2nd episode

Hello all,
I had an episode of afib about 5 years ago when I was 39. I went to the ER and they sent me home and told me to monitor my heart, and if it lasted longer that 24 hours to come back (they may have also just let me go knowing my wife is a nurse practitioner.). Anyway I converted w/o intervention after about 8 hours, but was in afib for probably 15-20 hours total. I saw a caridologist was on calcium blockers for 6 months, but had no further episodes until about 10 days ago.
I went to the ER during this episode, this time they shocked me back into normal rhythm. I went to another cardiologist (I'm now in a different state, temporarily) and he sent me to the hospital for observation after I told him I was felling some tightness in my chest.
So they monitored my heartrate for about 24hours, did a ct scan and an ultrasound of my heart. I go see my cardiologist on the 20th of this month to hear the results.
I do have some shortness of breath and some tightness in the chest (while in normal rhythm) but I wonder if it's just due to stress, as I'm fairly healthy, don't smoke or drink (it ticked me off that they kept reminding me that binge drinking can bring on episodes of a-fib!) and my resting heart rate is about 52 bpm, and my blood pressure is excellent.

I just found out that they found some calicifications in the ct scans that shouldn't be there, so it sounds like I really need to watch my colesterol.

Here we go!

I don't understand your comment.

I find it frustrating that I'm not being taken seriously by some of the doctors that treated me in the hospital. It would seem I'm just too healthy. I do know that my episodes seem to be brought on by stress and I'd like to find better ways to deal with it.
But, there is a history of bypasses in my family. 2 of my uncles have had mulitple bypass surgery. They don't really take care of their health, eat poorly, smoke and drink, but there still may be some heriditary issues.

I think you will in a couple years or so. You sound just like all of us did at the very beginning of this trouble.
PeggyM

I'm glad I found this message board. It sounds like a great resource. I'd love to hear comments or suggestions.

I was just reading through some past posts and came across something that suggested a link between high carb intake and episodes of afib. Is there evidence of a link? I tend to have high triglyceride levels - they've been up over 400 at times, but I can get it down when I concentrate on my diet.

Has anyone had any experience with the military and atrial fibrillation? I'm in the Navy Reserves and am just wondering if they will let me stay in knowing that I have infrequent attacks.

Derek,

Shortness of breath and and a feeling of tightness in the chest are common symptoms experienced during an afib episode.

Hans

I seem to be having shortness of breath and some tightness even when not in afib.

Derek - Since 'Holiday Heart' is a common factor that brings people to the ER with AF, it's not surprising they were queing in on alcohol consumption.

I'm thinking that since all your heart stats/numbers are good, in normal range, etc. that the stress/anxiety factor is high in your case. When you panic, it's common to feel short of breath and have a dry mouth. When you are in AF, it's can be the same thing.

The association between high carbs and afib could be that high carb diets tend to deplete magnesium and magnesium is the #1 essential electrolyte because w/o Mg, then the other critical electrolytes aren't able to function well, either.... especially potassium.

With high triglycideries, cutting way down on carbs is the way to reverse that quickly... and you need to do that and keep it there as your number at 400 is very dangerous.

What was your fasting glucose?

Jackie

Hi Jackie,
I'm still trying to sort out all the information I'm dealing with. While in the hospital for tests, my blood pressure was in the 120's-130's (I should say, it was when they checked it just before my ct scan- they did check it many times throughout the 24 hours, but didn't tell me the results), but I'm also in the Navy Reserves and yesterday as part of a routine yearly medical update, they checked my blood pressure 3 times (in about 20 minutes) and got 151, 145, and 138. I checked it myself yesterday after a brisk 20 minute walk and it was 138. I haven't had my glucose or triglycerides checked in several years, so it's probably about time.
I'll be sure to update you all after my appointment with my cardiologist on the 20th. I haven't heard much about what they may have found during my brief hospital stay.
I am concerned about the tightness and shortness of breath I sometimes feel (when in normal sinus rhythm), it seems to come and go with no apparent cause. It isn't painful or distracting, but it is there. I didn't feel it at all today.
I am taking my aspirin and also bought some fish oil capsules. My wife wants me to start CoQ10. I've also have a plan to start excercising more.

I should mention that they told me in the er (during my 2nd episode 10 days ago) that my glucose level at the time was 299 and that they were concerned that it was so high.

Derek,

Sounds like you may have a glucose issue. You can purchase a home glucometer on ebay along with strips. When I looked into it 6 years ago, the Bayer Ascencia Contour glucometer was an accurate home glucometer. I'd first purchased the cheapest drugstore model & later determined (by reading a white paper on that model) that its error range was larger than the effect I was trying to measure.

In any case, measuring serum glucose 45 minutes after meals, is generally a peak. So the two readings that are important are 45 minutes after meals and fasting.

In either case I'd like to see readings between 60 and 85 mg/dL. This is a tighter standard on the high end than the medical community will use.

Your chest tightness could also be angina.

In any case, learning to control your blood sugar tightly should help both afib and angina.

A reference here: [www.diabetes-book.com] Bernstein is a Type I diabetic. Trained as an engineer, his health was deteriorating on the standard protocol. He figured out how to control his blood sugar tightly. He tried to publish on this method, but was rebuffed by the medical community. Determined, he went back to medical school at age 45. He's been treating diabetics successfully since the early 1980's. At age 77 in his book, he publishes his own blood lipid numbers. They are better than an Olympic Athlete's not someone whose had diabetes for 65 years.

Additionally, paying attention to magnesium intake as well as sodium/potassium ratio are suggested.

Here are links to info for new afibbers.

<[www.afibbers.org];

additionally, the current Conference Room topic (CR 72) on sodium/ potassium ratios: [www.afibbers.org] This will help with blood pressure, too.

In your case, I'd be more concerned that the chest tightness may be angina rather than afib.

George

Thanks for the input, George.
I think it's amusing that apparently I have angina and atrial fibrillation, but I can still run 1 1/2 miles in 13 minutes. At least I did yesterday as part of the Navy's yearly physical health assesment.

Derek - you need to get your glucose under control now. If you can find a holistic or functional medicine MD, you'll make significant progress because it's obvious that you have a glucose handling problem. Don't wait for the cardiologist appointment to address this.

Jackie

Hi Derek,

The arteries are smooth walled muscles. Angina (if in fact you have it) can be caused by spasms of these muscles. Exercise may not set this off.

In any case, magnesium would be indicated for both afib and angina (by relaxing the smooth muscles and preventing spasm). Here are some studies relating magnesium and improvements in angina:
[content.onlinejacc.org]
[eurheartj.oxfordjournals.org]

Oral supplementation may help. A more effective approach may be [www.drmyhill.co.uk] to use a nebulizer. This has been reported to be as effective as injections.

Adding magnesium may help your blood pressure control, also.

One reason I suggested a glucometer is the lifestyle changes necessary to get your glucose under control without meds can be difficult (motivation wise). The glucometer acts as an objective reporter & motivator - it knows if you cheat. If you follow Bernstein's advice (linked above) you will most likely control your blood sugar. The glucometer will give you feedback that this is working. This should be a high priority. Another resource is Ron Rosedale MD's writing: [www.drrosedale.com] and book [www.amazon.com]

So, in summary, I suggest:

1. increasing magnesium orally and by nebulizer
2. normalizing and controlling serum glucose
3. getting your potassium/sodium ratio above 4 by reducing intake of sodium and increasing intake of potassium.

These steps will have a positive effect on your health, including potential angina, blood pressure and afib.

Lastly, if you take your blood pressure with a manual stethoscope and cuff, I suggest you take it next time you feel chest tightness. See if the pulse sounds regular or irregular. If irregular, then angina may not be the issue. If regular, then angina is more likely the source of the tightness.

Regards,

George

Thank you Jackie and George. This is where "the rubber meets the road" so to speak. I know I need to make some significant dietary changes.

Had a bad night, didn't sleep well and got about 5 hours of sleep. When I got up and started my morning routine, I just didn't feel right. No afib as far as I could tell by my pulse. Also had pain in left shoulder that radiates down my arm, but not sure if it's just due to the push-ups I did on sunday ( the only excercise I usually get is brisk walks).
I'm feeling little better this afternoon, but am still getting the pains in my shoulder and upper arm.

Derek,
Please get that checked out as soon as possible.
Louise

Hi Derek,

Here is another possible answer - muscle pain. First here is a link to many nested links on this I've posted before. Some of this will be duplicated below.

<[www.afibbers.org]>

Trigger point therapy was developed by the first female White House physician, Janet Travel, MD. She took John Kennedy on as a patient in 1955. As you may know, he had many problems from war wounds. Dr. Travel was able to "keep him together" well enough for him to campaign so when he became president, he asked Dr. Travel to be the White House physician. For a biography on Dr. Travell, see: "Janet G.Travell, MD, A Daughter's Recollection, Virginia P. Wilson. [www.pubmedcentral.nih.gov] More is written by her colleague, the late David Simons, MD, [www.pubmedcentral.nih.gov] this describes her work showing that trigger point pain can sometimes mimic heart pain.

Here is a description of trigger points: "a palpable nodular or band-like hardness in the muscle, a highly localized spot of extreme tenderness in the band, reproduction of the patient's distant pain complaint by digital pressure on that spot [referred pain], and relief of the pain by massage or injection of the tender spot." The distant or referred pain is an important concept. Many times the trigger point is not near where the pain is. An example, for pain in the thumb and web of the hand, the most likely spot for trigger points is in the bicep area. The next most likely spot are in the scalenes muscles, which are in the neck.

In your case, the Scalenes muscles are a candidate (but certainly not the only one) to refer across the shoulders and down the arm. In these drawings, the trigger points are denoted by "X's" and the possible referred pain area is in red. [www.triggerpoints.net]

Trigger points released is best taught in person, however it is possible to work it out by yourself. I did. I will do my best to describe several release techniques. The Scalenes are located next to the neck vertebra. To access them you must go in from the front, to either side of the windpipe. Sometimes pressing on these trigger points can elicit a "spooky" feeling.

Once you've experienced release personally, it is easier to figure out how to do it yourself, hence the difficulty doing this without hands on instruction.

Some previously prepared material on trigger points is below.

The best layperson’s reference on trigger points I’m aware of is Claire Davies’ book [www.triggerpointbook.com]. Like anything, this is not always effective, but I have had many dramatic and outstanding success with headaches, various arm, back, knee & other pain...

With the same pressure on them as the surrounding tissues, trigger points are around 4 times more sensitive. Unless someone has fibromyalgia (where very light pressure is called for), I generally use about 15-20 pounds of pressure when looking for trigger points (Tps) on most parts of the body. The exceptions are the face, where I use 3-4 pounds and the buttocks where I use 35-40 pounds. You can get an idea of how much pressure this is by pressing with your hands on a bathroom scale. On the body, I press very hard. I use the person’s reaction to locate the trigger points. Most of the time the person dosen't know the trigger point exists until you palpate the area.

My cookbook approach is:
1. Ask what hurts
2. Look in Davies book to see which muscles might be candidates for Tps (listed there in order of probability). An online resource is here [www.triggerpoints.net]
3. Go down the list palpating for Tps in said muscles as described in the prior paragraph.
4. Release any Tps found, generally using Jones'technique (described later) when working on others, or Davies' technique on myself. An online resource for self massage is here: [saveyourself.ca] and a quick reference guide is here: [saveyourself.ca]
5. Repeat 3 & 4 till you’ve gone through the entire list.

My description of Davies' self massage technique is to press in one direction – like ironing at a pain level of 7. Massage 6-12 strokes. Repeat several hours later (or the next day like I usually do). You don’t want to do too much at one time on one point. The Davies' approach can take many sessions to make the TP completely go away. However it is amenable to self-treatment. The Jones approach is much faster, but generally requires two people. For working on other people I use an adaptation of Jones’ Strain and Counterstrain technique.

An osteopath (DO) friend told me about Jones’ osteopathic technique to immediately get the trigger point to settle down. Basically, you find the trigger point, then, while holding it, put the muscle in a position where it relaxes & the trigger point is no longer sore. Then hold there for 90 seconds to two minutes. Here is a good explanation from
Jones who discovered this approach:

[www.jiscs.com]

Here is my summary/adaptation of Jones to release Tp's:

a. Palpate to find Tp based upon patient feedback. During palpation, Trigger (tender) points are 4 or more times more tender than the surrounding tissue, with the same pressure. On a normal person (not with fibromyalgia), press with about 20 pounds of pressure on most of the body. On the face, 4-6 pounds and on the big muscles of the
buttocks, 40 pounds.

b. Keeping your finger on the point, move the muscle into a "release or comfort" position using patient feedback. In this position the the pain diminishes by 2/3's or more. In many cases, the patient will say, "are you still pressing?" The DO that taught me said you are trying to "fold the muscle back on itself." This can be hard to visualize on some non-limb muscles. Trial and error with patient feedback are the key. Jones says that after 8 hours a day for 2 years, you don't need patient feedback. Sometimes turning a hand or foot a different direction can make the difference. Jones said that the comfort zone can be only 2 degrees of movement wide.

c. Having found the a "release" position, I keep my finger on the point with light pressure. This is not necessary for release, but so I can recheck it when I’m done. I then hold for at least 90 seconds to "reset" the spasm.

d. When bringing the muscle out of the "release" position, do it very slowly. Jones says this is important so the muscle doesn't return to spasm.

e. I then recheck to make sure the TP has released. If not, I try again. My adaptation of Jones’ approach works must faster to release the Tp’s than the self-massage. However it is hard to do on yourself.

One more release technique. Dr. Travell used ethyl chloride as a vapocoolant to chill the skin and then stretch the muscle. I have duplicated this technique using an ice pack. Generally, I rub the ice pack over the skin in the direction of the trigger point to the referral area in parallel sweeps. Travell went at a speed of 4 inches/second. Then I hold the ice pack over the trigger point while stretching the muscle. The stretch is not hard, just to get full range of motion, maybe 10 or so seconds. Then release slowly and recheck to see if it has releaased (no more pain on palpation).

When working on my wife, she usually requests I get as many points released as possible with the ice & stretch. Then I follow up with Jones' technique on those points that didn't release. This is normally successful. Lastly my wife does maintenance with Davies' massage technique as the other two are difficult (but not impossible) to do on yourself.

Women many times do not have the hand strength to generate enough pressure to find the trigger points. I get them to use a blunt tool or their knuckle to help here.


Other resources:

For those who want more detail, Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual (2-Volume Set - Vol 1 is 2nd edition 1999, Vol 2 is 1st edition 1992) by Janet G. Travell, Lois S.. Simons, and David G. Simons is the ultimate resource for trigger points. It is a medical school text and contains 1,664 pages in the two volumes.
[www.amazon.com] (have to make sure you get both volumes if you look to purchase this). A very detailed reference.

One area that Travell & Simons' cover that is not covered in Davies is the area of aftercare. They have specific suggested stretches for each muscle. The idea is to train the muscle not to spasm. You are not trying to make the muscle longer - only to get full, natural range of motion. Stretches should be of short duration - 6 seconds or so, repeated for several reps and then do them every few hours throughout the day. Another area they focus on is "perpetuating factors." These can be structural - like one leg shorter than the other, ergonomic or biochemical. My wife has a biochemical cycle that hits every 4 or 5 weeks for several days. During this time she is extremely "triggery." We have not yet figured out the cause thought have some leads.

Devices such as the Backbuddy , Theracane or various hard balls (dog toys are good) make good self-massage tools. You can lie on a ball or put it in a sock to get to hard to reach places. I’ve seen people use the handle of a shovel for this purpose.

More references:

A trigger point tutorial: [saveyourself.ca]

Here is an online guide - [triggerpointproducts.com]

Here is another online PDF - not the best, but it is available on line.
[api.ning.com]

Some personal success stories:

We were at a family cabin in with 4 couples. One of my wife's friends was there with very severe pain in her wrists & forearms. Denise asked her if she wanted me to look at them. She said she was afraid I'd hurt her. She'd been to the doc who sent her to PT. She said she could hardly drive home after the PT visit - the therapy made her hurt so badly.

I said that this approach would not increase her pain. I subsequently spent an hour and a half releasing 50-60 Tps on her. It was amazing how many she had. The result - the next morning she said her pain was reduced 95%. I taught her husband how to use the approach on her and got her a copy of Davies' book for use at home. Some times it only takes releasing couple of Tps to fix the pain - in some cases with dramatic results. The above story is the most involved I've dealt with.

A more simple case was a colleague at work. He had a headache that was severe enough to make him nauseous. After our meeting ended, I asked him if he wanted me to look at him. He did, so I found and released one Tp in the sternocleidomastoid on each side. That was enough to give him complete relief.

I tried it with my wife with her hip. I would find a Tp, then with on hand on the Tp, I would move her into a position of comfort - at this position the Tp was no longer tender. I would hold for 90 seconds. Then I would find the next Tp & repeat. It was a great success. More recently I’ve been working on a variety of shoulder, neck and face muscles to help resolve longstanding redcurrant migraine pain for her. She has many biochemical perpetuating factors that we've not yet solved - we can release the Tp's but they will return fairly soon because of these factors.

They are also a cause of my wife's migraines, though the base cause is the biochemical factor that makes the muscles susceptible.

A friend has a bad rotator cuff. I taught him this approach. It can't fix the rotator cuff, but with daily maintenance, he has normal range of motion and greatly reduced pain. Most of the pain is from trigger points, not the bad rotator cuff. The damaged cuff does act as a perpetuating factor, however - hence the daily maintenance.

In my own case, I had knee problems severe enough to keep me from running. I could still ski, with knee braces. If skied too aggressively or too much, I’d have a lot of pain right behind the kneecaps. I happened on to Davies’ book and started working through it. After weeks of massaging various Tp’s in my thighs, my knee pain was gone. I still give those points 20 seconds or so of attention daily as maintenance. I can ski very hard on very steep, bumpy runs with no braces and no pain.

There are many more of these stories.

George

Many thanks, George. I felt a lot better at 5 this evening and went for a brisk 3 mile walk (took about an hour) with a friend. I've decided the pains I felt in my chest must be muscle pain, as my chest is still sore from doing those pushups on sunday. But, I'm not sure what to think about the ill feelling this mornng. I checked my blood pressure again tonight and found it to be as low as 120/80.

Derek,

Glad it is not a major problem. The Trigger Point thing is worth looking into. Can't tell you how many people's minor and major complaints I've helped since figuring it out. Most chronic pain has a muscle basis - even if it has underlying structural or other issues. The structural issues can be a chronic precipitating irritant that necessitates ongoing maintenance. As my friend's story at the end of my post above illustrates. He spends 10 minutes a day "fixing" his shoulder in the morning. For this time investment, he gets full range of motion and dramatically less pain than before.

George

I feel the need to vent some frustrations. Here are some things that really tick me off
1. Doctors and nurses who suggest that drinking alcohol brings on episodes of a-fib. Why can't they just ask me if I drank excessively, or at all, for that matter? The answer is NO. I rarely drink, and when I do, it's a glass of port. It seems so underhanded, to suggest something, instead of asking outright. Alcohol has had no part to play in my episodes.
2. People who suggest that afib is caused by improper diet. Correct me if I'm wrong, but a-fib seems to be caused by a defect in the electrical system of the heart. Yes, I understand there are triggers, and it makes sense to try to figure them out and live a healthy lifestyle. But, I had someone compare rickets to a-fib recently! What kind of sense does that make????!!!

Derek,

I agree that they should look at you - not assume. From their perspective however, when I've discussed afib with my neighbor, an internist, he tells me most of the afib cases he sees are caused by "Holiday Heart" (i.e. binge drinking).

As to diet, there are triggers due to indigestion, some additives (i.e. glutamates & MSG) and various food sensitivities. In addition insulin spikes can cause electrolyte (magnesium & potassium) wasting thereby triggering afib.

Rickets is a new one, however.

George

Derek, consider yourself lucky if they are only hinting. I have long ago passed whatever age it is where they no longer conceal their suspicion that i must be a drunk. They do not ask me if i drink, but how much, and they poorly conceal their disbelief in my answers.

PeggyM

"Correct me if I'm wrong, but a-fib seems to be caused by a defect in the electrical system of the heart."

Yes, and these defects are strongly affected by the presence and/or absence of dietary substances called , not so quaintly, electrolytes. These are magnesium, potassium, sodium, and chloride. Some of us have found by trial and error that we can keep afib episodes out of our lives by careful regulation of these dietary substances. Ever since achieving success for ourselves we have been trying to get others to do the same, but are often blocked by this same attitude that you have expressed, along with others more remarkable by commonality than by difference.

Rickets is one of the short-term deficiency diseases. Afib seems to me to be a longterm deficiency disease, one that i and a bunch of other "isolated exceptions" have been able to relieve by means of diet and supplementation. For much more detail on the regimens we have used, please consult Conference Room Proceedings session 61.

PeggyM

"Yes, and these defects are strongly affected by the presence and/or absence of dietary substances called , not so quaintly, electrolytes. These are magnesium, potassium, sodium, and chloride. Some of us have found by trial and error that we can keep afib episodes out of our lives by careful regulation of these dietary substances"
This is certainly worth looking into. Has anyone noticed a link between dehydration and afib?
A coworker of mine linked afib and rickets, and it just seemed so silly a response.

Dehydration is a less common trigger:

<[www.afibbers.org];

"Derek, consider yourself lucky if they are only hinting. I have long ago passed whatever age it is where they no longer conceal their suspicion that i must be a drunk. They do not ask me if i drink, but how much, and they poorly conceal their disbelief in my answers."

Wow, that would be so irritating. It makes me feel like yelling "You're wasting my time!!!".

Well I solved one mystery. I didn't sleep well 2 nights in a row, but I just realized that the lemonade tea I was drinking is in fact caffeinated.

Hello again Derek. Dehydration is a very big deal with me, almost guaranteed to put me into afib. I have become obsessed about hydration because i really despise afib episodes. Drink your water, friend. Lots of it.
PeggyM

Thanks Peggy. Wiil do!

Makes me want to holler too, but i have learned at least some caution.The worst of the pompous ignoramuses is the arrogant kind, that will start to swell up like the Incredible Hulk if you disagree with them. I often do disagree, but you have to take care how you express yourself lest they grow even more un-cooperative.
PeggyM

PeggyM wrote:

> Makes me want to holler too, but i have learned at least some
> caution.The worst of the pompous ignoramuses is the arrogant
> kind, that will start to swell up like the Incredible Hulk if
> you disagree with them. I often do disagree, but you have to
> take care how you express yourself lest they grow even more
> un-cooperative.
> PeggyM

I've been thinking about this for a while. Doctors are providing a service, and if they can't figure out that you're being honest then it's time to move on and find someone who can actually help you. I wish I knew who to complain to. I'd love to see some kind of exposee on Dateline.