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Old 08-14-2019, 04:50 PM
 
Location: SW Florida
9,949 posts, read 7,211,456 times
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Quote:
Originally Posted by Jill_Schramm View Post
Thanks for sharing all that. Itís good to hear that the pacemaker has helped you feel so much better.

Reading through your account helps put my tiny tachy-brady episode in perspective!
Well, I know that whatever it is going on with your heart, you and your doctors will figure it out. I guess (heck, I know!) that it generally takes some time and a significant amount of testing to arrive at a diagnosis when it comes to arrhythmias.

I wish you well with everything.
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Old 08-14-2019, 05:13 PM
 
311 posts, read 216,569 times
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Quote:
Originally Posted by turkeydance View Post
"Care to play ďguess that arrhythmiaĒ in the meantime?"
Jeopardy: what happens when we want to post on C-D?
OMG.....our favorite dinner entertainment

But we do need to help Jill distract herself from her other issues
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Old 08-14-2019, 06:27 PM
 
1,164 posts, read 560,422 times
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Originally Posted by Travelassie View Post
So it could be that your a-fib (even if it's not all that frequent right now) could be a player in the apparently tachy-brady episode( s) you had. With any luck the beta blocker will help keep the afib under control by keeping your heart rate within normal ranges, and that may help with keeping any bradycardia at bay.

I've had supraventricular tachycardia (SVT) for many years, and have taken metoprolol since 2001 when I had an episode that wouldn't stop (HR around 190's) till I got Adenosine in the ER. I had testing afterwords to rule out cardiovascular disease (I don't have it) but they told me I'd have to take metoprolol for he rest of my life unless I agreed to a cardiac ablation. I refused the ablation, and the metoprolol did a great job of keeping the tachy to a minimum for many years, and I had a normal heart rate at that point.

I started taking diltiazem for high blood pressure some years later, and took both these drugs for many years. I mention this because both beta blockers, and calcium channel blockers (metoprolol and diltiazem, respectively) tend to lower the heart rate (which is why they're used to control heart rates in tachyarrhythmias), in some people they lower the heart rate significantly, most people not so much. But for many years I had no issues with either of these drugs.

Fast forward about 14 yrs, another episode that turned out to be a-flutter took me to the ER again, but this stopped shortly after I got there (had gone on for about 4 hours at home). They kept me overnight and I saw a cardiologist the next day. He scheduled a followup event monitor and a followup visit, and changed the type of metoprolol I was taking from the extended to the immediate release. At that point, heart rates were still ok, and the SVT episodes were short and infrequent. And no problems I could see with the drugs.

But about two years after that (around early-mid 2017), my heart rates began taking a nosedive (sometimes into the low 40s at that point). This was intermittent, and not symptomatic at first, and the heart rate would go up appropriately with activity. The cardiologist was concerned that the diltiazem and metoprolol combination was having a cumulative effect on lowering the heart rate and his opinion is that diltiazem isn't that effective for either tachy or blood pressure control so he took me off the diltiazem, and we assumed the heart rate would go up. Well, for a couple months, even without an increase in the metoprolol, the intermittent low heart rates continued, at times they'd drop into the 30's and I'd be a little light-headed when that happened. But then the SVT started up again, again, intermittently over the next 4 months or so, and were increasing in frequency (picked up on a 2 week Zio monitor patch), and the cardiologist tripled the metoprolol dose from 50 to 150 mg/day.

Well, that amount of metoprolol did a great job on the SVT but over time the incidents of bradycardia became more frequent, and were becoming symptomatic (light-headedness, exercise intolerance, chronic tiredness mostly) but I carried on, mostly waiting and hoping I'd get used to get used to the stuff, and being in denial that anything serious was really happening. And if I cut back on fhe metoprolol, the SVT would break through, and the bradycardia still happened.

But when I finally admitted the symptoms were getting to me, the cardiologist ordered another Zio monitor in January 2019, and the results showed numerous incidents of heart rates in the low 40's correlating with my reported symptoms, as well as some episodes of SVT. Within a short time the cardiologist referred me to an electrophysiologist, I think we both assumed I'd have that SVT ablation, maybe relieving the need for the metoprolol which was likely at least contributing to he bradycardia, and we would see where it went from there.


Well, from January 2019 onwards till I saw the EP in early April, the bradycardia became more frequent and the symptoms worsened, not just the light-headedness and tiredness, but also a couple of times when I came close to passing out, but hung onto something till it got better-at this point the HR would go into the high 30's or so. The worst experience, though, was the feeling that I was disoriented and confused, feeling as though I didn't have the mental wherewithal to complete a task or even finish a sentence. I found this frightening, I wondered if I might be spiraling down the rabbit hole into dementia at times. This happened several times when I was out in public, at an event, volunteering activities, with friends, and always when my heart rate went down into the low 40's, high 30's.

So when I saw the EP, he informed me that he believed I had atrial tachycardia (from review of my records), and explained why this would likely not be amenable to a sucessful ablation, but better off controlled with medication. He called the sick sinus diagnosis, and on the possibility (as he said) it "might"be due to he metoprolol, he proposed I taper off the metoprolol and switch to diltiazem. He said I'd need a pacemaker if this didn't resolve the bradycardia and control the SVT, and it didn't.

So the scuttlebutt was that while it's likely both the metoprolol and diltiazem (even separately) might be associated with bradycardia in some people, in most cases (including mine), these drugs only unmask an underlying sinus node dysfunction process that will continue to progress with time anyway. I couldn't disagree , as from what I had seen that bradycardia reared its ugly head no matter how little of the metoprolol I took, or with a drug (diltiazem) that isn't suppose to cause significant bradycardia in normal people, and it occurred at times more random than one would expect if it were solely in response to a drug. And I can now take enough of the medication I need to control the tachycardia and high blood pressure without having to worry about my heart rate going too low.

So I had the pacemaker a dual chamber St. Jude model, put in on June 12. No problems, I was discharged late the same day it was put in. There was a little pain (more of an ache like a toothache) for several days but nothing that couldn't be well controlled with some Extra Strength acetominophen. The incision has healed well, and a couple of pacer checks and adjustments in the office have indicated I'm atrial pacing at 84%, the rate response allows the heart rate to increase as I need it to and all is well. I have a remote monitor on the nightstand that communicates with the pacemaker via bluetooth and sends this information to the patient monitoring website for access by the physician or clinic, so after a time this will significantly cut back on office visits if all is otherwise ok.

And I feel so very much better, with much more energy with the pacemaker. I even feel as though what passes for my mind is back. And I even sleep better! I didn't want a pacemaker, dragged my feet when I was informed I needed one, but even my Queen of Denial alter ego must admit it was a good thing. And while I still feel it in place sometimes, even a few little mild twinges when I stretch out that arm sometimes, I'm well on my way to forgetting it's there.
Wow. And I thought Iíve had every arrhythmia in the book.

Iíve had aflutter combined with afib, which resulted in a 270 heart rate. The cardiologist in the ER needed the electrophysiologist to figure it out. She said it was a very clear case of the 2 happening at once. An ablation eradicated what she considered the more serious of the 2 - the aflutter, but I still occasionally get afib and need to be cardioverted, either with the ďpaddlesĒ or adenisone (No!).

PVCs and pacs come and go, mostly asymptomatic, but Iím very cognizant of my heart function. Iíve never had a cardiologist tell me any of it was life threatening, nor have any of them explained to me why it was happening. I too have been on metoprolol and will be for life. Iím not sure if it helps or not. Iíve never experienced anything like that 270 bpm episode since the aflutter ablation 15 years ago.
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Old 08-14-2019, 09:14 PM
 
Location: SW Florida
9,949 posts, read 7,211,456 times
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Quote:
Originally Posted by Cabound1 View Post
Wow. And I thought Iíve had every arrhythmia in the book.

Iíve had aflutter combined with afib, which resulted in a 270 heart rate. The cardiologist in the ER needed the electrophysiologist to figure it out. She said it was a very clear case of the 2 happening at once. An ablation eradicated what she considered the more serious of the 2 - the aflutter, but I still occasionally get afib and need to be cardioverted, either with the ďpaddlesĒ or adenisone (No!).

PVCs and pacs come and go, mostly asymptomatic, but Iím very cognizant of my heart function. Iíve never had a cardiologist tell me any of it was life threatening, nor have any of them explained to me why it was happening. I too have been on metoprolol and will be for life. Iím not sure if it helps or not. Iíve never experienced anything like that 270 bpm episode since the aflutter ablation 15 years ago.
Sounds as though you went through the wringer there for a while with the afib/flutter combination. I imagine a 270 heart rate made you feel utterly miserable.

I don't know that afib is less serious than aflutter, but I'm told ( by the EP I've seen), that an aflutter ablation is a pretty simple straightforward procedure, and as he put it, an easy ( relatively so) fix for aflutter. The afib ablation is more complicated, takes longer and the success rate isn't ( at least on the first go-round) isn't as high as for the aflutter ablation. Perhaps this is why your doctor chose to ablate your aflutter when she did.

I'd guess the metoprolol is controlling your heart rate at least to some extent, you might have more afib than you already do without this medication. Has your cardiologist ever spoken to you about either increasing the metoprolol, or changing what you take to an antiarrhythmia drug?

As to the why of afib, there are numerous ideas, explanations, theories out there about that. One of the current thoughts seems to be that it's associated with atrial tissue damage from aging, smoking, uncontrolled hypertension, diabetes, other disease processes that result in fibrosis and scarring, and enlargement of the atria. There are probably other reasons it occurs as well. They say that afib itself, especially if it's paroxysmal ( occurring now and then), isn't immediately life threatening, but it comes with the risk of stroke from the "disordered" blood circulation in the fibrillating atria, and stasis resulting in clot formation there. That's why ( depending on calculated risk factors for stroke), persons with afib are put on anticoagulants. I'd imagine with your history of needing cardioversion occasionally from afib you are also on an anticoagulant. Also untreated afib ( either persistent or permanent) can result in heart failure over time.

I guess afib is one arrhythmia I haven't had, though the electrophysiologist warned me that if I didn't get my blood pressure under better control, the tachycardia would get worse and I would get afib. I've had high blood pressure since I was a spring chicken and it's always been difficult to control, that's a genetic tendency for me as my dad had the same issues and I have two siblings with the same problems. The EP added another medication to my blood pressure "cocktail".
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Old 08-15-2019, 12:00 AM
 
1,164 posts, read 560,422 times
Reputation: 1986
Quote:
Originally Posted by Travelassie View Post
Sounds as though you went through the wringer there for a while with the afib/flutter combination. I imagine a 270 heart rate made you feel utterly miserable.

I don't know that afib is less serious than aflutter, but I'm told ( by the EP I've seen), that an aflutter ablation is a pretty simple straightforward procedure, and as he put it, an easy ( relatively so) fix for aflutter. The afib ablation is more complicated, takes longer and the success rate isn't ( at least on the first go-round) isn't as high as for the aflutter ablation. Perhaps this is why your doctor chose to ablate your aflutter when she did.

I'd guess the metoprolol is controlling your heart rate at least to some extent, you might have more afib than you already do without this medication. Has your cardiologist ever spoken to you about either increasing the metoprolol, or changing what you take to an antiarrhythmia drug?

As to the why of afib, there are numerous ideas, explanations, theories out there about that. One of the current thoughts seems to be that it's associated with atrial tissue damage from aging, smoking, uncontrolled hypertension, diabetes, other disease processes that result in fibrosis and scarring, and enlargement of the atria. There are probably other reasons it occurs as well. They say that afib itself, especially if it's paroxysmal ( occurring now and then), isn't immediately life threatening, but it comes with the risk of stroke from the "disordered" blood circulation in the fibrillating atria, and stasis resulting in clot formation there. That's why ( depending on calculated risk factors for stroke), persons with afib are put on anticoagulants. I'd imagine with your history of needing cardioversion occasionally from afib you are also on an anticoagulant. Also untreated afib ( either persistent or permanent) can result in heart failure over time.

I guess afib is one arrhythmia I haven't had, though the electrophysiologist warned me that if I didn't get my blood pressure under better control, the tachycardia would get worse and I would get afib. I've had high blood pressure since I was a spring chicken and it's always been difficult to control, that's a genetic tendency for me as my dad had the same issues and I have two siblings with the same problems. The EP added another medication to my blood pressure "cocktail".
Oh yeah, 270 bpm makes you feel like a goner.

Yes, the aflutter procedure is much more straight forward.

I take my pulse multiple times a day..... I don’t have on and off afib. My triggers are very clear... stimulation of the vagas nerve.

I’ve always had blood pressure on the low side.

All my other heart tests... echo, stress, ekg, are fine. Blood work...sugar, cholesterol , etc are fine. Stanford MD cardiologist says “it’s just you”

Lovely, just lovely.
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Old 08-15-2019, 09:11 AM
 
Location: SW Florida
9,949 posts, read 7,211,456 times
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Quote:
Originally Posted by Cabound1 View Post
Oh yeah, 270 bpm makes you feel like a goner.

Yes, the aflutter procedure is much more straight forward.

I take my pulse multiple times a day..... I donít have on and off afib. My triggers are very clear... stimulation of the vagas nerve.

Iíve always had blood pressure on the low side.

All my other heart tests... echo, stress, ekg, are fine. Blood work...sugar, cholesterol , etc are fine. Stanford MD cardiologist says ďitís just youĒ

Lovely, just lovely.
Maybe an electrophysiologist would be in order?
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Old 08-15-2019, 12:08 PM
 
1,164 posts, read 560,422 times
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Quote:
Originally Posted by Travelassie View Post
Maybe an electrophysiologist would be in order?
That’s what this guy is. I’m asymptomatic, so we are just staying the course with metoprolol until those rare (every few years) times I go into afib. Maybe this will change down the road .
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Old 08-15-2019, 12:12 PM
 
844 posts, read 296,255 times
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I hope you're feeling better and getting the help that you need.
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Old 08-20-2019, 07:42 AM
 
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I had another arrhythmia episode yesterday afternoon. I waited it out for about 1/2 hour hoping it might resolve on its own then I took one of my newly prescribed immediate release metoprolol pill (25 mg). It worked just fine. However, that combined with the 25mg extended release metoprolol I took at bedtime has made me feel really quite tired and dopy today. I am currently at my PCPís following up for potential low thyroid and just heard that my blood pressure is 100/65 (probably why I am feeling like a low-energy idiot). In the future I am going to divide the immediate release pill and only take the second half if I really need it. (BTW, I was given official permission to tinker with the dosage.)
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Old 08-20-2019, 09:20 AM
 
Location: SW Florida
9,949 posts, read 7,211,456 times
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Quote:
Originally Posted by Jill_Schramm View Post
I had another arrhythmia episode yesterday afternoon. I waited it out for about 1/2 hour hoping it might resolve on its own then I took one of my newly prescribed immediate release metoprolol pill (25 mg). It worked just fine. However, that combined with the 25mg extended release metoprolol I took at bedtime has made me feel really quite tired and dopy today. I am currently at my PCPís following up for potential low thyroid and just heard that my blood pressure is 100/65 (probably why I am feeling like a low-energy idiot). In the future I am going to divide the immediate release pill and only take the second half if I really need it. (BTW, I was given official permission to tinker with the dosage.)
Well, that's all you need to add to your other health issues.

Glad to hear the metoprolol seems to have short-circuited the arrhythmia, in any case. It's possible the extra metroprolol helped that low blood pressure along, but it's hard to say with possible hypothyroid issues as those can be associated with low blood pressure too. But yeah, a low blood pressure like that could make you feel dragged out. Is your heart rate ok (outside the arrhythmia incidents, that is)?

If it looks like those arrhythmias seem to want to become regular visitors in your life, IMO it wouldn't be a bad idea to speak to your cardiologist (or even your PCP if you don't have a cardiologist ) about getting a cardiac event monitor to detect and characterize the types of arrhythmias you're having.

The types of monitors available range from the Holter monitor which you wear from 24-48 hours, to event monitors you wear from 3-4 weeks (depending on physician's orders). There is even a monitor that consists of a two lead "patch" that the patient wears for up to two weeks (Zio monitor), which is convenient as it doesn't involve changing EKG leads or dealing with a transmitter. Which one is used depends on the frequency of the arrhythmia and the likelihood of catching an event within the timeframe the monitor is used.

An event monitor would hopefully give you and your doctor a good picture of the type of arrhythmia(s) you're having, their frequency, and how long they last. The information might well lead to a diagnosis and treatment specifically for the arrhythmia.

Anyway, good luck!
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