In Irregular rhythm - any advice?

Question

I have a history of afib, pvc's, pac's, and occasional tachycardia.  The last week or so I have had several episodes of irregular beats lasting a short time - maybe 15 or 20 minutes, once an hour or so.  It is kind of normal for me, so I didn't pay a lot of attention.  Today, however, I ate a large meal around 2:30 or so and by 3:15 I was in an irregular rhythm.  It isn't my typical afib and has calmed somewhat.  I am on Norpace CR 100 mg. twice a day, so I'm thinking that the drug is keeping it from turning into my full blown afib episodes, which sent my heart rate up to the 180's.  I checked my INR and it is a little low at 1.7 -- should be between 2 and 3.  I took an extra pill tonight and took my second dose of Norpace 2 hours early.  I have had such awful ER experiences, that my doctor said next time I could wait and come into the office unless I was having severe dizziness and sweating (which I think he meant would indicate heart attack).  Since I was an hour away from home, I missed the window to call the office today.  I am waiting until morning unless I feel worse.  My heart rate from my bp monitor has run from 112 to 146, it's around 128 right now and the irregular symbol is coming up most of the time. I can't take it manually and it is pretty irregular, but don't trust the reading as it usually isn't accurate if my hr is irregular.   I am taking more of my Atenolol and it seems to be helping, but too much makes my bp drop, so I am taking it sparingly.  Guess I'll stick it out til morning when I can call my ep's office.    I tried the cold water in the face, cold compress to the back of the neck, Xanax and relaxing (as much as possible under the circumstances) all to no avail.  The doctor said I should not have anything to eat in this situation, but I am doubtful they will do a electrocardioversion (the only way it's been stopped the last 2 times) because of my low INR.  Any input would be appreciated, even some moral support.  Just waiting it out . . . sigh.

Jerry_NJ · Answer

It doesn't "compute " for me.  My experience with developing an enlarged left atrium was it was detected some time in the past (don't remember when) as was the "leaky" mitrial valve.  This was determined using an echocardiogram, how was yours diagnosed?  

My cardiologist was "watching" the size of my left atrium, but given the risks of open heart surgery he didn't recommend going to a valve repair.  I am not sure that was the best decision, but that's what I live with.   Finally after going from about 18 months in NSR and being able to run for exercise (up to the age of 67) back to AFib, my cardiologist sent me first in for an echo... and after said no more electrocardioversion, I needed to talk with a heart surgeon about repairing or replacing my mitrial valve (the leak was worse, and the left atrium was beyond normal "Maximum" allowed).  The point of this story is my left atrium didn't just suddenly enlarge, it grew larger over a period of years due to high pressure put into the atrium by the leaky valve.

My surgeon did a mini-maze while in for the valve repair, which was successful, indeed the whole experience was rather pleasant once I go over stark fear of going under the knife.  However, the mini-maze didn't cure the AFib it returned in about 30 days, the valve continues to work well, the life threatening issue.  He also said (in spite of my age, he may not have used those words) my left atrium may shrink back some now that the pressure is off.  Thus, I have watched with hope the results of my echocardiograms for a sign of atrium reduction in size, it has not happened... but it hasn't grown either - that's the critical issue. 

I have never had a doctor mention a pace maker to me, and I do indeed have an enlarged left atrium and I am in permanent AFib, but I respond well to "rate control" with beta and calcium blockers.  My HR is never 160 unless I am foolish enough to try to return to running... I can no longer run more than enough to get out of the way from an oncoming truck when crossing the street ---- indeed this is something I had to do many years ago when crossing the street in Argentina , there on business.  The truck was in this case a public bus and I concluded the driver didn't care if he hit me. I was quick enough to make it to the curb : )

But I ramble, again, hope my input provided something useful, that you are able to read through my typos.  This post was long enough to require proof-reading, but I didn't, please forgive me.

DeltaDawn23 · Answer

Left home at 7:30 a.m. in afib and got back at 12:30 in normal sinus rhythm -- Not my favorite way to spend the day, but beats the heck out of spending time in the emergency room and/or having my heart going 160 beats a minute.  The whole thing just about wore me out.  I am feeling much better.  Sore throat and a burn on my chest, but still.

Had the imaging doctor tell me my atrium (both sides) was severely dialated and talking about an ablation with a permanent pacemaker.  Asked the nurse practioner who released me to explain, since in April my echo was mild dialation.  She gave me copies to take to EP, but thinks the difference was today I was in afib and last time I was not.  Any input on this would be appreciated -- it kind of scared me -- how did I get from mild to severe and a candidate for a permanent pacemaker in 8 months of feeling pretty much okay?  I see the EP in a month, so will see what he has to say.  Thanks again, all of you, for your help this past week.  It really made a difference.

DeltaDawn23 · Answer

I FINALLY after finding the cardio's nurse was out this morning, told my story to secretary TWICE, got another nurse about noon, told my story YET AGAIN and got an appointment with the Nurse Practioner.  I am definitely in Afib and have an appt. Tuesday a.m. at 8:30 to get a TEE and hopefully electroconverted.  Wish me luck.

DeltaDawn23 · Answer

It doesn't hurt to be optimistic as long as we're imagining the future anyway, might as well imagine something postive. Thanks for your input. I don't have to negotiate stairs except for basement storage and that can wait. I am doing my breathing exercises and keeping my hr down. Hope to get this resolved tomorrow. It is very wearing -- as I am sure you well know. Thanks again for the advice.

Jerry_NJ · Answer

My experience with Medicare (which is a changing subject) is it pays at least the 80% as long as the provider accepts Medicare rates (this is the basic problem going forward - as those rates have been going down) for electrocardioversion.  I'm going from memory, the last one I had was August 2008 and it was on an outpatient (same day) basis.  I had to have my wife drive to too and more importantly back home as I was sedated. 

I too have secondary insurance but it is mainly for catastrophic expenses designed to pay 100% once I hit a maximum out-of-pocket level ($5,000 I think it is).  All insurance seems to be moving in the wrong direction, pay more, get less...I am not optimistic about the future.  Do it now, not later seems a good economic strategy.

I can really say more than my cardiologist was not at all concerned when I was at 130 resting.  He did take action to reduce it with increased beta blockers, but we went forward on a scheduled basis, not emergency basis.  As for 150, that would concern me more but if it drops back and you have no other serious symptoms Monday with your doctor seems okay... especially as we are half way through Sunday here in NJ.

If your INR is over 2.0 you should have sufficient protection against clots.  

Best to remain calm, don't do anything physically that would put more demand on your heart rate.  Get up slowly and minimize trips up/down stairs if you house has stairs.  We're thinking it is time for us to get out of a 2 story house, but I'd like to stay here a few more years, maybe until 80 yo - a bit of optimism for you :  )

DeltaDawn23 · Answer

Thanks to all of you for your help.

DeltaDawn23 · Answer

Jerry, I was going to message you today and ask if, in your experience, I was being treated appropriately.  I am still running a hr in the 140's and yesterday, 150 for a time.  Then it will drop down.  I am to call the cardiac nurse Monday a.m. and then they will proceed from there.  The last 2 times I did not convert without electroconversion.  I fear they are going to want to try the IV drugs again and that didn't work the last 2 times either.  I just turned 67 also.  I wonder if I need to be admitted to the hospital for Medicare to pay for this?  The last time I was on private insurance, now Medicare with a supplement.  I am going to ask for a cardioversion (electro) tomorrow.  I would prefer to be treated as an outpatient, as hospital stays are no fun, and you are at the mercy of the system once you go in, but also need for my insurance to kick in.  Any input will be appreciated.

Jerry_NJ · Answer

The last time I went from NSR to AFib, turns out it was diagnosed as AFlutter, was years ago...I've been in permanent AFib since.  Well to the point, I was 67 at the time so already an old guy and just recovering from heart surgery which had put me in NSR, when my resting HR went to about 130.  I called my cardiologist and he told me to live with it until our follow-up, transition back to him form the surgeon, in a few days.  My point, yes think I have one, a HR of 130 at age 67 was not considered an emergency by my cardiologist.  This was over 5 years ago.

I have been spared the PVC (albeit I think the extra AFib driven beats are nearly the same thing) and other anomalies.

Wishing you a return to normal,  to better than normal.

Mommy2TnL · Answer

Thanks for the update!  Keep trying to hang in there.  It is easy for someone else to say "don't get discouraged."  :/    I hope your heart resets back to normal soon

DeltaDawn23 · Answer

Thanks for all your kind comments.  I am still hanging in there at home.  Still have an irregular beat most of the time and heart rates ranging from 120's to 150's, dropping to high normal a couple of times.  Felt somewhat better today.  I wonder if this could be aflutter instead of afib, it feels different from my previous experiences.  The nurse called it a "breakthrough" and said not to get discouraged.

gothic_beauty · Answer

Hello and let me say that I am so sorry that your heart is giving you so much trouble this week. I can completely relate to all of the anxiety and dread that go along with an irregular heart rhythm, so I can easily imagine the way you feel right now. I wish I could give you some helpful medical advice, but all I can tell you is to try to relax and take it easy. Don't be afraid to pamper yourself: whatever else you need to do at this time can wait, as nothing is more important than your physical and mental well-being. And of course, if things get worse, don't hesitate to seek medical attention. Even if you've had bad experiences there, if things get really scary, I would think that the ER is probably the safest place to be. However, I hope that your heart calms itself down on its own, and that you enjoy good health and happiness for many years to come. I am officially transmitting my moral support to you: don't despair, and feel better soon!! I will be thinking of you :)

CoolBin · Answer

Hang in there..i am sure it is nothing serious. Try not to think too much about it, since that would make it worse. Take care.

DeltaDawn23 · Answer

Thanks for the tips and the pep talks.  I talked to my cardiologist's nurse this morning and since I am already on the blood thinner and an antiarrythmic medication, they want to see if my heart will return to normal on its own.  I will have to go in Monday and be cardioverted if it does not.  I guess the main thing they worry about is blood clots causing strokes or heart attacks, so I am already covered on that front.  So I get to be lazy and sit around for a couple of days.  It seems like they ought to be paying more attention to this now, but the nurse was very helpful and said it is their method of dealing with this if you are already on meds.  I had to be electroconverted the last 2 times, but was not on the meds.  She said if I began feeling worse I should go to the ER.  A bit disheartened as I had hoped to avoid that.  Maybe it won't come to that.  I'm feeling a bit better now.

MichelleP_3811 · Answer

If you are having a bad bout of pacs or something like that then just try to hang in there until they settle down.  I find if I cough it sometimes helps to get them to stop.  Drink lots of water and do things like holding your breath and breathing deeply every so often to see if it will help calm the heart down a bit.  It has been 9 hours since you posted, I do hope you are feeling better.  Stay strong and try not to panic.  The calmer you can remain about this the sooner it will clear up.  I hope you are feeling better now.  (((HUGS)))

lilredbetty · Answer

Hey, I wouldn't mess about when it comes to my heart I appreciate you had a bad experience but I would ring the out of hours if you could, it's nothing to panic about but it does need seeing too I hope you feel better soon :)

Mommy2TnL · Answer

Eeekkk! I don't really have any advice since I'm still pretty new to this, but I'm thinking about you and praying that it lets up soon.  Please update us when you can  ((HUGS))