prevent clots from developing in the left atrium where
chaotic electrical activity causes blood to stagnate and clot.  With clots in the left
atrium, there is a risk of stroke - that is why we thin the blood.  As for magnesium depletion,
I'm not aware of that precipitating afib but it would be easy to check your father's magnesium
level to exclude low magnesium as a cause.
  Medications are used to control the rhythym and if those don't work, electrical cardioversion
is frequently used.  Your father sounds like he has been appropriately treated and cordarone
is an excellent drug to use to control the rhythym.  However, if he hasn't had an
echocardiogram or a blood test for hyperthyroidism, those tests should be considered.  Also,
it's good that he's going to be seeing a cardiologist.
  Hopefully, with treatment of the pneumonia and further tests as dictated by your
cardiologist, your father can resume his previous lifestyle.  I hope you find this information
helpful.
Information provided in the Heart Forum is for general purposes only.  Specific diagnoses
and therapies can only be provided by your physician.