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Avatar universal

Atrial flutter - under 30

Anyone else deal with this? I'm a 29 year old male, otherwise healthy, no family history of heart problems. Normal height and weight, don't smoke, physically active, drink 2-3 alcoholic drinks most days, seldom binge, 1-2 caffeinated drinks per day.

Back in November 2009, had an instance of atrial flutter. I woke up in the morning, got in the shower, and after a few minutes felt like I needed to cough and then rapid heartbeat (150 bpm) started. Didn't go away all day, so I went to the hospital. Was checked into the hospital, diagnosed with flutter, given digoxin and cardizem and eventually converted (not sure if the meds helped. Chest x-ray, echo and stress test were all normal, blood tests normal.

I reduced alcohol and caffeine at first, but eventually returned to normal after pretty much forgetting about the incident, thinking it was because of a lot of stress I was under at the time. But sure enough, I had another episode about a week ago. Same thing - got up in the morning and it started in the shower (anyone have fib or flutter episodes related to the shower?), didn't go away all day. This ER didn't mess with the meds given that I had prior history, and went straight to the DC cardioversion, which worked. They gave me a beta-blocker in the meantime until I see a cardiologist, so I've cut out all alcohol since then. Just trying to figure out how the cardiologist appt will go next week.

Do you think this is truly "lone" atrial flutter? Or is the fairly moderate amount I usually drink enough to provoke it (neither of the episodes were correlated with any binging)? If cutting out drinking will fix the problem, great, I'll do it. It would be nice to have a beer or glass of wine once in a while though. Do you think the cardiologist will want to proceed with an EP study/ablation, or perhaps just try a year with no alcohol?
5 Responses
1137980 tn?1281289046
I think ultimately it will be up to the heart doc for your plan of action but i can guarantee you there is more to it than just your alcholol intake.  Preventative measures until you make your appt. w. your doc next week are....no coffee, no iced tea, no colored sodas, no energy drinks, no red wine, lay off of sugar, lower your salt intake, keep super hydrated w. water because dehydration sets off the episodes, get a full nite of sleep...these are just the basics.  As far as the shower situation goes...personally i don;t know however i do know if you are just getting up from bed after lying prone all nite and within minutes hop into the shower that makes sense to me on why you are having some issues if you have an underlying situation going on.  Personally i doubt that beer would be your issue and studies have shown that red wine is notorious for setting off rapid heart beats.  Only your doc can advise you on what to do and w. a fib ablations are the way to go and are no brainers and a very simple procedure.  I would just get pro active until your appt. and if you do something that sets off the episodes the obvious answer would be to mix it up or avoid it if you can (we're not talking about showering here eeewwwww) good luck and we are here for you......
1124887 tn?1313758491
Hi, sorry to hear about your concerns.

Believe it or not - getting out of bed and into the shower is actually a quite stressful incident for your body (no, I'm not saying showering is harmful and you should stop, though). Anyway, going from sleep mode (with low heart rate, low blood pressure, etc) to a full awake and standing mode, possibly worrying about things you have to do at work, etc, will increase your adrenaline levels. In addition, you are dehydrated and your blood is thicker. It's possibly enough to trigger an arrhythmia.

To explain what atrial flutter is - it's in fact an extremely quick unifocal (from one point in your heart) supraventricular tachycardia, but it's so quick that your heart (luckily) blocks some of the impulses from reaching your main chambers (in your case 1 of 2 regularily). Some people live with atrial flutter, as it possibly just changes blocking frequence due to exertion levels (at rest: 1:4 giving a regular heart rate of 75, sometimes 1:3 giving regular heart rate of 100). The problem is, during hard exercise, there is a risk of no blockings, causing a regular heart rate of 300 and fainting (no one wants that). This risk is not present with Afib (except in strange cases of WPW syndrome) and most doctors actually prefer conversion to Afib instead of staying with Aflu.

Aflu is, like the most common form of SVT, the AV nodal reentry tachycardia, caused by a loop pathway in your heart. The relevant question is how much the arrhythmia is bothering you. Sometimes those extra pathways are almost impossible to activate, and you get an incident every 5 years or similar. In those cases, treatment with beta blockers, or no treatment, is common. It is then a good idea to stop drinking, smoking, no caffeine or other stimulants or stress that can trigger arrhythmias.

If you are bothered with flutter incidents regularily, ablation therapy is used to cut the pathway. It's impossible to know what your cardiologist will suggest, but since you're young and obviously bothered by this (mentally and physiological) I guess ablation is an alternative.
968809 tn?1288660510
I have atrial flutter and cannot for the life of me figure out a trigger. I've worn a 30 day monitor twice and every time I tried to bring on an attack. I went on a drinking binge, ate poorly, purposefully went without sleep, drank tons of starbucks etc. Nothing happened. I did stop drinking caffeine and gave up chocolate. During that time I had the worst attack in which I had to get chemically converted. I know not everyone is the same but just thought I'd share my experience. Perhaps the shower or your lifestyle isn't even the trigger for you. Could just be a weird coincidence. Good luck and hope you feel better.
Avatar universal
Thanks for the feedback. I'm leaning towards just having the ablation and being done with it (likely), but of course I'll have to see if the cardiologist is on board.

The ER doc gave me some metoprolol to take in the meantime, but it was a case where the cure was worse than the problem (very tired, dizzy, couldn't think well). The symptoms stopped when I stopped taking the drug (even though it was only 25 mg per day). I think I'd rather go get shocked every 6 months than take that every day.

I guess there's no way to tell how often I'll have these episodes if untreated, or just with some other drug therapy. I've only had two episodes, and there was 5 months between them. The good news is that I haven't had any fibrillation, at least yet. According to what I've read, this makes the odds getting fibrillation after flutter ablation considerably lower.
Avatar universal
One other possible contributor (though probably unlikely) is that I was struck by lightning (indirectly) as a teenager. It knocked me and another guy out for a few seconds. Being a teenager, and feeling OK at the time, I didn't seek medical treatment. I do have some remaining minor ulnar neuropathy in the arm where it hit me (I think the entry point was the metal watch I was wearing, which was destroyed).

For a few years after that, I was having short "panic attacks", which I now wonder if they were just shorter episodes of flutter or maybe PACs that would later develop into flutter. Probably an unlikely theory, but who knows.
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