Just a comment,living with AFib

[Jerry_NJ]

I just came in from about an hour behind my gasoline snow blower/thrower and snow shovel.  We got a small 6" or so of snow in Central NJ, much more north of here.

I suffer from permanent AFib, and take a lot of beta blocker and calcium channel blocker to control my heart rate (Rate control).   Still, and at age 73, I was able to handle that work, and the shovel included a front walk about 40' and about 100 sq feet or more on our rear deck so I could get the storm door open and so our small dog could get out - his legs are too short to deal with a 6" or more snow (a Westie).  

Bottom line is while I have much less strength/power as the AFib prevents me from really doing power muscle work, steady heavy work I can handle...still I am tired, with a heart rate that doesn't attract my conscious mind, I'll bet it is under 120 now that I am sitting inside typing (typos), still the general fatigue I feel doesn't make me enthusiastic about physical work.

I have a 6 month appointment with my cardiologist on Monday (day after tomorrow) and plant to discuss with him ablation, again, and reducing my BB and CCB does level.  I take those simply for "rate control" and I can monitor that and go back to old dose if the HR gets too high.  I bet he will object (here I think the US Medicare system pays such low rates that doctors try to avoid taking on time consuming patient work they feel has little chance of success/improvement).  I'm not say he/they are trying to kill us (but the new "affordable care act" program in the US is still rolling out, not optimistic that will result in improved care for the old folks) they try to utilize their time for those the most in need and those paying the "list price".  As long as I keep getting by, I don't attract much attention, then too he may be saying don't mess with it if it is working.

I can always change doctors if I can find one who will take on another Medicare patient, this is becoming a problem too.  Still, if a reduction in BB and CCB will still provide sufficient "rate control" I'd like to try it to see if some of my low energy is due to side effects.  One side affect, aging, is best handled by getting active if possible, and a bit less fatigue would see me out on walks more often.

Yep, looks like I made it, shoveled snow and no heart attack, AFib or not.  

[Jerry_NJ]

I changed from Metoprolol 25 mg twice a day to Atenolol (I think that's the correct name) as same dose level.

I started yesterday and noticed some reduction on my HR... I'm using my Oximeter (subject of another thread) to quickly check my HR and O2 level. The O2 level seems okay when up an active, over 95%.

Today after lunch, second day on Atenolol and third 25 mg dose, I noticed some dizziness after sitting for a few minutes.  I check my pulse and found it in the upper 50s.  So I went upstairs (some more exercise) to get my stethoscope to check my Oximeter HR reading.. the walk up put me into the low 70s, which was confirmed by stethoscope.  

I then went outside and did some light work, using an electric splitter to split some ash hardwood firewood.  All I was doing was lifting a few "rounds" mostly under 25 pounds.  I didn't feel dizzy, maybe a little short of breath. I check the HR again and it was about 70, very low from my past experience.

I decided to come in and make this post.  Sitting her for 15 minutes or so I have a HR of 51 O2 at 98%.  I can't think of any reason to argue with the facts, but maybe I'm not thinking clearly - low HR or not.

I may cut my does in half tonight to see what happens.  I will try to get some BP measurement too if I lower the Atenolol - I have never had high BP but my body has adjusted to years on BB, and the BP is low normal even with BB and CCB every day.

This suggests the Atenolol has a much stronger effect on my HR than did Metoprolol.

[Jerry_NJ]

I am yet to discuss with my Cardiologist or even his "office" but I got a telephone call from my Primary Care doctor's office telling me they received the Stress Test results and all is "normal". Good news, but not a surprise..well it was a surprise in that I have "failed" stress test twice in the past.  I have never had any blockage or bypass/stent work done, but for some reason I don't stress test "well".  Another lesson for me, in my slow and slower learning processes, the stress test simply means the heart rate is at your maximum for age - for me that is 135 and as I was off my rate control meds my just walking around HR was almost that high - no need to work out on the tread mill.  The technician double checked with my cardiologist (or a cardiologist) a couple of times before putting me on the treadmill.  On the treadmill I was walking so slow I had to concentrate on not overrunning the front.  They put a slight slope in for a minute or two and then right back down saying something like I was already at 117% (of the target), and the gave me the shot of nuclear fluid.

One learning for me is I am beta blocker dependent, my AFib will drive my HR into trouble area without them.

I send more as information - case history - not so much as a question.  Still I welcome all comments and advice.

[Jerry_NJ]

Yes, "vivid dreams" I think it is called (not sure what that means, maybe just that they are remembered) can be triggered by beta and calcium channel blockers.  I can say the 36+ hours I was off all meds before my stress test in included one night's sleep following a 24 hour no drug period.  I had my usual trouble mares, no change.  My problem with dreams may be more related to the mental struggle of dealing with aging, now personal not simply empathy.

As I may have already posted, when I went in for my echo and stress tests they, of course, took my HR, which was high (a bit over 100 when seated, but not truly at rest, I had to walk to get to the examination chair) but my BP was low, yes off all meds that lower BP an my BP went down.  

I went back on my normal BB and CCB yesterday starting around noon time, and this morning when I got up - short walk to the toilet - and took my resting HR it was about 67, a new recent low.  This makes me wonder if the period of no meds made my system more responsive to the meds when I started them again.  I did not take my BP.

[DeltaDawn23]

Glad you were able to get in so quickly for the tests.  What is the dream problem, and what med do you attribute it to?  Since my Norpace was increased and I am taking Lisinipril (I haven't quite worked it in with my bb so my bp doesn't go to low), I have been having very vivid, troubled dreams.  I remember reading some bp meds will do that.

[Jerry_NJ]

Thanks, an you pointed to the stopafib information on cryo-ballon ablation.  My cardiologist was not persuaded it had anything to offer my case, he still considers me a cast of more risk than probable benefit.

I did my echo and nuclear stress test today, boy that was quick, Monday the doctor gives me orders to have the work done and today, Tuesday, it was done.  The test center didn't look to be very busy, it may have just been a "lucky hit" me needing service at a time they were looking for patients.

One early interesting experience driven by be going off beta blocker and calcium channel blocker Sunday night, thus I was without medication for over a full day this morning.  My resting HR was an easy 100.  When the test center checked me out they were concerned about having me get on a tread mill, but on checking with my Cardiologist, they when ahead - my target HR was 135, I hit 170 in the bouncy fashion of AFib after about 3 minutes on a very slow moving treadmill, I'd guess about 2 mph, it was hard for me to walk that slow.  It had some slope but only for about one minute.  Conclusion 1) the beta blocker really works on me (I think the calcium channel blocker has less to do with the rate control).

On checking my blood pressure several times it was alway rather low in the range of 100/60.  I have never had a high BP problem and with BB and CCB I have had problems with the BP being too low.  But after using my current BB/CCB levels my BP became about normal, sometimes even a tinny bit high as in 130/85, but that was very rate.  I thus worried that I had become dependent of BB/CCB to control my BP.
Conclusion 2: My BP was not being held low by BB/CCB, even without those meds my BP is low.  This last conclusion may be stretching it a bit, but I was nonetheless surprised my BP didn't rise when I stopped taking BB and CCB.

The results are yet to be told, I asked for copies of the reports from the test center.

I have not yet started the 30 monitor, it is being mailed to me.  I wonder it this will also answer some questions about how I sleep.  One of my health complaints dream problems, trouble mares I call them, and every night.  The monitor should show if the dreams are causing a high run of HR.  I was also thinking about buying an oxygen saturation recorder to monitor my oxygen level during sleep, sort of a mini-amature-sleep study.

[DeltaDawn23]

Jerry -- I meant to get this to you before your cardio visit, but here it is anyway -- you might want to pursue it.  On stopafib.org there was an article about a cryo-balloon ablation procedure that was having great success even with pesistent afib.  It might be worth looking into.  Be careful out there with the snow.  Sounds like you are in pretty good shape for one of us afibbers.  Congrats on speaking up about your symptoms.  I think afib is considered "no big deal" since it isn't going to kill us.  Quality of life counts, tho and I think sometimes the doctors forget that.  Good luck on this.  Let us know how it comes out.

[Jerry_NJ]

Carey01, Thanks.

JustSera, Thanks, I hope we see more replies from you - I enjoyed your camaraderie with one old enough to be your father.  My cardiologist says it is fine for me to do physical activities as long as I keep my HR below about 140.  I think I suggested 140, not him.  

I did several weeks of cardio rehab under medical supervision following my heart surgery, I had returned to full time AFib before that started.  I was on a heart monitor all the time an over the several weeks I participated they kept pushing me to go harder.  

I had been a running (well 3 miles on mostly level ground in 30 minutes, some call that jogging, others cal it running, still others may call it walking fast) up to age 67 so my leg muscles even now still look pretty good, if I say so myself.  But the legs get the oxygen deficiency burn easily as the heart pumping blood without the help of the atrium chambers is not up to serious work loads.  The less than active life of the last few years has also put me at about 240 poiunds - I am near 6' 6" so while too much my "fighting" weight is only 20 pounds less, so I am less than 10% overweight.  

[Carey01]

I think its awesomne that you did the snow shoveling successfully without incident!  Congratulations!  Clearly you are managing your A Fib well!

[Jerry_NJ]

Thanks Tom, itdood,

Just back from my check-up with my cardiologist.   I many have been too harsh and full of doubt.   I think I needed to "say something"... which reminds me look on the web for the speech by Dr. Benjamen Carlson's at the National Day of Prayer yesterday.  It may be going viral on the web by now, some report of it on Fox News this morning.  In speech segment of political correctness he tells the story of the son buying two talking birds (of some kind, your choice) at $10,000 and sending them to his mother.  When he telephones a few days later to ask how she liked the birds, she said they were delicious.  He  asked, you cooked them? They could talk.  She replied, well they should have Said Something.  Clark believe political correctness is blocking the chance for open dialog on many of the problems facing this nation.  .

Anyway, I "said something" including a suggesting that I cut my BB and CCB dose in half and watch to see what happens to my "rate controlled" heart rate.  He said given my symptoms complaint we do the following:
1) wear a 30 day monitor (24/7) and after a one week base line recording cut my medications back to half - and then he can compare with the baseline.
2) get a nuclear stress test, it has been at least 5 years since my last
3) get an echocardiogram, it has been only a year, Medicare says only every two years for routine check-up, he said this is a diagnostic echo, so one year should be covered.

So, it seems my cardiolgist is willing to put in more effort to improve my condition now that I "said something".   He also confirmed that my conditions which now includes 5 years in permanent AFib  is not likely to respond to any rhythm control methods... fibrosis is setting in making it more difficult for the atrial muscles to fully flex through the intake/output cycle. This was the recommendation of the EP who looked at my case and tried an electrocardoversion about 5 years ago.  Keep in mind my history includes a failed attempt to stop AFib with a mini-maze done under open heart surgery.

When I told him about my driveway snow removal he was not concerned - but he will take a careful look at a heart monitor over the next 30 days.  I hope the wireless connection is better this time, 5 years ago when I wore a monitor I had to do a dial-up data dump once a day.

[itdood]

Hi Jerry. Have you looked into the new 5 box?   Good for you on dealing with the snow.  Take extra care,

[tom_h]

Jerry, I spent the entire weekend clearing 26" from my long driveway, and my heart was complaining a little last night by throwing a PVC every now and then.  There's no shame in picking up the phone and getting someone to do it for you.  Be careful out there!

[Hiker in Hawaii]

Don;t they call A-Fib an irregularly, regular rhythm...Is there any correlation between Heart Block and A-Fib or is that an apples to oranges comparison?...

[JustSara]

Hi Jerry,
    I read your post yesterday and just have to comment.  My husband had to take a nap after he snow blew the snow yesterday and he is only 53. As a matter of fact I took one too,and I didn't snow blow and I am 52.
    You will feel more like exercising if you set up a daily regimen,say an hour after breakfast go to the gym.  I am most rested with energy at that time and most of the retiree's are there too. Comradery makes the time go by fast. Start slow, you get strong fast.
    Your Doc sounds like he has your best interests in mind,don't worry it's easy to find one that doesn't and will do ablation on you for the money.  It's all about the money in this world. From the jurried research that I read and reading these posts of peoples personal experiences albation does not work for AFIB. It is an invasive procedure, with risks.
     My opinion.  Good Health Jerry  I don't usually comment.

[Jerry_NJ]

Premature Ventricle Contractions (PVC) are very common and occur at (almost) any age.  AFib if more likely in the elderly, or at least past middle age.  It was diagnosed in my case about the age of 60. I had been a run for exercise person up to and past that time so it was common for me to run at 160 and rest at 65.  I don't recall if I noticed the irregular beats due to periods of AFib or if that came up during a medical examination.   I was in permanent AFib when first diagnosed.  Electrocardio versions and medication kept me in normal sinus rhythm most of the next 5 years when I the enlargement in my left atrium prevented me returning to NSR (a lot more to the story, read my profile if interested).

To your question, when in AFib even if "rate control" is working I experience an out-of-interval heart beat about on in three, that is there is enough run of regular evenly spaced beats that my ear can detect on that is early (or perhaps late, can't say I've tried to label).  With effective rate control the resting HR is under 100, as an objective, I am well below that, albeit irregular in rhythm.  Nonetheless, my atirum are not working, so my heart has to work harder to get oxygen to my muscles and I notice it when I do physical work.  I do not notice anything while sitting, but often have a slight dizziness when I rise.  I think this may be due more to the medication than to the AFib.

[Hiker in Hawaii]

I'm glad you didn't get the heavy snow that they had in Boston, and most of New England...

What is the typical pulse rate of someone in A-Fib, and if you check your pulse, does it have a unique rhythm or feel any different than if it was a regular rhythm?..

I've been dealing with rhythm issues (on top of anxiety), lol so that isn't exactly the best combination....Ive had normal echos and even a normal cardia MRI, yet it seems like i get skipped beats frequently....A past Holter Monitor study revealed sinus and junctional rhythm....No A-fib was ever caught on Holter studies (ive had two) but i guess it could develop later in life...