What is normal for the abnormal?

I was very recently diagnosed with Afib. Heart felt weird, doc said go to urgent care, they immediately sent me next door to the ER.
And here I am.
Questions galore, but my question of the moment had to do with arrythmias.

Obviously, my 5 hour ECG in the ER indicated Afib. They sent me off with a 48 hour holter monitor, meds and a cardiology referal.
2.5 weeks later I saw the cardiologist... Who in his whopping 5 minutes with me (I only expected 61/2 so I was pretty disappointed there) basically said Afib, blood thinners, if it bugs you- ablation.

Later that week I got the 48 holter report from my GP. I was surprised to see that it said I was only in Afib 0.3% of the time, with the longest run at 4 minutes, but I was having PAC's 16% of the time and also some PVC's

My question #1 is: Is it normal to have PACs or other arrythmia issues along with Afib? Or is that really another issue?

My ER ECG report said I had a "Nonspecific ST and T wave abnormality" when I asked the doc about this he said something to the effect of that being just a bunch of stuff they put in the report (he clearly was not going to take the time to answer my question). The 10 second ECG he did the office that day said no Afib, the T wave abnormality was gone, but now I have prolonged QT.

So Question #2: If you have Afib do you usually have a changing set of abnormalities?...
I have been taking the med he prescribed (diltiazem), which I imagine could cause changes... but I'm curious what, if anything, is kind of "normal" for a gal with Afib?

You know, in case being abnormal can ever be normal

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bolimasa
My question #1 is: Is it normal to have PACs or other arrythmia issues along with Afib? Or is that really another issue?

Yes, that's very common.

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My ER ECG report said I had a "Nonspecific ST and T wave abnormality" when I asked the doc about this he said something to the effect of that being just a bunch of stuff they put in the report (he clearly was not going to take the time to answer my question). The 10 second ECG he did the office that day said no Afib, the T wave abnormality was gone, but now I have prolonged QT.

So Question #2: If you have Afib do you usually have a changing set of abnormalities?...
I have been taking the med he prescribed (diltiazem), which I imagine could cause changes... but I'm curious what, if anything, is kind of "normal" for a gal with Afib?

You should ignore the analysis printed on ECGs. It's nothing but a best guess by a machine, it's often meaningless, and doctors routinely ignore it. Normal for a gal with afib is the same as normal for a gal without afib. I doubt that the diltiazem has anything to do with the ECG changes you saw, but those changes really aren't significant anyway. You can take two ECGs minutes apart and get totally different interpretation by the machine.

Is the cardiologist you're seeing an electrophysiologist (EP)? If not, then you need to find one. EPs are cardiologists who specialize in treating abnormal heart rhythms such as afib. Think of them as electricians while regular cardiologists are plumbers. You need an electrician, not a plumber.

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Carey


You should ignore the analysis printed on ECGs. It's nothing but a best guess by a machine, it's often meaningless, and doctors routinely ignore it.

That is pretty much what he said... but I of course want to cover all my bases...especially if I'm heading to an ablation... and I do have my share of distrust that docs will really pay attention to everything)

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Carey
Is the cardiologist you're seeing an electrophysiologist (EP)? If not, then you need to find one. EPs are cardiologists who specialize in treating abnormal heart rhythms such as afib. Think of them as electricians while regular cardiologists are plumbers. You need an electrician, not a plumber.

Yeah he's an EP, appears to be a hot shit EP... (thus my low expectations for him spending time on my questions; at least his PA seemed decent!)) I hope he is actually good, especially if I get the ablation. [healthcare.utah.edu]

Do you have any idea what the chicken/egg answer is (I have yet to read much about PACS) Do the PACS cause the Afib or the Afib cause the PACS.... I was told 20+ years ago that I have the occasional "extra systole" (Until now I'd not noticed them in years!) and 2 inconsequential (most docs don't even notice them) murmurs... now I wonder if this was some precursur for where I am now.



Edited 1 time(s). Last edit at 06/25/2018 04:07PM by bolimasa.

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bolimasa
Yeah he's an EP, appears to be a hot shit EP... (thus my low expectations for him spending time on my questions; at least his PA seemed decent!)) I hope he is actually good, especially if I get the ablation. [healthcare.utah.edu]

Yes, Dr. Marrouche is widely known and has an excellent reputation.

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Do you have any idea what the chicken/egg answer is (I have yet to read much about PACS) Do the PACS cause the Afib or the Afib cause the PACS.... I was told 20+ years ago that I have the occasional "extra systole" (Until now I'd not noticed them in years!) and 2 inconsequential (most docs don't even notice them) murmurs... now I wonder if this was some precursur for where I am now.

Well, PACs and afib often go hand in hand, but PACs can trigger afib. PACs aren't caused by afib but they both share the same underlying atrial myopathy. That occasional extra systole was probably PACs. Doubt if the murmurs are relevant.

So it seems to me we should also worry about what is causing PACs?
Does anyone address the PACs as well as the Afib?

I guess I'd like to figure out what suddenly caused this to start...
Though I suppose maybe it's just the obvious "I need to lose weight" in hopes that it helps my BP... (which I have been working on with meds this last year) I may be overweight, but up until now never considered myself unhealthy.... I ski (several times a week all winter) , I hike (uphill! we have mountains!) , run a bit (on and off since wrecking a knee) ... always take the stairs (am I the only person who is happy to work on the 5th floor so I can do the 140 steps several times a day?) I eat relatively decent.

I do admit this last year I am at all time fitness low (nothing like new job stress to ruin a gal)... but I sure feel way too young and healthy to have a failing heart.... and the thought of blood thinners for life is so depressing... I took a chunk out of my knee on a trail on Saturday (luckily my INR isn't quite up there yet) but I don't feel like I lead a blood thinner friendly lifestyle. (I will not be giving up my skiing!!)

As I said, PACs and afib go hand in hand. They both share the same underlying cause, so trying to puzzle out the cause and effect is a useless errand. So yes, an ablation will address the PACs as well as the afib. I can't promise what the results will be, but if the ablation is thorough and done well, you will be free of both when it's over.

We've all been where you are now, trying to analyze this and figure out what causes what, what your triggers are, and so forth. Frankly, it's almost always a fruitless mission. Sure, some people will chime in here and say they (almost) cured themselves with this, that or the other thing, but in the end almost everyone has two realistic choices: medical management (drugs) or ablation.

And you don't have a failing heart. If you receive proper care for your afib, you will live as long as anyone who doesn't have afib. The choice you face is living with afib and various drugs for the rest of your life or ablation. I think you've made the right choice.

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bolimasa
Does anyone address the PACs as well as the Afib?

I had my first afib episode 14 years ago next month, after that, episodes came every 10-14 days and lasted 6-9 hours, till two months in I had an episode that would not convert. It lasted 2 1/2 months and was converted with flecainide. My understanding is this puts me in the "complex" category should I need an ablation.

I convinced my EP, who wanted me to just stay in afib, to prescribe flecainide on demand. I said I would create an electrolyte supplement program as my basis for staying in NSR. He agreed to this.

I purchased a recording heart rate monitor (beat to beat). I could "see" PAC's and PVC's in the data. As Carey says, PAC's and afib share the same underlying cause. My logic was to do 30 minute recordings during meditation (minimized artifact in the data from movement) and adjust my supplements based on minimizing PAC (and PVC) counts per hour.

What I ended up with was taking magnesium to bowel tolerance (currently 2 g/day as magnesium acetate or di-magnesium malate), a couple of grams of potassium as citrate and 4 grams of taurine.

This has worked to keep me in relative afib remission since (I get very infrequent episodes which I convert with 300 mg flec). My PAC counts are usually near 0 also.

I also realized that chronic fitness was my ticket to afib, so I detrained. I maintain fitness but do no endurance cardio. I only do short duration high intensity Tabata rounds on what most consider cardio. When I say I maintain fitness, here is an example, today I rock climbed, carrying a 50 pound pack bushwhacking up about 400' vertical on a very steep loose gully, then climbed for 5 hours in 95 deg heat at 7,000, while always nose breathing'. Then carried the pack down. In the winter I ski the steeps for 7 hours non stop. I also lift weights and do a lot of body weight training. I'm 63.

Over this time, I learned that excess calcium from food was not friendly to my afib.

I'm not saying my path will help anyone else, just what I did.

I look at high blood pressure as a metabolic issue with hyperinsulinemia as a root cause. When insulin is high, it signals the kidney to conserve sodium. The fastest way to reduced blood pressure is multiday water fasts. Why? Because they significantly reduce insulin. If one has co-morbidities, like high BP, fixing these organically (not with pharma) can reduce afib. Why? Because you are reducing the inflammation that may be a cause.

Though my BP has never been high, there was a 30 year (I think) study done by the Mayo Clinic following lone afibbers. One lesson from that clinic was that the afibbers got a lot of co-morbidities as time went on I determined that would not be me, so in 2009, I keto adapted and keep my fasting insulin in the range of 2-3 and A1C around 4.6 or so.

Many have put solving this afib problem as a very high priority. I put it as my highest in the beginning and spent a huge amount of time and effort reading papers trying to figure it out.

The takeaway from my story, isn't that what worked for me will work for anyone else, it is perhaps the analytical methodology that enabled me to figure it out.

I concur with Carey that solving this is difficult and being successful is a low probability event. Most of my friends with afib don't have the interest in putting in the effort I did, so I just send them to Dr. Natale in Austin for an ablation. That has worked well for them.

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GeorgeN



I convinced my EP, who wanted me to just stay in afib, to prescribe flecainide on demand.

What???

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GeorgeN

The fastest way to reduced blood pressure is multiday water fasts.

Note: Considered dangerous for people with "arrhythmias (especially atrial fibrillation)."

[www.wikihow.com]

George - I continue to be in awe of your research and discipline for managing your own unique biochemistry and metabolic needs that have proven so successful for you. A key point you mention is controlling inflammation... so critical because there are so many underling sources that few realize and it's so damaging. Another is using those core, requisite, supportive nutrients.

I'm sure your protocols will keep you healthy and active for a very long time; and, medication-free because you are balancing and optimizing essential, functional mechanisms that often aren't addressed by routine assessments.
Best of all - Afib Free.

Thanks for sharing.

Best to you,
Jackie

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GeorgeN
I'm not saying my path will help anyone else, just what I did.

The takeaway from my story, isn't that what worked for me will work for anyone else,

It's not just that it may not work, it's that it is potentially dangerous to undertake fasting and ketosis with afib, due to potential electrolyte imbalance. The supplementation which is generally advised here for afib based on anecdotal experiences and perhaps sparse measurements are unproven in this context. There is also the unknown effect of subclinical acidosis on arrhythmia.

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GeorgeN

Does anyone address the PACs as well as the Afib?


I had my first afib episode 14 years ago next month, after that, episodes came every 10-14 days and lasted 6-9 hours, till two months in I had an episode that would not convert. It lasted 2 1/2 months and was converted with flecainide. My understanding is this puts me in the "complex" category should I need an ablation.

I convinced my EP, who wanted me to just stay in afib, to prescribe flecainide on demand. I said I would create an electrolyte supplement program as my basis for staying in NSR. He agreed to this.

So, curious, is there a reason you did not have an ablation? Or did you simply progress quickly beyond the point where that would help?

I'm curious, as you obviously are an active fellow... I'm fairly active, and the thought of blood thinners for the rest of my life is pretty unappealing...
I did get a concussion skiing last year ... so the blood thinner/ head injury combo is worrisome.... even if I'm careful...unfortunately that concussion happened by no fault of my own... I had stopped to look for my kid, and got completely taken out by an out of control snowboarder... Hit me hard enough to launch me in the air and break my pole... my head was a mess for 6 weeks.
Blood thinners day one I had a strange hike which included navigating a construction zone ..climbing down a muddy slope in to deep ravine...
No problems, but I realize a slipping was in the realm of possibilities. Day four I hit a roller on a trail and took a chunk out of my knee... (funny how you can not fall in forever... but the minute you start the warfarin,,, LOL)

So yeah if there is a chance an ablation might get me off blood thinners I'm considering it.... I also get the impression that you have a better chance with ablation if it's done early (Is this true?)

Of course if I do do it...and have success, I don't want it to revert... so I would like to figure out, if I can, what triggers I may have and what all I can do to keep things under control. With only 0.03% AF but 16% PACs I do think I might need to consider the PACS. It will be interesting to see what the 30 day monitor I'm wearing now says.

Of course my head is spinning with all the (neurotic? LOL) thoughts and attempts at knowledge seeking....

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Jackie
A key point you mention is controlling inflammation... so critical because there are so many underling sources that few realize and it's so damaging.

This is something I'm curious about...both in regard to Afib and in regard everything you read everywhere in popular health literature.

So kind of off topic, but...
If inflammation is such a big deal, (and I'm not saying it isn't), how come they don't order any lab tests looking at it?
It seems like everyone is always shouting inflammation, this food causes inflammation, gut flora and inflammation... Anecdotal I know, but I've not run into anyone who's worried about inflammation who's had an measures of it.

Is there a specific reason for the warfarin in your case as opposed to the direct, oral anticoagulants like Eliquis? I'm surprised to see an elite EP choose warfarin, so I'm assuming there must be a reason for it. Bleed risk is higher with warfarin because of the infamous INR fluctuations.

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bolimasa

So, curious, is there a reason you did not have an ablation? Or did you simply progress quickly beyond the point where that would help?

At the time, 14 years ago, my EP did not think that ablation was appropriate for me, given the technology of the time. If my afib progressed past what it is now, I would consider it. I would not consider an ablation with the very light afib burden that I have now. I have almost no afib, my only limitation in activity is I don't do chronic endurance activity. I'm on no meds. I do take flecainide to convert myself when I go out of rhythm, Though my recent experience using CO2 from breath holding to convert may make that unneeded <[www.afibbers.org] . I seldom go out of rhythm so haven't had the opportunity to put this to the test again.

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So yeah if there is a chance an ablation might get me off blood thinners I'm considering it.... I also get the impression that you have a better chance with ablation if it's done early (Is this true?)

If a case is a "complex" case (likely would be me) and the left atrial appendage must be ablated, then life time anticoagulation may be required (or another procedure to deal with the potential clots in the LAA. I take no blood thinners. I did for several months during my 2.5 month episode 14 years ago.

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Of course if I do do it...and have success, I don't want it to revert... so I would like to figure out, if I can, what triggers I may have and what all I can do to keep things under control. With only 0.03% AF but 16% PACs I do think I might need to consider the PACS. It will be interesting to see what the 30 day monitor I'm wearing now says.

I found it useful to have my own monitor for more immediate feedback. I would monitor, then change things and see if PAC counts went up or down. Of course there is random variation, but I did get a sense.


As to @

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safib

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jpeters

comments. Yes, the electrolyte shifts when first adapting to ketosis, primarily caused by low insulin levels can cause afib. I knew this when I adapted 9 years ago. I did experience one afib episode as a consequence. I knowingly took that risk, weighing the benefit risk ratio for me. I'm fairly confident that with what I know now, I could avoid this with proper supplementation. Also my wife and an MD friend in NZ both adapted very slowly and had no perceived negative consequences (i.e "keto flu" an indication of these shifts). Subsequent to my adaptation, I've never had an episode because of ketosis. I've tested insulin levels below 1 and serum glucose as low as 31 mg/dL (1.7 mmol/L) without consequence. In fact with the 31 glucose, I went to the gym and set significant PR's on my lifts. My neurologist climbing buddy said he'd never seen anyone with glucose in the 30's who wasn't comatose. I told him they weren't adapted. I've done many multiday fasts including 19 5-day water fasts last year, that were weight stable.

As to acidosis, I've run my serum betahydroxybuterate (ketones) as high as 8 mmol/L without consequence.

As to unproven for electrolyte supplements. Yes if you are looking for RCT's. I live in the land of n=1. When I discussed this with the EP, 14 years ago, he said it was perfectly fine to be your own control, hence why he approved the program I proposed - use electrolytes to stay in rhythm and on-demand flec to convert when that failed. I've taken away my magnesium multiple times and the end result is afib in less than 48 hours, even when I haven't had afib for over 2 years. I also chatted with my ER doc climbing buddy who described how it was common to use IV mag in the ER to convert people with afib. Another cardio friend talked about doing mag experiments with rhythm issues as part of his medical schooling and mentioned favorable results.

I'm not advocating anyone do what I do, only reporting my experience. I have excellent kidney health. My doc, Steven Gundry, runs 24 pages of tests 2x/year from 4 different laboratories. He thinks I'm doing very well as have several other doc friends that I've shared my labs with. I also spend a huge amount of time in PubMed looking at full copies of papers before I do something. I study, instrument, gather data, analyze - then rinse and repeat.

I chose the warfarin.
He would have prescribed Xarelto.
I have concerns about the reversibility issue, and have no intention of living my life bubble wrapped.

Plus I do feel better knowing it has been tried and true for decades... my dad had afib ... and got put on some newest latest greatest med, 6 month later he was dead, there are all these "if you used XYZ for Afib" and suffered XYZ call this law office" commercials on the TV... to which my mom points and says... that is what your dad was on. Of course I'm not even sure what med that was or if it was blood thinner.... but it does make me cautious.

Of course if the INR biz ends up being problematic, I may have to reconsider. I'm only a little over a week into it so we will see how it goes. Fortunately for me I work at a med center so running over to the thrombosis clinic a few times a week is not a big deal.

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GeorgeN

I have almost no afib, my only limitation in activity is I don't do chronic endurance activity. I'm on no meds. I do take flecainide to convert myself when I go out of rhythm. I take no blood thinners. I did for several months during my 2.5 month episode 14 years ago.

I am confused... as I was under the impression that the docs wanted you take blood thinner for life if you were intermittent. Which it sounds like you are.
Or is is a choice you've made?
I know my BF seems to think that if I'm only doing AF 0.3% of the time I probably don't really need blood thinners.
I'm not sure what my take is on that...(I certainly don't want to have a stroke turn me into a vegetable and cause me to be burden on my children!) I'm currently doing a 30 day monitor... so I will wait to see what that says. Even then I obviously have no idea if it will suddenly come back... so I see why they are cautious and prescribe the thinner.

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GeorgeN
I found it useful to have my own monitor for more immediate feedback. I would monitor, then change things and see if PAC counts went up or down. Of course there is random variation, but I did get a sense.

And what monitor do you like?... I get the impression the Kardia is the popular one... but someone told me about the Emay and seemed to like that it can upload to some sort of software (to store/interpret?) and that you didn't necessarily need to send traces to a doc and that it detects more heart issues than just afib... or something like that... all I remember for sure is that she liked that one better. But I rarely see that one mentioned by anyone else.

% of time in AF is not a valid statistic. It's hours of continuous AF. A clot can form after about 2 hours. The PIP studies are narrowing this down. The data are good and the science is sound. DO NOT USE % time in AF to guide any anticoagulation decision!

For example 2 hours of AF in one month is 0.3%, but is also quite enough to kill your brain and possibly the rest of you. If CHADS2VASC says anticoagulate, then you'd be well advised to do it after an episode exceeds a couple of hours.

bolimasa -

---

So kind of off topic, but...
If inflammation is such a big deal, (and I'm not saying it isn't), how come they don't order any lab tests looking at it?
It seems like everyone is always shouting inflammation, this food causes inflammation, gut flora and inflammation... Anecdotal I know, but I've not run into anyone who's worried about inflammation who's had an measures of it.

Not off-topic at all because inflammation lies at the core of many cardiac issues (such as 'thick, sticky blood) as well as for total body. There are specific tests that address inflammation and are typically ordered by doctors who practice restorative medicine - now called Functional medicine which applies the science of systems biology in a practical setting. Specific tests have been listed in some archived posts - links listed below. These tests for "markers" of inflammation and other out-of-range influences that can be detrimental to overall health and unfortunately are not typically looked at since the focus seems to remain on cholesterol for which a statin can then be prescribed.

When there's 'silent inflammation,' there are numerous natural nutrients that help reduce and maintain inflammation at low, safe levels and also includes eliminating various exposures such as toxins, environmental elements, food sensitivities and such that often are the culprits in promoting the inflammatory process.

Here's a start on the inflammation topic.

Silent Inflammation – Risk Marker for Stroke, Heart Attack & Much More
[www.afibbers.org]

Clot risk
[www.afibbers.org]

Jackie

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bolimosa
I am confused... as I was under the impression that the docs wanted you take blood thinner for life if you were intermittent. Which it sounds like you are.
Or is is a choice you've made?

I was never prescribed anti coagulation long term. My CHADS2VASc <[en.wikipedia.org] score is 0. Except for age, which I can't do anything about, I intend to keep it there.

CHA2DS2-VASc
Condition	Points
 C 	 Congestive heart failure (or Left ventricular systolic dysfunction)	1
 H	 Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)1
 A2	 Age ≥75 years	2
 D	 Diabetes Mellitus	1
 S2	 Prior Stroke or TIA or thromboembolism	2
 V	 Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)	1
 A	 Age 65–74 years	1
 Sc	 Sex category (i.e. female sex)	1

Hence my hyperfocus on low insulin - which translates into no Diabetes Mellitus or Hypertension.

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And what monitor do you like?... I get the impression the Kardia is the popular one... but someone told me about the Emay and seemed to like that it can upload to some sort of software (to store/interpret?) and that you didn't necessarily need to send traces to a doc and that it detects more heart issues than just afib... or something like that... all I remember for sure is that she liked that one better. But I rarely see that one mentioned by anyone else.

I have an AliveCor/Kardia and it works quite well to detect afib. It will run a 30 second ECG. This lady <[www.livingwithatrialfibrillation.com] likes this monitor <[www.amazon.com] It purports to do the same thing, but does not require a subscription like AliveCor does. I've never used it. It also doesn't require a phone.

For testing for PAC/PVC's, I want longer (30 min or overnight) monitoring. i used initially a Polar S810 recording exercise heart rate monitor. It is now ancient. I did purchase an updated Polar, but it did not work and failed shortly after I bought it. I don't need to do that testing now, but if I wanted to, I have a setup of a Polar H10 strap <[www.amazon.com] with a an app <[itunes.apple.com] I record the data on my phone, export it to my computer and look at it in the Polar software:. Polar Precision Performance SW <[support.polar.com] . This is not seamless for someone who is not tech oriented. You could look at it in Excel, but I think the old Polar software gives the best visuals for my purpose. We talked about how to interpret these tachograms here <[www.afibbers.org] and here: <[www.afibbers.org] One could do longer term monitoring with just this app: <[itunes.apple.com] as it will also export the data, however you are stuck with your finger over the phone's camera as long as you are monitoring.



Edited 3 time(s). Last edit at 06/27/2018 09:49PM by GeorgeN.

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wolfpack
% of time in AF is not a valid statistic. It's hours of continuous AF. A clot can form after about 2 hours. The PIP studies are narrowing this down. The data are good and the science is sound. DO NOT USE % time in AF to guide any anticoagulation decision!

For example 2 hours of AF in one month is 0.3%, but is also quite enough to kill your brain and possibly the rest of you. If CHADS2VASC says anticoagulate, then you'd be well advised to do it after an episode exceeds a couple of hours.

Yeah I told him that 0.3% might not sound like much, but that my take was that any episode could potentially do harm... but... along the lines of what he is thinking, if it takes 2 hours to form a clot and all my episodes are super short, perhaps he is correct? My 48 monitor said my longest bought was 4 minutes... I guess it will be interesting to see what this 30 day monitor says. I had my first noticable afib in the week I've been monitoring last night when I went to bed... not sure how long it lasted.... then there is the issue of do I know I'm in affib? Are there times I think I'm fine when I am not?
I dunno... the BF is brilliant bioscience PhD... so he analyses things... and reads the literature... and is quick to spot the fallacies in scientific papers... so it is always interesting to hear his take on things. (and disagree sometimes LOL)

Get the Kardia device if you can. You can check anytime you'd like (except at night of course). If you're one of the more asymptomatic types then I think it would certainly be of benefit. You can also just check radial pulse. AF is "irregularly irregular". You may get several beats that feel evenly spaced and then a long pause or two before another salvo of seemingly normal beats. My heart's favorite reggae rhythm was often 7 beats on, three beats off. If I had a scrap of musical talent I'd put that to song someday.

Thanks Jackie and George for all the links to info. I have to admit I'm feeling a tiny bit overwhelmed. by all the info... and my propensity to check out everything on pubmed isn't helping much.. not enough hours in the day... that's for sure.

“How long do I have to be in A-Fib before I develop a clot and have a stroke?”

When blood is stagnant and not being pumped out of the left atrium, a clot can form. When the left atrium starts beating again, this clot can be pushed downstream into the left ventricle which then pumps this clot into the legs, lungs, brain or other organs causing an ischemic stroke.

But these clots aren’t formed instantly. It takes a while for stagnant blood to pool and clot. For example, if you have a ten minute attack of A-Fib, conventional wisdom says it’s unlikely a clot will develop.

The American College of Chest Physicians recommends that anticoagulation therapy be started after two days. But not everyone is in agreement that it takes at least two days of being in A-Fib for a clot to form. Dr. Antonio Gotto in Bottom Line Health says it takes one day for a clot to form, “There’s an increased risk for stroke if the irregular heartbeat continues for more than 24 hours.” (Some doctors are of the opinion that it takes as little as 5 1/2 hours of A-Fib for a clot to develop.)

Taken from the AF.com site

liz

Liz - did that comment address the state of the viscosity of the blood as being a primary consideration ?

Example... very thick, viscous blood, by its nature, has a tendency to clot faster if it's "churning" in the atrium: whereas blood with low viscosity properties, meaning a lesser fibrin content as well as absence of both oxidative stress and inflammatory factors including LDL particle factor, will take a lot more time before forming a clot.

Also, when discussing viscosity, it's important to consider the LDL particle factor and state of atherosclerosis in the individual because the increased blood viscosity in areas of low flow or shear, is predisposing to thrombosis.
This is known as the hemodynamics of blood flow that underlie the propensity for clotting. It’s also logical that Hydration status has a significant influence.

Preventive measures were discussed in a report in Townsend Letter… by Drs Pushpa Larsen and Ralph
Holsworth - mentioned in his post… [www.afibbers.org]

Related post:
[www.afibbers.org]

Jackie

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bolimasa
the T wave abnormality was gone, but now I have prolonged QT.

So Question #2: If you have Afib do you usually have a changing set of abnormalities?...
I have been taking the med he prescribed (diltiazem), (

prolonged QT can be a side effect of diltiazem <[www.lhsc.on.ca]

Also, magnesium has been called "natures calcium channel blocker." Maybe there is a way to substitute mag in here? Not that I'm suggesting you discontinue meds without consulting a doc.

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GeorgeN

the T wave abnormality was gone, but now I have prolonged QT.

So Question #2: If you have Afib do you usually have a changing set of abnormalities?...
I have been taking the med he prescribed (diltiazem), (

prolonged QT can be a side effect of diltiazem <[www.lhsc.on.ca]

Also, magnesium has been called "natures calcium channel blocker." Maybe there is a way to substitute mag in here? Not that I'm suggesting you discontinue meds without consulting a doc.

Interesting... I will have to look into the Mg biz
I would certainly prefer to get off the meds, though my GP suggested I continue on them until I see the cardiologist again in August. Part of me sort of wonders if my latest BP med has wacked out my electrolyte balance a little and that helped precipitate this problem. My numbers were fine in the ER that day, (though my K was at the low end of normal) but one has to always wonder if 'normal' could still be a problem causing alteration to my personal normal. (yeah, grasping at straws when the probable cause is simply pudgieness nudging up my BP)

I suspect I'll be getting an ablation... and if I'm lucky enough for it to work I feel like I need to figure out what to change to make sure it doesn't start up again. I don't want an ablation to simply be a bandaid for the underlying problem.

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bolimasa
(though my K was at the low end of normal) but one has to always wonder if 'normal' could still be a problem causing alteration to my personal normal. (yeah, grasping at straws when the probable cause is simply pudgieness nudging up my BP)

Potassium can be an issue for us in the afib world. I know I strive to keep mine >4.0 or so. My first afib episode, I also went to the ER as I did not know what was happening. My potassium was 3.2 as I recall.

Potassium can vary rapidly. My experience is if I get magnesium correct, then potassium falls in line.

Biophysicist Richard Moore's (MD, PhD) book: <[www.amazon.com] will lay out the case that BP issues are caused by the potassium sodium ratio. He also makes the case that high insulin is a huge actor in this picture. And crazily, he then promotes a 70% carb calorie diet, which will spike insulin. A case of not seeing the forest for the trees, IMO.

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GeorgeN

(though my K was at the low end of normal) but one has to always wonder if 'normal' could still be a problem causing alteration to my personal normal. (yeah, grasping at straws when the probable cause is simply pudgieness nudging up my BP)

Potassium can be an issue for us in the afib world. I know I strive to keep mine >4.0 or so. My first afib episode, I also went to the ER as I did not know what was happening. My potassium was 3.2 as I recall.

Potassium can vary rapidly. My experience is if I get magnesium correct, then potassium falls in line.

Biophysicist Richard Moore's (MD, PhD) book: <[www.amazon.com] will lay out the case that BP issues are caused by the potassium sodium ratio. He also makes the case that high insulin is a huge actor in this picture. And crazily, he then promotes a 70% carb calorie diet, which will spike insulin. A case of not seeing the forest for the trees, IMO.

Mine was 3.5 at the ER. (and I'd upped the banannas the 2 days prior since I was feeling weird)
Down from 4.5 in January '18 and 4 in Jan. '17
The last couple of years I've had some odd boughts with charley horses, and electrolytes can effect cramps too.
I've never really given much thought to Mg....
And insulin?
Diabetes has always been a naggging worry to me, as my grandma had it, and I have issues with my weight.
I don't consider my diet bad, we eat vegetarian more than not, avoid the processed foods, don't overdo the sweets (desserts are occasional treats, not dailies), I don't drink much, but carbs are my vice...my favorite snacks are homemade bread, rice, pretzels or cheese and crackers if I have them.

This is a reprint of the paper Joseph Kraft wrote in the mid-1970's. <[www.hippokrati.fi] A lot of people do an oral glucose tolerance test (fast for 12 hours, test serum glucose, consume 75 g glucose [was 100g then], measure serum glucose at 05., 1, 2, 3 hours). Kraft did this, only he tested insulin too and for 5 hours total. Everybody treats T2 diabetes as a disease of glucose. It is really one of insulin - generally too much. Kraft did ~15,000 of these tests over his career.

Kraft also wrote a book <[www.amazon.com] He did an interview with my friends Ivor Cummins and Jeff Gerber in 2015 <[www.thefatemperor.com] He passed at 96 in 2017. The bottom line from Kraft - something like 70 or 80% of those with a normal glucose profile on the test had an abnormal insulin response!

My friend, Catherine Crofts, in NZ did her PhD dissertation using Kraft's data. Her focus was to see if there was a test that would give the same result without a full five hour test. Her thesis is linked in this post<[www.apoe4.info] Bottom line, test inulin two hours after the glucose intake. If <30 you are golden. If between 30 & 50 you may have a problem, If >50 you do have a problem.

I purchased my first glucometer in 2006. I was very fit, but had an inkling all was not right. I was eating high carb vegan. Knowing what I do now, I'm sure my test curve (had I done one) would not have been Kraft Type I. In any case, I started trying to eat so I would not spike my glucose. This ultimately led to full keto adaptation in 2009. My diet is no longer vegan. Today it is a lot of leaves, but calorically it is likely 70% fat, a lot of that from avocados and unfiltered olive oil. Today, I would (and have) purchase this meter <[keto-mojo.com] as it measures both ketones and glucose and is the best mix of precision and cost per strip I've found. Getting a meter was an eye opener. I used to think oatmeal was great for me. I would roll my own oats from organic seeds to make it. Then I saw the huge glucose spike I got from it. The meter is objective.

I'm convinced that hyperinsulinemia is a root cause of much chronic disease today. Fixing it may not fix your afib, but it may fix your hypertension. If you weren't hypertensive, then you might not need blood thinners.

By the way, I think there may be newly developed antidotes for the novel blood thinners. There was a post about that here not too long ago. That might make life easier than worrying about INR.

Getting electrolytes right won't help all, but has helped quite a few.

Problem with a banana is it is carby. The carb spike may cause K excretion and nullify the benefit of eating it.

Pradaxa and Eliquis have FDA approved reversal agents. Praxbind and Andexxa.

It takes a 2 hour infusion of andoxanet alfa, significantly reversed by 92.7%. You had better be near a hospital that has this antidote. Coumadin's reversal agent is Vit. K.

liz

I discussed the reversibility issue with my thrombosis pharmD... I think he said that there is some for Pradaxa, and it's expensive. The drug that was recently approved for some of the other blood thinners is not actually available yet... When it is, it is supposed be $27,000.

We'll see how problematic the INR is. I hit the goal of 2 today... Now to see how consistent I am. At least I'm lucky that the thrombosis clinic is just a quick little work break.
Clearly the blood thinners suck... A friends dog scratched my arm the other night... A few little scratches look pretty horrible on warfarin.)

The first line of treatment for hemorrhage in an anticoagulated patient is simple plasma infusion until the drug wears off (12 hours or so). Reversal agents would only be used in cases where that wasn't fast enough.