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Old 11-20-2018, 03:01 AM
 
1,952 posts, read 825,450 times
Reputation: 3346

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I went into the ER tonight with atrial fibrillation, or at least I had it when I left the house. By the time I got there the beta blocker that I had taken had done the trick and sinus rhythm had returned. It was my second lifetime episode of afib, the first having occurred a little more than 3 years ago.

I had hoped that that one episode (which had a clear trigger) was to be my only one, but I guess I’m not so lucky.

Anyhow, it seemed clear to me that I should schedule a follow-up with a cardiologist ASAP. In fact, that was what my ER doctor was suggesting until they got my lab work back. The lab work showed that I probably had mild hypothyroidism.

So, now instead of giving me the list of recommended cardiologists as promised, they told me to go to my primary care physician and get more thyroid testing done. I was skeptical. I thought that hyperthyroidism was associated with afib and an elevated heart rate in general and hypothyroidism was associatiated with the opposite, an abnormal slow heartbeat (which I do not have). They came back with: “Hypothroidism has about 60 symptoms associated with it.” And I thought, but did not say: “Yeah, but an elevated heart rate is not one of those 60 symptoms.”

I checked online for about an hour after I got back, perused various medical articles as well as ressources more geared to the general public. I found nothing whatsoever associating hypothyroidism and palpitations or afib. However, I did find several sources saying that the medication used to treat hypothyroidism could trigger afib attacks.

So, I am thinking the hypothyroid thing is a total red herring (at least as far as my heart problems are concerned) and I should just find a cardiologist on my own ASAP and forget about diddle-dallying around with my PCP and may endocrinologist — particularly since I will be leaving soon (< 1 month) for an extended stay in a remote area far from medical help.

Maybe I just needed to get my thoughts down, but if anyone has other ideas, fire away!
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Old 11-20-2018, 05:59 AM
 
Location: Eastern Tennessee
3,638 posts, read 3,087,382 times
Reputation: 10075
Either a cardiologist or internist can chase this down and get you on the right track.

Good luck.
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Old 11-20-2018, 09:52 AM
 
Location: Central IL
19,649 posts, read 13,117,088 times
Reputation: 47265
Mild hypothyroidism is not likely to cause you major issues in the relative short term - your PCP should be able to handle it. But it sure seems that a cardiologist should be your first call, with two trips to the ER and going to a remote area soon.
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Old 11-20-2018, 09:58 AM
 
Location: Nantahala National Forest, NC
27,079 posts, read 9,241,433 times
Reputation: 30347
Yes, you need to find a cardiologist for a physical review, further discussion about your specific issues and discuss your planned time away, in case more treatment, meds etc might be indicated.

AF, as you know, strikes without warning...important to have an approved MD plan when that occurs...
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Old 11-20-2018, 11:18 AM
 
Location: The Driftless Area, WI
5,324 posts, read 2,678,690 times
Reputation: 12936
Quote:
Originally Posted by Jill_Schramm View Post
I went into the ER tonight with atrial fibrillation.... !

You show good logical thinking, Jill.


Hypothyroidism is not associated with a. fib and will take years (maybe) to kill you if not treated. Untreated a. fib can kill you, or worse, leave you with a severe stroke suddenly.


Hypothyroidism is really easy to diagnose and treat in most cases, although given this new age of specialization, the cardiologist may not want to deal with it. Makes appt's with both.


There's two problems with a.fib--[a] sudden, rapid HR, possibly so fast that the heart can't fill with enough blood on each beat so cardiac output actually goes down-- organs can't get enough blood and that can be a problem as you might imagine. Beta blockers can be used to treat the HR, but don't do anything to prevent or reverse the a.fib…..and..


2) blood clots in the heart (common in a. fib) breaking loose (embolism) and causing a stroke. The embolism is most likely to occur as the heart changes rhythm-- either going from regular to irregular or just as likely going back to regular from irregular. Those who go into a fib and stay there are less likely to develop embolism than those who jump back and forth (even if it's just two episodes years apart.


Most cases of a. fib are just one of those things-- no precipitating cause, but many are due to an underlying condition-- hyperthyroidism, pulmonary embolism, heart valve disease, MI etc etc. Those conditions must be dealt with.


Now here's some facts to confound your cardiologist with, and a good example of how the lawyers have made life difficult for docs & pts:
- the risk of embolism in untreated a fib is 5%/yr-- so, untreated it's virtually a sure thing you will have a stroke over the course of 20 yrs.


-using aspirin as the anticoagulant, the risk of an embolic stroke goes down to 3%/yr (risk of law suit, maybe unjustified as you will see below, prevents your cadiol from recommending this.)


-using warfarin as the anticoagulant, with all it's PITA problems of added expense, monthly blood testing and frequently needed dosage changes and risks of bleeding, the risk of embolic stroke goes down to 1.5%, but the risk of hemorrhagic stroke goes up to 1% (!!)-- so we're really only talking about a difference in stroke rate of 0.5%/yr between easy aspirin vs more difficult warfarin treatment.---that's one stroke every 200 yrs... worth it???


-the newer type anticoagulants (not cleared for use in valve disease) are an improvement on these numbers, but are really expensive. This may be the best choice for you, given your plans to be away from convenient follow-up care. They don't require routine blood tests.


Good luck with it.


Oh!-- almost forgot-- you experienced (I presume) aa episode of rapid, irregular heart beat. You are assuming it was a. fib, but another condition (PAT or PSVT) could also have been the culprit. An EKG at the time of the episode would be needed to define the situation. I mention it because PAT/PSVT could be enabled by beta-blockers if you have an "accessory pathway."
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Old 11-20-2018, 12:06 PM
 
Location: planet earth
8,622 posts, read 4,383,155 times
Reputation: 19484
I think you should have a complete work up and all the associative lab and other tests to determine your baseline right now.

FYI: Not saying this is true for you, but some people don't know that a-fib can be caused by dehydration, so make sure you are always properly hydrated.
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Old 11-20-2018, 12:07 PM
 
Location: planet earth
8,622 posts, read 4,383,155 times
Reputation: 19484
Also, most people will dismiss this, but from a metaphysical standpoint, a-fib indicates heart chakra opening.
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Old 11-20-2018, 12:37 PM
 
Location: Southern California
29,245 posts, read 13,584,926 times
Reputation: 18773
Quote:
Originally Posted by Jill_Schramm View Post
I went into the ER tonight with atrial fibrillation, or at least I had it when I left the house. By the time I got there the beta blocker that I had taken had done the trick and sinus rhythm had returned. It was my second lifetime episode of afib, the first having occurred a little more than 3 years ago.

I had hoped that that one episode (which had a clear trigger) was to be my only one, but I guess I’m not so lucky.

Anyhow, it seemed clear to me that I should schedule a follow-up with a cardiologist ASAP. In fact, that was what my ER doctor was suggesting until they got my lab work back. The lab work showed that I probably had mild hypothyroidism.

So, now instead of giving me the list of recommended cardiologists as promised, they told me to go to my primary care physician and get more thyroid testing done. I was skeptical. I thought that hyperthyroidism was associated with afib and an elevated heart rate in general and hypothyroidism was associatiated with the opposite, an abnormal slow heartbeat (which I do not have). They came back with: “Hypothroidism has about 60 symptoms associated with it.” And I thought, but did not say: “Yeah, but an elevated heart rate is not one of those 60 symptoms.”

I checked online for about an hour after I got back, perused various medical articles as well as ressources more geared to the general public. I found nothing whatsoever associating hypothyroidism and palpitations or afib. However, I did find several sources saying that the medication used to treat hypothyroidism could trigger afib attacks.

So, I am thinking the hypothyroid thing is a total red herring (at least as far as my heart problems are concerned) and I should just find a cardiologist on my own ASAP and forget about diddle-dallying around with my PCP and may endocrinologist — particularly since I will be leaving soon (< 1 month) for an extended stay in a remote area far from medical help.

Maybe I just needed to get my thoughts down, but if anyone has other ideas, fire away!
My immediate thoughts are magnesium deficiency and afib issues. There are MANY links to check out re: magnesium and afib.

I have two friends who entered the afib world in the last few years and both before were NOT taking enough magnesium, maybe some in a combo but MAYBE not enough.

They are now on heart meds and did so much research and taking their higher doses of magnesium and of course, doctors never mentioned magnesium issue.

Personally, I've researched magnesium for years and know it's value in our bodies...including big time in the cardio area.
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Old 11-20-2018, 01:33 PM
 
3,323 posts, read 5,461,385 times
Reputation: 9881
Quote:
Originally Posted by guidoLaMoto View Post
- the risk of embolism in untreated a fib is 5%/yr-- so, untreated it's virtually a sure thing you will have a stroke over the course of 20 yrs.
If it's 5% PER YEAR, isn't it just 5% EACH year? Not 5% this year, 10% next year, 15% the third year, etc. It's just 5% every year that you have the condition.

That doesn't seem to be the same thing, statistically, as saying you have a 100% chance in 20 years.

I'm not trying to minimize the risk; I read a medical journal article that estimated the risk at 1-15% a year. I just don't think you're using the statistic correctly.
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Old 11-20-2018, 01:45 PM
 
Location: Fort Lauderdale, Florida
11,877 posts, read 11,298,306 times
Reputation: 26855
Jill, do your research with your cardiologist. Sometimes the best ones don't take new patients.

If you call and they tell you that, say your GP referred you.

Cardiologists, like every other MD can be hit and miss.
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