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AFib episodes after insomnia
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AFib episodes after insomnia

In 2007, I was diagnosed with Perimyocarditis which was caused by under treated hypothyroidism. The myocarditis was diagnosed because I had AFib. Everything resolved and healed in 2008. Although, after that I found I could no longer handle eating dark chocolate (above 70%) and could not take any OTC medicine with pseudoephedrine in them. I have not been able to drink coffee for the last 35 years.

It took 11 emergency department visits to get a ED doctor to believe I had pericarditis. I knew I had it because a friend of mine had the same symptoms and encouraged me to keep going and eventually I would get a diagnosis. My therapist told me I now have PTSD from that experience and from the disease itself. I guess I am hesitating to pursue these symptoms with a cardiologist or primary doctor, because I am concerned that I won't be believed again. These symptoms are not like pericarditis, but every time I get AFib that's the first thing that goes through my mind, "Is this that dreaded disease again?"

I have longstanding PTSD (50 plus years) and suffer from severe insomnia at times. The insomnia has been worse in the last year due to new memories. When I increased my exercise from three days a week to five to six days a week in June 2011, I started to experience AFib episodes if I had insomnia. My solution was to back off exercise on those days I had insomnia. That worked for the most part. I do NOT have AFib during or after exercise, it comes on later in the day or that evening.

However, these Afib episodes are *not* like the ones I had with Perimyocarditis. During these episodes, while I am sitting I feel as if I will blackout or faint. It happens while I stand too. If I rest for 10 hours two days in a row, the feeling goes away, but afterward I have a dull ache in the center of my chest which dissipates after 24 hours with rest.

Recently, more symptoms have occurred during these AFib episodes including shortness of breath, weak legs, teeth vibrating, and cold sweats.

Until this last episode before Thanksgiving, I chocked up the symptoms to a combination of insomnia and PTSD, but now I am beginning to wonder if it might be something more serious. Possibly now I am overmedicated on thyroid medication.

My normal resting heart rate is a steady 52 to 54 (lying down) and 58 to 60 (sitting) due to longstanding (30 years, my endocrinologist's guess) untreated hypothyroidism with resultant borderline bradycardia. My heart rate used to be even lower, 42, from age 16 through age 50. When I have these AFib episodes, my heart rate goes up to the midrange 70s and is irregular and down to the low 40s with bigeminy beats and then back up again until finally leveling off with my normal heart rate. This occurs over the span of about four hours.

I had similar episodes, but without the blackout feeling and other symptoms at the beginning of 2010 and saw my cardiologist about them. After going through a slew of tests with my primary, my endocrinologist, and my cardiologist, it was determined that I had some type of thyroid infection and required more thyroid medication. The cardiologist confirmed it was AFib when he viewed the echocardiogram.

Should I see a Cardiologist or Primary Care Physician or my therapist?
Tags: PTSD, borderline bradycardia, bradycardia, dull ache in chest, Afib, Insomnia, Hypothyroidism
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1124887_tn?1313758491
Hello.

Sorry to hear what happened to you.

First, are you sure that you are experiencing A-fib now? First, I would think untreated A-fib would cause higher heart rates than midrange 70s, and second, you mention bigeminy which is uncommon in the setting of A-fib. You can have (that's common) ventricular premature beats / PVCs with A-fib (though some or most of the PVCs noticed on EKG during A-fib are often "pseudo-PVCs" caused by the irregularity in the heart rate, which will make some of the beats wide-complexed on the monitor (from what my cardiologist told me). That's often what happens with PACs too.

You can not have extra atrial ectopic activity during A-fib because the atria are already fibrillating (in fact, A-fib is just an extreme amount of PACs overwhelming the AV node which luckily blocks most of the impulses)

So, my first question: Are you sure those events are A-fib?

It seems your myocarditis affected the atria (which is from what I know less common). Often, even after the myocarditis is healed, your heart can maintain a higher irritability, which is the reason many sufferers from PACs and PVCs may have had a slight myocarditis at some point which we are not aware of. I am not sure what the criteria for myocarditis is, but as every infection we have to a certain degree affect all our organs (the headache during a flu is often actually an inflammation not unlike meningitis), I am not sure where the line is drawn.

Thyroids will of course stimulate the body and may cause arrhythmias, especially if you are overmedicated. Your PCP may easily measure FT4, FT3 and TSH so you get an answer to this

I'm not a doctor and can't provide a diagnosis, but if I should guess, I think the problem is divided, maybe due to your anxiety/PTSD, but also possibly linked to thyroids and your earlier myocarditis. Maybe it's a good idea to see all three of them.. I would first go to the PCP, then to the cardiologist and then your therapist.
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263988_tn?1281957896
When I had AFib episodes with the perimyocarditis they were similar: Heart in the range of mid 70s with dips into bradycardia. That's another reason I was not diagnosed. I do not think the doctors were taking into account that I have bradycardia.

My HR increased to well over 70 as the condition worsened because the myocarditis was not being treated. It took 3 hospitalizations for the doctors to discover I had myocarditis as well.

That was a nightmare because my heart rate was all over the place, down to the 30s and up into the 120s and that was in the ambulance on the way to the hospital. I saw the look on the EMT's face and he was freaked out himself. Not so great when the EMT should have the look of calm and does not. Eek!

Of course going from a calm, slow beat of 52 to 75 and irregular feels as if my heart is racing. I am used to a slow and steady, lub-dub.

I also had a pericardial effusion.  

Myocarditis is inflammation of the heart muscle which can sometimes occur when there is pericarditis. It was a minor inflammation but it caused the AFib.

Symptoms of myocarditis are similar to pericarditis:
- Leg swelling was one of the signs/symptoms I had which was severe. I wear compression hose and could not get them on my legs. (Not as common in pericarditis)
- Chest pain which resembles a heart attack.
- Tachycardia.
- Abnormal heartbeat or heart sounds.
I had all three of these; a murmur, tachycardia, and arrhythmia. These symptoms did not appear immediately.
- Fatigue.
- SOB (pericarditis SX too)

All my symptoms were caused by a virus and that is the reason it took so long for a diagnosis and my age, as pericarditis is more common in ages 20 - 30. Most of the doctors were looking for the elevated temperature for a bacterial infection.

In fact, one ED doctor told me I did not have pericarditis because I did not have a high fever. That was on Sept. 26, 2007. The next day, I walked into the ED check-in area and the receptionist took one look at me and told me she would be right back. She entered the ED and someone took me back ASAP. I was in such agony that I could not breathe right. My face was drained of color. A different doctor, thank goodness, told me I had pericarditis. This new doctor was shocked I was sent home without a prescription for pain medication.The ED doctor told my DH to call for an ambulance rather than drive me next time.

One of the symptoms of pericarditis is anxiety, which is also one of the symptoms of PTSD.
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1807132_tn?1318747197
I don't know if you have afib or something else on top of the afib but if you have new symptoms, especially feelings as though you will pass out, it warrants a visit to the doctor.  I would think if you are having episodes often they could give you an event monitor that you can record an episode and they can then distinguish if it is indeed simply your afib or something more.  But definitely follow up with your doctor since this are new or worsening symptoms.  Good luck.
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263988_tn?1281957896
I finally went to my family physician, he's a good listener. He said arrhythmias with symptoms are indicative of a more serious problem. I am glad he listened to me and took action.

My magnesium level was tested. It is the low end of normal, bottom number. I told him that in the past my magnesium level has been way low and there were attempts to raise it through IV magnesium They did not work. I should have been referred to someone at that time. It never happened and yet I was told low magnesium can cause heart problems.

My thyroid test came back and were good.

My family physician has referred me to a cardiologist. I have seen this guy before and I like him. Before the appointment, the cardiologist requested I wear an event monitor. None available as of this time. I am scheduled to see the specialist near the end of this month.

After reading numerous articles on MVP (symptoms similar to mine), I decided to decrease my exercise level from strenuous to moderate. My first session was today. My family physician *approved* and encouraged my exercise program: moderate aerobic exercise, 12 to 14 mph on a stationary recumbent cycle, 30 minutes, 5 to 6 days a week. I told him I refrain from exercise on those days where I have an episode. He agreed that is a good idea.
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263988_tn?1281957896
Well, I was not imagining my fast heart rate. My heart rate during the palpitations ranged between 74 and 194! I was shocked when my cardiologist informed of his findings. I wore an event monitor for three weeks. I was diagnosed with Paroxysmal Atrial Fibrillation. My events have occurred about once every 60 days or more. My cardiologist opted for a pill-in-the-pocket approach rather than taking the medications daily.

My symptoms began after my mother died and I started to have increased symptoms of PTSD and anxiety and panic attacks. I have not missed her, instead her death resulted in the emergence of horrid memories from my childhood. Those memories caused the atrial fibrillation due severe panic and anxiety attacks.

I informed my cardiologist about my childhood memories being linked to my mother's death and those memories triggering the atrial fibrillation. He agreed that anxiety and panic attacks can cause atrial fibrillation.

Also there is a link between low levels of magnesium and insomnia and increased risk for atrial fibrillation.
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