Any input rew PACS would be appreciated

This morning, after 27 hours of being in and out of Premature Atrial Complexes (PAC) I went to ER room and it was confirmed I was not in AF which confirmed findings I determined from my pulse. I was placed on EKG and given Lorazepam intravenously which restored NSR. Blood tests were taken which showed my Magnesium at a high level and all other items okay but that my body has been throwing off Digoxin completely. It was determined my anxiety over palpitations caused prolongation of PACs. I was given prescription for Lorazepam and told to see my cardio to get a Holter test and increase in Digoxin. I was also told I may be entering chronic PACS. I can only presume my anxiety has been elevated due to severe pain from a knee sprain.
I also presume PACs did not convert to full bore AF due to high levels of Magnesium I have been taking. My concern is forthcoming Digoxin dosage increase may itself contribute to chronic PACs and/or AF. I had been taking 25mg which was increased to 37.5 mg due to throwing off 25 mg a year ago but I cut back down to 25 mg due to negative literature re Digoxin. Incidentally I can shake PACs by exercising heart rate up to 86 bpm but when rate drops to lower levels PACs return. Any input re PACS would be appreciated.

Stephen

Stephen - on the magnesium blood testing - serum levels are not useful. The test has to be from what is inside the cells and is a specific test, not usually ordered. So, don't be misled that because your serum magnesium was elevated, that it brought about some heart rate irregularities...magnesium is calming to the heart. A potassium deficiency will definitely create palpitations and also arrhythmia.

When you were started on digoxin, did they tell you it depletes potassium? Probably not. I wasn't told either when it was recommended - but I chose not to take dig. After researching it, I didn't feel it was appropriate to take. It is recognized that dig can be proarrhythmic.

Hans has quite a bit of information on his book about why digoxin isn't used much any more now that there are better drugs....here are some quotes from Hans book....

One statement says: "Numerous medical experts have warned against the use of digoxin for vagal LAF and indeed, more recently, against the use of digoxin for any kind of LAF. Digoxin tends to increase thenumber of eipsodes and may cause the condition to become permanent.

" Digoxin is still routinely prescribed for patients with atrial fibrillation even though there is no evidence that it is beneficial and growing evidence that it may actually be harmful. Digoxin does not convert atrial fibrillation to sinus rhythm (19,20). Its ability to slow the heart rate during an atrial fibrillation episode is doubtful (21) and there is no evidence that it prevents future episodes of paroxysmal atrial fibrillation(23,24).

Dr. Rodney Falk, MD of the Boston School of Medicine sums it up, “Digoxin is probably not of value for preventing tachycardia at the onset of paroxysmal atrial fibrillation and its use as a sole agent for this indication, although wide spread, has no basis”(22).

Researchers at the U. of Michigan Medical Center go even further in their condemnation of digoxin. Their conclusion from a recent clinical trial, “The results of the present study suggest that digoxin may facilitate or promote early recurrences of atrial fibrillation after conversion to sinus rhythm not only inpatients with vagotonic atrial fibrillation, but also among the general population with atrial fibrillation”(6). It is now also clear that digoxin may not only prolong the duration of episodes, but may actually convert the paroxysmal form to the permanent form(6,23).

And if this is not enough, researchers have also found that digoxin can cause visual problems even at dosages normally considered safe and may significantly aggravate asthma symptoms(24, 25).”


And last, among the side effects listed are… “although digoxin is recommended for afib, the most common manifestation of digitalis intoxication is also atrial fibrillation.”

The obvious concern is....how to know if it is or is not toxicity.

Also – “Not only is digoxin highly toxic, it can react with herbs such as Siberian ginseng and with antiarrhythmic medications such as flecanide, propafenone and amiodarone (17-19). These drugs all increase blood levels of digoxin thus making a toxic reaction even more likely unless digoxin dosage is adjusted (18,19.)”

While you are on what seems to be a low dose, I would think there are better drugs to calm the PACs....but a lack of potassium or intracellular magnesium could also be the problem....

Are you being evaluated by a cardiologist or is this the ER docs? I'd shop around for a second opinion on the correct medication for your particular situation, if that would be an option.

Jackie

Jackie:

My Potassium serum level was 3.9 falling within expected range of 3.5-5.5. Both ER doctor and my Cardio stand on necessity of Digoxin and dismissed my accusations of useless and/or negative effects of Digoxin. My Digoxin level was < 0.2 below Expected Range of 0.8 - 2.0 which confirms I have been throwing off daily Digoxin 25 mgs. (actually prescribed 37.5 mgs but I cut down to 25mg) . ER doctor was disturbed that Digoxin levels were never checked by my cardio during the past year and a half.

So cardio will no doubt increase my Digoxin being he and ER doctor are advocates of. Meanwhile I'm on Lorazaepam to calm anxiety over annoying palpitations due to chronic PACs.

Stephen

37.5 mgs of Digioxin??? That's an awfully high dosage of it. Cardiologist had me on 0.25 mgs once a day for years and raised to twice a day after implantation of a pacemaker. I've been taking Digioxin for years to help reduce episodes of tachycardia. Ok, ok..... that's what they have been prescribing it for. I know long before I ever needed a pacemaker I was told too much Digioxin would stop my heartbeat. That's why 37.5 mgs daily seems awfully high dosage

Stephen

I was on digoxin for ten years and like you I was throwing it off. My Dr explained that my liver was too efficient at recognising it as a poison - and eliminating it. So was always on a very high dose. I think the usual way for determining digoxin is in mcg's though rather than milligrammes (mgs)

At some point in my research I discovered that the tests for digoxin toxicity do not always show up and that the toxicitiy can hide in other areas. I'll see if i can find the paper again.

After ten years on digoxin I was sent to see another cardio - I was in chronic AF by this time. The cardio said that it was caused by digoxin and he put me on antiarrhythmics. They made it worse. So now I don't take any meds and treat myself through diet - and no longer have AF.


I also think you need to see another cardio.

Fran

Fran:

When you were in chronic AF how did you get out of it to move on to diet approach? I delivered ER reports to my cardio today so he can review before my appointment Wed. I included Jackie's above posting re Digoxin which I highlighted most of. When I called cardio to see if I should come in today and had he looked at reports ------he said he did and he'll see me Wed and hung up after I asked him if I should increase my Digoxin or other meds to get me out of this now two day run of PACs not AF! Think he's annoyed at Jackies comments!

I am now commited to get an ablation even though he and ER doctors said they are not perfected. ER doc actually said -ablation would require a permanent pacemaker. Same ER doc who prasied Digoxin and claimed my run of PACS are due to body throwing off Digoxin

Stephen

Stephen

I didn't get out of AF to try dietry measures. What happened was I had done a lot of research on the excitotoxins (MSG etc) and decided that I had to ommit them from my diet. So whilst still taking digoxin I started eating fresh food from scratch. Then my cardio took me off digoxin and put me on a succession of antiarrhythmics and then beta blockers. My health went from bad to worse. But other things started to clear up - eg fibromyalgia. After a year of trying to get the tablets to work I gave up. I wondered what was the point in taking the meds to stop AF when I was in it 24/7. So I weaned myself off with Dr's knowledge but not blessing. So basically after a year on the wholsome diet and a week after stopping meds I suddenly reverted back to NSR. It was like a dream come true. I remember the evening so well when it happened. I was cooking in the kitchen and suddenly realised that I felt good. I was looking forward to the rest of my life, I wasn't dizzy and feeling like I would faint and my heart was normal. I was so happy. I went out with my husband in the snow plough that night to keep him company and to talk and talk like we hadn't done in ages. The northern lights were out and it was magical. I have only had thee short runs of AF since. Each time was associated with eating hidden MSG.

So that is 2 years of health that would never have happened if i had not taken matters into my own hands.

Hope that explains

Fran