New to Afib and terrified!

Hi All,

I had a random first occurrence of Afib in May 2016 at age 38 after a weekend of a lot of drinking. I woke up at 5:00am and immediately knew something was really wrong with my hearts rhythm - I went to the ER and was cardioverted after 5 hours of no response to the medication. The cardioversion worked and after some tests including an echo my cardiologist released me saying he thought this was a one time thing brought on by drinking too much.

Yesterday morning, 10 months later at 5:00am again I was awoken by the afib this time there was no drinking previously or any other reason I can think of that would cause it. I ate a banana, took a Xanax and tried my best to relax and deal with it. After three hours, I was starting to really panic so I decided it was time to go to the ER. While getting dressed I converted on my own and have stayed in rhythm.

After the first episode I was so nervous for so long worrying everyday and was just getting past the point of focusing on it daily and now its happened again, this time with no reason that makes it seem like its a "one off situation." I am so panicked and focused I can hardly function on anything other than my heart rate.

I am seeing my cardiologist on Wednesday but for now as the first time he doesn't want me on blood thinners because he said there is no reason to be on them as my stroke risk is virtually non existent. I am going to ask for a referral to an EP but is there anything that you all do to help the mental part of this? I am pretty sure its just a matter of time until this happens again and the thought of that terrifies me. I am leaving on a cruise in a week and travelling outside of the US and that makes me extra nervous.

Any input helps!

Welcome the club we all hate!

Heavy drinking is murderous on electrolytes, specifically magnesium. Other than the "binge" episode, can you figure any triggers for the others? We're you active at the time? Resting? Dehydrated?

Andrea,

I've been living with it off/on for years. If your echo was ok then your heart is probably otherwise healthy so AFib might only be an annoyance rather than making you weak, short of breath, etc. I'm up to multiple episodes a week now and have an ablation scheduled soon. Sounds like you've got two episodes under your belt, one self-terminating. You might have another one tomorrow, next year, or never at all. Plenty of time to see what develops.

I won't say don't worry, but don't worry!

Editing to add a few things: if you have it again, if you have any symptoms other than feeling the heartbeats (short of breath...) try to confirm they're not due to panic or fear - adrenaline is NOT your friend with AFib unless an elephant's chasing you. As far as the cruise goes, obviously your doctor has the final word there but I would suggest getting an AliveCor/Kardia device to use your smartphone or tablet to take your own ecg. That way if you have an episode you can check the heart rate (using wrist or neck won't count them all in AFib) - low 100’s and not dizzy, where's karaoke? 160’s and I need to sit down a minute - maybe time to see the ship's Doctor. None of this will probably happen but having the device would put your mind at ease. On my last cruise I snorkeled, even diving down 15 feet to a wreck, while in AFib (had been seeing an EP awhile before though).



Edited 2 time(s). Last edit at 03/27/2017 09:51PM by Mdep.

As wolfpack says, electrolytes, especially magnesium are important. As someone who's kept afib in remission pretty well for over 12 years with magnesium to bowel tolerance, I recommend trying it. Lots of things can deplete magnesium. Also, I think this strategy also has the best chance of working for someone who has relatively little afib. Afib tends to remodel the heart, so the more you have it, the harder it is to stay in rhythm. Hence the electrolyte strategy is best used early in the process.

Another strategy I've used is an on-demand med ("pill in pocket" or PIP), to take to convert me quickly. For someone with an otherwise excellent heart, this is something to discuss with your cardio or EP. I use flecainide. Propafenone (Rythmol) is also used for this purpose, depending on your circumstances. Here is a search of the site on this <[www.google.com] My strategy is to use the PIP flecainide to convert as soon as possible, when the magnesium fails. It usually converts me in an hour or two. The magnesium works well enough that I've only used 3 flecainide doses in about 4 years. This is after my afib career started with a 2 1/2 month episode nearly 13 years ago.

Afib is a pain, but the big issues are stroke (and you have a low risk for that) and cardiomyopathy with can come about if you stay in afib at high rates for many days or weeks. This also should not be a big risk for you.

I still think afib is awful whenever it comes, but I went to the ER the first time and have never done that again. I realized it wasn't an emergency for me. So it is just something I deal with. I still live a very active life and it doesn't interfere. I do pay attention and do not miss taking my magnesium.

George

Both times it has happened now has been right around 5:00 am and has woken me up. I will say the last time I drank was for my birthday and was three days of moderate drinking the last night being pretty heavy but that was march 15-17 with not one sip after and the episode was yesterday march 26th. Wouldn't that be too long after drinking to have that be the cause?

George, do you just take magnesium pills? Is it daily or just in an episode?

When I had the episode yesterday I didn't really feel bad, no chest pain, wasn't out of breath, not dizzy but I did feel exhausted by it. I felt way worse when I would stand because it would beat so much faster but the anxiety was BRUTAL. Do you all take vitamins daily or how do you keep electrolytes and levels ok? I stay super hydrated always and eat healthy.

I take a lot of magnesium daily - 2.4 grams/day currently. I use pills, powder, liquid, whatever. How much you can take is very individual (i.e. bowel tolerance).

For example I mix milk of magnesia with organic apple cider vinegar in a 2:7 ratio to make magnesium acetate. If you care, I can provide more detail.

I have mixed milk of magnesia with soda water to make magnesium bicarbonate.

I take magnesium glycinate tablets.

I take a di-magnesium malate powder that is marketed for horses, but is the same stuff they make for humans.

I have taken magnesium citrate powder.

I have taken magnesium chloride made into a water solution.

I don't do all of the above daily, just whatever I decide that adds up to 2.4 grams of mag for the day.

If it's happening at night, it's possible you have a vagal trigger. AF can fall into two broad categories - adrenerigic (activity triggers it) and vagal (rest triggers it). For me, as I am a runner, it was vagal. I would go out of rhythm seemingly randomly during the evening and nighttime hours whilst doing nothing more than sitting on the sofa or lying in bed. Sleeping on my left side was a guaranteed "on-switch" for AF.

I second GeorgeN's recommendation on the Kardia/AliveCor if you can afford one. That simple device will take so much mystery out of things.

Andrea39,

Convincing oneself that it's no big deal, helps tremendously in dealing with afib. If not complicated by other health issues, afib is tolerable for many of us. I had undiagnosed afib for about 5 years (just some occasional arrhythmia) and then it was finally caught on an EKG. After that point and going on meds, I documented all my episodes for the next 6 years until I finally had a successful ablation (10 yrs ago).

For those 6 years, I experienced 192 episodes (32 per year) that lasted for 1806 total hours (301 hrs per year). I was in good physical condition, so the episodes went pretty much unnoticed during their duration. Shortness of breath if going up stairs, etc. I had two visits to the ER early on (one conversion and one self converted) and then didn't bother anymore.

As others have suggested, diet and supplements are important. I didn't find that out until after my ablation, but I now take Taurine, Potassium and Magnesium daily to minimize the occasional irregular beats.

The single biggest help for me was to drink plenty of water to stay hydrated; just over two litres a day. I have two glasses in the morning, at least 1/2 hour before eating: a glass at 11.00 a.m., 2 hours after eating: one at noon, 1 hour before lunch: one at 3.00 p.m.: one at 4.00p.m., 2 hours before tea (my final meal) and one at 9.45 p.m.

You should start Magnesium right away - Mag Glyinate is best. If you can't get that right away but can get Mag Citrate use that until you get the Glycinate. The amount George takes is perfect for him but far too much for most of us. I would start with 200 mg in two doses with breakfast and tea and work up to bowel tolerance (the beginning of diarrhea) then back off a little.

Potassium is usually best added after you get your stores of Magnesium to a good level and Taurine helps a lot of people but not all (I can't take it)

Sam

Quote
Sam
You should start Magnesium right away - Mag Glyinate is best. If you can't get that right away but can get Mag Citrate use that until you get the Glycinate. The amount George takes is perfect for him but far too much for most of us. I would start with 200 mg in two doses with breakfast and tea and work up to bowel tolerance (the beginning of diarrhea) then back off a little.

Potassium is usually best added after you get your stores of Magnesium to a good level and Taurine helps a lot of people but not all (I can't take it)

I concur that the amount of mag I take is ridiculous for most people & starting with a low dose and working up is a great plan.

Quote
wolfpack
If it's happening at night, it's possible you have a vagal trigger. AF can fall into two broad categories - adrenerigic (activity triggers it) and vagal (rest triggers it). For me, as I am a runner, it was vagal. I would go out of rhythm seemingly randomly during the evening and nighttime hours whilst doing nothing more than sitting on the sofa or lying in bed. Sleeping on my left side was a guaranteed "on-switch" for AF.

I second GeorgeN's recommendation on the Kardia/AliveCor if you can afford one. That simple device will take so much mystery out of things.

A Kardia device is a great option. <[www.amazon.com] It gives you an ECG by connecting to an app on your smartphone.

Yes, if at night, likely vagal <[www.afibbers.org]

And flecainide would be the on-demand (PIP) med of choice in this (vagal) case.

I appreciate all the feedback, will certainly look into getting on supplements. I know the first go around in the ER my potassium was low; not sure this time since I didn't go but I bet it was. Maybe heavy drinking, even though it was 8 days before was the culprit. I could have gotten my levels out of whack and my body was trying to replenish but couldn't quite do it. Either way I certainly wont have more than a drink or two from now on, so not worth it.

Andrea,
Welcome to the club.
My first a-fib attack was back in 2004. After that i started having them about once every 2-3 months. After a few years of that the frequency increased to once every month. Just lately, I have been having them as frequent as once every 6 days. Needless to say I have long gotten over being fearful of them but I do treat them with a great deal of respect. As I write this I am arranging for an ablation. Meanwhile I do what i can to make use of natural anti-coagulants and blood thinners. For the most part this involved Arginine/Citruline, Taurine and Vit E. While in a-fib I take 800mg of Vit E twice/day and 1500mg Arginine twice/day. I take no aspirin as this more recently in the latest medica studies has been discounted as being good over the long term. I also supplement with Vit D and Vit B and folic acid (very important). It is the Arginine and Vit E that works to mitigate clots. This is really your real risk while in a-fib. Also, after coming out of afib, which I will do on my own after 24-48 hrs, I keep the Arginine and Vit E going for at least another 5 days (some say 7 days before you are risk free). My afib sessions are now more of an annoyance and inconvenience to me, and since becoming more frequent i am now motivated to get the ablation procedure done as soon as possible.
It is true that the longer you leave it before getting an ablation, the worse it will get. Moderate exercise does help a lot. Especially strength training. The Taurine strengthens the heart muscle...also some Carnitine helps.
I also supplement with a LIQUID magnesium (don't worry about taking too much of this) and I drink LOTS of coconut water (real unadulterated stuff) and potassium rich foods. Increasing your potassium intake will help the sodium pump within your body at the cellular level to rid the body of excess sodium. (incidentally, this is what your body is doing when you find you have to relieve your bladder more often when you go into a-fib.)

Yes , alcohol is a significant trigger. Also MSG (monosodium glutemate). So now you need to be a label reader. Do NOT take a calcium supplement. Just make sure you get lots of salads, garlic, dark leafy greens, however while in a-fib, avoid ingesting too much of the Vit-K rich foods which will increase your blood's clotting tendency. (kale and spinach are both Vit-K rich).

I have had lots of opportunity to observe the triggers and I can say that there are times when there just doesn't seem to be any but I end up in afib anyway. What I would say to this is to watch your hydration levels. At the same time, keep your salt intake to a minimum. It would be best to use sea salt (rather than table salt) along with an Iodine supplement (be careful with this, don't take more than the recommended dose unless you are told to by a naturopath or medical doctor).

Alcohol has a great dehydrating effect on our body...however the effects of alcohol you might not see until the next day or night or even 3 days later. So you might not thnk t hat alcohol has triggered your afib cause 3 days have passed, but in fact it has through dehydration. Also air travel...drink lots. However, be careful with drinking a lot of mineral water. Most of it is high calcium and high sodium. Evian water is one that is significantly lower in sodium.

It is a well-known fact that most all heart disturbances happen more frequently between the hours of 3am and 5 am . No coincidence that this is also the time that your body is the most dehydrated. So drink lots of water leading up to bed time and keep a bottle of water beside your bed.

For me...3-4 beer/ night for a couple nights running plus not drinking enough water and getting to bed too late for those same drinking nights is a sure-fire recipe for an a-fib attack on the 3rd day or night. I am a slow learner so I have had plenty of time to prove this to be true!

Coffee seems to have dual effects. I came out of afib a couple times shortly after drinking coffee but also it will contribute to your dehydration, so watch it with coffee. If you must have your coffee, drink only a quarter of the cup to get your fix and then park it. Also be sure you are drinking 100% Aribica bean coffee. NOT Robusta bean. A robusta bean coffee will often give ectopic (missed, delayed) heart beats.

Please also be aware that an over-active OR under-active thyroid can be a trigger for atrial fib. The over-active thyroid is better understood. The under-active thyroid is not. But there are documented cases of under-active thyroid causing atrial fib, that was corrected when the thyroid imbalance was corrected. I have a slightly under-active thyroid that has been helped by a thyroid supplement (Thyroid-Pro). I also have a heart valve that is slightly leaky...this is also a trigger for atrial fib. But nothing much i can do about that...except i do believe my heart beats and pulse is stronger when i am on the Taurine. Taking the Taurine and Arginine and Vit E, I find my legs don't tire so much and I can actually go about my day.

Strangely enough it doesn't seem to make the a-fib any better or convert to normal sinus rythym any sooner, by babying the situation. Get lots of rest when you are in a-fib and drink lots of water frequently, but also get up and move around and try to go about your normal day. You will probably find you will convert sooner...and you will most likely convert when you are not consciously thinking about your a-fib....which is somewhat strange I admit but...

Hope this helps...there is more to be said but lots of help on this forum. Best advice,,,stay calm...don't panic...don't get anxious...do everything you can do to keep your heart rate down. Breathe deep and exhale slowly. Also, and this is important..stay off your left side when lying down or sleeping. Sleeping on your left side can be a trigger. You will also find the rabbit in your chest to be a little more quiet when you are on your right side.

One last thing...pharmacology (drugs) are NOT a fix for afib. The only thing so far that has been a proven medical fix is an ablation.
I went down the road for a while on the beta blockers (rate control) as well as the rhythm control drugs but they soon stopped working for me...and the side effects can often be worse than the a-fib and can also in fact make the a-fib worse and can lead to further problems. If you must, i recommend the rate control drugs (eg: metaprolol) over the rhythm control drugs (these worked for me one time only as a pill-in-the-pocket method of converting to normal sinus rhythym, but that was it..never worked again. The rate control drugs can help bring your heart rate and thus blood pressure down to where your heart can convert on it's own, without electrocardio conversion. However, again, for me these don't work anymore.

All the best!
Jim

Best of Luck

I am 74 years old and this is my first knowledge of Afib. I entered the hospital - ER - late December with an infection caused by my gallbladder. Long story short, 12 days in hospital, sepsis, gallbladder removal, first onset (that I knew of and I had been to my primary doctor 2 months prior) of Afib. I am overweight, on blood pressure meds and a statin. Upon release from the hospital, was put on a blood thinner.......I could only afford Coumadin/Warfarin. Have been on this since December. My INR range mostly between 2-3, however, recently 3.3 at which time I sprained my quadricep and had a hematoma in my thigh which traveled down my leg.
Terrified of blood thinners.......want to get off of them but terrified of a stroke. Cardiologist does not recommend cardioversion. He does suggest using one of the newer blood thinners which are very expensive.
On the positive side, I have never felt the flutter, and even in the doc's office, he has to really listen.....the EKG does show it though.
Any suggestions would be helpful.