ER visit, increase in meds,

Hi, Everyone,

I just turned 69 last month, but this month, I had an episode where I *felt funny* last Saturday (11/2/2019) and took my BP which showed something like 165/106 and my racing heart rate was 187 bpm.

I tried the vagus interventions with no success, took my BP etc again after a couple of minutes, which was pretty much the same, so after 8 minutes, off we went to the ER--took us 15 minutes to get there. Triage screening indicated a WNL BP (somewhat high, but not what I got at home) and a pulse rate of 90 bpm.

I had the requisite blood workups, x-ray and observation. My last ER visit was months ago, when I was in SVT and Adenosine corrected that SVT (I thought I was in a-fib that didn't resolve itself...had no idea about SVT). At my followup visit to my EP, I was started on Flecainide (50 mg, twice a day) and continued with Pradaxa (twice a day) and Metoprolol ExtR, Lisinopril, and Simvastatin at night.

My EP is upping my Flecainide for better control versus PIP option. I'm supposed to start taking 100 mg of Flecainide twice a day.
Any caveats I should know about with my upped dosage and my other meds and my dx?
Thanks!
Sue

I was on 100 mg flecanide for a time. Really no adverse affects. I was also on metoprolol at the time. Flec is almost always prescribed with a beta blocker.

Only thing I remember from being on it was I had very vivid dreams.

Thanks, rocketritch, for ringing in here. It helps to know others walked this road before me and have more experience than I have!
I still have concerns about any change in medications, and my BP being all over the place, and then there's that pesky bradycardia (rare) and tachycardia, too.
Sue

Home Blood Pressure Machines sometimes read high. I have 2 new Omrons, that read about 10-15 points higher than I get in the Cardio Dr's Office. I took them in and tested them side by side against there manual method.

I was on a very small dose of metoprolol 25mg 2x.

I also used Flecanide as a PIP without metoprolol and had no issues as well.

I would not be the least bit concerned if your EP is recommending it.

Thank you both for your additional posts! I've done the comparison with my home BP monitor at the nurse's office with very little if any difference, so I guess that's good to know, yes?

Glad to hear helpful input about your use of metoprolol and PIP Flecainide. My EP ordered an EKG after 3 or 4 days of being in the increased dose of Flecainide--when I first began it, I had to do the same with the EKG.

I appreciate the hand-holding!

About the Flecainide, some people including myself have gotten Atrial Flutter when taking the Flecainide. It's listed as a side effect, and in reading responses here it is more common than the Drug Literature suggests.

I was prescribed Flec by Dr. Natale 5-6 years ago. He did not have me take a beta blocker. I regularly took 300mg a number of times with no issues.

...ronH

Ron, your weight must dictate your proper flecainide dose. I learned the hard way (3 days in cardio ICU) that at my weight 300mg daily caused a dangerous situation. I later learned I didn’t weight enough for 300 mg.

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susan.d
Ron, your weight must dictate your proper flecainide dose. I learned the hard way (3 days in cardio ICU) that at my weight 300mg daily caused a dangerous situation. I later learned I didn’t weight enough for 300 mg.

For on-demand or PIP flecainide, the max loading dosage is 300 mg for those weighing over 154 pounds (70 KG) and 200 mg for those who weigh less.

Thank you GeorgeN! Very valuable info you shared. I wish I read this before I wrecked myself. All I read on this forum was 300mg and I didn’t think weight was a factor. I relied on a questionably EP. I hope those reading that those who weighs in their one teens to 120s to be educated and rethink the 300mg dose. Flecainide is a black label drug and to increase my dose to 300 at 121 pounds was an iatrogenic advice.

When having a HMO Kaiser Permanente doctor when AF appeared in 2004, he was diligent to take a flecainide serum test to determine my original flecainide dose. In August I aggressively asked my PPO EP for a serum test before my 200mg day dose was changed to 300, which he refused saying it’s not accurate and after 5 days on the increased dose, a treadmill test will determine my correct dose..it was during the treadmill test that I had to go to the ER and ICU for 3 days. I was repeatedly told I was lucky. A flecainide serum test would had been less evasive and safer.

I recommend the flecainide serum test. You get blood drawn exactly 11 hours after your last dose. Perhaps had I had I been tested @200mg I would never had listened to his advice for increasing to 300mg and perhaps Multaq would had kept me from an ablation until I exhausted all other choices first. It’s almost shy of 2 months post ablation and my PVCs (I never had them before) are constant with a high the other day of 145HR and 162 last week. I was at my primary care doctor for a routine visit yesterday and he listened to my cardio freak show of pvc’s and now he listed heart murmurs to my diagnoses. Plus my prolonged QRS are noticed so multaq, with its estimated 28% risk of prolonged QRS is not the perfect drug either. I’m probably wearing my heart out. My heart was thumping all night and kept me awake again. I am hoping it’s the co-q-10 although pre ablation i took co-q-10 and it never triggered pvcs. I get more aggressive pvcs upon taking co-q-10 and if I stop the supplement for a few days my heart is calm enough with occasional pvc to function and walk because with pvcs my low hr could be in the high 30s which causes dizziness.