Just joined the Afib club yesterday...waiting time for referral?

Greetings, all. I'm a 53 y/o male who just joined your exalted company yesterday morning, when my primary care doc, during a routine yearly physical exam, looked up at me and uttered those immortal words: "Hmmm, that's odd - have you ever noticed your heart beating kind of fast and irregularly"?

And thus I'm now an Afibber.

Since I'm LAF, no other health problems to speak of, low blood pressure, low cholesterol, not overweight (though not a competitive athlete by any means) , and generally asymptomatic, it's actually difficult for me to know if I'm in afib stlll or not. I know that must sound strange, but I really can't tell. I try to take my pulse at my jaw or neck, and one time it seems I'm perfectly sinus regular, the next minute it seems like I might, maybe, could be missing every other beat. I have no baseline, no way to know whether either one is true or both are. Certainly I don't feel any different from minute to minute - since I never noticed a problem before my doc put the stethoscope to me yesterday.

(Though this might explain that mountain climb during the summer where I suddenly for no reason ran out of steam halfway up, when the day before and day after I was keeping up with everyone else just fine. And why as of today of course I'm hyper-aware of my heart like never before, hanging on every beat, trying to decide if I'm regular or not.)

Which brings me to my question for y'all. Given that I have no idea if I'm still in afib, and given that I have way to know if I've had just one or a hundred episodes before this (remember, I'm asymptomatic), does it seem like I should be waiting nine days to see someone again and figure out where I am? I read that converting early is important, that the longer an episode goes on the less likely it will be to stop - so if I am actually still in afib, wouldn't it be important for me to see someone sooner? And hit it with something stronger than a low-dose beta blocker? Or am I just fine waiting until 12/26? {though at least that will keep me out of the crazed post-xmas stores that day : }

Sorry to ramble so much here. I'm just 24 hours into getting up to speed with this whole big world - and still in the first stage of coming to terms with clear signs I'm not 25 any more. Basically still in the Kubler-Ross "denial" stage emotionally.

Any help or advice or questions you can throw at me, please - fire away. Thanks, all.

Jon / Seattle

Just for a start you can buy an Omron HEM712C blood pressure monitor (or similar) which (reliably my experience shows) indicates if you have an irregular heartbeat (along with giving you your heartrate and BP).

Hound, thanks much for that tip. I already saw a bunch of $249-ish ECG monitors on Ebay that looked reasonable, as well as the (simpler and cheaper) Omron that just does pulse and BP. One example:

http://www.ebay.com/itm/2011-Handheld-ECG-EKG-Heart-Monitor-MD100E

If it works I think having the ECG readout would be really really helpful. and worth the extra $125 or so. Does anyone have experience with those kinds of consumer-grade ECG devices?

thanks again /J/

I think your doc should have arranged for you to have a Holter harness for 24 hrs while you wait for the EP appointment.

Hi Jon,

Welcome to the club. A couple things: that "hyper-awareness" of your pulse may grow to the point where you can feel the irregularity. If it doesn't and you remain a "silent" afibber, then IMHO you need that EKG monitor. It is important to know when you go into it as well as what to do.

Which brings me to my question- did I understand that you are still in afib as far as you know, and you have an EP appointment in 9 days? You should call the EP's office in the morning, tell them that you have an appointment in 9 days, and tell them you are in afib. That usually gets you an appointment right then.

If you have been in continuous afib for days (or for an unknown period) they probably will put you on a blood thinner (coumadin, pradaxa, or xarelto- read the debate about these drugs on this website). After your thinner is confirmed, they will either try a chemical conversion or an electrical cardioversion (they put you out, shock you, and wake you right back up). With the chemical conversion, they give you a drug such as propefanone, flecainide, or a beta blocker. Protocols vary on this- some doctors want you in hospital for your first chemical conversation, others don't. Mine gave me 600 mg of propefanone and I converted 6 hrs later. Since you are silent, you won't know without the monitor-

Anyway, you are correct that you don't want to just remain in afib. There is a saying "afib begats afib;" your heart becomes conditioned to it which makes it easier for you to stay in it(bad); your atria can become enlarged (bad); there's just nothing good about it.

This is a very complex disease with more diverse causes than your average ailment. There is a lot to read on this website, start to educate yourself about your individual pattern, the disease is very unique to the individual. You should consider starting a journal to record when you are in it as well as what you were doing that put you in it. A book could be written about triggers, there are various food triggers, activity triggers (sex can be one), positional triggers, etc. A few lucky people find their trigger and avoid it and are able to stay in rhythm; may you be one of the lucky few.

You have a lot of reading to do- call that EP and if doesn't get you in, you might ask for a different EP-

Good luck,

EB

Hi Jon,
I purchased a Med Choice MD100E hand held ECG monitor. It comes with some software that works with MS Windows. It works well and will record and store 100 30 second "strips". You can then download the ECG strips to your computer to save and print if needed. Or, for a little less money, you can get a finger tip pulse monitor and SpO2 monitor that displays your pulse rate digitally and with a graphical display. It also comes with software for MS Windows and allows you to record your pulse rate and O2 levels up to 24 hours. I use mine occasionally for sleep study. It is a Contec Pulse Oximiter model CMS50E. Has built in rechargeable battery via USB.

Sometime in January, a snap on case for IPhone 4, 4S will be made available over the counter that is a one lead ECG. Check out [www.alivecor.com] for details. It is currently available to medical professionals so maybe your doc could order you one. Current cost is 199 US.

Cheers,
Ralph



Edited 1 time(s). Last edit at 12/18/2012 09:36PM by RalphL.

RalphL - thanks - I think I'm going to buy it. One seller of them seems to accept "offers" so there is an actual price that's lower than the $259 price that everyone lists on Ebay (that may be some kind of manufacturer's minimum listed price thing). And I think he does, if I read his listing correctly, throw in the fingertip oxy monitor too.

Really appreciate the advice. I'm sure it's worth it for peace of mind if nothing else - and if it saves me one clinic visit it's also paid for itself several times over.

/jon/

FiveBox Wrote:
> ...did I understand that you are still in afib as far as you know, and you have an EP appointment in 9 days? You should call the EP's office in the morning, tell them that you have an appointment in 9 days, and tell them you are in afib. That usually gets you an appointment right then.

FB, yes, that's what's going on, but note I'm on a beta blocker now too, prescribed by my doc (low dose - 25mg x2/day metoprofol). When I go into his office tomorrow for a blood draw (to check thyroid) I'll ask him about the delay and what he thinks. It's his referral to the EP and they've worked together in the past, so that carries some weight. But maybe not seven more days of weight....and wait. :}

Should I make sure, btw, that the EP is really an EP and not just an "ordinary" cardiologist?


> If you have been in continuous afib for days (or for an unknown period) they probably will put you on a blood thinner (coumadin, pradaxa, or xarelto-

For some reason they didn't, other than low-dose aspirin. Probably because my CHADS2 score is zero, they felt the risk was zero. But you're right, another thing to ask about. Thanks.

> Anyway, you are correct that you don't want to just remain in afib. There is a saying "afib begats afib;" your heart becomes conditioned it which makes it easier for you to stay in it(bad); your atria can become enlarged (bad); there's just nothing good about it.


Exactly. Which is my main concern here, and why I posted.


I really appreciate you taking the time. The idea of the journal is really a good one, and I should twist my own arm and do it.

Now back to a drink of warm (non-alcoholic <sigh>) cider.

thanks again, so much,
jon

You don't necessarily need anything expensive or complicated. For example, I have a Maxtec MD300C2 fingertip digital Pulse Oximeter. It shows digital heart rate and pulse ox numbers, along with a moving waveform that shows pulse ox changing with heart beat. The waveform looks like a sawtooth when in normal sinus rhythm, and the pulse number stays relatively steady. When in afib, the digital pulse rate constantly jumps all over the map, and the waveform changes from a regular sawtooth to irregularly spaced hills and valleys that represent the variable pulse while in afib.

It's pretty evident when you're in afib.

One nice thing about this approach is that it is highly portable.



Edited 1 time(s). Last edit at 12/18/2012 11:54PM by Asok Asus.

You may know this already, but make sure you see an EP and not a cardiologist - the former is a plumber and the latter an electrician. Yours is an electrical fault and plumbers aren't good at fixing those.

Gill (pronounced Jill and female)

Jon,

What you may learn is that cardios consider afib the hemorrhoids of cardiology.

If you are asymptomatic and your afib rate is < 100 BPM, your doc is not alarmed.

I don't know if the standard has changed, but they typically will want you on anticoagulants for 3-4 weeks before they try to convert you to normal rhythm. If you are in and out of afib all the time, for short durations, this may not apply.

You are correct you'd like to minimize the time you are in afib as "afib begets afib," and makes it more difficult to keep you in NSR in the future. Many docs do not share this urgency... I recently hired a concierge cardiologist to support me in some "off label" medical approaches to afib. When I shared that an EP had wanted me to stay out of rhythm and I'd objected, he questioned me what was so bad about being in afib. My own approach is to absolutely minimize any time in afib!

I've got monitors from ECG's to recording heart rate monitors, however, my well trained finger on the pulse point at my temple is my monitor of choice. That being said, I know where you are coming from, without a baseline. The very inexpensive monitor is an analog stethoscope. There is some info about using it to check rhythm in this CR51 proceeding: [www.afibbers.org] - along with some other monitors. It is a bit dated on the electronic side as it was written 6 or so years ago.

Good luck!

George

Hello Jon,

Welcome to the Club! If you have not already done so I would suggest that you read the afib FAQ's [www.afibbers.org] and the 12-step plan for eliminating afib [www.afibbers.org].

As far as seeing an EP sooner rather than later, I don't really think it matters that much. What is far more important is that you get to see a competent one. If you have now been in afib for more than 48 hours you'll have to wait 3 weeks (while on warfarin) before an attempt will be made to cardiovert you. I really don't think it will make any difference whether you wait 3 or 4 weeks for the conversion.

Hans