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Waking up to atrial flutter / atrial fibrillation
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Waking up to atrial flutter / atrial fibrillation

I am 28, physically fit/athletic, not smoking/using drugs, using only little alcohol, eating rather healthy, but I do have hypercholesterolemia which was found about two years ago. At that time I went to a doctor for "weird sensations of heart". High cholesterol was found via a bloodwork. (LDL 4.3 unmedicated then, was few months of the medication and LDL was 4.9). Back to 40mg of statins...

At that time, I was working for a REALLY stressful job (more than 80% of employees quit after 8 months of the new CEO stepping in), so I thought the stress might have caused the heart issues as well. I have had heart issues that have recently become worse, even though I quit the job nearly year ago and went back to school to study music (which I love!) :)

Anyways, as far as I can tell, I suffer from atrial flutter and more recently also from atrial fibrillation. Both seem to occur rather "randomly" after meals (mostly when I lie down/compress my torso) and while at sleep. Flutter happens only when asleep, but afib happens also after meals.

I usually wakeup after 3-4 hours of sleep to a fluttering sensation in inner ear, and then it turns to wildly racing pulse from 60-150. Pulse (from wrist) feels completely random, few slow beats, then some rapid ones and back to slow. Usually standing up stops it. Both cause mostly grief and annoyance since I really could use my sleep...

Alcohol has clear effect on afib, after drinking it happens much more often.

Sometimes when afib/tachycardia hits after meal/lying down, I feel dizzy, short of breath, numbness of jaw/face and a feeling of "impending doom" - BUT this most certainly is not an anxiety attack! I am still not feeling afraid, panicking or anything like that. It is just a feeling that "everything is not right". And it most certainly is not.

And when I wake up from sleep, it feels like someone wakes you up with a bucket of cold water, waking you up instantly - and completely. I feel like I´ve had a burst of adrenaline, my eyes are completely wide and open, although I should be very sleepy after few hours of sleep. After the "attack" has passed, it takes roughly 30 minutes to "cooldown" and to fall asleep again.

I´ve been at ER couple times, but as the flutter/afib is gone in few minutes after I wake up, they´ve never catched it. Same with meals / lying down.

Today, for the first time, I also had the "sense of feeling cold" after the afib. I was shivering for like 15-20 minutes, although I was under a very warm blanket in a room of 24C.

I do have some scoliosis at my neck and at first the doctors thought my c2/c3 joints were "at block", that there would not have been disc at all between them, but now they´ve noticed it´s there, but it´s just very small/hard to notice. I have no idea if this has something to do with vagal afib or not.

People tend to say, they have vagal afib mostly when they are sleeping on their left side, but I tend to wake up fluttering/afibbing from my right side. Something to do with my neck?

Anyways, I am going to doctor in few days and hope to get some bloodwork tested (adrenaline, thyroid, potassium, iodine, magnesium) and asking for possible holtering.

Recently, I´ve also had issues falling asleep, because my pulse is topping 100 (no flutter, no afib - just racing) When I stand up, it "normalizes" to 70-80. I was given beta blocker for this. It seems to help.

I have trained different martial arts for the past 20 years and I´ve learned to be VERY aware of my own body (positioning, breathing, heart, different sensations). I´ve never had any issues with my health before, so what I´ve gone through for the past two years have been a very humbling experience for me.

I´ve been at ER probably five times, but they just take the quick ECG which tells us nothing, because I have never had the flutter/afib for more than 15 minutes.

About 1.5 years ago I also had some variance of thyroid gland bloodwork. At some point I was at the high peak of the "normal values", then month or two later I was little bit under the normal values. I´ve also had higher than normal creatine values. Just listing everything that comes in to mind, in case it might have anything to do.

I am looking for any insight, comments etc to get this thing sorted out. What can I do? Do I have any options here?
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11 Comments Post a Comment
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1182699_tn?1297578384
So you know you're in afib or aflutter by monitoring or just a feeling you're getting? I have similar experiences, but the shivering, impending doom, etc. do sound like panic attacks. You can also have nocturnal panic attacks. I have found in my case that my panic attacks are direct results from my heart arrythmia, I know I would not freak out if I did not feel my heart. PVC's, PAC's, and whatever else may be going on that they haven't been able to catch. My doctor told me when I wake suddenly I am having an adrenaline response to the myoclonic jerk, which seems to be setting everything off. It's interesting you talk about the scoliosis...I was diagnosed in my late 20's and I wonder now if it is affecting the vagal nerve. Are you seeing a cardiologist as well? You could ask for a holter (24 hour) monitor or an event monitor that you wear for 30 days. WIth what your feeling, your doctor may allow it. I hope you feel better and get answers soon.
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Avatar_m_tn
I don´t think it´s anxiety attack for few reasons.

1) When I have fluttering and vagal afib feelings, I don´t feel "impending doom", or anything like that. I feel annoyed, frustrated and slightly stressed that my night sleep is "ruined yet again".

2) I´ve had the feeling of "impending doom" only after a meal, when I´ve been lying down for a while. It does not start with that, it starts with dizziness, nausea and heart starting to beat much quicker than normal. Last time (few weeks ago) this happened, I also felt that tingling/numbing sensation around jaw and headache. After getting one symptom after another, the feeling of "impending doom" popped. Few minutes ago I was feeling fine and now suddenly, everything seemed to went to hell. :D That´s the reason for that. "What´s going on?!"

3) Last night, after sleeping 3-4 hours I woke up. I can sense the afib from my wrist pulse very clearly. Pulse was racing totally randomly from 60-150, few short beats - then suddenly much quicker. Fluttering was something "I sensed before the afib started". Flutter wakes me up "smoothly", while afib wakes me up in a blast of adrenaline. After the afib stopped, I started to shiver for 15-20 minutes. Otherwise I was feeling very well/good.

I don´t mind having panic attacks, but I don´t simply think I have those. OR if I do, it´s a cause from heart arrythmia and that it would only fit the cases when I´ve felt the "impending doom" few times.

I am seeing just a general doctor for now and hope that he´d send me toa cardiologist. Problem is, I think he might just overlook everything and think that I am just some crazy mofo. :p

Yeah, I would love to have that event monitor to finally catch the flutter/afib. I was holtered once, but that was before I´ve had any fluttering/afib. That was when I had

Since everything in my life has been so good (new great school, stuff going better than ever with girlfriend etc) - I was wondering if actually THAT might be the cause for vagal afib.
I just read this about vagal afib:

"Short-term stress classically should not set off vagal AF - but calming down afterwards often will."

(source: http://www.a-fib.com/VagalA-Fib.htm#11 )

Just tossing wild guesses around. Won´t get me anywhere, but ...meh.

What worries me is the increasing repetitiveness of the fluttering/afibbing. First these seemed to occur once in a few month, now I´ve had like four in past month alone. :(
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Avatar_m_tn
Lovely that you can´t edit your posts...

"Yeah, I would love to have that event monitor to finally catch the flutter/afib. I was holtered once, but that was before I´ve had..."

... any fluttering/afib. That was when I first went to a doctor for the weird heart sensations. That was the time I got to see a cardiologist. At that time they also echoed my heart and everything was fine. They also did that jogging (or well spinning) ECG, where they found out that my oxygen saturation was getting lower than it should. Around that time I quit the job and never found out what caused that, but the doctors were not too alarmed about it, they just tossed some questions marks around possible causes."

I am now going to get the results etc from this "private doctor company" and take them with me to the general doctor.
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1137980_tn?1281289046
Okay i am going to toss in my two cents worth on this one...to me the answer is evident...and that is we don't let our hairdresser put the transmission in our cars right?  The point is you need to see a HEART doc not a GP in my humble opinion.  A heart doc is just that...that is their specialty...they did added years as a specialist during school ad training and that is basically all they know, have seen everything, and know exactly what to do.  You don't normally have to deal with the process of elimination with a heart doc...because its simple...they know....a family or GP doc is super important as well however the heart is not their specialty and they to me do not have the experience in diagnostic not surgical and will no doubt do process of elimination thru meds, etc. and that is just not right.  I would yes see that doc and ask him/her for a referral because A. Its your body and your life B, The heart is not something to play a guessing game with C. You will get the answers from a heart doc pretty much immediately w/out being a test monkey for your doc with the ...well lets try this or the well i just don't think so....or the i wouldn't worry about this....not fair to you my friend...let the HEART doc order the holter and save yourself alot of un necessary worry and frustration...i think we have all been there ONCE and then learned our lessons.  Its your life....you have only one shot.....and its you NOT the docs that dictate your decisions in this life...again think seriously about this and don't waste anymore time and go see the doc that really knows...good luck and let us know...
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Avatar_m_tn
Sigh. I managed to sleep less than 2.5 hours. I fell asleep instantly, but woke up to a ~100ish pulse that I could clearly feel through my neck. It was steady, but quick. No flutter or afib. I also had a feeling of pressure around neck from the back and sides. What on earth can cause this?

As soon as I rose up, it started to ease up, but I´d really need more sleep.
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Avatar_m_tn
Same for today. I woke after 2.5 hours of sleep, with tachycardia and felt my pulse strongly from my neck (behind and sides). No idea if it is the vagus nerve or something else, but if I DO NOT wake up for the tachycardia, it turns to flutter/afib which happened few days ago.

The cause is my neck or something. Extra doctor visit today. Hoping for quick X-Ray.
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Avatar_m_tn
Just got out of hospital after similar symptoms to yours, but they managed to catch mine while I was there and it showed up on the ECG.

Definitely go and see a heart specialist - they can fix this. Try find one that has an interest in arrhythmia.

You won't be able to fix it yourself, so get off the internet and get it solved!
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Avatar_m_tn
Sorry to hear of your continuing complaint.

I just started going through the same from the end of July 2011. I know how physically and psychologically wearing flutter/afib can be.

My background is that I had first couple of MIs in February and April. The second landed me in hospital where I underwent angioplasty and stenting of the circumflex branch of the Left Anterior Descending artery which was totally occluded. Two further arteries on the left of the heart which were only partially occluded were left untreated.

Had 9 weeks of symptom free recovery and then went back to work part-time. Within a week and a half of returning to work at the end of June, I was back in hospital (Only for a day) with chest pain (4/10) of what  I suspected to be a pulmonary embolism. Nothing was found.

Gave it another week and a half of rest at home and returned to work, part-time. Within a week and a half of returning to work, I was off-sick again. This time I was woken from sleep by flutter/afib that lasted a couple of hours and continued sporadically, together with some short-duration chest pain during the next two days. I was left physically shattered and was off work for another week and a half.

After this episode, at the beginning of August,I visited my General Practioner in medicine. I explained the situation to my General Practitioner and he requested fitting of a Holter monitor. But the National Health Service being short of resources the fitting appointment won't be until the beginning of September 2011. After reading some sources on the net, which indicated that very often the 24-hour holter monitor won't capture any abnormalities because of the random occurence of flutter and AF, I decided to purchase my own hand-held ECG machine + finger oxygen/pulse meter.

In the meantime, I had to return  to work and the same happened again within a week and half, except this time the flutter and afib has continued on and off for a week, accompanied by some short duration chest pain (Relieved by taking increased aspirin dose) and I have been off work because it makes me feel so awful and drains all my strength.

Luckily, when this happened this time round I was able to capture the abnormal heart rythyms on an ECG trace using my own machine. Result !
This showed not only that I had a bradycardic (Slow) resting heart beat (averaging 45BPM, as low as 38 - Lance Armstrongs RHB was 32) whilst awake, but that, on occasions, I had flutter (Classic saw-tooth shaped wave on the ECG) and AF which on occasion broke through to the ventricles pushing the heart BPM up to 120. Strangely, flutter on its own didn't appear to push up the pulse rate.

After three weeks of use, I've now got about seventy readings now, spread throught-out the day, 10 of which show major rhythm abnormalities and most of the rest show the saw-tooth pattern of flutter.Most of these results have been e-mailed to my GP. It appears from these ECGs that I have been experiencing low amplitude flutter most of the day, without feeling it and that it is only when it  intensifies is it that you notice the sensation. I've likened the sensation to Gambolling spring lambs/a vibrating tuning fork under your chest.  No wonder, I've been feeling so bl**dy tired if I got near constant flutter in the background.

No doubt, if I'd have waited  for the NHS to find this out, I'd have waited for ever - confirmed by my later reading of the Oxford Handbook of Clinical Medicine (One of the standard crammer  texts for UK medical students) which states that only 10% of Holter tests show any of the heart symptoms complained of   by the patient, and of the remaining 90%, only 20% show symptoms and these are usually unrelated to the patients original complaint and the remaining 70% show nothing. So, hardly an efficient diagnostic technique.

The availability of the ECGs to me means I have  been able to do some elementary comparisons of the timing of the components of the beats and their shape with various standards. And the results of this analysis has suggested some possible causes e.g.

My PR interval has a duration of 333milliseconds - the standard is 200ms - references state that this suggests first degree heart block i.e. a nerve conduction problem.

My QRS complex has a duration of less than 67 milliseconds - the standard is 120ms -references state that this suggests an atrial or junctional rhythm focus i.e. the heart beat is originating away from thenormal place, the Sinus node of the heart.

My QT interval is 600milliseconds - the standard is 450ms - references suggest that this could suggest a susceptibility to tachycardia.

My T wave is biphasic, i.e. it has a negative (Inverted) component below the Iso electric line - references suggest this is evidence of a recent MI - T wave inversions are supposed to right themselves within a few weeks of an MI.

When the flutter episodes first happened they usually occurred at night, or just before I woke in the morning. Now they are happening at any time during the day, but especially following a doze after a meal.

I've also notice that they are provoked by certain food and drink - coffee, cheese and alcohol.

Reading the literature there's one shed-load of possible causes of flutter/AF ranging from any form of heart disease you care to name to lung problems, problems with the osephagus, problems with the vagus nerve and parasympathetic nervous system, endocrine problems, specifically thryroid and even problems with the neck.

With my history of idiopathic syncope, pre-pubescent Raynaud's, childhood bronchospasms and pneumonia, neck injury from a car accident, and familial heart disease on both sides of the family, I suspect that it will give the medics more than enough problems determining exactly what's going on.


Nick

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Avatar_m_tn
Thanks for the comments. It has been years and my issue has partly solved itself. It basically just vanished / is very rare compared to what it used to be.
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612551_tn?1247839157
Well I didn't read the long posts, but checked in to see why you came back to the post and I am happy to read you are doing better, even if you don't know why.

Hope you have a great 2014, including an more heart rhythm issues/problems.
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Avatar_n_tn
I have just started to have these symptoms.  3 months ago I was stented in 2 places.  Everything was fine until yesterday. Yesterday I went to an ENT for an unrelated issue and the doctor cleared my sinuses with I do not know what kind of mix of nasal spray and a scope that he placed up my nostrils.

Following that procedure and me breathing better, I went back to work. At about 8pm in the evening, I started having flutter/fibrulations of the heart. Its very noticeable, also a feeling of catching my breath.  But it only happens when I am laying down or sitting. When I am standing, no issue or feeling of palpitations.  I was debating going to the ER but instead I decided to try to fall asleep. I did fall asleep and I slept thru the night. Didnt notice anymore palps.  But this morning, I woke up, sat up in bed and the feelings of palps/missed beats has returned.

Not sure what to do as it is July 4th and the only place to go would be an ER.  Other than the worry aspect of these feelings, I dont have any other symptoms so I  am not sure if this is an emergency or something that will resolve itself as yours has.  I wonder if the nasal spray had some sort of steroid that may have affected my body in some way and if and when the streroid leaves my body will the palps just normalize?  Its too coincidental that the ENT did whatever he did and then that evening this issue began so I am sure there is a relation between it.  I will try to call my doctor to find out.
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