Heart rhythm problems - surgery?

[mhrocks]

My dad is 65 years old and he's been retired for about a year.  He's been having problems with his heart rhythm for at least a few years, but it's been much worse for about the last 6 months.  Sometimes he seems to have a fast heartbeat when he's totally at rest and the rhythm can also be irregular.  Lately he's also had a few shortness of breath episodes.  A few weeks ago I convinced him to stop drinking coffee, stop using Rogaine, and cut back on alcohol.  He says he feels way better, but he did have a bout of these symptoms a few days ago.

He wore a heart monitor for 24 hours recently and the (highly recommended) local cardiologist who read the monitor told him he has impaired function and he needs to undergo a surgical procedure on his heart ASAP.

I don't have anything against doctors, but through my own experience and through a conversation I've had with a couple in medical school, I've learned that surgeons like to perform surgery.  In other words, when presented with a medical problem, a surgeon is most likely to choose a surgical solution.  It's understandable.  If you're an expert in a certain field and you're presented with a problem, it's natural to choose a solution from within your area of expertise.

I wonder if there are other choices available to my dad before he resorts to surgery.  For example, on his doctor's advice he changed blood pressure medicine about 6 months ago due to a persistent cough and it was right around this time that his heart problems became much worse.  Now that the cough is gone, it makes sense to me to at least try going back to the other medication to see if the problem disappears.

Can anyone offer any advice?  I just don't want to lose my dad and my mom is worried out of her mind.

(As an aside, I'm 32 and I definitely have heart rhythm issues from time to time.  The things that seem to be related are stress, Rogaine, alcohol, and coconut oil.)

[mhrocks]

Thanks a lot, I will post again as things develop.

[DeltaDawn23]

I agree, I think a 2nd opinion is in order.  I don't where your Dad lives, but in the Midwest, Cleveland Clinic is "the" place to go for heart issues.  He needs to find a electrophysiologist  (cardiologist that specializes in heart rhythm disorders) who does a lot of ablations.  I am considering this procedure myself and am still doing research.  I would not wait too long if his cardiologist thinks it should be done ASAP.  Catheter ablation is not a considered a surgery, there is no cutting, it's all done through arteries in the groin and sometimes the neck.  Wishing your Dad the best of luck with this.  BTW, I do think you are right that if you're a surgeon, surgery is usually the answer.  If you're a hammer, everything looks like a nail;-)

[MichelleP_3811]

I would think they would be fixing his afib and they really don't need to see it in its worst form to know it is bad.  I would say to get a second opinion just try to find one from a different network.  They would then likely not confer with each other on the type of care.  Here we have advocate or north shore university health systems to name a few.  So try to find out what group they are with and choose a doctor with a different group.  In regards to ablating afib it is usually better to try and get it earlier rather than later as the heart can become to use to it and not be fixable.

[mhrocks]

Jerry, to answer your question, it's like you said, the cardiologist recommended the surgeon in the city.

[mhrocks]

Thank you Michelle & Jerry for taking the time to write.  Jerry, my dad is a fisherman too.

I just got off the phone with my folks and I got a lot more info.  My original post was based on an email my dad wrote last night.

The "surgical procedure on his heart" which was recommended is actually catheter ablation using radiofrequency energy and cryothermy.  He has fibrillation in the atrium and flutter in the ventricle.  He doesn't seem to have any problem with blocked arteries or leaky valves.  The cardiologist says his fibrillation is caused by too much electrical activity in his heart.

The cardiologist says he has been on Rhythmol for too long at too high a dosage and he wasn't prescribed some sort of essential companion medication.  These things have certainly caused him damage according to the cardiologist.  He checked my dad's heartbeat during their meeting and said it was "perfect" at that particular time.  He also said my dad's condition was bad enough to warrant undergoing the procedure ASAP so I guess that's based on the result of the 24-hour monitor he wore previously.

My dad is concerned because none of the doctors he's seen have actually listened to or recorded his heart during one of his bad bouts of fibrillation.  Is it a good idea to put him on a longer term heart monitor to record one of these things?

He would like to get a second opinion.  How would you go about finding a good doctor for this that is unconnected to the doctor he's already seen?  He doesn't mind traveling.

[Jerry_NJ]

Open heart surgery is a scary subject - been there - done that, see my profile.

My experience is one goes to a surgeon after that is recommended by a non-surgeon doctor.  Is the subject cardiologist also the surgeon?

In my heart surgery case, atrial fibrillation related (possibly) to a leaky mitral valve was recommended.   I was treated for AFib (with some success) for about 10 years, but at the age of 67 the leaky valve had caused so much enlargement in my left atrium that surgery was "mandatory"... doctor said he'd give me 5 years of congestive heart failure if I didn't undergo surgery.  I did and am very pleased with my brief and only contact with a heart surgeon.

In my case it is clear sooner might have been better, but given the small but real risk associated with heart surgery, my cardiologist put off surgery recommendations until it was clear I was headed down the path to congestive heart failure in a few years.  

I am now in permanent atrial fibrillation, an earlier mitral valve repair might (just might) have stopped the atrium enlargement soon enough to allow successful treatment of the AFib.  But, now going on 6 years later, I am still alive and about the same heart-health wise.  I can still get around, even took my 14' aluminum boat out fishing yesterday (yep, retired does have its advantages, fishing on a Thursday (an no license required, just like a kid again) which takes some "heave ho" and while tired when I came home to dinner I was able to handle on my own.  I'd say I can walk a few miles if the path isn't too hilly.  So, even with AFib and beta blocker+ meds I still get around well for a man 74 years old.

Good luck, and while possible a surgeon is shopping for business, i doubt it in the case of Medicare as that generally means they get paid a lot less, and I doubt too that they just want more practice.  I could be prejudiced, my son is a Critical Care Anesthesiologist and spends much of his time itn surgery.  

[MichelleP_3811]

This is the patient area so you must keep that in mind as we don't replace the advice of a medical doctor.  If you want you can post your question in the expert forum and see if you can get some professional advice though there is a fee to do so.

What I will say based on my own personal research is your dad's health and well being depend on the type of arrhythmia he is having and the overall health of his heart.  Do you know what type of arrhythmia he is having?  If it is afib he should be on blood thinners to cut the risk of blood clots and stroke.  If he is having runs of ventricular tachycardia and his heart is unhealthy he may run the risk of his vt converting into ventricular fibrillation which is pretty fatal in short order if not treated.  That said, it takes a lot of factors for a person to fall vfib, a super bad heart and sustained vt and even then it isn't necessarily going to happen however, if he does have vt and it sustains for longer than 30 seconds an ICD is often recommended to get him out of the vt before it can turn into something deadly.  This all said, there are other arrhythmias like isolated ectopic beats in the atria - pacs or ventricles - pvcs that are not really considered dangerous at all unless someone is having upwards of 20,000 a day but again in a healthy heart a person may still tolerate the situation well.

As for whether or not he should do the surgery or whatever they are recommending it may be wise for your dad to seek out a second opinion to find out if he hears the same advice from another doctor.  That said, I would make sure he has a complete and total work up of his heart to see what the general health is.  If his heart is healthy that is a good thing. But whether or not to do the procedure or not is really up to him and how badly his symptoms are making him feel.  I will say that the beta blockers could be contributing to the problem if they slow his heart rate down too much.  Beta blockers do help some people with ectoipc beats but with others it makes it worse so he may want to try changing meds first to see if that helps.  Cutting back on caffeine alcohol and sugary foods may helps as well addressing an stomach issues like acid reflux.  I am not sure how much those things contribute to afib I know alcohol can be a factor in afib but not sure what really triggers vt.  The things I mention though are big triggers for ectopic beats but ectopic beats.  Anyways, I wish your dad the best of luck getting his heart healthy again and he is lucky to have a son looking out for him like you are.  Take care and keep us posted on how he is.