Advice re Afib or Ectopics etc

Hello to all

I will launch straight into my situation and questions and hope that from the collective wisdom on this site, those with experience can help.

I am a mature male, in the UK.

For the past 3 months, I have been experiencing a daily irregular heartbeat. This happens at least 12 times per day and lasts for about 30 to 60seconds each time. It is throughout the day but more prevalent upon rising and just before bedtime i.e. about midnight. My pulse remains around the upper 50s to lower 60s. It does not race.

Approximately 10 years ago I had something very similar but with tachycardia. I was prescribed Metoprolol and aspirin but gradually weaned myself of both over a few months. Apart from the extremely rare chest thump upon strong exertion, I have been unaware of any heart issues over the past 10 years.

Previously and now, the heart episodes are accompanied by excessive burping. With less burping, there are fewer irregularity episodes or vice versa.

I bought a Duo EK 4664 heart monitor device that links to my smartphone. It confirms that I am experiencing ‘irregular’ heartbeat episodes. I sent copies of the readings to my GP. He said that the trace is not indicative of AFib.

I was given an ECG at the surgery which did not coincide with an irregularity, so read normal. I am currently on the waiting list for a holter monitor.

In the interim and given my age, I have been concerned over the possibility of a stroke or heart attack. I asked the GP if I should take a daily low-dose aspirin and he said no. He did not suggest an alternative.

At this stage, I am seeking advice on 3 main questions.

1. With no tachycardia, could this be AFib or is it highly likely just to be ectopics, so therefore of less concern?

2. I am not on any medication whatsoever but have been taking 1000 iu of Vitamin D3 daily for the past 2 months. From this week I stepped the dose up to 2000 iu daily, plus 15 mg of zinc. I understand Vitamin D3 contributes to blood thinning. For protection, should I be taking something, and if so what?

3. Can anyone provide any advice on reading the Duo EK 466 heart trace?

Thanks

Alba



Edited 1 time(s). Last edit at 04/14/2021 10:20AM by alba.

Welcome to you, Alba. Sorry you have to ask those questions, but you'll find helpful people here.

I've little advice to give you, as I'm no expert, but may I suggest you see a cardiologist or, better, an electrophysiologist ? Show him or her your tracings.

It's often useful owning an ECG monitor, when having to deal with short duration but annoying HR troubles, as they rarely happen when one would like to see them.

AFib is easy to identify once you're used to the typical sensation in your chest, your throat or under your fingers while checking your pulses.

There are some good videos on YouTube from Dr Sanjay Gupta explaining that. They may help.

It could be afib without tachycardia, but a doctor has seen the recordings and said it's not, so it's probably just ectopics (PVCs and/or PACs).

A few short bursts of ectopics don't put you at risk of forming clots, so you probably don't need to take anything. A more meaningful measure would be knowing your CHADS-Vasc score.

I don't think anyone can offer tips on reading an ECG, but if you want to post a recording we could take a look at it and perhaps offer some insight.

I would start looking at all of the factors that might be leading you down the road to AFIB and make the lifestyle changes now before the beast takes up residence in your life. Family history, your diet and lifestyle, lab work, cardiologists etc. Prevention is a good strategy. Don't ignore it - get busy with trying to sort this out.

Thanks for the 3 replies.

Re my lifestyle. All my life I have been really good. I have never taken recreational drugs, smoked, or drank alcohol, other than one glass of wine with a meal on occasion. I only have coffee very rarely. I have always eaten healthily and maintained a good bmi, which currently is 26. I possibly could have exercised more but for some time now I walk briskly or use a treadmill for 35 minutes 5 days per week.

I am not taking any medication for any issue. I have always been anti-medication where possible. I weaned myself off of metoprolol and aspirin as quickly as I could, 10 years ago. I am not at all keen on taking an anticoagulant, hence why I am trying to determine whether I hopefully just have ectopics and not atrial fibrillation.

Now the bad bit. Due to kidney cancer 4 years ago, I only have one kidney which functions a bit below par. This often happens when the other kidney is removed. All my blood results are in the normal range except for serum creatinine which has been out of whack for the last 4 years. This can't really be corrected because it is because of reduced kidney function.

I am still in good health with good mobility. I can run up 8 flights of stairs without impediment.

Thanks for the link to the CHADS - Vasc Score system. My score was 2, purely on the basis of my age. As I said, I am quite mature.

I would like to add a couple of recent traces of my heart irregularity, in the hope that someone can interpret them for me. I don't know how to add them, however.

Thanks

Alba

Since y'all looking at ECG's - how's this one look?

I am off flecainide for 10 + days - Holter on the way.

nlama by M, on Flickr

Nice & regular! About 95 BPM ish at least looking at the first line.

ECG 1


I hope I have created the link to my ecg correctly.

What do you think? I can try and add another if required.

Alba



Edited 1 time(s). Last edit at 04/14/2021 03:35PM by alba.

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alba
What do you think?

Looks like NSR with frequent PVC's interspersed. PVC's have a wide and non standard QRS waveform. Here is an example, with the PVC's being those pointed to by the red arrows:

Thanks George!

Many thanks, GeorgeN, for that interpretation of my ECG.

I am not knowledgeable in this area. Can I take it from what you are saying that my irregularity is not Afib and therefore reasonably benign?

In your trace, what is the explanation of that big drop after both PVCs?

I want to avoid anticoagulants and antiarrhythmics if possible. I don't know the extent of your knowledge and also don't want to put you on the spot, but from my ECG does this seem possible in respect of both these drugs?

My preference is for natural methods in dealing with this problem. Although it is slightly contraindicated for CKD, I would also be prepared to take low-dose aspirin if it would be beneficial.

Alba

I agree with George: NSR with frequent PVCs.

It looks like you're throwing about 24,000 PVCs per day, which is a lot. Cardiologists arbitrarily set 20,000 per day as the number that is "too many" and will treat it at that point. The trouble is, the treatment would likely be your old friend metoprolol. It's not that they're dangerous -- they're not -- it's that that most people find that many very uncomfortable.

The recording you posted is definitely not afib.

You do not need aspirin. All that will do is cause an increased risk of GI bleeds, particularly if you're "old" (you keep saying you are but you don't say a number and everyone's definition of old is different). If you were going to take any type of anticoagulant, it should probably be low dose Eliquis or Xarelto. Much safer and more effective than aspirin.

Many thanks Carey for your interpretation and your corroboration with George.

I would be interested to know how you calculated 24,000 PVCs per day. I am not experiencing them all day. They are there virtually immediately after rising and persist intermittently until about 30 minutes after breakfast. The intermittent runs are for about 30 to 60 secs at a time. I am much more comfortable after lunch and most of the evening. They recur close to bedtime which is usually about midnight.
They started approximately 3 months ago and disappeared for about a week, two weeks ago.

I have been too negatively invested in what has been going on with the pandemic, and there have been other worries that could have impinged on my psychological wellbeing. It has been a particularly stressful year. I have not tried it but if the irregularity is benign and possibly related to my psyche then possibly meditation and relaxation techniques could possibly return my heart to equilibrium.

For the sake of reinforcement of what I have taken to be a positive and reassuring message do you really think that these PACs are not dangerous and more just uncomfortable and tiring?

Thanks

Alba><

Sorry Carey, our posts crossed.

Alba

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alba
I would be interested to know how you calculated 24,000 PVCs per day. I am not experiencing them all day. They are there virtually immediately after rising and persist intermittently until about 30 minutes after breakfast. The intermittent runs are for about 30 to 60 secs at a time. I am much more comfortable after lunch and most of the evening. They recur close to bedtime which is usually about midnight.
They started approximately 3 months ago and disappeared for about a week, two weeks ago.

Carey just counted the number of PVC's he could see during the time period you sampled, then grossed that up for 24 hours. Obviously assumes the rate is constant, which you say it is not.

10-15 years ago, my first wife was experiencing what turned out to be PVC's. This was before the common availability of home ECG monitoring. I have used recording beat to beat Polar heart rate monitors for years as I can "see" quite a bit in the heart rate vs time tracings. This includes PVC's PAC's & afib. She was getting quite a few PVC's a minute including bi & trigeminy beats. Bigeminy is essentially a normal beat followed by a PVC or PAC. Trigeminy is two normal beats followed by a PAC or PVC. We started her on magnesium glycinate and increased it to bowel tolerance. When we checked two or so days later, the number of PVC"s were reduced 100 fold. Her brother recently let me know he was having the same issue. So I reached out to my first wife and asked her how it was going now. She said she still takes magnesium to near bowel tolerance and she rarely ever feels anything.

Stress can deplete magnesium, so this could be an easy fix. As long as a person has normal kidneys, if there is any excess in the serum, it gets urinated out.

Yeah, if the rate of PVCs varies, you'd need to wear a monitor for a week or so to get a good idea of daily totals.

Thanks, GeorgeN for that explanation. I clarified my irregularity instances just in case that is how it had been calculated.

I had a vague recollection that magnesium could be a mineral to consider with regard to heart issues. My wife takes it regularly for another issue. However, I have CKD 3b and magnesium supplementation is I believe definitely contraindicated. I briefly considered a magnesium spray to avoid gut transit but did not fully explore whether this could be a harmful delivery method. in the case of CKD. I will look at that again. I used to have an Epsom salts bath which is a very effective method of magnesium top up. Unfortunately, we moved house and now only have showers, so would have to consider a magnesium spray as an alternative.

Thanks again to you both for a prompt, reassuring, and knowledgeable response to my questions and concerns. I feel much lighter and more relaxed this evening. What I must do now is find a natural way to hopefully eliminate my arrhythmia.

Alba

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alba
I used to have an Epsom salts bath which is a very effective method of magnesium top up. Unfortunately, we moved house and now only have showers, so would have to consider a magnesium spray as an alternative.

If you determine that transdermal magnesium is OK for your CKD, this post has links where you can make your own lotions with either magnesium sulphate (Epsom salt) or chloride. You can just put either in water in a concentrated solution and apply to your skin and let it dry.

Thanks George. That's useful

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alba
I used to have an Epsom salts bath which is a very effective method of magnesium top up. Unfortunately, we moved house and now only have showers, so would have to consider a magnesium spray as an alternative.

Or magnsium footsoak 20 min done with magnesium chloride,which has greater transdermal absorption than magnesium sulfate (epsom salt). I have read articles that magnesium chloride footsoak delivers more Mg to body than epsom salt soak of whole body in tub.

It will prob. progress into full blown Afib/ARR heart action sooner or later...... like i had around 25K pacs a day at times while having ARR on other days...a real mess....but look at it this way for me those Pacs or maybe pvcs who knows either or were horrible......were WORSE than having an ARR....now i know medically its better to have what your having then ARR as Carey pointed out but i was happy when my huge string of bad beats turned into an ARR because after the ARR was over i had no more action of any kind in heart for at least a day or 2 before the vicious cycle began again...what a life that was until finally getting My Ablation to clean everything up.
So to wrap up i am saying to you its prob. better to actually move into lone afib mode for 2 reasons....#1 if you were anything like me those never ending pac or v c's were worse than my ARR......more dangerous or not i was happier in ARR then pac hell.
#2 Once you get into your full Afib status then you Qualify for an Ablation to clean everything up once + for all hopefully.

GL either way but don't feel bad if you progress into afib...if it was me i would be dancing to get into afib so to trigger a final solution/ablation cause right now your in limbo.

Please do not follow the advice from George with his megadosing "experiment of one (or a few)" uninformed nonsense about magnesium supplements. In your case it may be dangerous. You have had kidney cancer and now have one functioning kidney which may or not have issues. Please see a nephrologist before taking any magnesium supplements. Also, the standard treatment for excessive PVC's is beta blockers. The dosage can be adjusted, you may be able to find a sweet spot under a doctor's care. Also, with your CHADs score you should be on OACs and not aspirin. You will be far unhappier as a stroke victim than with the PVC's if it were to come to that.

Thanks for the further replies.

I will look into the foot soak Poetkim. I bought some magnesium oil spray which arrived today, but a foot soak may be easier.

Thanks safib for the alert re the magnesium. Due to having only one kidney and CKD, I am very cautious as to what I can take orally. I even limit my banana intake because of the potassium. This is why I was exploring topical magnesium, and have yet to determine whether that is suitable.

I did invite GeotgeN'sresponse because my preference if possible is for a more natural or alternative treatment to drugs. Ten years ago, I had a similar episode to what I am experiencing just now, with added tachycardia. I gradually weaned myself off of the metoprolol despite the fact I was told that I would need to take this drug for the rest of my life. My heart rhythm eventually normalised with only a rare thump in the chest when I over-exerted myself. I hope and pray vanlith that I don't progress to afib and I can get back to that position again.

Intuitively, I have always believed there is some sort of gut involvement, be it vagal or a hiatal hernia. I drank aloe vera following my episode 10 years ago. I can't say if that was the cure, but my heart did return to equilibrium in time.

Safib, you mention being "able to find a sweet spot under a doctor's care. My wife and I have had significant interactions with doctors over the past few years. I am afraid I have lost confidence in doctors and even more so over this past 'COVID year'. Personally, I don't find them to be that invested or proactive. In the past few years, we have had to push for treatment, and I believe it is going to become even more difficult now and in the future. By way of just one minor example, you mentioned consulting a nephrologist., I won't go into the details, but I was unsuccessful in trying to involve nephrology in my care. With regard to my current heart issue, I was unable to achieve a face-to-face with a GP. I am now on a waiting list for a 24 hour Holter monitor, and a few weeks have passed already.

Hence my reason for joining afibbers.org!

The sweet spot I was referring to was in balancing side-effects and relief of PVC's, nothing more.

I am sorry for your level of medical care, as you describe it. However, the answer is not using some of the uninformed and even dangerous views expressed here as a substitute. Note that the site warns that "The AFIB Report, Forum and Database do not provide medical advice. Do not attempt self-diagnosis or self-treatment based on our reports." Good luck with your approach.

I echo safib's concerns regarding magnesium and would advise extreme caution for you. With impaired kidney function, all electrolyte supplements are potentially dangerous no matter how you receive them.

I'm not up on the transdermal magnesium literature, but I'm not so sure it's an effective way of acquiring magnesium. Last I read said it's not, but it's not a subject I follow carefully so I could be wrong. But if I am wrong, then you need to be very, very careful. Absorbing magnesium (or anything) through your skin is no different than taking it orally as far as your kidneys are concerned. No matter how it got there, if it's in your blood stream then your kidneys and your heart will have to deal with it, so keep that in mind.

As a rule, I recommend extreme caution for anyone with kidney disease trying to supplement any of the electrolytes. You're definitely in doctor-supervision-required territory with that sort of thing and if you can't find someone willing to supervise then I'd say it's just a no go. But even a GP can monitor your electrolyte levels and kidney function, so if you can't engage a nephrologist then at least get your GP on board with what you're doing.

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Carey
I'm not up on the transdermal magnesium literature, but I'm not so sure it's an effective way of acquiring magnesium. .

This is the only study I've ever found on the topic. I also recall an anecdote where a fellow was able to replete his intracellular magnesium levels, as indicated by ExaTest, via transdermal magnesium chloride.

As you note, with compromised kidney function, it is an area to be very careful.

In my case, oral consumption was much more effective and time efficient than transdermal.

Thanks to everyone for again trying to assist.

Rest assured I am cautious due to my specific health situation. I would not take risks and need to have all the facts to hand.

All my life I have avoided medicinal drugs where possible. I won't even take paracetamol. Following my kidney ureterectomy, I avoided using the morphine pump. I hope I can get past my current heart problem without having to take an anti-arhythmic and more specifically an anti-coagulant. At the most, I hope it would just be 'pill in the pocket' anti-arrhythmic for a period.

The main reason I sought information and advice on afib.org was my concern over having a stroke or heart failure whilst possibly waiting some time to see a cardiologist. The GP ticked the box and passed me on, with virtually no advice. The fact that weeks have already passed and I am on a waiting list just to get to the first base of getting a Holter monitor does not indicate I will be seen soon.

I needed some reassurance that my heart trace was not afib and was hopefully less dangerous PACs or PVCs. I have largely received that, which has helped me to be a little more relaxed whilst waiting for my consultation. I had also hoped to get advice on a natural anti-coagulant possibly like a specific dose of vitamin D3 or low dose aspirin, as a precaution.

My ideal would be to have a referral to a nephrologist and have a full blood analysis, etc to rule out any impact of my kidney function on my heart. Also, referral to a gastroenterologist to rule out vagal issues, etc. In addition, a full analysis of my heart in terms of valves, exercise stress and electrophysiology, etc. I expect my chances of that are almost as remote as winning the lottery! It is only the Tony Blairs of this world that can have the immediacy of a top cardiologist transported across London on a scooter, to determine the cause of his arrhythmia!

Thanks again to all for taking the time to reply.

Hi alba,

I believe you can order at least some labs on your own in the UK. You might be able to at least get serum magnesium & perhaps RBC (red blood cell) magnesium.

If you try the transdermal mag, if you get more rather than less ectopics, I'd use this as an indication that you might be getting an excess serum build up (you probably already thought of this). Although a lot harder to determine how much you are getting into your system, the transdermal approach should be milder than oral.

Good luck with whatever route you choose!

George

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alba
I had also hoped to get advice on a natural anti-coagulant possibly like a specific dose of vitamin D3 or low dose aspirin, as a precaution.

You still seem to believe that low-dose aspirin is a safe drug. It is not safe, and the older you are the less safe it is. The safest drug to prevent blood clots is Eliquis. The other NOACs such as Xarelto are almost equally as safe, with the exception of Pradaxa. Pradaxa has a higher bleed risk in the elderly.

With a CHADS score of 2 and no afib but a lot of PVCs, anticoagulation is a judgement call. I personally would choose to take a NOAC if I were in your shoes because I've seen far too many times what strokes do to people. Sometimes survival is not the better outcome.

Thanks GeorgeN. I may consider having a private mag test. I already do this for vitamin D. We lived in France for a period and it was so easy to get any type of blood test. There were numerous private labs in the smallest towns.

Hi Carey. I am not sold on aspirin and probably would not take it. As I said I very rarely even take paracetamol. I read Hans Larsen's paper on aspirin and it is a bit off-putting.

I looked at Eliquis and it too is off-putting, due to the extensive list of side effects!

I recall when I was in the hospital, a gent in the bed opposite had experienced a stroke due to a brain bleed. I had a suspicion he was on an ant-coagulant, which he subsequently confirmed. Anti-coagulants make me a little nervous,

You could be damned if you do and damned if you don't.