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Afib with Rapid Ventricular Response

Heart Rhythm Conditions | Last Active: May 21, 2019 | Replies (30)
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@predictable

Hi @soliloquized. I'm weighing in at the suggestion of Teresa @hopeful33250. I'm awestruck by the complexity of your symptoms and by how firm and calm you are in your relations with the medical professionals you have encountered. My own experience bears little resemblance to yours. I'm hypertensive from a genetic kidney defect that steals my potassium, so when I was diagnosed with A-fib four years ago, nobody seemed surprised (except me). My symptoms showed up almost exclusively on an EKG. I have no sense of irregular heartbeat except from watching a blood pressure meter or seeing an EKG report. My heart rate (about 58 bpm for years) rose modestly to about 70-75 bpm after I started medicating the A-fib with Carvedilol. We assume my A-fib changed my heart rate initially by +30-35 bpm and the Carvedilol pushed it down by half of that, winding up at 70-75 bpm. I'm also taking Coumadin as an anticoagulant, although it let me down one time last summer, and I suffered a "small stroke" that keeps me a little off-balance even now.

I hope you will be able to get your doctors to meld their analyses and further studies so that you have a stable vision of what's troubling your heart, and I hope you and your doctors reach a unanimous conclusion on steps to take. Compromises are not very satisfying, I know, but neither is treatment that seems like a set of trials. Do you have access to a university-based medical system or a noted clinic like Mayo where research- and patient-driven diagnosis and treatment are available? Martin

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Replies to "Hi @soliloquized. I'm weighing in at the suggestion of Teresa @hopeful33250. I'm awestruck by the complexity..."
Soliloquized | @soliloquized | Dec 17, 2018

Thanks for the reply. The physician is part of the UPMC (University of Pittsburgh Medical Center) cardiology group (Heart & Vascular Institute), though it seems to involve a constellation of physicians rather than a practice per se.

The doctors at the hospital where I was admitted have a history of over testing, according to my wife's former employer. I'm not going to weigh in on that much, but without consulting me on the need, I was scheduled for an adenosine stress test, and I'm sure that'd been followed by a heart catheter, as that is the tests my wife's former employer (a cardiologist) complained about. After telling me that restoration of normal sinus rhythm is best done within 72 hours of the occurrence of afib, the fact is they were making no attempt to address the afib directly.

Prior to afib, I was on 600 mg of Acebutolol, (200 mg three times a day). Upon being admitted to the hospital, they discontinued the Acebutolol and had me on less than 100 mg Metoprolol. Online equivalency charts list 200 mg Acebutolol as equivalent to 100 mg Metoprolol. And guess what, I'm now on 300 mg (in divided doses) of Metoprolol, which conforms exactly to the equivalency chart for the dosage of replacing 600 mg (in divided doses) Acebutolol with 300 mg Metoprolol. Hospitals scare me, they drastically reduced the beta blocker, I can't imagine the reason why, it's almost like they dosed me like a new patient that wasn't on beta blockers at all. I even spoke with the Electro Physiologist (EP) in the hospital, he told me he doesn't know who put me on Acebutolol, but I told him it was another EP and my cardiologist (at the time) was also aware and wrote the prescriptions for it. (Acebutolol is an older drug with a few unique properties, ISA - intrinsic sympathomimetic activity - It slows the heart an average of 4 beats per minute less than an equivalent non-ISA Beta Blocker).

Ironically, my previous cardiologist told me, only a few years ago, that unless I lose weight, I'd end up in afib. I wish I'd be proactive on his prognostication.

Thanks for the comments and suggestions. Wish you very well in your health.

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