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Old 08-26-2019, 01:32 PM
 
Location: SW Florida
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Quote:
Originally Posted by guidoLaMoto View Post
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.




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?.
Yes, it's a topic with which I have much personal experience, so I like to know as much as I can about it.

Actually, what they are NOT ablating for afib are AV node dependent accessory or reentry pathways, as they do for AVNRT and AVRT tachycardias. The electrical signals causing the "fibrillation" in the atria are found entirely in the atria, are not AV node dependent. The ablations for afib look to me (as I understand what I read) involve isolating or interrupting these atrial aberrant electrical signals by 1)pulmonary vein isolation, 2) Maze procedures (doesn't look as though this is done much these days, or 3) AV node ablation, which seems to be a last ditch attempt to control the adverse effects of afib by destroying the AV node and installing a pacemaker.

https://www.mayoclinic.org/tests-pro...t/pac-20384969

Quite a bit more involved than AVNRT or AVRT, or for that matter an a-flutter ablation.

The other thing is that the arrhythmias other than afib aren't believed to carry the same risks for thromboembolism as does a-fib. So anticoagulation isn't generally considered for patients with these other arrhythmias (thank goodness, the monkey on my back is atrial tachycardia.).

But all this is just peripheral information to someone with documented a-fib and is trying to deal with that. So IMO the take home message here is that a-fib is a different animal from all those other arrhythmias, you can't just lump them all together.

Last edited by Travelassie; 08-26-2019 at 01:41 PM..
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Old 08-26-2019, 03:45 PM
 
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Sigh. I had another episode this afternoon. It really does not seem like afib to me. I have the odd irregular beat (like a PVC) then a whole bunch of normal beats, then another odd beat, then more normal beats. My HR increase, but I did not get super high — in the 80s, low 90s max. So, yes, high for just sitting around, but not afib high. I did feel a little symptomatic — a little flushed, lightheaded and ill-at-ease. I resisted taking a beta blocker (either immediate or extended release) and now I am mainly back to normal again. (Still having an odd heartbeat every 30 minutes or so.) This episode went on for about an hour and a half and was distressing enough that I left a friend’s house early so I could get back to the meds if I needed them.

Tomorrow I am going to call the cardiologist I saw in the hospital and my electrocardiogist. I know why I have procrastinated. It just seems like such a struggle dealing with this whole thing. What I want is more heart rate monitoring (maybe an event monitor, not just a 48 hour Holter monitor). But I know that before they do this they are going to insist that I do a stress test. I don’t know how many times I have told them I have never ever ever ever had any problems exercising. I can get my heart rate up appropriately, do not have symptoms, do not have irregularities. And I am already up the wazoo with medical appointments and am just not looking forward to more. But I will need to jump through all the hoops ...

So I would like someone to give me an event monitor, then use their brain to figure out what is really going on with me, instead of the old let’s just throw a bunch of medication at the problem and hope something sticks while not the patient worse in the meantime.
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Old 08-26-2019, 05:42 PM
 
Location: SW Florida
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Quote:
Originally Posted by Jill_Schramm View Post
Sigh. I had another episode this afternoon. It really does not seem like afib to me. I have the odd irregular beat (like a PVC) then a whole bunch of normal beats, then another odd beat, then more normal beats. My HR increase, but I did not get super high — in the 80s, low 90s max. So, yes, high for just sitting around, but not afib high. I did feel a little symptomatic — a little flushed, lightheaded and ill-at-ease. I resisted taking a beta blocker (either immediate or extended release) and now I am mainly back to normal again. (Still having an odd heartbeat every 30 minutes or so.) This episode went on for about an hour and a half and was distressing enough that I left a friend’s house early so I could get back to the meds if I needed them.

Tomorrow I am going to call the cardiologist I saw in the hospital and my electrocardiogist. I know why I have procrastinated. It just seems like such a struggle dealing with this whole thing. What I want is more heart rate monitoring (maybe an event monitor, not just a 48 hour Holter monitor). But I know that before they do this they are going to insist that I do a stress test. I don’t know how many times I have told them I have never ever ever ever had any problems exercising. I can get my heart rate up appropriately, do not have symptoms, do not have irregularities. And I am already up the wazoo with medical appointments and am just not looking forward to more. But I will need to jump through all the hoops ...

So I would like someone to give me an event monitor, then use their brain to figure out what is really going on with me, instead of the old let’s just throw a bunch of medication at the problem and hope something sticks while not the patient worse in the meantime.
,
I absolutely agree with you that the next step in figuring out what's happening with your heart would be an event monitor. It could be something that's benign, just annoying (like PVCs or PACs, perhaps), to other arrhythmias that might also be more annoying than dangerous but depending on their frequency, can be controlled with medication. They need to rule out anything that could be dangerous if you had heart disease and treat, or reassure you as needed.

They may want to rule out coronary artery or other heart disease at some point, perhaps with an echocardiogram or a stress test, but I'd think that could come later.
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Old 08-26-2019, 06:49 PM
 
Location: The Driftless Area, WI
2,900 posts, read 1,126,024 times
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Quote:
Originally Posted by Travelassie View Post
...the monkey on my back is atrial tachycardia.).

.
I agree with you about cardiac monitoring and Stress test for Jill. Her description sounds more like premature beats &/or PAT and less like a fib.


Your PAT reminds me of my experience as a med student. I was working in the cardiology dept at Uof I when they were the world leaders in the then new area of His Bundle electrocardiology. Dr.Rosen was getting huge amounts of grant money and his dept included funding for 20 some fellows. Huge.


There was a weekly dysrhythmia conference attended by the fellows and the residents and students on rotation in cardiology. Dr.Rosen would flash EKG after EKG on the screen showing all sorts of strange dysrhythmias and call on various attendees to make the call. Sometimes everyone would be stumped and it wasn't long before I realized that those cases were almost always "PAT with variable block"- usually due to digitalis toxicity. ...Once I figured that out, anytime everyone got stumped, I would raise my hand and state in my most dignified baritone voice, "Why, that's obviously PAT with variable block. Probably dig toxicity."...I quickly became the Wunderkind to Dr. Rosen, but man, the looks I got from the fellows. I'm glad they didn't carry weapons.
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Old 08-29-2019, 06:32 PM
 
418 posts, read 128,813 times
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I actually saw my electrophysiologist. When I first called they said that the first opening was in January. Then I explained my situation (really strange rhythm, sometimes symptomatic with chemoradiation right around the corner) and suddenly an opening appeared the very next day. He agreed that an event monitor was a good idea. I am going to get that and a stress test on Tuesday.

However, now I am having the weird arrhythmia again and am not sure what to do. I am wondering if I have partial heart block. I can feel that there are very fast heartbeats going on somewhere in me and yet when I take my pulse I am feeling irregular, hard thumping slow ones — about 48 to 56 beats per minute. It was that way for a while, then it got faster and more irregular — up to around 90 to 100 bpm. I am not sure how to make it stop. I do have the immediate release metoprolol, but am concerned that will make the heart block worse if that is what I have.

I am going to give it a little bit and see if it goes back to normal on its own. Could I have afib combined with a partial heart block? Does that make any sense?

I am having no symptoms at the moment besides the very annoying arrhythmia.
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Old 08-29-2019, 08:07 PM
 
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Yup, completely back to normal within an hour and a half. It didn’t suddenly reset, it went back gradually with gradually increasing periods of normal sinus rhythm and decreasing periods of whatever the abnormal rhythm was.
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Old 08-30-2019, 04:25 AM
 
Location: The Driftless Area, WI
2,900 posts, read 1,126,024 times
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Taking a pulse at the wrist ("polso" is Italian for "wrist") is inadequate because early beats don't have time to fill the heart all the way with blood, so they may not be felt all the way down a the wrist.


A. fib is a heart block, in a manner of speaking, because the AV node is getting bombarded by signals from the atria @ 400+/sec and not all of them can get thru-- kinda like the Three Stooges all trying to get thru the doorway at the same time. (absolute & relative refractory period).


The problem with popping pills for these events is that the med won't build up to an effective blood level for hours and your episodes are sudden and short duration. If you take the meds on a regular basis, it may or may not work, may or may not be counter-productive, as you already realize....But I know the feeling-- you want to do something! Be patient. Wait for the monitor results.
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Old 08-30-2019, 02:05 PM
 
Location: SW Florida
9,949 posts, read 7,211,456 times
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Quote:
Originally Posted by Jill_Schramm View Post
I actually saw my electrophysiologist. When I first called they said that the first opening was in January. Then I explained my situation (really strange rhythm, sometimes symptomatic with chemoradiation right around the corner) and suddenly an opening appeared the very next day. He agreed that an event monitor was a good idea. I am going to get that and a stress test on Tuesday.

However, now I am having the weird arrhythmia again and am not sure what to do. I am wondering if I have partial heart block. I can feel that there are very fast heartbeats going on somewhere in me and yet when I take my pulse I am feeling irregular, hard thumping slow ones — about 48 to 56 beats per minute. It was that way for a while, then it got faster and more irregular — up to around 90 to 100 bpm. I am not sure how to make it stop. I do have the immediate release metoprolol, but am concerned that will make the heart block worse if that is what I have.

I am going to give it a little bit and see if it goes back to normal on its own. Could I have afib combined with a partial heart block? Does that make any sense?

I am having no symptoms at the moment besides the very annoying arrhythmia.
So glad you got in to see the electrophysiologist. Yes, bradycardia can go along with afib, but there could be a number of reasons for the palpitations you're feeling. The best way to see what's going on is on an event monitor, unless it's documented it's just guessing. Hopefully that arrhythmia will show up when you have the monitor so the EP can see it.


As for the medication, in your shoes I'd probably contact the EP's office and seek their advice.
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Old Today, 12:36 AM
 
418 posts, read 128,813 times
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I had another bout of non-stop scary somewhat symptomatic arrhythmia on Thursday evening and my husband convinced me to go to the ER (again). There, they found that (again) I had a sinus arrhythmia, not otherwise specified. They ran all kinds of blood tests as per usual.

Everything came back normal, except for my d-dimer level which was 1.09 mg/l where the upper limit of normal was .5 mg/l. Apparently, d-dimer is a protein that is shed when the body goes to work on a pulmonary embolism, and palpitations can be a symptom of PE and PEs are more common in lung cancer (which I have), so it looked like a real possibility or at least something go rule out. So I had a special CT scan to check for PEs, but they found nothing.

Still, I had this high d-dimer rate. Apparently, having cancer often leads to “false positive” d-dimer. There are articles describing the average d-dimer rate for various kinds of cancer, and it turns out my d-dimer level was almost exactly the average level for someone with squamous cell lung cancer (1.06 mg/l).

So while my elevated d-dimer rate turned out to be a false positive for PE, I am thinking that it is a true positive for something else besides just “having cancer,” but I am not exactly sure what. Maybe the hypercoagulative state that often accompanies cancer. Anyway, it was the first indication that my cancer is systemic in some way and not just in these three closely clustered lymph nodes. It also made me wonder whether or not this d-dimer level was linked to my frequent arrhythmias recently and whether these strange increasingly frequent arrhythmias are not actually my very first cancer symptom (I mean aside from my one palpable lump).

Anyway, tonight I was woken up just a little while ago — around 1:45am with the arrhythmia again. I got out of bed and used the ekg app on my Apple Watch. I am now back in sinus arrhythmia, but before that I am pretty sure I had a bunch of PVCs, but then I definitely went into something that I hope was just a supraventrical tachycardia, but might have been a ventricular tachycardia— the beats looked close together, even and in a relatively simple sawtooth pattern with a wide amplitude. It was a little scary. But now I am back in sinus mode again.

Also, this morning I am getting a stress test and tomorrow I am getting my 30-day event monitor. The nurses at my EP’s have assured me that I can wear it even though I am going to get radiation. I don’t know how true this is though. I will have to ask my oncologists about this and the d-dimer level.
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Old Today, 05:19 AM
 
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
Apparently, d-dimer is a protein that is shed when the body goes to work on a pulmonary embolism,

Still, I had this high d-dimer rate. Apparently, having cancer often leads to “false positive” d-dimer. There are articles describing the average d-dimer rate for various kinds of cancer, and it turns out my d-dimer level was almost exactly the average level for someone with squamous cell lung cancer (1.06 mg/l).




..., but before that I am pretty sure I had a bunch of PVCs, but then I definitely went into something that I hope was just a supraventrical tachycardia, but might have been a ventricular tachycardia— the beats looked close together, even and in a relatively simple sawtooth pattern with a wide amplitude.

.

You figured it out again---d-dimer is a protein whose level goes up when the coagulation cascade is activated. Many cancers show hyper-coagulable status.


Wide complex beats are not necessarily PVCs. Wide complex just means there's delayed conduction thru the ventricles. That might well occur with PAT. PAT should show p waves. PVCs don't. "Saw-tooth" is how 2nd degree AV block is often described.


Tell your cardiologist you know it's "PAT with variable block." That always works.


Another trick I used to pull when put on the spot by the professor was to state a "fact" and quote an imaginary reference from the medical literature. They didn't want to admit they hadn't read it, so they'd agree with me and change the subject.
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