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Avatar universal

Defibrillator at 39???

For many years I have had episodes of heart flutters and what felt like quivering.  I went to a Cardiologist four years ago.  After wearing a holter, stress test, and echogram he said, "Sounds like atrial-fib, don't worry about it, it is not life-threatening!"  I lived with this condition for years.  I am a firefighter in Oklahoma and was fighting a house fire in December 2000 when I felt the quivering.  Since noone actually recorded this rhythm, I went to the paramedics on scene and had them hook me up to their monitor.  They said, "I was in V-Tach!", which quit on its own within minutes.  The emergency room doctor diagnosed the rhythm as SVT.  During an Electrophysiology study, V-Tach was induced and an ablation was not possible.  The next day they implanted a Medtronic defibrillator.  One week before my first post-operative check up, I had another episode which I received two shocks at 30 joles.  During this episode, I was conscience and felt ok as usual.  This was the same feeling I have had in the past.  When they read the ICD, I was in V-fib.  They placed me on Sotalol 80mg twice a day.  Since I have been taking the medication, I have not had any episodes.  Although, the heart flutters seem to be constant now.  I have worked out with free-weights and ran most of my life.  I would like to start working out again, but I am afraid!  I have never had an episode from weightlifting, but usually after running I would go into the rhythm.  Also, they thought I would be able to return to work as a firefighter.  I do not see any possible way to return to such a "safety sensitive" job.  What do you think?
44 Responses
Avatar universal
Probably the best way to sort this out before returning to work would be to perform a closely supervised exercise treadmill stress test and see how you and your defibrillator perform under maximal physical stress.
Avatar universal
I hope it's okay to suggest another web site.  They don't provide medical advice, but have a very supportive bulletin board where you get practical advice from people who have been there.  It is  zaplife.org for people with defibrillators.  

Signed: defibrillator at 44
Avatar universal
I have had probably twenty stress test in the last eighteen years of my career.  None of which produced any abnormal rhythms.  Moreover, they performed a stress test after the first episode on the fire scene.  I have no blockage, damaged heart muscle, or heart injury.  I do not know the actual cause of the arrhymias.  It is simply an electrical problem, caused from heart disease. I guess????
Avatar universal
I forgot to thank you for your suggestion.  The web-site certainly sounds interesting, and I want to thank you for the information.
Avatar universal
Thanks for the concern!  My electrophysiologist is one of the top specialist in his field, but I have thought of a second opinion.  When the Nurse read the ICD, it was definetly V-fib, and the doctor informed me of the same.  I am no doctor, but I have been told the reason I stay awake is because my heart is strong and healthy with no blockage-I was a runner and worked out.  However, as I get older, I will not stay conscience.  Thanks for your advice!

Tim
Avatar universal
Tim, how many bpm was your heart rate while in v-fib?
Avatar universal
Tim, I agree with Hankstar, you couldn't have been in v-fib; you must have been in v-tach.  As my cardiologist explained to me, in v-fib your heart is not pumping blood; it is just quivering like a bowl of jello.  I go into v-fib and pass out within about a second.  It wouldn't matter if your heart is strong and healthy; you can't stay conscious when it's not pumping oxygen to your brain.  If your doctor and nurse are telling you you're in v-fib as opposed to v-tach (very rapid heartbeat), I would definitely seek another opinion.
Avatar universal
Ok you guys, you are scaring the hell out of me!  I have classes today, but I will call my doctor this afternoon and ask for more records.  I trust and appreciate your opinions and concerns.  What are the side effects of taking Sotalol?
Avatar universal
Tim, I took Sotalol for a little more than two years.  It worked very well for me stopping the arrhythmia, but the only side effect was what my doctor termed "profound fatigue."  I always felt like I was dragging an elephant around.  Last summer I switched meds due to this (to amiodarone--which I know has a lot of potentially very serious side effects), and now I feel "almost normal."
Avatar universal
I only have a minute before my next class, but I reviewed the medical records I have.  I found, what I believe, is the results of the first reading.  Under DEVICE PROGRAMMING, DETECTION it reads:  X  VF    320 ms  NID  18/24  RNID  9/12.  Also, after reading through other records, I found results of the EPS study (maybe) and under comments: HIS PURINJE SYSTEM: Block below HIS Bundle electrode_seen during arterial pacing, Function (  ) occured.  Whatever that means??? LOL.  Talk to you guys soon and thanks again for the information.
Avatar universal
Savannah -  I have had a very similar experience to you.  This type of episode happens to me once maybe twice a year.  Normally day in and day out, I feel heart flutters.  (early beats, fast beats etc)  I have had these checked out and have had the same cardiologist for over 10 years.  He checks me out yearly with a stress test and echo.  The one episode I get similar to yours is described like this.  I feel something funny in my chest.  Like my hear beats out of whack for a second, then I get a very long pause.  At least 4-5 seconds.  I do the same as you, I search for a pulse in my neck or wrist.  I feel like I am fading (not lightheaded or dizzy) just fading and then my heart starts to beat very fast and very irregular.  This lasts for another 4-5 minutes and it goes back to a normal beat.  I usually take a 1/2 of a 25mg of Tenormin also.  It helps to bring the fast beat down quickly.  I don't notice any problems with my breathing during that pause.  It just feels like I'm fading out.  (that is the only way I can describe it).  I have described this episode to my doctor.  He doesn't feel it is necessary to do a EP study because they happen so infrequently.  He thinks it might be a short run of A-fib.  I figure that if I can jump up to try to get help and look for a pill that it probably won't hurt me, however I'm telling you when I get that longer pause, it really really scares me.  Are your pauses longer than 4-5 seconds.  Hankstar do you have any idea what that could be?  The pause is worse than the fast irregular beat.  Anyone else get this?
Avatar universal
I don't know if v-fib is always fatal.  In my case, it sort of was.  I collapsed and was saved through CPR and defibrillation, then got an implanted defibrillator which zaps me when I go into v-fib.  From what I understand, every time I get zapped my life has been saved by the defibrillator.  I think an EP study would be very good for you--either they can induce v-fib or you can feel more at ease with the thumps and pauses of your heart.  (By the way, I frequently cannot feel my pulse and they have trouble finding my blood pressure.  I find it helpful to quit trying to take your pulse--it just gives you something to worry about. I figure if it's serious I'll know soon enough.)
Avatar universal
Zapper (or anyone else in the know)...

I was really interested to read about v-fib in understandable terms. What I've ever read about in medical books describes it as fatal? But here's the case with me:

I was taken via ambulance to the emergency room today. This is the second time that has happened to me in my life (25, F., thin, no drugs or drinking, not any big deal medical problems), although I've actually had around 15 "attacks." I am known to have SVT, but it feels nothing like what I experienced today.

Here's what happened. It's the same as always. The doctors said I had my SVT turn into something more, and to see a cardiologist, or better yet, an ep, BUT they said because of the infrequency of my attacks, the likelihood of ekg findings were like trying to find a needle in a haystack, so an educated guess was the best treatment. They also said my heart was quivering! Which is how you described it, however, they said they didn't catch the actual arrhythmia, other then bursts of SVT on ekg that might have been short a-fib or flutter, too short to see (and I had only a turning feeling in my chest with them, no symptoms). They said it was possible I had v-fib and not a-fib? So I should see an ep to find out, and that it was unquestionably cardiac.

Okay, so here's my experience. I was seated, and just hung up a phone call, drank a cup of black tea, not under any stress, and then I felt I couldn't breath at ALL. I waited a second, and realized my heart felt funny in my chest, and I was starting to pass right out (no dizziness, just going black), so I tried to find my pulse, first in my chest, then wrists, finally jugular, which is usually easy to find a pulse on, and I could feel nothing, this was maybe 5 seconds, I still COULD NOT breath in, and lay on the floor, and tried again to feel my heartbeat in my chest with my hand, and it felt stifled? tamped down? for lack of better words... so instinctively I POUNDED with my hands VERY hard (gave myself bruises) and then my heartbeat came back, very, very, very fast, I would guess around 200 palpable bpm, and I wasn't more then mildly lightheaded and a little short of breath, and called 911. I stayed very calm and still through the attack, because my 2 year old was present and I really didn't want to scare him, but I felt that if I didn't breath shortly or my heart didn't begin to beat I would then black out entirely.


The paramedics came, and took my pulse at 180 (was slower by then) and also said my orthostatic pulse was 40 pts high (whatever that implies... they thought dehydration and IV'd me). My pulse went down to 100 bpm by the time they got the EKG on me, and then I felt totally normal, except it was in SVT, as is pretty normal for me. My blood pressure was, seated, 90/44. Standing, I felt a bit lightheaded, but in a different way then when I nearly fainted before, and my blood pressure went up to 110/70 or something and my heartrate shot up to 140. They said was too fast, just for standing.

I went in the ambulance with an IV for dehydration and breathing oxygen. During the ride, they saw a few runs of tachycardia (laying down my heart was doing a steady 75 or so), and at those times had trouble getting my pulse, and said my bp was really, really low, they couldn't get my bloodpressure to read? They kept trying to take it and saying, "hmm, I still can't hear anything, how you feeling?" to me, "fine."

6 hours in the ER, on IV (which slowed down my standing heart rate), and they did a chest xray, and a continuous ekg, basically normal except runs of SVT (I assume) that they said were becoming afib or flutter, like I said before, or maybe something ventricular. Blood labs normal (metabolics, TSH, calcium, Ph). I felt fine, and left.

Came home, read about about my symptoms, and I don't understand how it could be afib? Or flutter. Or anything atrial really. It seems like people can walk around with those problems a long time and not be effected, but you can have bursts too that aren't usually more symptomatic (they won't make you faint or your heart quiver?? Had trouble understanding what I was reading). However Vfib seemed to fit completely, especially because with one of my attacks I passed out and was only semi-conscious for hours after that, and was dizzy afterwards. But it began the same way, couldn't draw a breath in, couldn't get a pulse. Can SVT incite Vfib? Can Vfib NOT be fatal?? But present with these types of symptoms, of feeling about to die, what with the can't breath at all, keels over, semi-conscious and with no pulse, then faints, all in seconds without warning in a young person with SVT? What about plain old v-tach? Can that be responsible for breathless fainting with no discernable heart rate, in a matter of seconds?

It will be weeks before I see the electrophysiologist. Your feedback will really quell a lot of anxiety I have over this, which won't help any, I am sure:)

In addition, I have a long history of exercise intolerance any finally find I get dizziness when my heart rate exceeds 140 or so. I don't experience too much breathlessness then. So I don't exercise now, but would like to. And sometimes with prolonged mild SVT I get vertigo attacks. With intense sudden SVT I tend to get a sudden vertigo attack that goes quickly, else leaves me breathless.

I've had an echocardiogram, 2 holters for 24 hours, changed my diet and eat well, an exercise stress test where I became presyncopal at 150 bpm after like 2 or 3 minutes, and almost fell off the treadmill, normal autonomic testing 2X. Does electrophysiology sound indicated? Sounds scary! But worth it if it can get to the root of the problem.
Avatar universal
Thanks for responding Hankstar. I realize you are not a doctor but you are very knowedgeable.  I can tell you this, the pause IS longer than just the pause from an early beat.  I know this because I feel something funny in my heart, I reach for my pulse, it is not there and I wait and I wait, to the point where I feel like I am fading out/blacking out, whatever you want to call it.
My doctor also said the same as you, an EP study poses more risk than what is probably happening.  And yes, I went 1-1/2 years without it happening, then it happenned last year around July.  I ate some cold ice cream and boom, it fluttered, paused and then beat very fast with absolutely no uniformity to it.  I wouldn't call it quivering like the other people are, I could definately feel the beats, they were just all over the place.  I did feel a little wierd in my head, but I have never felt short of breath or passed out from it.  I do take 1/2 of a 25mg Tenormin at night.  If I take more, I get really sluggish.  If I have an episode of this I just take another half and within 5 minutes, I am fine.  Most of my skips/fast beats have been caught on tape.  This hasn't and that is why it worries me.  It comes out of nowhere.  It just doesn't happen often enough to justify wearing a moniter.  Thanks for your words of wisdom.  It sounds logical.  I just HATE that pause and even though you say it isn't as long as I think it is, it is long enough for me to get up and walk into another room before it beats again.  And with this scenerio it always jumps into those fast beats for a few minutes.  I've read some threads from the doctors on this site that state pauses can be serious.  I never get this when I exercise and I work out 5 days a week.  I'm very fit, don't do drugs and drink very little alcholol.  I have noticed that keeping yourself hydrated does help, HOWEVER one of these episodes happened one night when I drank two tall glasses of water really quickly.  You just can't win can you.  Thanks again!!
Avatar universal
i too suffer from PSVT and i have been treating it for 2 years now with atenolol. i still get the thumps and bangs every now and then but it has helped mucho....i do sometimes notice these "pauses" that you have mentioned. they seem to happen to me when changing positions of my upper torso. swinging a golf club has become quite an experience, and laying down flat in bed every night and waiting for my heart to start beating again reminds me that im still not "cured" of this and will never be probably. ive heard that the pause could be several PVC's in a row (which could be a bad thing)....my psvt has always been triggered by postural changes though...same old story, bending over too quickly, roller coster rides etc. im convinced that it all related to vagal nerve stimulation, and im starting to convince my doctor of this. we are scheduled to start some "studies" on htis within the next few weeks....ill pop in and out to tell you how it goes if anybody is interested.???
Avatar universal
I should make this really clear. I know what you guys mean about thumps and pauses and such... I have those on a very regular basis and have been told they are PAC's, or sometimes on holter have shown that it's right when I go into paroxysmal atrial tachycardia, and I never worry about them, and they don't cause me symptoms. I have had them every few minutes all day long before, and it's kind of scary, but not such a big deal.

I have also experienced an occasional feeling of a hummingbird in my chest when they are real frequent, like suddenly the whole thing deteriorates into rapid fluttery beating, and the most I might feel is slightly dizzy and short of breath. It's rare at any rate.

BUT I am not describing these events. Nor am I talking about boring old tachycardia which is sustained. That's a different ballgame then what happened.

Zapper described it best as the world standing still! Wow. That's right on. I don't "feel faint" either... I either really faint or come close to it, and am WAY out there if it lasts long. This time wasn't too long, so it wasn't so bad. The other time I was in an ambulance, it lasted a few minutes, a minute, I don't know, I was out for some time though. This time it was not subtle, it was like being clubbed over the head:( But it didn't last TOO long. The most alarming thing was I wasn't able to breath. Not at all. Not in. I wanted to desperately. It wasn't even "short of breath" exactly, it was, "I can't breath! AT ALL!" Like if you drowned or something. I was dimming out. I don't know if I passed out because I had my eyes closed, on the floor. I felt really, really odd. I almost felt dead, as morbid as that is to say. Because it was like my heart had stopped beating. And then kickstarted again.

It was longer then 4-5 seconds, if it was skipped beats I would guess this one would have been... 7-10 beats?? 10 seconds? Just a guess. I've had it longer, the worst time, last time in the ambulance... 7 years ago... it was over a minute. It felt like 20 minutes though, since I didn't draw any breath during that time. And wound up out cold. And I had no discernible pulse then either. I don't know what to make of this, or why docs wouldn't take it seriously, but I learned that the more I pressed for answers, the less I seemed to get, so I stopped asking, and I feel *a lot* more comfortable discussing this stuff anonymously on a forum then with a doc!

I don't really understand how a-fib can cause such a wide range of symptoms, or that I could have it cause mine? It certainly was FAR beyond atrial tachy, which I've had up to 180 sustained. Not at all like that. I'd take a year solid of atrial tachy over what I had yesterday. I was told my heart may have suddenly sped up so fast it just quivered? But then I read about other arrythmias, ventricular ones, that cause more sudden symptoms, more like mine? At any rate I made an appt. with an ep for tuesday. I was totally unimpressed with my cardio today, since I called for an appt. and told the receptionist what happened, and she claimed I hadn't been there since 1999, which isn't true, I was there 8 months ago or so. And didn't bother since, as they said they couldn't help me. I took their word for it;) And I tried to explain what happened, and that the ER doc told me to be seen right away, even if it meant going to a new cardio, and she told me to see a new cardio then, mine was too busy for the next few weeks. It was ridiculous. My symptoms aren't even "symptoms" they are flat-out "signs" for anyone who knows the difference in med. terminology. And they are pretty severe if you ask me.

I appreciate hearing everyone's words of wisdom and support, and if anyone else can relate, PLEASE let me know.

And I don't know much about EP tests, except they hurt, what ARE the risks? I'm pretty scared that if I don't figure this out, it will eventually just kill me, seriously. I came close 7 years ago, in my mind, and I don't think I've looked at life quite the same since. Interestingly, the very first feeling I had with it was that time had stopped and the room was hot, and nothing was moving, like Zapper implied. But at that time I didn't connect it with my heart. This time I was smart enough to try my pulse, and it was gone... and then I was pretty gone too...

Thanks for your support everyone, I can't tell you how much it means to me to hear from others (not to sound dramatic, but it really does). I am going to have this figured out once and for all, whether or not the cardiologist is compliant, or cares, or whatever. I'm my own number one, and I know it.
Avatar universal
Hankstar,

I don't mind the correction, sorry to get your post confused with Zappers.. the way the reply feature works on here, you can't see the topics written to you while you are writing your reply, and there were a lot of replies back, so I, as usual, lol, got it all mixed up.

I don't not think I might have paroxysmal a-fib. It seems to be a bit different then regular a-fib? I have so much trouble figuring a-fib out because I read such different things about it. When they talk about people tolerating it, I just couldn't tolerate what I had for more then a very brief time, as I'd pass out, so it makes me think, well that's not me. Then I read it can be symptomatic too, well it's confusing! I read something that kinda clarified it for me about it depends on how fast it comes on, what your cardiac output is, and how fast your ventricular rate is going that determines your symptoms, so maybe mine is just a bad combo of all.

We'll see what the ep doc says on Tuesday. I am glad to hear the risks are so low, as I hope that I can have that test, even though it sounds scary (even if not dangerous), just to figure this whole mess out. I'd really love to not live with this anymore. And since my heart is, in general, not so good, with the tachycardia as well, maybe the whole thing would be for the best. I'll post again after I've seen the doc, to let you all know what he has to say.

Again, thanks for your insight. Thank goodness I've had NO symptoms today, no bumps, hiccups, or turnovers in my chest, and no short of breath feeling at all. That's reassuring!
Avatar universal
PVCs/PACs/SVTs etc may be indicative of a strong healthy heart (re: Hankstar's comments) but I would take a moderately weak heart any day of the week if it meant I wouldn't feel every bloody skip.  Today I went to the gym in a quest to get on with my life after given the OK to do so by my cardiologist, and yes as soon as I started excersise the stupid thing started beating all over the place (a-fib I think) Fortunately I am asymptomatic ie I don't feel faint or breathless, but its a real downer on an otherwise good day.
just needed to get it out there.
Avatar universal
I can not wait to get back to the gym, however I have not been released to do so.  My whole life is at a stand still, and I have to retire as a firefighter.  Guess our healthy hearts are nice to have, but I too would trade.  I feel every little bump, and it scares the hell out of me.  Although, I have never had any episodes from weight training, running seems to trigger v-tach pretty much everytime.  Good luck!!!

Getting fat in Oklahoma

Tim
Avatar universal
Savannah,
Please let us know how your appointment went!
Jodie
Avatar universal
. IT IS THE VENTRICLES PAUSING TO CHANGE GEAR AND TO START BEATING VERY RAPIDLY FROM A SPOT IN THE ATRIUM TAKING OVER THE HEART'S REAL PACER THE SINUS NODE.

Hankstar-can this create that awful pause?  Can you explain this a little more?  If this was the case, it wouldn't be a-fib like my doc thought?

Jodie
Avatar universal
Dodgybeats says:  "as I started excersise the stupid thing started beating all over the place (a-fib I think) "

Have you gotten your thyroid checked?  This can cause a-fib you know. (especially when excercising,it can get worse)
Avatar universal
savannah,
PSVT with a very high ventricular response rate (say<250bpm)can cause a very thready and fast pulse that will be very hard to detect and may not be felt at all because of decrease ventricular filling before the ejection. short runs of this could be what you are experiencing. i have felt this too in the past along with kind of what you are describing with the breathing. it kind of feels to me like an electrical jolt through the upper torso, and having the wind knocked out of you by mike tyson at the same time....and as far as getting jerked around by your doc., run....run away as fast as you can and find someone else. apparently they dont care about your health there,(not to mention that they dont need your buisness). actually its a pretty common practice for physicians today to turn away the "more involved" cases if they have a full load and can make "easy" money (sad but true). seek out an Electro Physiologist that is associated with a large teaching university...they will be more than happy to take you on, and you will also be recieving the best care possible in most cases.
Avatar universal
Please stop typing in bold letters.  They are very difficult to read.  Thank you.
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