Atrial Flutter?

[arthur]

I am an athletic male, aged 52, diagnosed with lone AF (3-4 self-converting episodes in past 6 mos) which appears to be triggered by a combination of physical stress and competition (1 hour lone workouts with sprints 2-3 times per week have never precipitated AF).  I have had a stress echo, nuclear stress, numerous EKGs, blood work, etc...all are fine, suggesting the plumbing is in working order.  Regardless, I have been getting premature contractions on and off (up to 3-6 per minute)...and AF rears its ugly head when I play competitive sports.  

As you can imagine, with all this going on, I have been very attentive to my heart and its irregularity...my usual pulse rate is about 40-50 during the day and my heart is bit enlarged as a result of a lifetime of strong exercise. My cardiologist is a bit perplexed, however, he points to the likelihood of a high vagal tone mixed with an over-sensitive atrial muscle/vein connection kicking in APCs.

Now for the question:  I have noticed a peculiar sort of "vibration" vaguely reminiscent of AF (but slower) in the chest during particularly active APC episodes.  The interesting thing here is that the heart beats in a perfectly normal manner (40-50 bpm), with the occassional "skip" (between 1-3 per min).  Are these simply APCs and the "vibration" my imagination, or is it possible for something like atrial flutter to be at work, even though the bpm remain low (I had read extensively on the matter and found no example of a normal heart rate associated with flutter).  My chest is thin and at times I can feel these "vibrations" very distinctly (my wife has felt them by holding her hand against my lower abdomen, so it's not just me).

If it's not flutter, then could you speculate as to what else in the chest has the capacity to undulate on its own?  Could it be esophageal in nature?  And if so, is it possible for a "fluttering" esophagus to coax an excitable atrial muscle into arrythmia?

Thank you for this chance to ask these questions.

Arthur

[maryann]

My husband recently had a stress test.  He has a history of high cholesterol and has been taking Pravacol for about two years. His cholesterol is now down to about 210. The stress test was just part of his normal routine physical. The only diagnosis given from the test was an "atrial flutter."  Is this serious?  He's always been very healthy, a non smoker and of normal weight.  Thanks for your consideration.

[Bobbi Jo]

I have been getting PVC's for the longest time.  Sometimes they are very bad . . . a string of multiples.  Once, even sent me to the emergency room.  Of course, the adrenaline coursing through your body during these episodes can't help.  I wen't through the 24-hour Holter Monitor and echo-cardiogram last year after my visit to the ER.  This is when I finally got the diagnosis.  I was told that I suffered from PVC's and that they are harmless. I really have a difficult time coping with these.  I sometimes feel like my heart will just stop.  I would appreciate anyone who can be more reassuring to me.  The Dr. just kind of sloughed it off as no biggie, not particularily offering me ways to cope.

[[email protected]]

I'm a 40 year old male in good physical condition. Ex Boxer and Weightlifter that has been dealing with atrial fibrilation, missed/skipped, fast morning heart rate, and extra beats for about 5years. It all began one afternoon when I leaned over to pick up something off the floor and my heart went insane. Out of no where my heart rate jumped of the charts and I became extremely shackin with fear. The medics came and after a few hours of experierimentation with a host of drugs my heart beats returned to normal.  I began with the use of Atenolol 50 mg. twice daily, which at first seemed to slow me down as far as activity and energy. But soon thereafter the atrial fib. become more present and often. Seeking out a second, opinion another Cardiologist added lanoxin(digoxin).25 mg. That seemed to put the tachycardia in check but did nothing for the extra beats which always followed by atrial fib. Soon thereafter I sought out another cardiologist, whom added Rythmol 150 mg. 3 times daily to my diet. That seemed "for a while" to put me on track. Calcium Channel blocker drugs did nothing for me except worsen the extra beats and make very dizzy. After about a year he incresed the Rythmol to 225 mg. 3 times daily. And now, up to 300 mg. 3 times daily as the frequency of the Atrial fib. has increased. I have had extensive tests done, all with the same result, show no abnormalities. Due to the frequent occurances of the extra beats and Atrial Fib. my Cardioligist feels that the Rythmol will be substituted with Sotolol.  I will be going to the Hospital when they introduce this drug to my system.  I want to share with all that have read my letter that when my condition first presented itself I was horrified with fear, panic attacks, etc.  I was mentally unable to drive, scarred to be away from home and always felt comforted by knowing that there was a Hospital close by. My life came to a halt. Diazapam seemed to curb my fears to some degree and with the addition of this drug I slowly became less anxious.  Bottom Line; I woke up one day angry at myself for living my life in fear! I figured if The Good Lord was calling my name I'd go. Until then I was going to live every day and without fear!  What we all experience is gut-wrenching and having a heart ailment myself I speak from my own inner horror. I want to let all know that your not alone and I want to send all my love and courage to all of you. From the Men and Women that have dedicated their lives to the study and endless hours of research, to the thousands that suffer from any of these conditions. Please feel free to share:  adonis_98117***@****

[Eugene]

I've been on quiniglute to keep my heart in sinus rhythm for a few years.  I have been implanted with a aicd and am on my third model.  I was implanted in 1990.  I have had heart attacks where the lad is completed occluded and ejection fraction in down to 14%.  My team has just decided to put me on Coreg and switch the quiniglute to amiodarone .  I have started 3.25 mg on Coreg and it drops my pressure down enormously ...77/44 .  My prinival has been cut to 5 mg. once an day I'm feeling like a zoombie and wonder if I will ever adjust to this.  I'm a little concerned about the amiodarone with all its side effects.  Is it better to load the body and work down, or start slowly and go up? Will be so anxious to get your thoughts .  GENE

[GillianI]

I have been diagnoised with Atrial Fibrilliation, any suggestions
as to any triggers which may start an attack?

[arthur]

PACs or APCs are premature atrial contractions and PVCs are premature ventricular contractions.  The premature electrical (ionic) signal begins in the atrium (top of the heart) for the APC and in the ventrical (bottom of the heart) for a PVC.  They both feel as if the heart "skips" and to distinguish one from the other, you need an ECG (EKG) trace.  Check with your cardiologist for more info, however, by themselves, they are considered benign (as most Drs believe they occur at some background level for most people).

-Arthur

[marie]

What's the difference between APC's and PVC's??  These sound very similar in their descriptions??  Is this just another name for PVC's?  If they are different, please describe how they are different.  Thank you.

Marie

[arthur]

The "skips" (assuming they are APCs) can get as busy as every two  or three beats, but for me this does not persist...usually backing off to 3-6 per minute for a few hours and then disappearing totally for a while.  I have the odd ability to lose them completely by lying down, and regaining them by sitting up.

Arthur

[Carrie]

How strange!  When mine are bad, lying down usually takes them away for awhile, then when I get back up, they start up again.  Nice to know I'm not the only one who deals with this.  It can be very frightening and annoying!
C.

[arthur]

I have gone through the Holter monitor thing, and a 21-day "call-in" type monitor.  The Holter monitor recorded quite a few different types of arrythmia (APCs, VPCs with atrial abberations dominating, no AF, just skips).  Same thing with the 21-day monitor (which caught one AF episode).  These "vibes" are very puzzling as their presence generally announces the likelihood of "skips".  They appear to be centered in the chest cavity, and can actually get quite strong, in that I can feel the shaking in different parts of my abdomen and even my back.  Even the "feeling" of heart pulsations seem to be altered, although their rythm, sound and EKGs are fine.

No idea as to what besides the heart can pull off this trick?
(My own theory is an irritated and trembling esophagus wall which is close to a sensitized atrial muscle is stimulating the atrial muscle to fire prematurely...based on symptoms of reflux currently under investigation).  Physical reasons for arrythmia have been reported in the literature (e.g esophageal diverticula and of course, all the anectodal stuff on the internet).  The APC sensitivity to my posture is a clear sign of a physical component, no?  What I am a bit afraid of is the possibility of an aortic aneurysm...something I don't think would show up on any of the tests conducted thus far.

-Arthur

[Carrie]

I'm very anxious to hear how the doctor answers you because I have some of those same sensations you speak of (the vibration thing) I have SVT(Supraventricular Tachycardia)Do you ever have those APB's as close as every other beat??
C.

[CCF CARDIO MD - DLB]

You could possibly be having atrial fibrillation or flutter, even if the rate is slow. A Holter monitor would be an easy way of sorting out if you are indeed having such frequent episodes and would be my first step.