Rinse, repeat...

So after no AFIB of any duration since 2019, I wake up Sunday morning, walk to the kitchen, and here we go again. I had honestly forgotten about it and had come off of my diet, exercise, sleep commitment completely. Couple nights of client dinners, company christmas party, big game on Saturday...all included cocktails of various types and quantities. In addition my commitment to sleep has disappeared.

The routine during my last group of episodes was to head into the ER, get a load of tests, and then be ECV's. This time, I call the cardiologist on call and they suggested I increase my daily dose of 50mg of Metoprolol ER by another 25mg, wait 5 hours, then do it again. Then get up Monday and head to the ER. The increase in Met. really handled the rate and symptoms...I was completely comfortable and we did as directed. Get to the ER mid morning on Monday and it is triage personified. There were definitely people there sicker than I so no complaints.
Basic blood tests, IV bag for fluids, and then wait. Generalists did not hear from cardiology all day...so, at 4:00pm, they advise I was to be admitted and cardiology would see me on Tuesday morning (past the 48 hour window). They also communicate no more Met. unless heart rate gets over 120 sustained...so I start to get the symptoms...lightheaded, dizzy, chest flutters, occasional chest pain...hear goes between 95 - 165. They come in take another Trip. blood sample, another EKG and call me stable...although I was extremely nauseous. My wife gets frustrated and calls the nurse...who was amazing...she demands the cardio team see me immediately as it is now coming on 11:00am. So what happens? I convert by taking 2 tabs of Potassium and an extra 25mg of Met....no ECV required.

Couple of added comments. I had to request the blood thinner shot...they deemed it not neccessary. There was internal disagreement between doctors on ECV or no, TEE test or no, wait 3 weeks or no, effectiveness of ablations or no, etc.... This is my first AFIB episode in 5 years and 7th overall 3 - 2006/2007, 3 - 2018/2019, and 1 now. Not really in the market for ablation at this point.

I could go on but you get the point...very important to educate and advocate for yourself. I have learned so much from this site and am extremely thankful. And I live in a community with worldclass healthcare (top 20 university hospital)...



Edited 2 time(s). Last edit at 12/11/2024 04:58PM by shca67.

Quote
shca67
I had honestly forgotten about it and had come off of my diet, exercise, sleep commitment completely. Couple nights of client dinners, company christmas party, big game on Saturday...all included cocktails of various types and quantities. In addition my commitment to sleep has disappeared.

Not really in the market for ablation at this point.

Sounds like the first intervention is to resume diet, exercise & sleep commitment, plus materially moderating alcohol. Perhaps discussing an on-demand script for a med like flecainide for a quick conversion, if needed (& if appropriate for you) with your team. See the original paper from 2004 on this approach [www.nejm.org] (I've used this successfully since 2004 with relative infrequency). I'm sure susan.d would suggest I reiterate that the max flecainide dose/day is 300 mg if you weigh more than 154#/70 kg & 200 mg/day if you weigh less.

I guess there are some reminders, hopefully gentle and of short duration, that we need to be careful and conscientious, maybe even fastidious, about our personal hygiene of all kinds when we have a history of cardiac arrhythmia. This runs from periodic dental exams and remediation, oral hygiene, sleep hygiene, relational hygiene, physical and exercise hygiene, perhaps spiritual in some of us....and to avoid the old bad habits that may have precipitated the undesired earlier events and tendencies.

I'll be the first to admit, though, that even I need the odd forceful kick in the pants from time-to-time. It's a great wake-up call, even if it's disappointing in so many ways.

And yes, one must advocate for oneself. However, that doesn't come cheaply, or easily. It requires learning and analysis, something which so many patients and clients of all kinds, in all milieux, are loath to do or simply can't be bothered. Rotter's 'Locus of Control' comes to mind. In order to be a great self-advocate, you have to have some basics learned about your circumstances and what the future might hold if you do A and not B.

Over the last 18 years with afib, I have come to now see it as my teacher in so many ways. And everything I learn to keep my afib calm is good for me, and healthy for me, in so many other dimensions of living... find your balance and peace.
Jeff