AFib, is there the double beat or a single beat?

[Jerry_NJ]

First:
1)  I suffer from permanent atrial fibrillation - have been so diagnosed since December 2007.
2)  I listen to my heart beat via a drug store quality stethoscope - I am unable to detect my pulse with my fingers
3)  My beta blocker and calcium channel blocker usual hold my resting HR to the low 70s first thing in the morning and to the low to mid 80s in the evening, after walking up stairs to go to bed.
4) I hadn't taken much note of now the heart beat sounded, I was just counting for a full minute.
5) My personal biography gives more details on my heart treatment history if this subject is of interest to you.

The last couple of times I noticed while listening to my HB (it may have always been there) a distinct and regular two sound beat.  Looking on the web I find that is the sound one is supposed to hear.  I have also noticed a lower HR, was in the mid 60s this morning.  Is this (normal) extra beat I have just noticed an indication that I may be in normal sinus rhythm?  That is, I know when in NSR there is a lower "P" wave on the EKG prior (in time) to the Ventricle beat.  wWhen in AFib the "P" wave is very indistinct (fibrillation noise).  So it occurs to me that the new sound I am now hearing may be the Atrium beat (P wave) followed by the Ventricle beat, ie., NSR.

I had my 6 month check up with my cardiologist last month, and had a EKG at that time.  I was in AFib at that time.

Simple question:  If I am in AFib can I still hear a double beat heart beat?  I think this is what the doctor is listening for when he/she is checking with a stethoscope.  I do recall my doctors (more than one) say they can hear I am in AFib, I never asked what they heard.  The missing "P" wave beat?

Yes, wishful thinking is influencing my thinking here, but I didn't think this up and then hear the double beat, I was just doing my routine HR check and noticed the different sound.  My hearing isn't the best either, but my low frequency hearing is fine and that's all that may be needed to clearly hear the heart on a stethoscope.

[Jerry_NJ]

Thanks for the ongoing inputs... and spade thanks for the reference, it was short enough for me to read (I have a short attention span) and helped me understand how the atria and ventricle chambers coordinate/operate.  I have surely read in the past but had mostly forgotten.  I was wondering how four chambers result in only a double beat, the article you provided points out the atria operate together, as do the ventricles.  It also seems clear that when in AFib the atria beat would not be heard, at least not in the low cost stethoscope I have coupled with my 73 year old poor hearing.

I have never read before of any cases of a person going from long-term (years) AFib back into NSR.   I have been on BB and CCB since 2008, but that was prescribed for "rate control", not "rhythm control".  Again, my doctors had given up on trying to achieve rhythm control, NSR.

While I do have symptoms from AFib, I do not have the violent discomfort that some people have, thus my doctors think I should live with just rate control.

If I somehow miraculously converted to NSR I can't say I feel any better - still have the general low energy fatigue feelings which may be due more to my medications than to my AFib .  

I will hold off for a while contacting my doctor as I just had a full checkup, including the many point EKG.  I will guess there is no risk of letting my heart run in NSR, if it is.  

I have looked unsuccessfully on the web for a sound track of a heart in AFib, I have found several sound tracks of a normal HB, and I can say mine sounds much that way now.  There is some irregularity in my HR, but it is well spaced out, I may notice it only a few times in a one minute count.

[is_something_wrong]

Yes, a P wave can be seen on any EKG recorder, but the challenge is to reduce noise. Noise can be a severe problem with portable EKG recorders, especially cheap ones. The P wave is easiest seen in the so-called leads I and II. Lead I measure the electrical current from right arm to left arm on a 12 lead EKG, and lead II measure the electrical current from right arm to left leg. You don't have to place the electrodes there, if you can set up lines reflecting the currents I mentioned, P waves should be easy to pick up.

Did your heart rhythm sound regular? As you know, A-fib is very rarely regular, except at high heart rates (tachycardia). If you had a slow and regular rhythm, you were likely to be in sinus rhythm or ectopic atrial rhythm (which also can happen when atrial fibrillation goes away, because the sinus node can be a bit "slow" after being suppressed by atrial fibrillation for years, it sometimes needs time to wake up).

I really hope you are back in sinus rhythm. The easiest way to confirm is a standard 12 lead at your GP's office.

Please keep us updated!

[spade22]

This is something I found from a medical quiz

"If a patient has atrial fibrillation (the atria no longer respond to heart pace-making cells) an S4 heart sound (an extra, low frequency beat occurring before the first heart sound) will not exist.

t. The S4 heart sound is a sound that is produced by the atria. If the atria are in fibrillation and not contracting, the S4 sound can not exist."


This website has some links to NSR an afib sounds:
http://www.a-fib.com/overview.htm

I hope  that helps.  what sounds encouraging to me in that you have noticed a different sound.  Keep us posted!

[Jerry_NJ]

Thanks I had hope you'd give input.

My other, maybe not clearly stated, point is this hearing the two step beat came first, that is I didn't go looking (listening) for it.  Rather I had a almost subconscious expectation for how my heart sounds, and I noticed recently that it has a "new' two beat signal. In fact I was at first trying to decide if I had to count both, but that meant my heart would be in tachycardia... upwards of 130 bpm.  I'll keep a watch.

I am sure my cardiologist had written me off for ever being back in NSR.  On the other hand my surgeon gave the mini-maze a 60% chance of curing the AFib and also expected my (even my aging) heart left atrium would shrink some due to the reduced "back" pressure caused by the previously leaky mitra valve.  But, that surgery was in November 2007, so the healing and shrinking should have happened long ago.  I can also say I had an echocardiogram a couple of months back and the left atrium measure came in the same, a bit over the line on the too large size.  

I'll keep an eye on this and will check the link you provided.  It almost makes me want to buy an EKG to make a measure myself.  I wonder if a three or four point EKG can pick up the "P" wave.... having asked I can remember when I was on a monitor for cardio rehab following my surgery the nurse said she could see my missing "P" wave.  The monitor I was using had three contacts: left and right above the nipple area and another, best I can recall, on the left side much lower.

[is_something_wrong]

That's a very interesting question. I've actually asked myself that question several times.

The first sound in the "ba-bam" sound the heart produces, is the mitral and tricuspid (atrio-ventricular) valves closing, where the second is the aortic and pulmonary valves closing.

However, I would assume (without knowing for sure) that even in atrial fibrillation, you can hear two sounds, because the atrio-ventricular valves close early in the cardiac cycle (when intra-ventricular blood pressure is higher than the filling pressure, which often just is 4-8 mmHg.) The aortic valve closes late in the cardiac cycle, when your aortic blood pressure exceeeds intra-ventricular pressure.

For an illustration, please see:
http://en.wikipedia.org/wiki/File:Wiggers_Diagram.png

So, I would assume that both NSR and A-fib can produce the "ba-bam" sound. But if your heart rate is regular and slower than usual, it's not impossible that you are in sinus rhythm.

Again, I'm not very sure of this.