Three Issues in Heart Arrhythmia

I’ll be interested in how many others are dealing with these three main issues in my heart rhythm: 1) Atrial fibrillation, 2) “Blood thinners”, and 3) Hypertrophic cardiomyopathy.

Atrial Fibrillation: I know about this only because it was discovered in a regular EKG four years ago (at the age of 78). I have no sensations from the a-fib, but I have concrete evidence from regular heart-rate checks. My previous heart rate was around 50 bpm day after day, but it rose to nearly double to provide the diagnosis. Fortunately, my medical team at that time was considering a new hypertension medication — Carvedilol — but had not prescribed it because of my already low heart rate. The a-fib speed-up in effect cleared the way to Carvedilol (brand Coreg), which now helps control my blood pressure while helping hold my heart rate to about 70 bpm!

“Blood thinners”: I was placed on Coumadin (generic Warfarin) when a-fib was diagnosed — a common reaction to a-fib, which often sets up conditions for small blood clots to form in the heart and be passed into arterial blood pumped out to any or every place in the body. My HMO prefers Coumadin, because there is a ready and inexpensive antidote for it if I suffer any open wounds or internal bleeding that could become fatal. Not so with other “blood thinners” yet, although research is working to develop antidotes for Eliquis and Xarelto and other anti-coagulants, but the antidotes are not available yet. With Coumadin, I have regular lab tests to check my anti-coagulation index and be sure that it doesn’t get too low (threatening blood loss from wounds or sores), every month I stop into the lab 10 miles away for a blood-tap in my arm, and the next day, I get a call from a pharmacologist with instructions on whether to change my Coumadin dosage and by how much.

Hypertrophic Cardiomyopathy: In general, this is thickening of the heart muscle to the extent that it lacks full flexibility to pump blood out into the body and to receive the return flow and send it to the lungs for removal of waste and carbon dioxide. In my case, doctors assume that my chronic hypertension is responsible for making my heart work harder than normal, resulting in the kind of muscle growth that I’d prefer to have only in my legs, arms, back, and belly! HCM also may be inherited, which may be a factor in my situation. The combination of HCM and a-fib can interfere with the heart’s efficiency and cause the heart to work harder than before; one result is “diastolic dysfunction,” caused mainly by a-fib, that slows the movement of blood coming into an atrium from the lungs and passing through to the left ventricle for distribution. We deal with all of this with added medications and larger doses of them to keep my BP under control.

Sound complicated? It’s not so complex in practice. My brilliant nephrologist worked three years with an endocrinologist and a cardiologist to develop the medication recipe that keeps me going strong. She found an inherited kidney fault that was wasting essential potassium, and tailored my medication to preserve potassium and thereby keep my BP under control.

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