Atrial Fibrillation, Palpitations

• By missmatic
• Posted December 31, 2008 at 12:14 pm
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I have had similar symptoms for quite awhile and understand your anxiety completely. You need answers and the ones you're getting aren't clinically satisfactory. I don't have an answer, sorry to say, and can only offer some suggestions.

First you need to get your records and find out what blood work was ordered at the times you went to Mayo, to ER and to doctors. There are specific blood tests that can give an indication whether a person has had a heart attack for instance, and one would expect to be ordered in at least one instance that you related. CK (creatine kinase) might be one. There are often more tests that can be done and that patients aren't told about because their insurance doesn't cover them without a preliminary test being positive. At least that's my understanding unless someone can correct me. Sometimes patients are told that everything is normal when there are abnormal test results that don't indicate any particular, known disorder.

You need to research and ask cardiologists a lot of questions. Start by reviewing your labs. If anything is even in the borderline of normal or only mildly out of range of normal, research what the test means. See if anything changes from one test to another and note what your symptoms were at the time of each and any other factors that come to mind. Research your symptoms and see what pops out, starting with arrhythmia, then arrhythmia and your age or some other factor... Everyone knows their body and history better than anyone else and the questions that come to your mind as you research are questions you might try putting to cardiologists. Sometimes the cause of heart symptoms is outside of the heart. Even if you don't understand the technical language and even when you can only read the abstracts without a supscription, look at the research and professional journals - Lancet, Medline, Heart, any heart-related professional journal...

Make a timeline history of your symptoms as briefly as possible. Have you ever been seriously ill or been exposed to any toxic substances? What is the family history of anything?

Ask your doctors what information the tests are supposed to provide that's not already been established. Ask about the limitations of the tests. Ask how a particular test can or cannot diagnose a cause of your symptoms. Have you had a chest CT? It's my impression from personal experience that sometimes tests that are less likely to diagnose the cause are ordered, misleadingly steering the diagnosis into the direction of "normal." Ask questions and always get copies of your tests and educate yourself enough to be able to use them to ask the questions you need answered. If you have a condition that doesn't fit the
usual out-of-the-box, formulaic diagnostic strategy, you will need to be persistent with doctors. Insurance rules impose limitations on them that can prevent patients like yourself from getting necessary tests without doctors finding a way to justify them.

I don't know that the acid reflux meds are such a good idea. They can cause imbalances and are sometimes prescribed when in fact the digestion needs a boost with digestive enzymes and not the removal of them. You might consider researching traditional as well as alternative sources. Also, it's not a good idea to medicate symptoms before a primary diagnosis is made because as you noted, your meds might have masked symptoms.

Your record can cause problems. If doctors start dumping you into the "anxiety" wastebasket, other doctors and ER personnel will sometimes use that as a diagnostic criteria, which can turn into a slippery slope.

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• By mhills
• Posted January 3, 2009 at 1:25 pm
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You're quite young to have atrial fibrillation - it's more common when you're older - but young people have it, too. And what you describe sounds like classic afib.

Were any of the doctors that you saw electrophysiologists? You should definitely see an EP - that's a cardiologist that specializes in heart rhythms.

Stress is a definite trigger for many folks, and alcohol, caffeine, some foods, exercise, and even smoking can be triggers. Dehydration and loss of electrolytes also are common. Those who have the vagal form of afib often have GERD.

Since you have afib, it's important to learn everything you can about afib. You might want to start at www.stopafib.org - after I was "cured" of afib by surgery, I couldn't stand on the sidelines and watch other suffer, so I started this resource to help. In our patient resources section, you'll find lots more resources to look into as well, including discussion groups focused completely on afib. Learn everything you can before your next episode.

Take comfort in the fact that afib in and of itself isn't deadly - it's the irregular rhythms in the ventricles that cause people to drop dead of sudden cardiac arrest, and afib is in the atria, not the ventricles. But afib is potentially lethal if it causes blood clots and stroke, so you need to learn more ASAP. And the longer it goes on, the more it can lead to heart failure. Also, any chance that you have sleep apnea? It is very commonly correlated with atrial fibrillation.

I hope some of this helps.

Mellanie

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• By jareeves4581
• Posted January 3, 2009 at 8:56 pm
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Mellanie, thank you so much for your reply. This is surely something that is of great concern to me and I appreaciate all of the help and info. I can get. As I said previously, I had an episode that they diagnosed as Afib in 2004. At that time, they put me on Cardizem and a 81mg asprin. I also started taking Lexapro to help me get over the "hump" so to speak. It took me a little while but I managed and after a year or so I would have told you I didn't think it would ever happen again and I was in perfect health. Well, a couple of months ago I was having pains in my back(left side) and pinches in my left shoulder and pains that ran down my left arm to my fingers. I went to my doctor with concerns of this and he didn't believe it was my heart and thought it was something to do with an inflammed muscle or nerve because of all the heavy lifting I do at work. Less than a week after that though I was back in the hospital again feeling like I was having a heart attack. My pain started in my back but soon moved around everywhere it seemed. In the hospital, my heart raced around 125bpm for nearly 12 hours. My medicine was changed by the cardio to Bystolic(still take 81mg asprin). Since then, I have had some bouts of palpitations but they have not been persistent only lasting a second or so but enough to scare the daylights out of me. The doctor has me wearing the heart monitor now for 30 days to see if we can catch anything. The only thing we have picked up on so far is a few palps, a fast beat when I exercise, and some bradycardia at night when I am asleep coming in at around 48bpm. The cardio does not think I need to have a nuclear stress test done and for the most part seems to think that I will be fine to continue taking meds. I trust my doctor, but I still have concerns when I lay around sometime and my heart rate is at 80-85bpm and others at 60bpm. I have to say though that overall the racing, out of rhythm heart hasn't been the worst for me seeing many stories of others. Will this most likely get worst over time? I have only had the one case of Afib in 2004 but quite possibly could have had many more since then if not for the medicine. Sometimes at night or during the day I feel me heart beat fast a couple of times and then regular a couple and so on. How long did you live with Afib before you progressed beyond meds? I am hopefully going to be a father next July, LORD willing and I am scared to death literaly of not living long enough to see my child grow and mature. I wanted to say to that I had another episode yesterday where I was hurting in the back and it moved elsewhere making me fell full and flushed like I was about to pass out but my heart never fluttered or went to racing and the monitor didn't pick up on anything either. I prayed and took deep breaths and overcame the problem somehow and have felt fine since. How far do I keep continuing to go with this if my Afib has only occured once? The doctors say that the palpitations and irregular beat is not taking years off of my life but I still wonder. I am young and I will admit that I like to go out with friends still and have a few drinks. I am scared now to do that. When I do drink, my heart seems to speed up but normal rhythm returns and I haven't went back into Afib, but once again, it could be the medicine working. What do I do Mellanie? I want to live my life like a normal 27 year old. I am not a wild child but I still like to have some fun but I worry so much now about my health that fun is hard to find. If all I am having is occassional palps and a flop every so often and the doctor says its o.k. should I just move on? There is no history in my family on either side of heart disease nor any other type disease. We have been so fortunate. As a matter of fact, an average life span of my family would be somewhere in the mid to high 80's. Please direct me anyway you can. I just hope there is possible long life ahead of me even though I had an Afib episode at the age of 24. Hope to hear from you soon. Thank you so much!

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• By kiminz
• Posted January 9, 2009 at 10:05 pm
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It is possible anxiety is playing a roll in this too, especially if you are really worried about it. I have experienced irregular heartbeats, dizziness and chest pain having panic attacks. So it is possible that stress can do this. You have done the right thing having it all checked out. AF is really common, more so in older people, I have a client who is 71 and has had it most of her life due to a heart condition she was born with. She amazes me that she never worries about it, even when she is in heart failure, it doesn't stop her trekking around in Papua New guinea! If you can try and relax, avoid smoking and too much alcohol and stimulants as these all effect the heart , a bit of regular exercise each day, even just half an hour of walking lowers your chance of heart disease. Try and relax and enjoy this wonderful time in your life and if you're still concerned talk to your doctor again about how it is effecting you. I hope you are doing well.

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• By carrieha
• Posted January 10, 2009 at 9:52 pm
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Hi all, this is all too new to me. I was born in 83 with heart problems. I had 2 open heart surgerys in the first few months of my life. After the surgery I was well just had to have a check up every year to unc. I went on with my life as normal. I started having dizzy spells, fast hear beat, sweating, feet tingling, ect and the dr noticed I needed a stent up in my aorta bc the blood was not flowing well. After this I was okay for a few months then the systems starting back. I was given a heart monitor ( this is my 5th monitor) and finally I had an epicode of the fast heart beat and passing out. I recorded the rythem and my pulse was 210 so they explained why I was passing out. The dr then preformed a cardiac ablation to get my heart back in normal rythem. This was 2 months ago and I have been okay up till 3 weeks ago. My system came back and my pulse was 170. I went to duke and they were able to see my hear fluttering then going into afib. They put me on 2 iv to get my pulse down and to make sure I did not get any blood cloths. I had an EPP done to show the back of my heart and check for clots there were none. Good news! The dr decided to do another ablation and thinks he has fixed it this time. I can only hope bc I am 25 yrs old just married and want a family and this is scaring me to death. I have allot of pain under my left breast and on my side toward my back they keep telling me its scar tissue, but the pain want go away and it gets worse after I have the surgery. I am on an antinflamitory which does nothing for me and I have had 2 chest x rays which come back okay. This is fustrating.. Any advise?

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• By skler
• Posted March 11, 2009 at 8:12 pm
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Hi,

I've had similar symptoms off and on for most of my adult life. I have Lone Atrial Fibrillation, occurring a small percentage of the time and lasting a day or two when it happens. I also do occasional heavy lifting in relation to my job. In my case, I had many concurrent symptoms that were scary and difficult to diagnose due to their overlapping nature. The intermittent atrial fibrillation I have may well be the result of pacemaker cells in the pulmonary veins and so I am a candidate for pulmonary ablation, In the right hands and barring other health issues, this procedure is said to be highly successful and can actually cure the arrhythmia! If mine ever becomes chronic, I will seriously consider taking the risk of having that procedure. With regard to other symptoms, as often accompanies arrhythmias, I experienced anxiety and stress, which can be an ongoing thing, but quite treatable in most cases. On top of that, I have some muscular problems and moderate pain associated with my mid back, i.e. scapular region. This has never been definitively diagnosed with me, though I did pay for an MRI and found that I have a prolapsed disk in that region (more often, disc problems are asymptomatic). It usually only flares up, painwise, in conjunction with the cumulative or after effects of heavy lifting or upper body exercise. On top of all that, I have a sliding hiatus hernia that I inherited from my dad and sometimes must be careful not to overeat or sleep on my left side, or else I have to deal with reflux into my esophagus! I was pretty stressed out when I first began experiencing all of these things in my mid 30's, but have been working and getting along pretty well for the last 20 years or so. The human body is astonishingly complex; subjective sensations and pain, though a helpful warning sign, can be misleading and difficult to interpret, so I guess my advice would be to find good health professionals and learn to trust them, while at the same time being assertive and encouraging them to base their diagnostics on as much physical data as possible. I can definitely relate and feel empathy for you! :-P My intuition is that you will be healthy and have a wonderful life with your family!

Best of luck! :-)

Skler

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• By Ed-S
• Posted October 12, 2009 at 11:41 am
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I too am an occasional "a-fibber." My first happened at age 47 and took about 12 hours to convert with IV cardizem. I had a second confirmed episode 16 months later that spontaneously converted in about 45 minutes. Since that last one, I occasionally have short episodes where I can feel my heart rate increase quickly (to about 100 to no more than 115); however I seem to be able to abort these episodes within 5 to at most 10 minutes with deep breathing. I also take potassium chloride (in the form of salt substitute) as a precaution.

I've been lucky so far in that my a-fib seems to be fairly well controlled with just atenolol 100 mg and cardizem 180 mg (taken twice a day). I have not been in an ER for a-fib in about 14-15 months.

Here are some thoughts I have based on my own notes and experiences that you may want to examine based on your own a-fib experiences:

1- Do you sweat heavily due to workouts or from your job? Are you getting up a lot at night to urinate? Many people do- especially diabetics and those with sleep apnea. This can cause electrolyte imbalances. I have a history of low potassium levels including when I had my 2 "major" a-fibs, so I take 2-3 multivitamins daily, plus extra magnesium and potassium (in the form of salt substitute WELL-mixed in crystal light). I also take potassium before and after every workout on the treadmill, and if I feel a possible a-fib episode coming on.

2- If you aren't sure about being diabetic or having sleep apnea, be sure to check with your primary physician about checking your fasting glucose, your electrolytes esp. potassium and magnesium and to ask about whether you should have a sleep study done. Sleep apnea is now very common yet very under diagnosed, and there is a known association between sleep apnea and many forms of heart disease including a-fib.

3- I believe sometimes we all have some baseline anxiety, which we experience subjectively as "stress." Under these conditions, we tend to breath shallower and more quickly. There is some data that breathing more deeply and less frequently is healthier and more "heart-friendly." When I feel a possible a-fib coming on, I do deep breathing in a way taught to me by a pulmonary therapist- deep slow breathing through the nose, then a long exhalation by mouth with lips pursed as if whistling. You can probably find this technique online- it's used a lot especially by athletes and emphysema patients. I feel it's possible some combination of anxiety/shallow breathing may affect some cases of a-fib, including mine. During the short episodes of high heart rate my BP sometimes will rise to 220/120- but I can usually deep breathe it down at least 50/20 points in 1-4 minutes. I am working to incorporate deep breathing into a daily routine.

4- I believe my a-fib case may be affected by tyramine sensitivity. When too much tyramine is consumed, it causes both your heart rate and your BP to increase a great deal ( http://en.wikipedia.org/wiki/Foods_containing_tyramine ). I have noticed, admittedly in a subjective way, that when I avoid foods high in tyramine, those 5 minute episodes of racing heartbeat occur less often. Trigger foods for me: red wine, brazil nuts, certain aged cheeses (especially aged cheddar), leftovers (especially meat) in the fridge more than about 2 days, sauerkraut, tofu, soy sauce, and some aged meats (like salami, summer sausage, aged steak, smoked meats- basically anything that is aged to increase flavor). 80 proof spirits don't seem to have the same effect on me though I am sure they have some tyramine in them, just not as much as red wine in my experience.

5- This is an easy one, but if you believe you have a-fib, don't take any over the counter nasal decongestants such as pseudoephedrine without a physician's advice.

Please keep in mind, I am not a medical professional and am sharing very subjective info based on my own personal situation. I offer these comments to help others think through their own situation, and stimulate discussion especially with qualified medical professionals.

Best of luck to all!

Ed

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• By lulu1421
• Posted November 9, 2009 at 2:10 pm
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Have you ever had your thyroid checked? I have read that this can cause atrial fibrillation. I sympathize with you, in that I recently had an afib episode with high BP, and that was something new for me. Just before it happened, a transformer had blown right by my bedroom (city utilities), and I had also taken Requip XL for restless legs, but couldn't get to sleep because of this noise and a sore throat. I know that dehydration and low potassium/magnesium can be causes of afib. I also have anxiety and have dealt with that many years. I do hope you are able to relax more and not worry so much about it. I know that is easier said than done, because I'm in the same boat. I'll pray for you.

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