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Old 08-20-2019, 10:32 AM
 
418 posts, read 128,813 times
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Yeah, I should probably do that. Itís just that I have such a great electrophysiologist that heís never available. The first available appointment he has is in mid-October. And I am really reluctant to take it because a God only knows where I will be (both physically and health-wise) by that time. I liked the cardiologist I saw in the hospital and he said he was going to have his office reach out to me and set up an outpatient appointment for a stress test. But I havenít heard anything. Maybe I should just take the initiative and reach out to him, even though he is not my regular electrophysiologist.

Also, I am starting to get overwhelmed with all the different medical issues and appointments. Although I guess it could be a matter of just one or two more appointments. And I suppose I could wear the monitor straight through other medical treatments, right? I mean there is no reason I couldnít have the monitor and have an endoscopy or chemo or radiation at the same time, right? I suppose I could just inquire about this. But I would prefer not having yet another appointment only to find out it wonít be feasible.
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Old 08-20-2019, 01:51 PM
 
Location: SW Florida
9,950 posts, read 7,211,456 times
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Quote:
Originally Posted by Jill_Schramm View Post
Yeah, I should probably do that. Itís just that I have such a great electrophysiologist that heís never available. The first available appointment he has is in mid-October. And I am really reluctant to take it because a God only knows where I will be (both physically and health-wise) by that time. I liked the cardiologist I saw in the hospital and he said he was going to have his office reach out to me and set up an outpatient appointment for a stress test. But I havenít heard anything. Maybe I should just take the initiative and reach out to him, even though he is not my regular electrophysiologist.

Also, I am starting to get overwhelmed with all the different medical issues and appointments. Although I guess it could be a matter of just one or two more appointments. And I suppose I could wear the monitor straight through other medical treatments, right? I mean there is no reason I couldnít have the monitor and have an endoscopy or chemo or radiation at the same time, right? I suppose I could just inquire about this. But I would prefer not having yet another appointment only to find out it wonít be feasible.
I completely understand. Electrocardiologists are busy busy people, and you want one that's busy (more experienced and in demand), but I'd be reluctant too to schedule an appointment that far ahead when you don't know what you'll be dealing with otherwise with your health.

In your shoes I'd probably call the office of the cardiologist you saw in the hospital, tell them of your new arrhythmia event, maybe ask about testing (the stress testing was mentioned, how about an event monitor?), see about an appointment with the cardiologist, something like that. See what they say.

A regular cardiologist can order, review results, arrive at a diagnosis for an arrhythmia and prescribe medication, at least initially. And can always refer a patient to an EP, with test results if things get complicated, or the doc thinks the patient should see an EP. If you can see a cardiologist, get this testing done sooner than if you waited to see an EP (who would order this testing if it's not already done), those test results could be available to the EP if you saw him/her at a later date and your treatment/management could go from there.

I don't guess this happens very often, but when I had my episode of a-flutter in 2015, and stayed overnight in the hospital, the cardiologist I saw (after asking if I had a cardiologist and I said no) really took control of things. He changed a couple of the medications I was taking, and I got a call from his office a couple days after discharge, informing me that he had brought my records into the office, and requested that they order a 3 week event monitor for me and set up an appointment with him after that when results were in. He managed the tachycardia after that, and I have to say that the results of the testing he subsequently ordered over the next few years, were available to the EP he referred me to finally, allowing the EP to arrive at a diagnosis and treatment very shortly after I saw him.

I guess depending on the tests or procedures, those could be done while a patient is on a monitor. A holter monitor has the shortest timeframe (usually 24 hours, sometimes 48) and might be scheduled around another procedure. An event monitor could be disconnected during a procedure (like it is when the patient showers), and reconnected afterwards. The Zio patch remains in place but the manufacturer lists on its website procedures that are ok and not ok to be done while a patient is wearing a patch. I recall being reassured that the Zio patch I was wearing would in no way interfere with the nuclear stress test I had ordered, and neither would the stress test interfere with the Zio monitoring. So you can run any of these questions by the providers and they'll tell you.
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Old 08-21-2019, 04:42 AM
 
418 posts, read 128,813 times
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Thanks, travelassie!

Today is going to be cancer diagnostic testing day all day, but hopefully tomorrow I can get the ball rolling with the cardiologist I saw in the hospital.

I was also thinking that the significant increased afib episodes recently may be directly related to my cancer (I.e. not just a general response to emotional stress). Maybe there is more inflammation in general in my body, or I am generally physiologically out-of-whack and this general systemic disorder is triggering the episodes. I am more inclined to think this because: 1) my arrhythmia episodes have been gradually getting more frequent and serious since about last November which was the same time my palpable lymph node seems to have first appeared and 2) the episodes do not necessarily coincide with times I am *feeling* more stressed out. I have definitely had them when I am feeling calm and relaxed. Very often them seem to come out of thin air now and that was rarely the case before.
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Old 08-21-2019, 02:25 PM
 
Location: SW Florida
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Originally Posted by Jill_Schramm View Post
Thanks, travelassie!

Today is going to be cancer diagnostic testing day all day, but hopefully tomorrow I can get the ball rolling with the cardiologist I saw in the hospital.

I was also thinking that the significant increased afib episodes recently may be directly related to my cancer (I.e. not just a general response to emotional stress). Maybe there is more inflammation in general in my body, or I am generally physiologically out-of-whack and this general systemic disorder is triggering the episodes. I am more inclined to think this because: 1) my arrhythmia episodes have been gradually getting more frequent and serious since about last November which was the same time my palpable lymph node seems to have first appeared and 2) the episodes do not necessarily coincide with times I am *feeling* more stressed out. I have definitely had them when I am feeling calm and relaxed. Very often them seem to come out of thin air now and that was rarely the case before.
There are sooooooo many proposed causes of a-fib, some have basis in fact and others speculative, and the causes may differ in different people. It may well be stress related (but not necessarily caused by stress), or triggered by inflammation or other events happening in your body, but that's speculative and you could drive yourself bonkers trying to figure it out (though I'd have those same thought processes in your shoes, I'm sure). And I'm sure you've run across this already, but you'd get as many opinions ( some solicited, many not, LOL) about this as there people to offer those opinions.

Whatever it is, you sure don't need an afib (or other arrhythmia issue) complicating your treatment for your cancer-if for no other reason that it'll make you feel worse. If you can get it identified and under control (hopefully with rate control meds, they're the cheapest and have the fewest side effects) see if they think you might need an oral anticoagulant, hopefully it can take its rightful back seat to your other health issues.

If you see your docs at Moffitt sooner than the cardiologist, it'd be a good idea to let them know of your arrhythmia issues. They need to know all you can tell them about your general health and other medical conditions anyway, and they may be able to get you some help with your cardiology issues as well.

Best wishes with all of it!
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Old 08-25-2019, 11:30 AM
 
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I did a little research on my own a few nights ago when more arrhythmias were getting in the way of my sleep. I think I have what they call vagal afib because I only seem to get it when I am relaxing, not when I am stressed out or physically active. I also read that beta blockers actually exacerbate this kind of afib since they cause you to relax and this actually triggers the vagal afib more.

In any case, I stopped taking the extended release beta blocker and since I have stopped I have felt great ó no arrhythmia at all. I am definitely feeling better than when I was on it.

I know that when I do have afib, the immediate release, pill-in-the pocket beta blocker is definitely effective in the short-term, but maybe it was sitting me up for long term issues which were then definitely compounded when I started taking the extended release beta blocker (metoprolol) every evening.

Maybe I will go back to having a problematic afib event once every six months or so, instead of every week or even every 3-4 days as was happening this summer.
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Old 08-25-2019, 11:48 AM
 
Location: The Driftless Area, WI
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The root cause of a fib usually isn't important (although hyperthyroidism & mitral stenosis come to mind) because they generally can't be treated per se. Two problems of a fib-- HR goes so high that cardiac output falls & intra-cardiac blood clots embolize causing strokes. Treat the first with beta-blockers or Ca channel blockers and the second with anticoagulants.


Some a fib cases are associated with "accessory pathways" allowing a short cut of the depolarization wave from the atria to the ventricles, avoiding the normal path- the AV node. Those paths can be obliterated with radio-therapy. About half the cases need a second treatment.


Those accessory paths are highly variable. Some are slowed down with beta-blockers. Some are sped up. (It has to do with the Goldilocks zone of the refractory period.)


Accessory paths can allow for "circus movement" of depolarization. The atrial impulse passes down the accessory path and then backwards back up from the ventricle to the atrium. A positive feedback system.


IN your case, Jill, you notice the irregularity more at lower heart rates. It very well may be "rate related," but it also might be that when going fast enough, you don't notice the irregularity-- too small a difference in the cycle lengths between beats.
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Old 08-25-2019, 02:28 PM
 
418 posts, read 128,813 times
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Originally Posted by guidoLaMoto View Post

IN your case, Jill, you notice the irregularity more at lower heart rates. It very well may be "rate related," but it also might be that when going fast enough, you don't notice the irregularity-- too small a difference in the cycle lengths between beats.
Iím sure I donít have afib at my normal, un beta blockered heart rate. I am very sensitive to the irregularity of afib and besides I have been tested multiple times with EKGs and Holter monitor and everything is always normal. One of the reasons I went to urgent care last week is this I wanted to get the arrhythmia documented.
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Old 08-25-2019, 03:56 PM
 
Location: SW Florida
9,950 posts, read 7,211,456 times
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Quote:
Originally Posted by Jill_Schramm View Post
Iím sure I donít have afib at my normal, un beta blockered heart rate. I am very sensitive to the irregularity of afib and besides I have been tested multiple times with EKGs and Holter monitor and everything is always normal. One of the reasons I went to urgent care last week is this I wanted to get the arrhythmia documented.
Or at this point it may just be paroxysmal and comes and goes regardless of the beta blockers. In that case it would seem the extended release beta blocker isn't helping much.

I can well understand why you'd want to discontinue a drug you think may be be at least, not helping the arrhythmia. And with all your other health issues you want that %$*&&### arrhythmia out of your life. But I'd just suggest you keep an eye on it ( don't think it'll let you do otherwise if it shows up again ) and keep your other providers ( ie, you PCP and cancer docs) in the loop about it-especially if you have recurring incidents.They may be able to direct you to a cardiologist who can help you with whatever is going on.
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Old 08-25-2019, 04:07 PM
 
Location: SW Florida
9,950 posts, read 7,211,456 times
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Quote:
Originally Posted by guidoLaMoto View Post
The root cause of a fib usually isn't important (although hyperthyroidism & mitral stenosis come to mind) because they generally can't be treated per se. Two problems of a fib-- HR goes so high that cardiac output falls & intra-cardiac blood clots embolize causing strokes. Treat the first with beta-blockers or Ca channel blockers and the second with anticoagulants.


Some a fib cases are associated with "accessory pathways" allowing a short cut of the depolarization wave from the atria to the ventricles, avoiding the normal path- the AV node. Those paths can be obliterated with radio-therapy. About half the cases need a second treatment.


Those accessory paths are highly variable. Some are slowed down with beta-blockers. Some are sped up. (It has to do with the Goldilocks zone of the refractory period.)


Accessory paths can allow for "circus movement" of depolarization. The atrial impulse passes down the accessory path and then backwards back up from the ventricle to the atrium. A positive feedback system.


IN your case, Jill, you notice the irregularity more at lower heart rates. It very well may be "rate related," but it also might be that when going fast enough, you don't notice the irregularity-- too small a difference in the cycle lengths between beats.

Well, while a-fib is technically categorized as a " supraventricular ( above the ventricles) tachycardia", along with the other types of atrial or AV associated arrhythmias, it's kind of a different animal ( involving a different mechanism) from those you mention that involve accessory pathways. I think you're talking about Atrial Node Re-entry Tachycardia (AVNRT) and Atrio-Ventricular Reciprocating Tachycardia (AVRT) in your descriptions of the abnormal pathways.

https://www.webmd.com/heart-disease/...ar-tachycardia
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Old 08-26-2019, 01:05 PM
 
Location: The Driftless Area, WI
2,900 posts, read 1,126,024 times
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Quote:
Originally Posted by Jill_Schramm View Post
Iím sure I donít have afib at my normal, un beta blockered heart rate. I am very sensitive to the irregularity of afib and besides I have been tested multiple times with EKGs and Holter monitor and everything is always normal. One of the reasons I went to urgent care last week is this I wanted to get the arrhythmia documented.

Documentation is important, but also keep in mind that emboli are most likely to be thrown when converting from regular to irregular or vice versa.

Quote:
Originally Posted by Travelassie View Post
Well, while a-fib is technically categorized as a " supraventricular ( above the ventricles) tachycardia", along with the other types of atrial or AV associated arrhythmias, it's kind of a different animal ( involving a different mechanism) from those you mention that involve accessory pathways. I think you're talking about Atrial Node Re-entry Tachycardia (AVNRT) and Atrio-Ventricular Reciprocating Tachycardia (AVRT) in your descriptions of the abnormal pathways.

https://www.webmd.com/heart-disease/...ar-tachycardia

Very good. Your'e doing your home work. I didn't want to get too detailed in the explanation. But what do you think they're ablating with those radio waves when they treat the a fib?.
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