How long to stay on Eliquis after one episode of Flutter...

Ok So I have had my first ever flutter in April... 150 pulse...Took 2 days to 'convert using meds only. When they did Cardizem drip plus Metopropol it STOPPED my heart for 5 seconds and it happened 5 times over while I was watching the EKG trace... I saw and shrinking cone and was dying..... It didn't hurt and I didn't see jesus (lol)...then it righted on its own a couple of hours later and I went home .... Feel good !

Heart plumbing is strong...no defects apparent. Health excellent never smoked etc etc etc . They prescribed metopropol which I have permission to split coz I was zombified on 50 mg twice day...

Plus Eliquis...
Co -pay was going to be $280 so I getting the genuine thing from 'somewhere north of here'...

Question:.... As I am not fluttering, and after say a month, is there reason to stay on Eliquis forever ? I check my pulse and blood pressure twice every day as I am a hypochondriac (lol), so I am know I am not afibbing or fluttering...

I am exploring ablation in July as those 5 second flat lines, or 'gaps' as they called them, scared the bejaysus out of me....

How's your blood pressure? Do you have diabetes? Are you over 75?

If the answer to all three questions is no, then if I were in your shoes I would discontinue the Eliquis. I'd stop the metoprolol too. It's a rate control drug that prevents nothing. It only slows your heart down when you're in an abnormal rhythm. If flutter happens again, I would resume taking both of them immediately.

I'd be more concerned with the pauses. Do they happen when you're not in flutter? If you don't know the answer to that question you should ask your doc about wearing a Holter monitor for a while.

Did the holter 2 years ago when I had some palpitations after working in the yard all day in 90 degrees with only a beer for to drink..... Hate water......Negative result from the 48 hour holter.... Negative EKG....Stress test at that time was discontinued after 2 of the 3 phases because "Your heart is so strong there is no point"...

Seems the 5 seconds gap 'mini-death' was causes by the Cardizem stiil going at full belt through the drip at the same time as the beta blocker was surging up. My Doc said "they will know not to do that next time".... Too right they will !
That metoprolol is too powerful for me.. I am doing 25 mg twice a day just now and even that has me drowsy...

No diabetes ..no nothing.... I am 71 but I suffer from...nothing...so this flutter was the first thing that has ever happened to me...

No varicose veins...no clots, nothing..ever.. BP is 120/80 with pulse 68....

Don't know if the specialist will agree to ablation after only 1 event but 'the internet' says flutter always turns to afib and is always progressive... I have read so much I dont know what to believe...

Personally, I wouldn't pursue ablation after a single episode. Although it's true that flutter often progresses to afib, you don't know how frequent it's going to be. For all you know this event was a one-off event due to something like an electrolyte imbalance and won't happen again.

What is the difference between Afib and flutter? (In dummy terms please )

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katesshadow
What is the difference between Afib and flutter? (In dummy terms please )

Afib is chaotic firing of cells in the atria. That's why it produces an irregular heartbeat. There's no rhythm to these signals and they cause the atria to just quiver instead of pumping.

In contrast, flutter is a stable, regular rhythm that often produces very high heart rates (mine routinely went as high as 250). It's caused a single signal going around and around in one of your atria propagating itself. https://www.youtube.com/watch?v=lVl9tfYbvbQ

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allserene
No diabetes ..no nothing.... I am 71 but I suffer from...nothing...so this flutter was the first thing that has ever happened to me...
.

So, you had a glucose tolerance test ? Even better, one with a Dr Kraft insulin survey?

.



Edited 1 time(s). Last edit at 05/02/2019 11:13AM by allserene.

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Carey
Personally, I wouldn't pursue ablation after a single episode. Although it's true that flutter often progresses to afib, you don't know how frequent it's going to be. For all you know this event was a one-off event due to something like an electrolyte imbalance and won't happen again.

You give me hope ! Certainly it all feels very settled since the single 'event' of flutter
Seems there are so many possibilities ranging from a flutter event never to be repeated, to annual (or less) repeats of flutter and eventually fibbing..

Our hobby is travel so I don't want to get caught out in Denmark or Switzerland with a 150 pulse...

My current dilemma is wanting to get off Eliquis and the 25 mg (spit tablet my idea) Metoprolol...but doctors don't want to get involved and have a 3 week waiting list anyway (Aurora)....and the specialist's earliest appointment is mid July (Wisconsin)....

Leaving messages for them to phone me with advice doesn't work...

jeez ...I had better service on the UK NHS

Any thoughts on whether metoprolol can 'prevent' a likely recurrence....or is there anything to do that ? Since it stopped my heart 5 times for 5 seconds each time, I am not happy about metoprolol/Cardizem combination....



Edited 1 time(s). Last edit at 05/02/2019 11:17AM by allserene.

Thank you. How would one know the difference between atrial heart flutter and "regular" heart pounding (like when you get nervous)?

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katesshadow
Thank you. How would one know the difference between atrial heart flutter and "regular" heart pounding (like when you get nervous)?

I had no idea and just thought I had palpitations... After 7 days I went to the doc and he put me on his office EKG and I was at 150 beats and he could tell by the trace that it was flutter... I have a blood pressure monitor at home which wouldn't have shown the flutter trace, but it would have shown the 150 beats (resting) ...or have blown up ! Doc said 150 pulse for 7 days is like running a marathon for 7 days with no stops...and will wear the heart out ...Any new sign of palpitations will have me upstairs on the pressure/pulse machine and down to emergency

So the answer is...if you are at 150 or so resting.... call the doc sharpish !

Flutter produces a regular rhythm while afib produces a very irregular rhythm. You can tell them apart by simply feeling a pulse. That wouldn't be diagnostic, of course. The only way to diagnose either rhythm is with a 12-lead EKG.

As a general rule, if your heart rate is over 100 when not exercising and it doesn't come down to normal when you relax, you need to visit a doctor. That's never normal.

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allserene
My current dilemma is wanting to get off Eliquis and the 25 mg (spit tablet my idea) Metoprolol..

You could just call your doctor's office and ask for a Metoprolol RX for 25mg tablets and then cut them in half to achieve 12.5mg. That's really low and shouldn't cause you long pauses. Remember always that metoprolol comes in extended release (met. succinate) which should never be cut and "standard" release (met. tartrate) which is perfectly safe to cut in half. I've done the latter myself. And, should you have an event, you can just take a full tablet if half of one fails to lower the rate enough. Plenty of flexibility there. There's really very little harm that can be done with simple beta blockers as long as you're smart enough not to overdose (which it seems you certainly are).

As for the Eliquis, you can plead your case with the prescribing doctor. If you've truly been in NSR for a month then it should be OK to stop. I'd be making the same argument if it were me.

The only place you're likely to get a Cardizem drip is in an ER, so I wouldn't worry about that. You can always tell them you don't want it.

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wolfpack

My current dilemma is wanting to get off Eliquis and the 25 mg (spit tablet my idea) Metoprolol..

You could just call your doctor's office and ask for a Metoprolol RX for 25mg tablets and then cut them in half to achieve 12.5mg. That's really low and shouldn't cause you long pauses. Remember always that metoprolol comes in extended release (met. succinate) which should never be cut and "standard" release (met. tartrate) which is perfectly safe to cut in half. I've done the latter myself. And, should you have an event, you can just take a full tablet if half of one fails to lower the rate enough. Plenty of flexibility there. There's really very little harm that can be done with simple beta blockers as long as you're smart enough not to overdose (which it seems you certainly are).

As for the Eliquis, you can plead your case with the prescribing doctor. If you've truly been in NSR for a month then it should be OK to stop. I'd be making the same argument if it were me.

The only place you're likely to get a Cardizem drip is in an ER, so I wouldn't worry about that. You can always tell them you don't want it.

Good thinking..... I am cutting 50s of Metoprolol tartrate in half at the mo and I feel a bit snoozed on them but not much... Can they really prevent another event or is it just to 'get a start' in case one kicks in ?

My latest reading on Eliquis is that they don't dissolve clots, they just stop new ones forming.......and as I am not fluttering, and never had evidence of a clot ever, I should be ok to stop after a month... I see my primary care Doc on May 31st (first appointment available !) and I am sure he will duck the question and leave it for the new specialist 17th July (first appointment available !)...

I have changed docs from the original hospital prescriber as I thought the hospital was a chaotic contradictory schizophrenic frenetic dump, and that's putting it benignly... They managed to stop my heart 5 times, the shower curtain was ripped and hanging, the telly was on the blink and every staff member gave me a different story as to when and who was going to do what next.. and that was if I could find them. Still waiting for the bills. I went over the wall on the 3rd day as nothing was going on but the bills and the ever changing promises........ growl growl growl...

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allserene
Can they really prevent another event or is it just to 'get a start' in case one kicks in ?

Beta blockers don't prevent anything. All they do is slow your heart rate down if you have an episode.

I do know one person who says BBs prevent afib for her, but I'm skeptical. If true, it's probably just because they reduce stress by blunting the effects of adrenaline.

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Carey

Can they really prevent another event or is it just to 'get a start' in case one kicks in ?

Beta blockers don't prevent anything. All they do is slow your heart rate down if you have an episode.

I do know one person who says BBs prevent afib for her, but I'm skeptical. If true, it's probably just because they reduce stress by blunting the effects of adrenaline.

That is the conclusion I am coming to .... At $4 a month copay for beta blockers, I dont have my usual excuse to stop, but I try to avoid all medication if possible. If I stop Eliquis mid May I was thinking that I will just take the evening one for 2 weeks before they run out. My thinking was that the slow heart rate overnight would be the more likely time for a clot to form....but that's just wild amateur speculation and I might be better just stopping rather than having my system turned on and off for 2 weeks.... I have ordered some more from 'somewhere north of here'...so I can keep those and be ready immediately in case I get an episode. What I am hearing from all over, is that all I can do to help prevent an episode is get plenty of light exercise, eat well, electrolytes, and low stress and keep my fingers crossed. ..and its too early to ablate after only one flutter... I wonder what percentage of sufferers get one flutter and then never again with no progression... I was diagnosed with MS in 1998 and my doc told me to stop driving for life. I didn't. I bought a Kawasaki 1000 instead. Since then I have had two minor episodes of burning scalp etc lasting 6 weeks each.. So dodging bullets has been my specialty....up to now..



Edited 1 time(s). Last edit at 05/02/2019 06:42PM by allserene.

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allserene
I thought the hospital was a chaotic contradictory schizophrenic frenetic dump

Yes. Most ERs are. Bear in mind they exist to stabilize life threatening conditions. Anything less than that is going to get scoffed at or treated with a sledgehammer approach to get you out of there ASAP. I’ve done the drill myself and regretted it.

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wolfpack

I thought the hospital was a chaotic contradictory schizophrenic frenetic dump

Yes. Most ERs are. Bear in mind they exist to stabilize life threatening conditions. Anything less than that is going to get scoffed at or treated with a sledgehammer approach to get you out of there ASAP. I’ve done the drill myself and regretted it.

The ER wasn't the worst of it and in fact they were ok really.... When they halved me from 150 pulse to 75 in half an hour with cardizem, it was looking good, but then when it went back immediately to 150 as soon as they turned down the drip, they shrugged and said I would have to be admitted...and that's when it got grungy.... My doctor changed every few hours and the typical meeting with him was 25 seconds or so max... I was told I would have the TEE echo thing the day of the eventual conversion , then it was put off to the next day (in the morning), and then I was told it would be most likely in the afternoon but if not then, it would be yet another day !... This was now day 3 and I was sat in this scruffy room with a defective telly and the usual 400 lb crazies and vagrants screaming and shouting in the adjoining rooms.. I was desperate to get out and one of the crazies was screaming he didn't want to be discharged coz it was worse where he lived.... I should have stolen his identity and got out of there... Anyway I cancelled the forever promised TEE and they let me out with a script for Eliquis and Metoprolol and no indication as to whether it's for life or what or what to do if it made me catatonic (which it did)... ... Then my primary doctor retired and the new guy has a 3 week waiting list (primary doctor)... Having my heart stop 5 times was bad enough, but the hospital experience was worse. Left a voicemail for the new specialist 2 days ago and the call has not been returned..... If I ever get another flutter and the emergency room can't convert me with cardizem at the first try, I will ask for immediate electrical cardioversion to try and avoid a 3 day + admission.... I am also changing hospitals and waiting for the thousands in bills...

This is why we want to be seeing a cardiologist and/or electrophysiologist for atrial arrhythmia. Hospitals and general practitioners are not where we want to go.

I hope you have at least a cardiologist. Do you? If not, I’d get one right away.

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wolfpack
This is why we want to be seeing a cardiologist and/or electrophysiologist for atrial arrhythmia. Hospitals and general practitioners are not where we want to go.

I hope you have at least a cardiologist. Do you? If not, I’d get one right away.

Totally agree..the regular doctors just aren't into this stuff. My doctor who retired this week recommended a highly rated electrophysologist and I have made an appointment for 17th July. Earliest available date ! That's the trouble with good ones, there is a long wait to see them. I left a phone message 3 days ago to touch base but he didn't reply... I feel like I am on my own without even telephone advice, but at least the affiber forum has useful accounts of various experiences...

If I get a flutter in the meantime, there is no chance I will be able to see him and I will have to go into emergency again ....but in a better hospital this time; one with locking lockers, and with a supply of books and underwear and my own toothbrush/toothpaste...

On the 'withdrawal from metopropol' front, I cut out the evening 25mg last night and the bounce back has sent my BP to 165/95 with a 72 pulse. I am happy about the pulse as I am traditionally a 72 man, not a 57 man. Now all I have to do is get the pressure down to the 128/82 that I used to enjoy up to the 'event' 3 weeks ago... I am still doing the Eliquis for now, and I am assuming that stuff cant increase BP

Unless your heart rate is very high, or you're experiencing other symptoms such as fainting, chest pain or shortness of breath, there's really no reason to go to a hospital for afib or flutter. Take the metoprolol to slow the rate down, continue the Eliquis, and wait it out. If it continues longer than you can tolerate it then consider going to emergency, but when you do I would suggest asking to skip the drugs and just do a cardioversion. There's absolutely no reason for you to be admitted.

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Carey
Unless your heart rate is very high, or you're experiencing other symptoms such as fainting, chest pain or shortness of breath, there's really no reason to go to a hospital for afib or flutter. Take the metoprolol to slow the rate down, continue the Eliquis, and wait it out. If it continues longer than you can tolerate it then consider going to emergency, but when you do I would suggest asking to skip the drugs and just do a cardioversion. There's absolutely no reason for you to be admitted.

You are still making a lot of sense to me... Instead of laying in a horrible hospital bed for 24 hours taking Metoprolol and waiting to convert, I might as well do it at home and at least I will know I am doing the right dose (would do 50mg twice a day) and not at the mercy of an overworked nurse.... Not racking up a thousand a day in fees for 3 days would help my blood pressure too ! After 24 hours, if I dont convert, then I can try see if the specialist will give me the volts at his shock-shack..... and if not then I suppose its the local emergency room, but, as you suggest, leaning on them heavily to do the volts after I tell them I have been doing metoprolol for 24 hours at home with no conversion... ps I have bought a second blood pressure meter with an international AC adapter just to check on the first machine . $28 is nothing in this game and like it said on my calendar "Information is the currency of power"...

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allserene
. My doctor who retired this week recommended a highly rated electrophysologist and I have made an appointment for 17th July. Earliest available date ! That's the trouble with good ones, there is a long wait to see them. I left a phone message 3 days ago to touch base but he didn't reply..

That’s why we want to “team up” a cardiologist and electrophysiologist. You’ll get in to the cardio much faster, often same day, and he or she can handle anything with regards to medications. Also, the EP *will* return his calls.

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wolfpack

. My doctor who retired this week recommended a highly rated electrophysologist and I have made an appointment for 17th July. Earliest available date ! That's the trouble with good ones, there is a long wait to see them. I left a phone message 3 days ago to touch base but he didn't reply..

That’s why we want to “team up” a cardiologist and electrophysiologist. You’ll get in to the cardio much faster, often same day, and he or she can handle anything with regards to medications. Also, the EP *will* return his calls.

Heck that's a good tip... on United Medicare it's $50 to see a specialist, so doing a cardio and an EP is worth $100 to get a foot in the door. Seems EPs are 2 months+ wait just to talk to them, and then 6 weeks minimum for an ablation if necessary.. The GP is 3 weeks now too ! Trouble is all the expensive tests that they suggest .... My annual max copay is around 6 k and I must have run up a chunk of that already, so I might as well go for it all this year...

Really good EPs have even longer waits. 6 months.

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wolfpack
Really good EPs have even longer waits. 6 months.

Should think myself lucky then...or unlucky if the wait is proportional to the competence... lol...

My 92 year old mother got a full hysterectomy in the UK with a 2 day wait...and 100% free...
My pal got new pigs heart valves in 6 weeks...

Their prostate screening is poor though... I had cyber-knife in the US and that isn't even offered on the NHS
Took my malignant PSA from 6.5 down to 0.7... Prostate cancer is an underestimated killer...

Quote: "Prostate cancer is the most common non-skin cancer in America, affecting 1 in 9 men.

n 2019, nearly 175,000 men will be diagnosed with prostate cancer, and nearly 32,000 men will die from the disease. One new case occurs every 3 minutes and
a man dies from prostate cancer every 17 minutes.

It is estimated that more than 4 million American men are living with prostate cancer.

A non-smoking man is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined."