Heart Rhythm Episodes - AFib; Tachycardia, High Blood Pressure

So far, my afib is once a year or less (knock on wood) but severe (last time I ended up in ICU) due to tachycardia and low bp. My heart flops around like a big fish, I am short of breath, have chest and jaw pain and so on.

Even with afib once a year, my original doc pressured me to do blood thinners, and then the hospital doc told me to go home and forget it happened! I was happiest with the doc in the ICU who did an echo to make sure I had no clots, because the episode lasted 7 hours, longer than usual.

It sounds like you could use an EP. Do you have access to one? It also sounds like your afib has become more frequent relatively quickly.

I hope you find help! Have you identified any triggers? Mine is eating after 5. And I drink low sodium V8 for potassium. Who knows what helps. I only take diltiazem when I have an episode but I carry it around.

I did see an EP (arrhythmia specialist) at the Cleveland Clinic but he seemed to only want to discuss my suitability for a Watchman Procedure (answer, yes, but only if I could get a retinologist to vet its being necessary to protect my retinas against wet macular degeneration. Seems to me we've discussed this before).

That doctor ordered an echocardiogram, which came out pretty good - from slight to moderate valve regurgitation (mitral value, trace; tricuspid slight; aortic valve moderate).

The EF was 65 and they couldn't determine whether the left ventricular wall was thickened ("because of Afib" - uncertain just what that means, as it's sounds like saying they weren't able to diagnosis my problem because of the problem itself). FWIW that's a significant finding as it seems thickening there can be a result of strenuous exercise (perhaps I need a second opinion about that as I DO work out regularly which my home cardio said was fine. But ought I observe precautions?)

I was/remain very concerned about that weeks-long episode of tachycardia (one week of which was monitored by a heart intervention checker by a company called Biotel). The Cleveland Clinic doc didn't provide any insight as to what might have caused it, though, even though he repeated the desirability of learning what was causing both the Afib and the non-stop tachycardia .
(Should I have an angiogram or other way to evaluate my arteries, including checking for blockages and where my circulatory system may be short-circuiting, thus leading to the Afib - also the tachycardia?)

Overall the consult wasn't very informative except that he prescribed Metoprolol (25 mg AM and PM) for the tachycardia. Since I wasn't having it any more, though, it not only wasn't needed, the one time I took it it felt like it was killing me! Specifically, I was left gasping for breath even standing still much less exercising, while my BP dropped to 47/50, pulse to 50 bpm. (That was resolved by my home cardio saying I could take it PRN, at half that dose. That's what I've done after that one awful experience. That is, during the month or so since then, I've taken it three times at only 12.5 mg when I became breathless and couldn't exercise normally.)

You asked about triggers. If I push myself "too much" (whatever that is - during aerobic exercise), that's when the severe tachycardia-Afib has occurred. Also, my pulse doesn't drop after I stop exercising as it ought to.

Likewise, overeating before my bedtime (a very night-owlish hour - probably like your trigger except that my circadian rhythm is WAY later than yours). You say you're OK as long as you don't eat after 5 PM. But what is your bedtime after that hour?
For me it's not just a matter of when I eat but how much - whether I have a too-full stomach.

Alcohol is also a trigger, not just ANY but a few drinks (which I scarcely ever indulge in any more now that I've made the connection). FWIW alcohol is one of THE most commonly recognized Afib triggers. Plus, of course, the known lifestyle risks of smoking, overweight and high blood pressure none of which thankfully apply to me.

I remember the vivid description of your annual Afib attacks - truly paroxysmal and traumatic, involving a dash by ambulance to the hospital ICU and what sound to be almost all the symptoms I've read of, of a heart attack. One of the main differences between our Afib treatments seems to be that you take, per PRN prescription, a Calcium channel blocker, while my "pill in a pocket" is that beta blocker, Metoprolol.

Apart from the increased stroke risk from Afib, I'd ALMOST say I'm cardiologically fit, considering my lipids are within range and my echo (including EF) was OK. That is, EXCEPT that I've learned that Afib, especially when tachycardic, endangers my heart by wearing it out. That is, literally , as various comments from Dr. Google proclaim. Tachycardia reputedly significantly reduces longevity by leading to congestive heart failure or even cardiac arrest. Thus, even though I don't have any symptoms, it's doing me harm. Tachycardia does us all harm. (I hadn't a clue!)

My spine is completely fused and there are other ortho/neurological problems with hips and feet.

However, I do fine on the treadmill as long as I hold on to the arm rests. I realize this changes what muscles are getting the most workout but it still gives me a good cardiac workout, so don't forego that treadmill because of the other problems!

I need that workout (otherwise I'd be almost completely sedentary) for my heart health.

Also, of course, healthy eating, minimal or no alcohol, watching your BP and weight, and (need I say?) avoiding smoking!

Sure! Your heart is a muscle and needs exercise.
That means conditioning yourself.
It's important to be regular about it, though you don't have to be fanatic about working every single day for a long time.

I use artificial salt (potassium) instead of sodium and take magnesium tablets. I'm told my electrolytes are just right per labs.

Those are both important for heart health. (The magnesium also relieves night time leg cramps.)

I take magnesium also 🙂

Hi, folks!

Just a quick suggestion for Afibbers on coumadin:
If you can afford one of the newer anticoagulant meds, please consider switching over.

You'll eliminate the bother of having to get your INR checked every two weeks or monthly (or whatever schedule your MD has you on). AND also avoid any food interactions that may affect your optimum INR levels -- so CRITICAL in minimizing stroke risk.

Good luck!

LarryG -- Fellow Afibber (on Eliquis 5mg B.I.D.)

HOWEVER, if you go to the ER or a clinic for treatment of a wound, first thing ask them if they have an antidote for the anticoagulant you choose -- NO MATTER WHICH ANTICOAGULANT IT IS. I have had three clinics admit they didn't have my antidote in stock, and a good friend of mine died during transfer from an ER without the antidote to another hospital that had it on hand.

Thanks for sharing that, Martin.

Did you report that to the State oversight agency? That would be a serious regulatory violation... that the treating hospital would surely pay dearly for, IMO.

I've made a note to check with our (small) local hospital to learn whether or not they have on hand antidotes to whatever blood thinners I take.

Of course, it's possible I could have a bleeding problem (including a cerebral hemorrhage - i.e., bleeding from either a stroke or head injury) at some other location, at least, it's prudent to check what's available at my nearest hospital.

Too often patients (and their doctors) forget there are two kinds of strokes - ischemic and hemorrhagic . Even though only ~15% of strokes are hemorrhagic ( and blood thinners protect fairly well against the ischemic kinds) , for patients taking anti-coagulants, bleeding strokes are far deadlier.