Firefighter with AFIB, please help!

Hi All:

Thanks for doing this. I'm hoping you can help me.

So I'm 46 year old male, good health otherwise, 160lbs at 5.8"

I've had AFIB for 20 years, and take 80mg Sotolol 2x per day plus baby aspiring 1x per day.

My AFIB has always been triggered by alcohol consumption, following by anything that would raise my heartbeat quickly. (Especially getting sick to my stomach from drinking, etc)

I stopped drinking 10 years ago and was AFIB free for 9 years. Not a single episode.

3 years ago I became a volunteer firefighter which I love doing.

The problem has come back. Whenever there is a super high stress call (Life at risk for someone, etc) and I jog lightly from my car to the fire engine, I sometimes go into AFIB again. (Adrenaline)

Meanwhile, I go on over 500 calls per year, and never have a problem with most of them. Nothing happens on dull, routine false alarms, etc.

After it happened 3 times in a single year (I usually convert by myself after 17-29 hours or so) my cardiologist recommended Papone Ablation which was done Feb 2017.

I went on several tough calls since then and no problems! I was so happy.

This past Saturday night, we had a fatal car into a building and I jogged from my car to my gear rack, and into AFIB I went.

The only good thing to report is the episode only last 6 hours.

I'm so upset because I thought I was done. I don't want to lose the Fire Department.

I guess a second ablation may be in my future but I'd prefer to avoid it of course.

Can you guys offer any guidance? I bought Potassium and magnesium vitamins thinking that might help?

Please help!

Thanks

Maybe a calcium channel blocker to take on-demand when you know you are going on that type of call. Don't know how fast it'd act and you'd need to intentionally keep your HR down till it did.

Along with the calcium channel blocker, you could consider taking either PharmaGaba or L-theanine to help lower the anxiety/stress signals you are generating from the adrenaline surge. It would be good if you could have your adrenal function tested to see if you need adrenal support and something to help manage the excess cortisol. I know about this from my own personal experiences with job stress triggering AF.
You can send me a PM and I can give you details.

Definitely start with magnesium since anyone with high stress jobs typically are very low in intracellular magnesium and that will affect your heart. The potassium won't help initially, if you are Mg deficient....so you need to optimize magnesium first and then consider both dietary and supplemental potassium.

Jackie

Your going into AFIB as you jog to the Fire Engine? Can you just walk fast? I suggest try walking fast, and stay calm enough to breathing deeply, Sounds like you need to avoid that sudden rush of Adrenaline. In my experience I get more PAC's when I am in a similar situation that can lead to AFIB. If you are not getting as much Oxygen, while running, PAC's are more likely.

Drugs taken prophylactically like a Calcium Channel Blocker or a Beta-Blocker would probably help, as they would lessen the impact of a sudden burst of Adrenaline on the Heart. I would try a CCB, or a Cardio-selective Beta-Blocker like Bystiloc, as they will not cause sedation and sluggishness, like standard Beta-Blockers.



Edited 1 time(s). Last edit at 10/06/2017 03:43AM by The Anti-Fib.

Thanks, George.

Normally, I go from my bed to the engine in under 2 minutes, so there's very little time for anything to kick in on demand.

Thanks, I'm going to start with the MG and see if that helps at all. I sincerely appreciate all your help

Magnesium is natures calcium channel blocker. So my suggestion is to push it to bowel tolerance.

Can one screw up their rhythm with too much of any one electrolyte?

Libby:

Yep, you can with Potassium, too much of that electrolyte can kill you.

Liz

Thanks, I thought there was something to watch out for.

Quote
Elizabeth
Libby:

Yep, you can with Potassium, too much of that electrolyte can kill you.

Liz

True, but difficult to do orally. You'd get plenty of warning signs beforehand in terms of gastrointestinal distress. To kill yourself with potassium supplements you'd have to grind them up and either inhale them or take them as a suppository!

That being said, do tread carefully with potassium. Ratchet that up slowly. An "oops" with magnesium will simply have you making a beeline for the restroom, nothing more.

Wolfpack:

My mother was taking a heart med. and had to take potassium with it---we changed her heart med to a drug that did not leach potassium so the potassium med was stopped. I was the one that took care of her meds., I was then going to Florida to visit my daughter and told my sister in law about the change in meds., well, for some reason when she put my mothers meds together in her pill box she also included the potassium, well my mother started to have reactions, was out of it, they had to take her to the hospital and they gave her enemas to flush out the excess potassium.

A few years ago I took a potassium supplement after reading here that we need it----I started having short runs of AF, I am vagal, but these runs happened during the day as well. I stopped the potassium supplement and the AF runs stopped, in my blood work my Potassium levels are always towards the high end of the lab values, so I didn't need the supplement and shouldn't have taken it.

You can buy potassium supplements in powder form.

Liz



Edited 1 time(s). Last edit at 10/06/2017 11:31PM by Elizabeth.

Libby - Regarding the precaution about taking too much supplemental potassium.... it's definitely true, you can take too much and have various consequences. Anyone considering taking supplemental potassium should first do a log for a week's food intake and the equivalent potassium content. There are charts listing each food and the typical potassium content. Oregon State has a useful link with important information plus the content chart. [lpi.oregonstate.edu] It's always preferable to get potassium from foods rather than supplement.

And, you can't mention potassium levels without also considering sodium intake and intracellular levels because they work in tandem and if one goes up, the other goes down... with both positive and negative effects in the body. Refer to Conference Room 72 on the topic of Role of Sodium and Potassium in Atrial Fibrillation. [www.afibbers.org]

When supplementing with either potassium or magnesium, the precaution is also that there must be healthy kidney function. If not, then a physician should supervise and monitor with testing. If kidneys can't clear out these minerals adequately, problems can result.

Too much potassium intake, food or supplements, in some individuals can result in arrhythmia while others may have different symptoms. You can do a search for archived posts by TomC who found that if his dietary intake of potassium was too high, he'd have Afib. As a result, he researched and bought a Cardy Meter which is a quick, reliable way to check potassium levels. He offered the details in Conference Room 74 at this link [www.afibbers.org] and there are important comments and observations about the affects of potassium and arrhythmia at this link, so please check it out.

I'll share another observation from the opposite side of the potassium spectrum. A friend told me about a man who does running for his favorite form of exercise... daily and many miles. At one point, he began to have a bouts of fainting. A trip to the urgent care center revealed he was in bradycardia and was admitted for pacemaker installation. Before he was discharged, he was told that while his heart rate was extremely low when he was admitted. He was also very low in potassium and it was entirely possible that once his potassium levels were in range, the pacemaker would probably not be used much. That turned out to be true.

Jackie

Thanks Jackie! I'll definitely check this all over. My potassium has tended to run about 3.5, but I've been trying to eat more produce and it was 4.1 at last check. I don't think anyone's ever checked intracellular sodium or magnesium. My heart rate is really low at night (38 - 42), but I don't have any symptoms. The story about the runner getting a pacemaker he may not have needed is a scary thought.

I spent the last two years taking more potassium than you can imagine, and it all began with the article Jackie linked to above. I credit it with giving me two years of relief more effective and safer than anything medicine has to offer.

Carey:

Not everybody is deficient in Potassium as you apparently were. Before people take Potassium supplements they should know what their blood work indicates. My blood work shows that my Potassium levels are around 4.6 which is at the upper level of the lab scale. So for me, taking supplements is a no,no.

Liz

Quote
Elizabeth
Not everybody is deficient in Potassium as you apparently were. Before people take Potassium supplements they should know what their blood work indicates. My blood work shows that my Potassium levels are around 4.6 which is at the upper level of the lab scale. So for me, taking supplements is a no,no.

I was not deficient and your levels are not at the upper level. You might want to read some of the articles in the archive here.

I don't recall recommending supplements to anyone, so I'm not sure why you're lecturing me on it. I was asked to write an article on this subject but I declined for reasons that your response illustrates. I'm not going to venture into the potassium subject on this forum. I explained to Shannon why I won't.

My last two blood tests: Potassium 4.5 Reference range 3.5-5.3 another one: 102 Reference range 90-111

Your statement "I don't recall recommending supplements to anyone"-- I was responding to a poster that asked "Can one screw up their rhythm with too much of any one electrolyte?" Then you stated "I spent the last two years taking more potassium than you can imagine. I credit it with giving me two years of relief more effective and safer than anything medicine has to offer". You did not state if that potassium was from food or supplements, you needed to be more explicit, ----I would say your response to Shannon was a wise choice.

L

Quote
Elizabeth
My last two blood tests: Potassium 4.5 Reference range 3.5-5.3 another one: 102 Reference range 90-111

Your statement "I don't recall recommending supplements to anyone"-- I was responding to a poster that asked "Can one screw up their rhythm with too much of any one electrolyte?" Then you stated "I spent the last two years taking more potassium than you can imagine. I credit it with giving me two years of relief more effective and safer than anything medicine has to offer". You did not state if that potassium was from food or supplements, you needed to be more explicit, ----I would say your response to Shannon was a wise choice.

I have no idea why you think what I said had anything to do with you.

I don't need to be more explicit about anything if I'm not offering advice, which I haven't. I'm not sure where your animosity and hostility come from but you've made yourself crystal clear. You don't don't need to keep finding reasons to reemphasize it.

Quote
Carey
I spent the last two years taking more potassium than you can imagine, and it all began with the article Jackie linked to above. I credit it with giving me two years of relief more effective and safer than anything medicine has to offer.

Although not direct advice, this looks like advocating by example of taking large quantities of K+.
Everyone is different, but since you eluded to it, I am curious as to your total intake? supplement + through diet? Did you keep track?

I had a K+ level of 5.7 several years ago. I was weak and feeling like passing out at times, also got AFIB.
I analyzed my diet the next week, and found out I was taking in over 8,000mg/day, just through food. (4,700 RDA) I was taking 400mg/day in K+ supplement, which I obviously didn't need.

We are all experiments of one, for sure.

In my case, there's a maternal hereditary trait for Hypokalemia. I found this out the hard way about 6 years ago when my then baby daughter got a stomach bug and threw up on me. Two days later, I've got Montezuma's Revenge as it were. That dropped my K levels to something like 1.7 and I became paralyzed on the toilet. I though it was the end. At the ER, after the labs came back, they moved the defibrillator into my room while they started the KCl drip! Ever since then I've been on prescription KCl at 10mEq/day which seems to be the right level for me. I haven't had a problem since. Tests show my serum K levels in the 4's. Supplementing magnesium is what really did the trick for me when it came to PACs and other ectopy.

Wolfpack - Your statement " supplementing with magnesium really did the trick for me" is the mantra or golden rule for the majority of those with arrhythmias since the property of magnesium is relaxing.

Accurate intracellular testing helps target which minerals need adjusting up or down. Many people add too much potassium before they have worked on repleting magnesium intracellular stores; and since it's commonly found that those with arrhythmia-type activity are typically found to be low in intracellular magnesium, that can work against success.

What's also not frequently mention is the need for just the right amount of sodium and only a very minor amount of calcium to make those systems function properly. Those affected by arrhythmia tend to have problems balancing or maintaining proper ratios of all the core electrolytes. I'll be offering a post about how stress plays into this balance and how adrenal function and influence contributes to the complexity of keeping these ratios in safe ranges that don't affect the heart... and even other systems in the body.

All too often in our fast-paced world today, we clamor the quick fix... or the aspirin effect.... hoping for a 'magic' solution or pill that will wipe out AF like aspirin can do for a headache ..to wipe out our AF and we can move on. Unfortunately, it can often be a lot more complicated and is one of the main reasons this forum came into existence just because there are so many factors to consider, measure, test and then experiment with.

Complicating all is the biochemical/biophysical uniqueness of every individual so no one thing at one specific dose works perfectly for everyone but the trouble-shooting guidelines and risk assessment management help significantly to narrow down focus areas.

There should always be a cautionary note for supplementing with magnesium and potassium…or even eating a very high potassium diet and that is to be sure of healthy kidney function. If not, then a physician should supervise and test with supplementation.

Jackie

Quote
The Anti-Fib
Although not direct advice, this looks like advocating by example of taking large quantities of K+.
Everyone is different, but since you eluded to it, I am curious as to your total intake? supplement + through diet? Did you keep track?

I wasn't advocating anything, directly or indirectly. It was simply an offhand comment regarding what I had done in the past. If someone wants to go out and load up on potassium based on that post, I wish them luck but I'm not owning responsibility for their stupidity.

As I said, I don't want to dive into this subject because, for starters, explaining it adequately would take an entire article, not just a post. Second, many people (including medical professionals) have such deeply ingrained fears of potassium that are deeply held but largely irrational and unjustified. In my experience, the effort it takes to overcome irrational beliefs based on hearsay just isn't worth it.

What I would advise anyone who wants to use potassium above and beyond simple dietary sources is 1) to read all the articles on the subject in the archives here. 2) Buy, learn to use, and validate a potassium meter. 3) Collect enough data to show that it actually helps you and that what you're doing is safe, and then take all that evidence to your EP and get him or her onboard. That's what I did. It was not cheap, quick, or easy. It takes effort.

And for those who care, I was taking 20 mEq of extended release potassium tablets 4 times daily, along with amiloride, a potassium-sparing diuretic, plus an ACE inhibitor, which also retains potassium. Any doctor would react to that combination with alarm. It's a combination all the textbooks tell you to avoid, but those drugs were knowingly prescribed by both my PCP and EP specifically for the purpose of keeping my potassium levels consistently above 4.5 (my natural set-point is ~3.8-4.0). Doing that completely prevented my flutter from occurring. The only breakthroughs were my own fault (eg, dehydration), and when those happened I chemically cardioverted myself with a large bolus of bulk potassium chloride. 100% effective every time.

No, I do not advise that anyone takes large doses of potassium chloride until you've done all the homework I did and you can reliably measure your potassium levels at home.

Quote

I've got Montezuma's Revenge as it were. That dropped my K levels to something like 1.7 and I became paralyzed on the toilet. I though it was the end.

Wow, it nearly was the end. You're very lucky to have survived that. Hyperkalemia takes insanely high levels to become truly dangerous (~7.0), and unless you have kidney dysfunction, diabetes, or you're taking potassium-sparing drugs, it's a lot harder to become hyperkalemic than most people think. It's actually very hard. But hypokalemia is different. It's easy for otherwise healthy people to become dangerously hypokalemic, as you found out, and that will kill you a lot faster than hyperkalemia ever will. Hypokalemia makes the heart twitchy, very hyper-responsive and therefore very prone to arrhythmias, including lethal ventricular arrhythmias. Hyperkalemia does the opposite and makes your heart less responsive. Specifically, it widens the refractory period, which is how it prevents/terminates reentrant arrhythmias.

Potassium chloride

Among the various salt ions that allow our bodies to function, one of the most tightly regulated is potassium. It's required for all manner of nerve signals, proper brain functioning, and for the constant beating of the heart. The body keeps most of our potassium in cells with only a small fraction present in our blood. A large dose of potassium chloride introduced into the bloodstream, like that used in executions, would irreversibly paralyze the heart.

L

Quote
Elizabeth
A large dose of potassium chloride introduced into the bloodstream, like that used in executions, would irreversibly paralyze the heart.

Which is why you shouldn't inject potassium unless you happen to be a physician familiar with IV dosing protocols.

Quote
Carey

Which is why you shouldn't inject potassium unless you happen to be a physician familiar with IV dosing protocols.

And when they do, the potassium bag (small) is paralleled with the saline bag (large). They are supposed to run out at the same time. They don't. When the saline runs out first, the high-concentrate KCl burns like a red hot poker in your arm! I needed two bags of KCl, and when it happened the second time around, I stood up and kinked the KCl line with my fingers until the nurse came around. Of course I got yelled at for it, to which I replied "You try it!"