First Post - New to Afib

Hello everyone. I was diagnosed with afib in September of 2016. I woke up at about 4am cause I had to urinate. As I was standing there, I got really, really hot, lightheaded, started sweating profusely, and managed to get to my couch and sit down wondering what just happened. About 6am I went to the ER, and I remember the girl at the counter that took my vitals asked me if my heart rate is always in the 30's. I said I dont think so. Well they did an EKG on me, and I was told I was in afib. My reply was "what is afib".....they explained it to me. If I remember right, by noon time I had converted back to NSR on my own. I was put on 25mg of metroprolol twice a day, and eloquis. Over the next year, I would get these episodes where Id get real hot, light headed and think I was going to faint. But they would go away within a couple minutes. Well in Oct of 2017 the same thing happened only afterwards I was completely exhausted, sweating my tail off and out of breath all day long. I went to the ER, and again was in afib. I was admitted to the hospital and put on cardizem drip for 2 days. On the 3rd day they cardioconverted me and sent me home. For the next couple months, I kept having these episodes, and would go to my cardiologist, and he would tell me I wasnt in afib and my blood pressure was ok and gave me a holter monitor to wear for 30 days. It even got to the point where he would tell me what was happenning to me wasnt cardiac related. On valentines day I worked (desk job), came home, was sitting on the couch and had another of these "episodes" and threw my BP cuff on and was 288/180-something. I called 911 and they came and did an ekg and said my heart rate was slow but that I was in afib and my blood pressure was still high. So into the ER they took me, and kept me over night, blood pressure came down, they said I wasnt in afib, and sent me home. Somewhere during this time in February my cardiologist added amplodipine, and a water pill, hydrocloric..... to my medications. The amlodipine cause my BP was still a little high and the water pill basically cause my left lower leg swelled up. Well into March and my episodes kept happening but my blood pressure was always ok, but still I called my cardiologist and he was on vacation til the end of march, so I called my primary and she set me up an appointment with another cardiologist for a day or 2 later. So I went and saw him, and he seemed to think I just have a classic case of High Blood Pressure, and had me stop the amlodopine and started me on Procardia. So I was then on metroprolol, the water pill, eloquis, and procardia. The episodes seemed to stop. Fast forward to a couple weeks ago. I had 2 episodes during the same day at work, (desk job), checked my heart rate and it was at 149. And it stayed high. That was on a Thursday. On Friday I went to my cardiologist and yes I was in afib, and he increased my metroprolol, doubled it to 50mg twice a day and was told that Monday I had to go in the hospital to be monitored while they put my on sotolol. THat whole weekend I was completely winded and warm. So I went in Monday, and Tueday about 5am I converted back to NSR and the only change was 2 doses of 80mg sotolol, 10:30 Monday morning, and 10:30 monday night. So they sent me home on Wednesday and increased the sotolol to 120 mg twice a day. While my blood pressure is good, and heart rate stays in the 50's and 60's all day long, I do get an occasional spike of over 100 - 130 heart rate at least once a day, and a dip into the 40's at least once a day, and I still get these episodes, but not too often. Maybe once a week, when before I was getting them just about everyday. So now Im on the metroprolol, eloquis, a stronger water pill cause my leg is swelled up, the procardia, and sotolol. Im still getting the occasional "episode" although my heart rate is good, probably even on the low side besides the occasional spike, and dip during the day. The other evening at dinner it spiked to 133 and I got light headed and felt like I was going to faint. The one thing Im noticing is wierd pains in my arms, or legs, and sometimes a really nasty pain in the back of my shoulder towards the base of my neck. Needless to say Im scared. My mother, died 2 years ago at 71 from heart related issues. Im not sure what they were but she would always talk about here heart medication making her tired, but she never shared with me or my sister what her actual issues were. And her mother died after her 3rd heard attack, so Im feeling like Im "NEXT". Im 54. I know this is long-winded but any advice, opinions, insight into any of this would be greatly appreciated. I know I go in and out of afib, but do these episodes sound like an afib attack coming on? Or could it be something else. I dont know what to think anymore. Thanks in advance.

Juan

Juan, welcome to you. Sorry you're suffering from all those horrible symptoms.
I'm new to this forum too and can't help you very much, but there are lots of kind helpful people here and I don't doubt you'll get good advices.

Welcome to this excellent site!
Start reading, educating yourself. Don't think there is one advise to fit all but there are basic things (supplements, lifestyle) you can do that may help.
You might consider visiting a holistic doctor as well?
Best wishes!

Wow. Maybe I missed it, but beyond Metoprolol (which deals with rate), were you put on Flecainide or anything else for heart rhythm? That's pretty wild that you hit the high blood pressure and heart rate, but this Afib is like a swiss army knife of freaking surprises LOL.

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FrankInFlorida
Wow. Maybe I missed it, but beyond Metoprolol (which deals with rate), were you put on Flecainide or anything else for heart rhythm? That's pretty wild that you hit the high blood pressure and heart rate, but this Afib is like a swiss army knife of freaking surprises LOL.

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juanLopez1245
So they sent me home on Wednesday and increased the sotolol to 120 mg twice a day.

Sotalol has Class II (betaadrenoreceptor blocking) and Class III (cardiac action potential duration prolongation) properties.

Thanks George, wow it's like us "patients" eventually have to know the full medical and pharmaceutical spectrum just to understand why we don't feel well (and why we are at risk etc), amazing knowledge that George / Wolfpack / Carey / Shannon / Jackie and others here have...

Sotalol info, [en.wikipedia.org]

Patients manage AF. I learned that quickly and early.

Knowledge? You flatter me! I’m just an engineer who takes an analytical approach to everything. Panic is useless. Unless you’re being chased by a sabre-toothed tiger. Then it’s good.

Everyone stay healthy!

Great post Wolfpack, but your engineering perspective along with your experience and knowledge (and same with other great posters here) is very valuable. Just today, at a Dr. visit, she said "only mayoclinic.com is to be trusted", well, I trust much more so, the feedback of others (like yourself) who have been there, done that, and have experience to share. Very valuable and helpful, thank you...

Juan:

How are you checking your HR? If by Finger/Pulse check I would do it at least 12-15 seconds. There is variability in AFIB HR, and you would get varying rates, especially if only a 6-second count is used. An EKG would be the most accurate way of determining your AFIB HR.

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wolfpack
Patients manage AF. I learned that quickly and early.

Knowledge? You flatter me! I’m just an engineer who takes an analytical approach to everything. Panic is useless. Unless you’re being chased by a sabre-toothed tiger. Then it’s good.

Everyone stay healthy!

Funny! My cardiologist said me, some months ago, that I had an engineer (which I'm not) habit : trying to understand everything. It's obsessive, but I can't do without that...

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FrankInFlorida
Thanks George, wow it's like us "patients" eventually have to know the full medical and pharmaceutical spectrum just to understand why we don't feel well (and why we are at risk etc), amazing knowledge that George / Wolfpack / Carey / Shannon / Jackie and others here have

So the funny part here Frank is that other than Jackie, everybody you mentioned has an engineering background. Jackie is a registered dental hygienist.

In my case, I realized early on that nobody cared more about my health than I did and also I was willing to invest more time in my case than anybody else.

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The Anti-Fib
Juan:

How are you checking your HR? If by Finger/Pulse check I would do it at least 12-15 seconds. There is variability in AFIB HR, and you would get varying rates, especially if only a 6-second count is used. An EKG would be the most accurate way of determining your AFIB HR.

I have an apple watch (iWatch) that has a built in heart rate app. Its right on the money. I compare it with a co-workers app on his phone and they're usually identical when checking my heart rate with the both of them. I also have a digital blood pressure machine that I bought from Rite Aid which has HR on it as well as BP and compare my watch to it. I prefer the watch because i can wear it to work and it keeps the high reading for the day and the lowest.

The iWatch is solid info. That’s good.

Yes, Frank - sadly that is the case. While I'm obviously not an engineer, I was harmed on several previous occasions and I should have known better than go for the treatment options recommended by my doctors without doing some research first. However, way back then (in the Dark Ages), medical information was not as readily accessible as it is now thanks to the Internet.

But, when Afib entered my life, I was determined to learn all I could to be sure that I wasn't harmed again by blindly following medical recommendations. I was doing quite well on my own for the first seven Afib years, and then I found this forum by Hans Larsen and learned much more useful information than was ever provided by the initial cardiologists.

I was also fortunate to have met early on, a family practice physician (Harvard Medical School), who was branching out into holistic approaches to medical treatments. He was nutritionally oriented and that fit with my DH focus to assess and advise dental patients on nutritional health so he guided me to many useful resources to help learn about the underlying factors that allow various ailments to manifest ... including arrhythmia. While I wasn't able to avoid ablation, the nutritional approach has helped me remain healthy, active and viable and if it weren't for Eliquis, I'd be on no Rx drugs at age 82. I'm not alone, I have other non-afib friends my age who share the same goals and nutritional savvy who are also healthy, med free and mobile. We are a cult.

Jackie

I like my cardiologist. Sometimes I have questions that I want to get a detailed explanation for but cant because I either forget by the time my 15 minutes with him is up, or I just plain forget because we've gone over other things and he flies outta the appointment. The one question I have is, when I get lightheaded and very warm, is that due to high blood pressure or low blood pressure? Ive been told both by him, and ER people and paramedics. The first time I was told I was in afib, I had gotten really really lightheaded where I thought I was going to faint, very warm where sweat was pouring off of me, and at the ER is when I was told I was in afib. That was Sept 2016. Since then, while hearing the monitor and the 2 incidents that happened during that time, i was told there was no unusual heart activity and I was not in afib. So the first time it happened I was in afib and since then no, and I was getting these episodes almost daily. But I had gone into afib 2 more times but the symptoms were shortness of breath, exhaustion, and high heart rate. Just trying to get a handle on it all.

High blood pressure can cause AF, hopefully that can be controlled. Before I go to my doctor I write down any questions that I want answered, you should do that, too bad these doctors are in such a hurry. Have you had blood work done for Magnesium,and potassium most people are low in these electrolytes which can cause many of the symptoms that you are having.

Hopefully Shannon or Carey can respond to your post.

Liz

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Elizabeth
High blood pressure can cause AF, hopefully that can be controlled. Before I go to my doctor I write down any questions that I want answered, you should do that, too bad these doctors are in such a hurry. Have you had blood work done for Magnesium,and potassium most people are low in these electrolytes which can cause many of the symptoms that you are having.

Hopefully Shannon or Carey can respond to your post.

Liz

Thanks for the reply Liz..... My blood pressure has been good, even during these episodes, it has been good 95% of the time. I check it a couple times a day, and its always good. I actually had one of these episodes in my cardiologists office before he came into the room, and my girlfriend got him into the room within 30 seconds, he checked my BP and he said it was fine in both arms. As far as blood work checking for levels of magnesium and potassium, I dont know, but I assume so because I have had tons of blood work done since this started happening and am always told, "your blood work came back fine"..... I can say since Ive been put on the metroprolol, procardia, eloquis, lisinopril, and the water pill, the episodes are much more infrequent, maybe once a week, once every 10 days, but there are alot some days, I just feel like crap, almost like one of these episodes are trying to make an appearance, but dont. I start getting warm, and so slightly lightheaded but it goes away immediately. Make me a nervous wreck!

I did just order, and receive my Kardia mobile device, and did my first EKG, so I will be staying on top of it that way as well.

Hi Everyone,

Like Juan l am a newbie posting for the first time, although l have followed the forum for a while. I am 63 yr old female & was diagnosed a few months ago with afib & bradycardia after my new sports watch was showing high HRs whIle running. A Holter monitor picked up the afib (vagal); otherwise l was asymptomatic.

After reading that "afib begets afib," l figured l best try to become able to determine when l am in afib so l can try to convert if possible. I think l'm getting there - my resting HR is high 40s-low 50s & when it jumps to the 80s-90s l can feel a bit of a flutter.

I am sure l have daily episodes, most lasting several hours. My question to you all: what, if anything, do you do to try to convert?

Thanks for your help - l appreciate any & all advice. What a steep learning curve this is!

Kind regards

Anne

Hi Anne,

Get a Kardia if you can. Best measurement device ever for home use!

Welcome to what certainly sounds like vagally mediated AF. My episodes were also just a “fish-flopping” 80 or so bpm. I even set a record low of 55 bpm while in AF. Those 2+ second pauses in heartbeat will certainly get your attention!

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AnneC
I am sure l have daily episodes, most lasting several hours. My question to you all: what, if anything, do you do to try to convert?

So some vagal afibbers can convert episodes with exercise, I could during the first couple of months of my afib journey, 14 years ago. Then I had a 2.5 month episode that wouldn't convert ( ultimately converted with 300 mg flecainide). I've subsequently converted every episode with on-demand flec, not wanting to risk another 2.5 month episode.

Many of the conversion techniques talked about increase vagal tone - ice water in face, bearing down & etc. These work for adrenergic afibbers as they decrease sympathetic tone, however are unlikely to work for a vagal afibber (though wouldn't be harmful to try).

When I was over consuming calcium by stress eating wheels of cheese during a divorce, my control got worse and I was much more sensitive to triggers. For example, the rapid decrease in heart rate after orgasm. I use this example as I could feel my heart "going off the rails." When I felt this, I could get up and move around. Even changing my position from horizontal to vertical was enough, many times to change vagal tone and either convert or ward off an episode. Don't know which as I wasn't wearing a monitor and couldn't tell if it was afib or just runs of PAC's. I would also be sensitive to the common "being prone on the left side." Again I could feel something starting and I could get vertical and move around and ward off the episode.

When I'm in an episode, the only thing that works for me is on-demand flecainide (300 mg in my case, 200 is the prescription if you are under 154 #'s).

Chronic fitness, endurance exercise, was my path to afib. After a while I determined this was suboptimal for me and quit doing it. Part of my afib remission strategy. If I were to run today, I would always do it with nasal breathing only. I would recommend Patric McKeown's book <[www.amazon.com] and listening to interviews & presentations he's done. I think this may allow you to exercise and not have it be a trigger. I stay active, but do bodyweight exercise and more anaerobic stuff now. That seems to work for me.

I also upped my electrolytes - magnesium to bowel tolerance, potassium, a couple of grams/day and taurine a couple of grams/day. This has worked pretty well for me for around 14 years. The time it got degraded was when I was eating too much calcium as I mentioned above. It took me 18 months to figure this out, but when I quit, the impact was nearly instantaneous for the positive.

Welcome,

George

Thanks very much George,

My EP has put me in a 2-month period of detraining (after l ran a half marathon on April 15) to see what happens with my resting HR & afib. I never had dizziness, lightheadedness or difficulty breathing while running, and don't recollect any strange feelings afterward.

I am on no meds as yet other than low dose aspirin but have just started supplementing with 1000 mg magnesium & fish oil & have ordered taurine.

How does flecainide affect your bradycardia?

The EP has said l am probably headed for a pacemaker in the next 2-3 years for the bradycardia but l remain hopeful l can resume some distance running. But your experience seems to tell me otherwise?

I know what you mean about the pauses - followed by the WHUMP!
Night time entertainment for me.

Thanks again for your thoughts, very much appreciated -

Anne

I’m not aware of Flec really affecting bradycardia, but it is often prescribed with a beta blocker (rate control drug) to mitigate the risk of flutter induced by the Flec. The beta blocker will slow the rate when in rhythm and may make one feel “sluggish”. It can also cause a lengthy pause in HR immediately following conversion for AF to NSR.

Not sure why your EP is thinking pacemaker. A resting HR of 40-50 is quite normal for an endurance athlete.

"Not sure why your EP is thinking pacemaker. A resting HR of 40-50 is quite normal for an endurance athlete"

I agree, Is the EP taking into account the fact that Athete's have lower HR's? Sounds like he missed this obvious connection. My EP did the same thing to me.

When it comes to resting HR, I by no means am an athlete, but during the day, (I work a desk job) my HR is in the 50's, with an occasional dip into the 40's and probably a couple times a week I hit the very low 40's. Is that too low? I imagine when Im asleep its pretty low, maybe even lower than that? I brought this up to my cardiologist and he said it was ok.

No, it's not "too" low unless you're experiencing dizziness or fainting. Are you on a beta blocker? If so that likely explains it.

I’m in the 40s just about every afternoon. Not a problem.

I took up distance running only 3 years ago (at age 60, go figure) and my event results are nothing to write home about so l am not a highly-trained athlete - l just love running. Along with a RHR in the 40s my EP is also concerned about my numerous nighttime sinus pauses (currently as long as 3 sec).

When l am in afib my HR can shoot up to an "astronomical " 100 or so - and l seem to feel only a floppy fish or fluttering, and then only if l am paying attention. But afib it is, and l seem to be spending long periods in it, so l am determined to mitigate it any way l can to slow its degeneration into something more sinister.

I feel for those of you for whom an afib episode is debilitating. I am not there yet, and don't want to be.

Kind regards

Anne

It amazes me how some people dont even know they have it. My cardiologist says people live for 25 years with it and dont even know. When I have a bout with afib, it kicks my ass. I get super warm, sweat like crazy, gasping for air, light headed, zero energy.....

Anne,

I'm not a highly trained athlete, either. I started running to lose weight. That wound up being about 120 lbs or so. I doubt the medical community has a trove of data on what happens to the body when its mass is reduced by more than a third in the span of a year. Needless to say it's stressful.

If you've been running for 3 years then your heart has adapted to it. It is probably a very efficient pump and AF won't lead to any sort of hemodynamic instability, as it doesn't for me. Like you, I "max out" at around 100bpm, and that's only when an episode starts. It very quickly ramps down into the 80's and, like you said, is just a "flopping fish".

Vagally-mediated AF isn't known for being very progressive. Likely it'll stay the same as you navigate the meds vs ablation roadmap.

Anne:

I got a pacer because when I was in AF and going into NSR, my heartrate would almost flat line for a few seconds, that was caught in my doctors office, I would almost black out when that happened. That only happened to me when going from AF to NSR. I have had no problems with the pacer which I have had for many years and I feel safer when going into NSR from AF. You have to do what is the best for you, don't listen to people that may not know what they are talking about.

Liz

The sinus pause would justify a pacemaker. In that case, it probably won't "fire" very often.

Hi George,

Thank you for your clarity. I'm v interested in your management strategies, as I enjoy mountaineering and hiking a fair bit as well. I'm curious about how you determined that it was the increased Calcium intake from cheese, rather than emotional stress (maybe a combo? ) that made you susceptible to triggers for AF. I've just had an episode, after some hiking with friends in Switzerland... normally I wouldn't consider hiking as a trigger (especially since I've adopted the nasal breathing 4 months ago), but then I remembered your posts about eating cheese, and i certainly have been eating waay more than I usually consume (nearly none, in normal life!). And I had run out of my Mag citrate powder. I have found emotional stressors to be the most reliable triggers, yet I can't pinpoint any for this most recent episode. Any thoughts welcome. I was at higher altitude than I'm used to, but was consciously not pushing myself.