Atrial Fibrillation and long-term management with medication

Thank you both,
Your experiences are very helpful to know about.

Same here.
No matter how much I know I've been well educated (including to a degree in medicine) I find myself being a bit intimidated by doctors and their prescriptions - especially if they are affiliated with a top ranked medical center.

Resulting in feeling they have some kind of power over me, especially if they prescribe a medication. Thus it can help if someone reminds me (like windyshores above) that they can NOT force me to take something.

(Or even for that matter, undergo a procedure.)
That old "MDeity" effect, often aggravated by a given physician's portraying themselves as such.

to hmccarth5
Just for the record, I get my Xarelto from Canada at a fraction of the cost in the US. My brother who has constant Afib also gets his meds there.

I have no way of getting medication from Canada.

check private message.

I take xeralto and Cardifilil and had a nosebleed that wouldn't stop had to get my nose packed at the ER.
I am now concerned about going back on it,The ER doctor told me to see an ENT CHECK MY NOSE. ETC.
I only had one Afib type episode and my primary DR CALLS IT paradoximal?

It's called paroxysmal atrial fibrillation. I have afib once a year, and when it happens, it is dramatic with very high heart rate and diltiazem lowers already low blood pressure to I always end up in ambulance. Mine started in 10/2015.

I declined blood thinners and have not had a clot. For an episode greater than 5.5 hours, they did an echocardiogram to make sure no clots were formed.

My cardiologist has come to agree with my decision not to take blood thinners. The scoring system, CHADS2, changed during these years and I actually do not meet the requirement anymore because they removed female gender as one of the factors in the score.

Did your doc provide a good explanation for why you are on a blood thinner? Do you have diabetes or high blood pressure or other risk factors?

My elderly mother is on Coumadin and has nosebleeds- one yesterday in fact. I buy BloodStop or NasalCease products on Amazon and they make it possible to avoid ER.

Hi, Windyshores,

This is especially interesting to me as I only qualify by age, since don't have high blood pressure and am a woman.

May I ask if you are below the cut-off age (I forget what it is)? I'm 76 so I do qualify with that one CHADs2 [sic?] point.

I may be repeating myself, but the arrhythmia specialist I saw at the Cleveland Clinic doctor there assumed I would need to take the blood thinner both because of age and sex. You expressed surprise that he had apparently not heard of the gender write off.

(Or is that guideline gender still somehow controversial?)

If I recall rightly you only get AFIB ~ once a year (albeit with great fanfare - ambulance and heavy duty symptoms). I OTOH get it ~ daily, but with almost no symptoms (slight breathlessness sometimes).

Perhaps that frequency even without symptoms, factored in his recommendation. Certainly, my local cardiologist still feels I need a blood thinner. (Didn't ask him about the weighting of gender in that decision. I will.) To note, though, my overall impression of the local doctor, is that he is "old-fashioned" overall - i.e., follows guidelines that were in place previously. That he's not up to date, to say the least.

Certainly, it wouldn't explain the directives of the Cleveland Clinic doc, who is quite young (to my eyes anyhow). Frighteningly, too, he is considered a world class arrhythmia
specialist! :O

Thank you!

And BTW, my AFIB episodes are OFTEN at least 4.5 hours (usually during sleep - I can only tell thanks to a cardiac App on my Apple Watch). It's never been suggested I even go the hospital when that occurs, much less have another echocardiogram! (If they did, I'd practically live there!).

In fact, my local cardio only had me go to the ER when my heartbeat recently went into constant tachycardia - at that point, for days, but it lasted for weeks before it, mysteriously, stopped. Never diagnosed.

Since as mostly reported then (during the three hour ER monitoring) sinus tacycardia - supposedly - I was just sent home to be followed up. Only, my cardio told me to go about my business including returning to the gym and not seeing me again for months (until my previously scheduled appointment.)

He didn't even change that recommendation when a week's long event monitor (my request) showed that indeed I was in tachycardia most of the time during that week. Nothing outrageous, but (not even counting brief spikes much higher) often up to 135 and certainly over 100 for almost the entire period. (In fact, the up and downness of it made the ER nurse suggest I might have "tacchy-brady syndrome" - what it sounds like.)

I feel very uncomfortable observing the widely divergent opinions and recommendations I'm getting. The Cleveland Clinic physician threw me off the most. I thought was going to be getting a state of the art overview - certainly one with which all top cardios would agree.

Not so! 🙁

Even though we have such different intervals, I remain diagnosed as having paroxysmal AFIB.

One doc wanted me on blood thinners, and one doc told me to go home and forget it ever happened.

My heart flips like a fish and my heart rate goes as high as 200. My big problem is low bp and they are afraid it will go too low on diltiazem. Last time they even put me in the ICU.

I am sorry yours is so often and lasts longer!