Arrythmia

[karan84]

I am 39 yrs old with well controlled hypertension since 7 years.(On losartan 100mg).My sleep pattern has disturbed over the past 5 months as I get up after 4 hours seep and am very active.It then takes time for me to go off to sleep again.Sometimes I have frequent wakening in the night and get up with adull headache.There is no stress that could have disturbed my sleep pattern.recently about 2 months back I started having PVC's(premature ventricular contractions or missed beats).Then about 3 weeks later I had an episode of atrial fibrillation(AF) lasted for half an hour.It was ECG documented.Got Holter which showed 9 PVC in 48 hours with no other problem.Stress test was normal.Echo was also normal.I had this episode of AF at 7 in the morning which woke me up from sleep.My doctor told me that first episode was harmless but only strange thing was that it was unusual at this age without any risk factor.I again had an episode at 7 in the morning 3 weeks after the first episode and it subsided in 10 minutes.It was then that my doctor told me to start low dose aspirin and clopidogrel(75+75) and keep a pill(Flecainide 50 mg) in my pocket in case the arrythmia lasts for an hour or so.I thought I would do some breathing exercises to maybe decrease the frequency of this problem but after doing deep breathing i had a minute of AF which subsided on its own.This has actually worsened by quality of life as it can happen anytime and anywhere.i was going through the internet and it seemed that this was a vagally mediated event as it was happening in the morning.I have got all my tests done and they are normal including thyroid and electrolytes.I also had an episode of tachycardia at 3 in the night a few days back which subsided in three or four minutes but it woke me up from my sleep.can anyone guide me on how to proceed with the management as it is quite disturbing.is there any relation between AF and PVC.

[karan84]

Thank a lot for clearing a lot of my doubts.My concern now is travelling long distances as I am fearful of the fact that the episode can  recur anytime. What would I do then if I am travelling and I have this arrythmia.

[CFS56]

I would definitely ask my doctor about doing a sleep study.  My EP sent me for a study and I have sleep apnea.  I am female, not overweight, exercise, none of the typical things you would think.  Worth a shot.

[karan84]

Thank you.Except for sleep problem I dont have any other risk factor.My BMI is 22.I take a very light dinner and my investigations are normal.i avoid sugar because of family history. Regarding exercise,yes that is lacking but otherwise I am not obese at all but rather on slightly thinner side.

[seaweib]

I agree w/ the previous poster regarding sleep apnea.  Not getting a good nights rest defintely can at least contribute to arrhythmia if not cause it.

The other thing that I would add is to see if there are any other risk factors in your life with regards to diet and/or lack of exercise that may be causing this.  Diets high in fat, carbs, or sugar cause some people to be more prone to premature beats.  Also, getting exercise helps out a lot of people with benign arrhythmias like you have.  Also, alcohold and caffeine of course are big culprits.

[CFS56]

The first thing that pops into my mind is sleep apnea.   This can cause awakenings in the night, afib, tachycardia, hypertension and headaches when you wake up.  

[is_something_wrong]

Hello.

No, there are no relation between AF and PVCs. Of course, they may share a cause (for example: Stress, thyroid disturbances, structural heart diseases, etc. which may cause all sorts of arrhythmias, including PVCs and atrial fibrillation), but PVCs do not trigger atrial fibrillation.

Atrial fibrillation is triggered by a specific type of PACs that origin from the upper parts of left atrium. In theory, anyone can get runs of atrial fibrillation, but the arrhythmia rarely sustains unless chances in the left atrium (enlargement, dilation, which may happen as an effect of hypertension) allows it to do so. The problem is, during atrial fibrillation, the left atrium doesn't have any pumping force, so it becomes "weakened" and dilated, just like any muscle that are not in use. This is why atrial fibrillation often progress into longer episodes and eventually ends up as a permanent condition.

An occational run of AF would not likely cause this to happen, though.

You are right about the vagally vs sympatically mediated AF. It's two mechanisms that may both cause AF. In the vagally mediated form, your heart rate is slow and the "backup pacemakers " in your heart go wild and trigger atrial fibrillation. In the other type, your stress levels are making the heart tissue irritable, which may trigger the arrhythmia.