atrial fib problems

[Steve518]

In 2004 I had a heart rhythm episode where I went to ER which they diagnosed as atrial fibrillation.  They treated me with some meds which stopped it and sent me home.  They gave me a prescription for a beta blocker called Metoprolol and told me to use this medicine if I had another episode.   From 2004 to 2008 I had a couple episodes that could have been a recurrence of the atrial fibrillation but I never was sure.  Then in 2008 after moving to Russia I had a definite episode that was very uncomfortable.  I took 25 MG of the Metoprolol which seemed to have no effect.  Fortunately, I knew of a US Family practice doctor who was in Moscow at the time.  I contacted him and he told me to take 50 more MG.  After an hour or so my heart rhythm returned to normal.  He suggested I go on a 25MG per day maintenance dose following this incident and that if I had another episode in the future I could again take up to 50 additional MG of the medicine.  When I was back in the US in the summer of 2008 I discussed this with my Primary Care Physician and he agreed with the plan.  I remained on the daily maintenance dose (25MG XL (extended life -  good for 24 hours)   In 2009 and 2010 I had a couple more episodes each year and each time I took an additional 50 MG which would return my heart rhythm to normal.

Then just over a week ago, I started having heart rhythm issues again.  The additional Metoprolol has had no effect.  In fact I tried going to 50 MG per day for a week and for the last 3 days I have tried 75 MG a day but again without effect.  My symptoms seem to vary over time and with different situations.  
• Sometimes I am hardly aware that my heart is out of rhythm
• At other time I can definitely feel it.  The sensation is like the heart is pounding in a strange way and I am out of breath.  Sometimes it feels like my heart has a sore muscle sensation or like something is pressing against it.
• If I exert just mildly (which of course  I am trying to avoid) like climbing a set of stairs or doing something slightly isometric in nature it usually brings on the above sensations.
• Usually when I first lay down at bedtime the discomfort and out of breath feelings are very pronounced.  Then after 10 or 15 minutes my body seems to adjust and I am able to sleep but if I awake with an  intense or frightening dream my symptoms are very intense (perhaps this is related to an adrenaline surge)

Now here is the most interesting part to me.  I have one of these home blood pressure machines here.  You put on the cuff, press a button and it inflates.  When it is finished it gives you your blood pressure your heart rate and it has a little symbol that illuminates if your heartbeat is irregular.  I take this measurement in a rest condition either seated or laying down.  Whenever I take this measurement I always seem to get the same results no matter how intense my symptoms feel to me (including when I feel rather normal), and these are the results:
Blood pressure:  100 to 120 over 80 to 85 which is pretty normal for me on Metoprolol
Heart Rate:         90 to 100 – This seems too high for a rest heart rate
Irregular Heart Rate Symbol:  On

As a check against the machine I have had my wife measure her rest heart rate using the same machine.  It is normal (high 60’s for the heart rate and the irregular heart rate symbol is off)

So here are my questions:
• How serious is it to allow this condition to continue.    Is this something that can be put off to the summer when I plan to return to the US or do I need to address it now?  
• Given the background above -- If I were to visit a cardiologist what would the next step be.  If it would be to try a different or stronger medicine perhaps he could tell me what that might be and if I could get it here in Russia I could try it and see if it works.
• If it can’t be controlled with medicine I understand there is a procedure called oblation.  Clearly I would want to be in the US for that under my medical insurance.
• Any other suggestions?

[Steve518]

An update on my situation.  I came back to the US on 15 Feb.  I was put on the brand new (FDA approved just months ago) blood thinner called Pradaxa, which unlike Coumadin requires no monitoring.  I was on that for 3 weeks then had the cardioversion to put my heart back in rhyhm (the shock treatment).  I did not require the TEEG.  I am now continuing the Pradaxa 150MG twice a day to the keep the blood thin.  The doctor may discontinue this after a month and just have me resume it if I have another episode.  For the rhythm issue I am taking 100Mg of Flecainide twice a day and 50 Mg of Metoprolol once a day.  So Hopefully this regimen will keep me stable.  and allow me to return overseas in about a month.  Thanks for sharing with me on this forum which better prepared me to talk with my doctor and put my mind at ease at the time

Steve518

[Steve518]

Dawn,

Thanks for the information.  What kind of regular medicine are you on to control the a-fib?  Is it  Pradaxa or Rhythmol or something else?

Thanks,

Steve

[DeltaDawn23]

Another thought: for me it's all a calculated risk.  Is the inconvenience of the blood thinner worse than the possibility of a stroke/heart attack?  Everything seems to be a trade-off.

[DeltaDawn23]

Steve --

I have been on Coumadin for about 6 weeks following an electro-conversion.  It isn't that bad.  Mine is staying within normal limits now, going on a every 2 weeks check.  Lovanox (Heparin) shots can thin the blood as a "bridge" until the Coumadin kicks in.  There's also a new drug out, approved by the FDA for A-Fib -- Pradaxa.  There are less dietary and checking restrictions, but it still has some issues common to all blood thinners, you need to be checked if you fall or hit your head to make sure no bleeding.  They may do a TEEG (transesophageal echo) to make sure you have no clots in your heart, that could be thrown during the procedure, causing a stroke or heart attack.  Whether you need the on-going blood thinner depends on your risk factors.  There's a Chads 2 formula that will tell you what your risk of stroke is.  Mine was 3%, which is significant.  I'd rather take the meds than suffer a heart attack or stroke.  Ablation is sounding better and better to me.  Ask about the "pill in the pocket" strategy with 600 mg. Rhythmol.  

[Steve518]

Clay,

Thanks for the dialog these last few days.  I will update you when I can

Steve

[claytex]

DEAR STEVE:  ARE YOU IN AFIB NOW??? IF YOU ARE THEY WILL PROBABLY GIVE YOU BLOOD THINNER FOR 3-4 DAYS BEFORE THE TRY CONVERTING YOU..DUNNO JUST A GUESS ... I WAS IN IT FOR SEVERAL DAYS THE FIRST TIME I HAD IT AND DIDNT KNOW WHAT WAS GOING ON.. THINK THEY KEPT ME ON THINNER ABOUT 4 DAYS BEFORE THE CARDIO VERSION... HOWEVER, I THINK THEY HAVE SOME SHOTS THEY GIVE NOW THAT CAN THIN THE BLOOD IN A FEW HOURS.. HOPE ALL GOES WELL FOR YOU.. LET ME KNOW IF YOU CAN ....CLAYTEX

[Steve518]

Dear Clay,

Thanks for the update.  Very helpful.  I fly to the US on the 15th.  At that point I will have been in A fib just over two weeks, so it sounds like they will want to put me on blood thinner and cardio-vert me with either the shock or medication.  Thanks to you  and McMasters for the warning on Amiodarone.

Steve

[claytex]

Dear Steve; to answer your question about blood thinner, I dont think there are other options.   I was given the generic for coumadin.. its called warfarin.  I will add this... whether or not your placed on a blood thinner depends on the kind of arrythma you have and your cardiologist.  The only times I had to take a blood thinner is if I was in Afib for several days before I was shocked back.. When my afib started,  it wouldnt come and go... I stayed in afib until I was shocked back.. I was usually not put on blood thinner and if i was it... was only for 30 days following the cardio version.  As I understand it the people who need blood thinner are the folks who go into and out of afib fairly regular. I think there is a danger of the blood pooling in the heart and causing a heart attack or stroke... Also, when I went into afib, if i could get to the ER and get shocked back within the first 48 hours of going into Afib, I didnt have to take blood thinner.  After I had the heart ablation in July, I was placed on blood thinner for 3 months while my heart was healing.  It wasnt really tooo bad... uhhhh better than the other alternative...laffin.. uhh not funny I guess..Im glad WMcMasters confirmed my feelings about Amiodarone.... He is sure correct... dont let them put you on that crap... The Flecainide worked good for me.. I  was on it about a year before my ablation.  I only took 50 mgs twice daily... and if i did go into afib I could take 300 mg of flecainde and it would stop the afib... was the only medication that would convert me back..... and I had no side effects from the Flecainide...like I said earlier though it can have side effects if your heart is not otherwise in good shape... hope this helps.. If you come to the US...Id sure recommend the Austin Heart Hospital in Austin, Texas...Your probably from somewhere else ...but I think those folks really know their businesss.. They sure fixed me up good as well as two other folks I know who had ablations there.. We all  went to a Dr. Coffeen there... Id put him up against any Electro Physiologist... whats funny... is i found out he was an electrical engineer before becoming an EP... makes sense I guess.. I think the boy knows his electricity..laffin..he did a good job of rewiring me...well I guess i got off the subject...sorry.. hope some of this helps.. If you have anyother questions just let me know.. will be glad to share what little I  know..Have a good day Claytex

[WMcMasters]

What Claytex says about Amiodarone aka Cordarone, is kind. My mother had to take that for her A-Fibs. Because nothing else worked. Ended up "I believe" causing an unexplained peripheral neuropathy after two years of use and she became bedridden and died as a result. Only one doctor theorized Cordarone it was the cause, a nerve specialist, when I told her cardiologist I suspected Cordarone, was causing her neuropathy. I was told there are only a handful of drugs that work like it, and the others have worse side effects.

[Steve518]

Thanks for the information.  It was very helpful.  I have decided to return to the US now and get a thorough check out by a cardiologist.  I am/have been taking 81MG enteric Aspirin daily.  I have heard that cardiologists like to use Cumadin as a blood thinner.  I am not wild about this idea.  Are there other options for blood thinners that don't require the constant monitoring and dosage adjustment that Cumadin does?

[claytex]

Dear Steve: I had AFib for about 12 years.  I was put on toprol xl.  Metroprolol is the generic for toprol xl. I stayed on it for years.  I usually took 50 mgs twice daily or 100mgs daily. It is a very mild arrythmia medication.  It slows the heart rate and helps keep you from going into afib.  I could not take the generic metroprolol... It gave me flu like symptoms... bronchittis, chest congestion etc... but the toprol was fine... It worked about like you are saying it works for you..not perfect but helped.  I took it for years... my heart would not go back into regular rhtymn unless it was shocked back (electro cardio version). I found there are lots of things that aggravated the afib... caffine (coffee,chocolates, cold drinks with caffine, cigarette smoke(niciotine), alcohol, sleeping  with my arms above my head, lifting things above my head.. thats a few.. As time went on my afib attacks became more frequent until in 2009-2010 I had to get shocked back into regular rhythm  about every three months.. I finally had a heart ablation proceedure at the Austin Heart Hospital in Austin Texas in July of 2010 and now have no afib problems ...what a relief.  I think your correct about not having an ablation until you return to the US. I did lots of research before I had mine and found a hosptal and a doctor who had done lots of successful ablation proceedures... If you are in good physical shape and get a good Electro Physiologist to do the ablation in a good hospital that has lots of good and modern equipment for it, you usually have about  a 75-80% chance of correcting the problem.  At least that is pretty much what I discovered in my researching the situation.. Also, are the doctors putting you on any kind of blood thinner?.. If your going in and out of afib, you may need to be on blood thinner.  You sure need to take one 81 mg asprin daily if your not on a thinner in my opinion.  There is a medication for afib that they put me on the last year thats a pretty strong afib medication.  It is called flecainide and worked really well for me.  It is pretty strong though and unless your heart is in pretty good shape, it can cause congestive heart failure... I had no problem with it, im 69 but am very active and my heart is in good condition.I can max out a stress test...go 15 minutes.... I will add this last comment, at one point a new cardiologist gave me a medication called Ammidironine I think  it was others like it are called Pacerone... that stuff is bad news... I got off of it after 30 days... it can turn your skin blue colored, you have to stay out of the sun and it can really mess up you glucose, thyroid, triglicerides numbers and etc.. I think I spelled Ammidarone wrong both times, but you can find the proper spelling on line... be damn sure no one gives you that stuff. I later found out its  a last chance sort of medication...Its a half life medicaton and stays in your system for months.. if not permanent... I dont know why that damn doctor gave it to me... guess he didnt like me laffin.. hope this helps .. If you have any other questions about Afib or heart ablations, please feel free to send me a message and I will share my experiences  with you.. I have plenty to share after having it so long.. Just glad to rid of afib and hope it stays gone....laffin... Claytex...Also  I would try to find a good Cardiologist there and see him...