Possible Atrial Fibrillation or Flutter

[jwells_red]

28 yrs old, 5'6", 149 lb, & pregnant. Quick med. history: Early 1999 - DVT in left calf due to skiing accident while on oral contraceptives (age 19).     Oct. 2003 - Discovered Hyperthyroidism (Grave's Disease) and was put on Propyl-Thyracil.    Sept. 2005 - Became pregnant with first child; continued thyroid meds.    2006 - Discovered (hetero) Prothrombin Gene Mutation (diagnosed by my OB/GYN).
May 2006 - Gave birth and was put on anticoagulants (needles) for 6 weeks post-pardum.
2006 - Shortly after having first child, discovered heart palpetaions and was put on Novopranol.
Late April 2007 - Had Radioiodine treatment to destroy thyroid.    Late July 2007 - Discovered severe Hyperthyroidism (TSH 100) after going to emerge with pulse between 43 - 46. Discontinued Novopranol immediately and now taking 100 mcg of Synthroid.    Dec. 2007 - Became pregnant with second child, due Aug. 12.    Feb. 4 - 5, 2008 - 24-hr. Holter Test (after waiting 6 mths. for apmt.). No results yet.

Lately I've been having more 'episodes' (increased heart rate and 'pauses' in my heartbeat. Scary at times. It's like my heart stops for a couple seconds and the next beat is harder, sometimes with a funny sensation in my head. Maybe I've developed Atrial Fibrillation or Flutter from Grave's Disease. I have not been diagnosed with anything yet. No one seems to be too concerned; we'll see when the Holter results come in. I know I have palpetaions frequently without having these 'episodes' that I wouldn't notice, but I sometimes randomly check my pulse and find one or two during the check. I'm not sure when I last had my TSH checked, but wasn't very long ago. My dr. doesn't tell me what the levels are, just says, "it's fine" or "normal". I read with the A-Fib/Flutter, anticoagulants may reduce risk of stroke. Considering my blood clotting disorder I'm wondering if I should, but b/c I'm pregnant, don't know if it's best not to. Suggestions/Comments?

[jwells_red]

Hello, and thanks for your reply. So, I should just try to be patient and wait for my Holter results, right? So hard to be patient... I've been waiting three weeks now... The Internist who ordered the test won't be in until the 28th. :o( If that comes back normal, perhaps I will suggest an echo; I had one of those done years ago and they discovered a pin-size hole in my heart. They said it would be grown over by the time I turned 21, but they never did recheck it. I am also going to try to get my TSH levels checked asap to see if my meds need to be adjusted...

To Fran2:
Thanks for your comments. My OB/GYN said it's really up to me if I want to be on blood thinners during the pregnancy. Hard to decide. I wasn't on them for the last pregnancy. Wouldn't be so bad if I could just take a pill, but I'd have to give myself injections... :o( I have to be on them for 6 weeks post-pardum regardless. It's so frustrating to be wondering what's wrong with my heart and if I'm at an incresed risk of heart attack or stroke and whether or not blood thinners might help prevent a stroke. And then also worrying about every little ache in my legs and wondering if I'm developing a blood clot!! Ugh! I have a 21-mth-old daughter and, as you know, another on the way. I can't imagine if something ever happened to me!! So scary to even think about... Oh, just to clarify, my palpetations started months before I got pregnant. I'm really not up on all the abbreviations, so could you fill me in on what PSVT, PAF, and IUGR stand for? :o) Oh, also, the blood clotting disorder that I have would not be helped with aspririn, I can't remember the exact explaination, but the aspirin would affect a different part of the clotting process than my actual clotting problem.

I will post updates when I hear something from my tests. Thanks guys!

[Michael J. McWilliams, M.D.]

I think it is tough to make recommendations without knowing what you are dealing with.  For palpitations, I will often do a EKG, holter, echo and sometimes a stress test.  The management can be complicated depending on what is found.  In the vast majority, the results are normal.  It is probably best that you communicate your concerns to your doctor and await the results of your tests.

I hope this helps.

[anacyde]

If you haven't had an echo, I'd ask for one.

[fran2]

Hi...I'm pregnant as well, and have Afib.  I'm not an expert by any means, but I would certainly check with your doc to see if you should be on blood thinners when pregnant.  I know that there is an increased risk of blood clots during pregnancy anyway.  As for the Atrial Fib....They have me just on Low dose aspirin. They were going to put me on low molecular weight heparin, but decided against it.  I do know however that heart palpitations are common during pregnancy, and can be quite bothersome.  That's what they thought I had early on...PSVT.  But after a couple of 24 hour holter monitor tests, they diagnosed a clear PAF.  I'm taking a Beta Blocker (Atenolol) since my 2nd trimester, (started at 12.5mg but as the pregnancy progressed I've had to increase it to 75mg a day to control the AF)  The concern with taking beta blockers is IUGR, but so far baby is growing big and strong.  I know they sometimes prescribe them for other arrythmia's, but if your palps are considered benign than they might not give you anything at all.

I just wanted to offer my support.  This has been a time of anxiety and questions for me...from what I hear being diagnosed with AFib in pregnancy is a fairly rare occurance.  Another thing that increase palps in pregnancy is having low iron as well as thyroid problems.  I'd definatley ask my doc for a referral to a cardiologist.

Good luck.