Afib diagnosed 40 year old male

I am very active running 12 miles a week, as well as weight lifting. I am a firefighter with 15 years on the job. I was diagnosed with afib on 4/13/21. Cardiologist states alcohol and dehydration caused it. I drank 3 days prior. Maybe I am being hard headed but I dont think I was dehydrated at the time. I had an echo done. He stated I have mild left atrial enlargement measuring at 4.3cm. He doesnt know why I have that. I was tested for sleep apnea. Results show I do not have sleep apnea. I also was placed on a 14 day monitor. Those results showed no afib, but averaged 20 pac’s daily a longest run of 3 pacs in a row. Cardiologist did not give me any medication. Since 4/13 my heart has not felt the same. I have pounding heart beats when either relaxing or preforming light tasks. I am woken up in the middle of the night with these pounding heart beats. I feel every single pac about 20 a day. I feel them relaxing, while running, or when I am woken up with these pounding heart beats. When I wake up in the middle of the night to use the bathroom my heart rate shoots up to 130, as soon as I lay back down my heart rate drops to my normal resting heart rate of mid 50’s. I also have chest discomfort that surronds my heart. Doctor states all my symptoms are benign, and is not concerned. Are all my symptoms associated with afib? Anyone else experience these symptoms? I dont think I have had another episode of afib, but my heart has not felt the same since. I struggle with these symptoms daily and dont know what else to do. Cardiologist gave me the ok to return to my job, but of course I am worrried if all this gets any worse I am gonna be taken off the truck and lose my job. Any insight would be greatly appreciated.

Is your cardiologist also an electrophysiologist (EP)? If not, you need to find one and get a second opinion. What your cardio should have done was have you wear a monitor for a week. What you've described could be afib or it couple be a couple of other things (not likely anything dangerous). A monitor would answer that question. It's just an adhesive patch you stick on your chest, so no one will know you're wearing it.

Also, being taken off the job due to afib would be extremely unusual as long as you don't experience dizziness or syncope with these episodes. There are plenty of firefighters (and every other job you can name, including pro athletes and airline pilots) working with afib. Properly treated, afib is not disabling and does not shorten your life expectancy.

Thank you for your response. My cardiologist is not an EP. I do have an appt scheduled end of February with an EP so time will tell my future. I did wear a monitor, it showed I average around 20 pac’s daily and no afib was shown. Are the symptoms im experiencing afib? Anyother insight or suggestions is much appreciated.

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Bob Thorton
Thank you for your response. My cardiologist is not an EP. I do have an appt scheduled end of February with an EP so time will tell my future. I did wear a monitor, it showed I average around 20 pac’s daily and no afib was shown. Are the symptoms im experiencing afib? Anyother insight or suggestions is much appreciated.

Bob, sorry to have you join us!

I'm guessing the symptoms are not afib. Suggest getting a Kardia device to check. Here is one for $38 on eBay. Along with an app on your phone, it takes an ECG and will analyze it and you can look at it, too, for a visual. [www.ebay.com]

Exercise at your level over years, could be enough to set the stage for afib. It was for me, first episode at age 49, I'm now 66. See my post on exercise here and follow the links. Alcohol can be a trigger, but afib would likely have occurred much closer in time to the episode. So I kind of doubt it was the trigger. Till you get it figured out, not drinking would be a hot option. Did you exercise close in time to the episode. Usually for someone who is fit, the trigger is vagal and happens after the exercise. Could be quite a while after. In my case, my first episode was preceded by a training run on a 14,000' mountain a few days before. With less intense exercise, the afib would likely occur a few hours after you've settled down.

In addition, the other possible culprit, at least in my case is electrolytes. In my case, I found that supplementing with magnesium to bowel tolerance helped a lot. Start low dose and increase slowly. Bowel tolerance is very individual. I assume you have good kidney function, from what you've described. With poor kidney function electrolyte supplementation is not suggested. Going along with this I also put 2 tsp of potassium citrate powder in a liter or so of water and drink it over the day. My version of timed release. A lot of potassium at one time will get urinated out quickly.

Moderating your exercise per my link with the electrolytes may be helpful. Was in my case. I've been able to keep afib mostly in the box for over 17 years while still maintaining excellent fitness. In my case the issue was duration time intensity of exercise. So by moderating intensity for longer duration activity, I don't get the trigger.

Thanks tor the response! 2 weeks prior to all of this happening I ran a half marathon. No training, just did it. It was the farthest I ever ran prior. I normally run 3-5 miles at a time. I felt great while I did it. My cardiologist didnt think that was the cause. I do workout quite often. Maybe I over did it? I will add this to the presentation I am preparing for when I speak to an EP at the end of February. I trust the cardiologist I saw, but I am uncomfortable everyday. Something is off for me. I literally went from feeling my best everyday, to 11 months of misery. Pounding heart beats, heart feels stressed out, pac’s relaxing or working out, and chest discomfort.

When you experience these episodes where you say your heart rate climbs to 130, have you felt your pulse? Is it a regular rhythm or just kind of all over the place with no rhythm at all? Did you experience one of those episodes while wearing the monitor?

I agree with George that it's probably not afib, but you should get a Kardia so you can see what it is. Once you record a strip you can post it here and we'll help you figure out what it is. If it's really just PACs, their sudden appearance could be a sign of things to come. PACs and afib are pretty tightly related.

My heart rate only spikes higher than 100 when I go from laying to standing. I talked to my cardiologist about this, he told me to drink more water and add salt to my diet. I drink tons of water. Unless he wants me to drown myself, I cant drink much more then what I consume. I have an apple watch, and can read basic heart strips. Its for sure pac’s. The monitor I wore stated I average 20 pac’s daily, and did not detect afib. Is 20 pac’s daily terrible? Does that mean the diagnosis has started? When does a cardiologist or an EP actually treat afib with medication or ablation? I’ve read the longer it goes untreated the harder it is to treat? My cardiologist states there is nothing to do. Do people actually just wait it out until it gets worse? Im trying to be proactive. Any feed back is appreciated. You guys are great!

20 PACs daily really isn't anything to worry about, but 20 PACs a day doesn't create a heart rate of 130 either. Well, maybe it does for a few seconds when it's being displayed by a monitor showing real-time results, but it wouldn't produce a rate that high over a 30-second sampling period, and that's what counts. Arrhythmias lasting less than 30 seconds generally aren't counted as true arrhythmias.

That said, a sudden unexplained increase in PACs signals something is going on, so by all means see that EP and continue looking into this. So far I don't think most EPs will think you need treatment, but it's definitely something you need to stay on top of. My first afib episode occurred when I was 46. It didn't require treatment until I was 54.

My heart rate of 130 only show its face when I wake up in the middle of the night to use the bathroom, as soon as I lat back down it instantly drops to my resting heart rate of low 50s. Ive recorded it as sinus tach to sinus brady. Thank you for your response! Can you share how your first experience was? What were you doing? Do you have symptoms similiar to mine when it started? What took 8 years before your required your treatment? How were you treated after 8 years? How are you now? Any education you can share would be greatly appreciated! Thank you for your help!

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Bob Thorton
I was diagnosed with afib on 4/13/21. Cardiologist states alcohol and dehydration caused it. I drank 3 days prior. Maybe I am being hard headed but I don't think I was dehydrated at the time.

"Alcohol is a diuretic. It causes your body to remove fluids from your blood through your renal system, which includes the kidneys, ureters, and bladder, at a much quicker rate than other liquids. If you don't drink enough water with alcohol, you can become dehydrated quickly."
- healthline.com

FWiW: when I had two recent recurrences of a-fib after 3 1/2 years in remission, my cardiologist ordered a nuclear stress test. My primary care physician noticed the result first. She had a nurse call me to say I needed to draw the attention of my cardiologist to the result as she, my primary care doctor, was very worried about it. When the cardiologist saw the result, according to one of his nurses who called me, he "cleared space in his schedule" for the next day to see me to arrange a heart catheterization. The test result indicated "ischemia" to two regions of my heart, indicating partially blocked coronary arteries.

When I saw the cardiologist, he discussed heart cathetization, specifically, the cardiac angiogram he was going to do to get a definite idea of what was going on with my heart. He discussed methods of treatment if he confirmed what he suspected. The proposed treatments were either the placement of a stent or stents by using a catheter or to open up my chest and transplant arteries from elsewhere in my body to supply the heart with blood. Otherwise, I would be liable to have a heart attack.

All this came as quite a shock to me. I had been fairly religious for decades to conduct myself in ways that my heart would not end up in a condition like this. I had exercised regularly and conformed to my best guess of what a heart healthy diet was.

The point of mentioning all this here is to say that in the week and a half to two week period between when my cardiologist informed me of all this and being told what the actual cardiac angiogram result was, I experienced a lot of different symptoms that I became alarmed about.

I was very cautious not to overdo anything, in case one of my supposedly almost blocked coronary arteries finally became completely closed. I thought often about what had happened to my ex-wife. Her life changed forever when she had a severe stroke the day before she was scheduled for heart surgery to repair or replace a heart valve. She was confined to nursing homes after that, with severely limited abilities. One night at 10 p.m. I called a cardiologist to ask if I should go to the emergency ward to have pains in my chest and back evaluated. It was not a usual week and a half to two weeks.

However, when the cardiac angiogram was over, the cardiologist announced that my heart was very healthy with good blood flow through the coronary arteries. The nuclear stress test was completely inaccurate. He had told me prior to the angiogram that there was a small chance nothing was wrong, i.e. these stress tests are inaccurate 10 -15% of the time, but I took that to mean not much of a chance.

Whatever symptoms of potential impending heart attack that I had had during the previous short period of time faded away.

Just saying. If you are alarmed about your symptoms, get a second opinion. If I had doubts about some assurance that nothing was wrong given to me by a cardiologist, I would have made an appointment with another one as soon as I first had doubts. When I had my first a-fib recurrence after 3 1/2 years, I managed to get an appointment with a cardiologist within 4 days, because I was willing to drive 1 1/2 hours to get there. I saw a different one about a week and a half later closer to home. It was interesting to hear the differing opinions.

Its your heart.

Thank you for sharing your story.

I had a “type2 MI” on 12-26-20 from a bad afib and adenosine challenge in the ER, and I also had a rushed angiogram..so I’m a little familiar to your story and what thoughts went through your mind until you received good news after the angiogram procedure. It’s a wake up call not to ignore your symptoms and procrastinate getting it looked at.

since your a firefighter, wouldn't the stress of the job be a possible trigger? Isn't it like some crazy high percentage for firefighters die from heart attacks yearly?

so far, my cardiologist has diagnosed me with lone AFib, i think the biggest battle for me so far has been the anxiety. (my first and only AFib was Jan 11th 2022, and i'm 48.) Maybe that is what you are dealing with? I am perfectly healthy also, so they say, but after such a scary event. You can't help, but have some deep fear which is really rough on you at times. The only difference between you and me it seems is I'm on Metoprolol, a beta blocker, 25mg x2 a day and 81mg aspirin. I hope to get off it soon if its possible. I wore a monitor for 2 weeks and no afib events at all. I see the EP on Feb 10th and hopefully learn something more.

Adamh,

keep me posted on what your EP says. I have my first appt with an EP at the end of Feb. I try not to stress at work. I am perfectly healthy like yourself, and dont know why it happened. Its been 10 months since my episode, but have lingering side effects which I am hoping the EP can educate me on. How long was your first episode? What do you think caused yours?

I was in AFib for about 20ish hours i think it was. I was stuck in the ER until their was room in the hospital. The cardiologist had to make a special trip to see me the next day in the ER. Once he saw me, they adjusted my meds (beta blocker metoprolol tartrate) and like two hours later, i went into sinus rhythm. It makes me wonder if he saw me earlier. Maybe I would have gotten back to normal sooner.

I don't know what caused mine and nor do they really. My only guess (and theirs) is I was drinking like 2 sugar free monsters a day and pre-workout drink loaded with caffeine every day. On top of that, i was sleeping horribly (i think i have apnea.) I do about 150+ minutes of cardio a week. I weight lift abut 5-6 days a week doing split body part routines. So add all that in and me being 48 now, i just popped i guess. My body just cant handle the stress like it did say 10 years ago even. It caught up to me possibly?

Everything is good for now except the anxiety. You feel everything and concentrate on it. I am trying to figure out new habits or routines to follow so i can learn to manage it better. I think i am getting there but it is not a fast process.

I will share of course what the EP says. They might suggest an ablation as a more permanent treatment for me, but we will see. So far no AFib since and overall nothing to report. Just seemed to pop that one day. lol.

Your routine sounds a lot like mine. I am very active running 9-12 miles a week and weight training 3-4 times a week. I now just have lingering symptoms of
Pacs, pounding heart palpitations. Do you have any of these symptoms daily? Noone can tell my why. I am also more aware of my heart beat and feel every irregularity. I never had any of these symptoms prior to my 1 episode. They gave me cardizem iv in the ER. I was in afib for about 7 hours. They did not prescribe me any meds and blamed
It on alcohol and dehydration. I drank 3 days prior. Doesnt make sense to me since I drink water all day long. I feel they just made something up since they dont know….

Hello Bob,

You are at the right place for information. There are many very educated posters here who are willing to share knowledge. Very very helpful...

First AFIB was 2006...had 3 episodes over 18 months that required cardioversion/chemical conversion in ER's. I was 38, active and fit. Prescribed beta blocker...moved from Atenelol to Metoprolol Succinate over the years...Have EP and Cardio...had high Calcium score 5 years ago so I added 80mg of Lipitor and baby aspirin. Had three more episodes in 2019/2020...Have had several stress tests, structural tests, etc...to confirm no structural abnormalities or blockages. Have reduced intake of high fat/high chol. foods, no caffeine, less sugars due to Calcium score...feel better and have lots of energy. No headache since...I still drink, and am committed to being hydrated and getting sleep following.

PVC's/PAC's come and go. Largely regulated by natural intake of electrolytes, staying hydrated and GETTING PROPER REST. A key contributor to arrythmia's, especially Lone AFIB, is the failure to get adequate sleep. I have been a chronic night owl my entire life...proper rest has had a significant impact on my PVC/PAC/AFIB reduction.

In short, try the diet modifications/hydration/rest angle. Natural sugars via fruits, lots of vegetables and proteins via lowfat sources works for me. I do take a beta blocker and have become acclimated to any side affects.

Best of luck,
Scott

Thanks for sharing your story Scott. I feel having the afib episode 10 months ago has ruined my life. I have not had an episode since, but my heart has done wierd things since the episode. Pounding hearts beats, heart feels stressed, and now I get pacs. My cardiologist doesnt seem to care. I have an upcoming appt with an EP hopefully he will be able educate me on what is going on.

Hi Bob,

Any update here? Did you get to speak with an EP? I share similar experiences as you so just curious as to the outcome, if any.

Basically nothing to report. He stated in about 10-15 years we as in him and I will have to have a conversation about afib. He says my daily pacs are normal and harmless. He stated he could perscribed me a low dose beta blocker if I wanted, but stated if he was me he wouldnt take anything. I made a follow up in August. I still get daily symptoms. Have not had an afib episode since my first and only one last April, almost a year. But all my symptoms started after that. You say your symptoms are similiar? How so?

I had my first and only episode of Afib in Dec. of 2018 at the age of 27. Seemingly happened out of nowhere one night, ended up in the ER for a day until a cardiologist told me to take the meds go home and to see him at his office the next day at which point I was back in sinus rhythm. My echo came back perfectly normal and there were no obvious triggers. Doctor said he thinks it was a freak thing or could be "holiday heart", I like many others didn't get any real causes or answers as to why this happened. After my own research I came to the conclusion that it was probably a vagal trigger. I was always an active person, running, weight lifting etc. and never had an issue until this event. Right after Afib I used to get PAC's often and I was very aware of my heart which can be mentally draining. I have come to the realization that my triggers tend to be very correlated with my gut and acid reflux. I don't get heart palpitations as often anymore but when I do, there is often a stomach issue or some nasty heart burn involved which I think is irritating to the vagus nerve. The cardiologist also said I had "borderline sleep apnea" which I'm sure wasn't helping the situation. I now use a night guard to help with snoring and to increase air flow. I do still find myself experiencing the same thing as you at night when waking up to go to the bathroom, my heart rate shoots up, not sure what this could be but it's just something I've learned to deal with. I get sharp pains around my heart at times also, but the doctor said it was nothing to worry about as long as it's not a dull ache/pain. I started taking magnesium a while back which has helped quite a bit with the fast pounding heart rate when going from sitting to standing but I guess not enough. I learned to take life a little more slowly, instead of jumping right out of bed, I sit up for a few seconds before standing, it seems to be effective. Unfortunately I'm sure that's not a privilege you have when you get a call on the job though. This is a journey and you'll learn your triggers along the way. I have found this forum to be a great resource and sometimes it's just nice to know that you're not alone!