My afib has changed

I've had a light case of afib since 2015. I'm currently 71 yrs and in good health besides the afib. I'm on 15 mg of Xarelto daily and take a mult-vi-min, plus extra K2-MK7, Vit A, Vit D, C fish oils, (maybe some other things) and of course, lots of magnesium. Usually I take Mg glycinate but also like the orotate version. I try to take Taurine, but have a sulfur-pathway problem so get some side effects. I try taking very small amts every other day or so. I like that it helps with electrolyte balance and I've always felt electrolytes are a big key in afib. / I've recently experimented with taking some arginine to up nitic oxide and open up the vessels.
I'm writing tonight because my afib appears to be taking some kind of turn. The past few weeks I've had tachycardia very frequently. My doc urged me to take my generic Carvedilol, 3.125 mg tabs twice a day instead of 'as needed' way as I usually do, which is rarely. The beta blocker helped the tachycardia but not 100% and any beta blocker I take lowers my 'normal' BP too much so I back off. / have a stress test/echo-cardiogram tomorrow which may show organic changes in my heart which may explain the new symptoms. This is the first time I've felt like a 'heart patient', with my body feeling weak and 'winded'. Am not exactly happy about this. No doubt my capable (but entirely western med) cardiologist will suggest another medication. I'm not opposed to meds, but really like helping the body and heart naturally, too.

I'm taking as much magnesium as I can throughout the day, and mostly it resets my heart for the better, but sometimes, I keep adding more and more, waiting for that 'turn-key' good response, and it's not forthcoming. (Btw, I had an Exatest done 4-5 months ago, showing normal mineral levels. -Because I notice value with magnesium, I still push it in my daily diet).
Yesterday I took a few Thorne Calcium/Magnesium Malate 1:1 ratio. For the first time my heart slowed down and felt much better. Re-reading Mildred Seelig's Magnesium book, she mentioned one must have an equal balance of calcium and magnesium for heart health. And there was some warning about taking lots of supplemental magnesium without any calcium. (Does anyone have an opinion on this note?) I certainly can't do much supplemental calcium as I feel a hardness in my heart area with it. (One of the leaders on this forum recommended I let my calcium come from the daily diet and concentrate on getting enough magnesium with diet and supplements). And of course potassium is important too. I guess what I'm wondering tonight is whether anyone has comments on tachycardia symptoms; what that might mean and what you did for it. Also, are there any ways to know how to supplement for the major electrolytes more intelligently/precisely?

The question is, what is this tachycardia? Is it a regular or irregular rhythm? Do you have a Kardia or any other sort of device that will show the rhythm?

My advice is to pay close attention to what works for you. While arginine is supposed to reduce tachycardia , it may not work that way for you. Or maybe try beet root powder or L-Citrulline which both can increase nitric oxide. Perhaps reducing the number of supplements you take, unless you've experienced a known benefit, to see if an unknown item(s) is causing issues.

"I certainly can't do much supplemental calcium as I feel a hardness in my heart area with it." What do you mean by hardness in your heart? Maybe titrating the amount of calcium that seems to have benefit without this hardness.

"This is the first time I've felt like a 'heart patient', with my body feeling weak and 'winded'." Perhaps from the Carvedilol? Carvedilol may cause hyperglycemia (high blood sugar), as well as other symptoms.

Hi Cal Gal....well i have few suggestions

Cut out the Fish oil as it is quite commonly linked to exciting your heart (eat Salmon or Sardines)

Cut out the Carvedilol as this can only mask or disrupt any productive (diet + supl.) things you do.

If your taking a MV you don't need to supl. Vit A ESP. if you eat a good diet as there is plenty of A in that (generic heath advice)

No calcium supl. as you are leaning anyway as your prob. getting plenty from your diet + if not then eat more Calcium rich foods as that will more then compensate for your extra Mag. intake.

Like George said if your looking for Nitric Oxide....taking L-Citrulline or L-Cit malate makes L-Arginine in your body then nitric oxide is the result.

MOST IMPORTANT.... Cut the Mag. Orotate as it is basically useless for your heart (4% absorption) unless your looking for bowel movements LOL.
With Mag. Glycinate your on the correct track combined with the Mag. Malate you just discovered is great also But add 1 more in Mag. Taurate.
Taking those 3 TOGETHER will in every likelihood help you greatly. It did wonders for me in turning my between 2-25k PAC's a day into a few if that in a 24 hour period along with stopping the odd very short (a few seconds) runs of Tach. that i myself has getting not to mention it has helped my sleep quite a bit better + leaves me so refreshed in the morning like never before.
I take 25% of the daily dose of EACH of the 3 Mag. when i get up + the same amount 1/2 hour before bed....25% x6=150% of the daily Mag. dose so your getting plenty + that is not including your multivit. amount + the food amount also. That's just me though as everyone is dif. as you may req. more or quite possibly less Mag. GLY/MAL/TAUR so i would start on the low side + if nes. work your way to higher dose like maybe take those 3 Mag. an extra time in the afternoon for 3 times a day or 225% the daily dose.

Ok if you have any Q. about what brand of the 3 Mag. i take or if your at all interested get back to me/us as you could not have come to better place for advice from the people who actually live this subject of AFIB + everything related.

abbreviations make it difficult to understand clearly the message.

Hi Carey,
I don't know what kind of fast heart rate it would be called. Perhaps it was flutter. Sometimes it would be be in rhythm and sometimes not.
I'll see the cardiologist next Tuesday for a follow up on the stress test and echocardiogram and will ask more questions. It seemed to come on a few weeks ago without any reason that I could sense. When the rate was high (nothing higher than 140), I felt extreme fatigue & lassitude.

On my first visit with my current cardiologist, he showed me the Kardia tool, but hasn't insisted that I get it. I have dragged my feet on this.

Thanks, George.
I'll back way down on my supps and see if any might be causing this.

Yes, it seems that I can take a little calcium before I get that feeling of 'hardness' in my heart area. Btw, a calcium scan I had done around 9 months ago showed a score of 44, which is said to be within normal range for a person of my age/gender. 7 to 8 years ago my scan score was 14.

I'm not sure my body liked the Coreg as much as metrolprolol, although both caused my BP to drop a little too much. After my stress test yesterday, I was prescribed 125 mcg of digoxin to take instead of the Coreg. It supposedly lowers heart rate without taking down the BP. I had a touch of dizziness from it but it went away.

Thanks for your notes, Vanlith.

As I said earlier to GeorgeN, I stopped my Carvedilol today when I started 125 mcg of Digoxin prescribed yesterday after a Stress Test. I never cared for carvedilol, so good to be off it, even if I only took it 'as needed' in the past.

I was taking the supplemental A (alternating with beta carotene) after reading Kate Rheaume-Bleue's book on Vit K2 in which she likes the trio of K2, D, and A. (A side note: Something I've been doing the past few months has made my nails stronger and healthier. I wondered if it could be the A, or maybe the K). I only take 1000 IU of D daily, since I live in the sunshine state. My last D level was around 50.

I will look into L- Citrulline or L-Cit Malate. I'm not as familiar with these. (Why wouldn't one take the L- Arginine directly instead of having the Citrulline create it?).

I have a whole shelf lined with many versions of magnesium. :>) I'll give your trio a try but the doc mentioned at the stress test yesterday that she'd like me to have no more than 400 mg /day of mag.

Can you tell me your product preferences for the 3 Mags and breakdown the amounts you use at one sitting, like when you rise in the morning?

Many thanks for all replies to my original post. -Cal-Gal

Your cardiologist put you on digoxin? So he's a general cardiologist and not an electrophysiologist (EP). Is that a correct guess? Have you ever been diagnosed with heart failure?

When I first had afib over 18 years ago, I went from paroxysmal to a 2 1/2 month persistent episode within 2 months of my first episode. I went to a highly recommended cardiologist as the second cardio I'd gone to. He immediately told me that digoxin was his favorite afib med. I'd already found this site and I read the founder of this board, Hans Larsen's book, " Lone-Atrial-Fibrillation-Towards-Cure" [www.amazon.com]

I refused the med based on what I'd read. The cardio & I had several hour long discussions. Finally, he got frustrated with me and referred be to the EP in the practice. When I told him my afib story, he said, "You obviously have vagally mediated afib and there are certain meds we won't prescribe (i.e. digoxin). I had to bite my tongue to not suggest he give the cardio an inservice on afib meds.

Below is from p78 of the book (p 90 of the PDF).

Special Note on Digoxin
Digoxin (digitalis, Lanoxin), originally derived form the foxglove plant, has been in use for 200 years as a heart medication. The primary indication for digoxin is in the treatment of heart failure (congestive heart failure) especially if accompanied by atrial fibrillation. From this original application digoxin has expanded into the treatment of atrial fibrillation and lone atrial fibrillation. Most medical textbooks still laud digoxin as an effective drug for heart failure. Does it actually work?

The Digitalis Investigation Group, a large team of American and Canadian researchers released a major report, which presents the findings of a large, randomized, double-blind, placebo-controlled trial of digoxin in the treatment of heart failure patients. The three-year trial involved over 7000 patients with heart failure (left ventricular ejection fraction less than 0.45). The patients were divided randomly into two equal-sized groups with one group receiving 0.250 mg of digoxin per day and the other group receiving a placebo; all patients in both groups continued on ACE inhibitors and diuretics. The average follow-up time was 37 months. At the end of the trial 35% of the participants had died in each group. The death rate attributable to worsening heart failure was slightly less in the digoxin group, but the number of deaths from other cardiovascular events such as arrhythmias and strokes was higher. Patients on digoxin were less likely to be admitted to hospital for worsening heart failure (26.8 versus 34.7% for controls), but had higher admission rates for suspected digoxin toxicity (2.0 versus 0.9%).

The researchers conclude that digoxin does not reduce the risk of death from heart failure or other causes, but that it does reduce the rate of hospital admissions, especially for worsening heart failure. In other words, while digoxin may, to some extent, ameliorate the symptoms of heart failure it does not reverse or cure it nor does it reduce the risk of death from this condition[12,13].
British researchers followed 484 heart failure patients for three years and found that the mortality among those taking digoxin was 38.9% as compared to only 21.3% among controls. The researchers conclude that the use of digoxin in heart failure patients is associated with an adverse prognosis and suggest that beta-blockers and spironolactone may be a better choice for ameliorating the symptoms of heart failure[14].

Digoxin Toxicity & Interactions
The “therapeutic window” for digoxin is very narrow. Most patients are started on a daily dosage of 0.250 mg/day; however, this is often too little for some patients and too much for others. Very careful evaluation is required in order to find just the right dosage. Unfortunately, this is rarely done in actual practice.
Researchers at the Health Care Department in Maryland found that in the period 1985 through 1991 over 200,000 of 3.3 million digitalis users were hospitalized because of digitalis intoxication. It is ironic that digitalis is often prescribed for people who suffer from atrial fibrillation and yet, the most common manifestation of digitalis intoxication is also atrial fibrillation. Other symptoms of digitalis poisoning are nausea, vomiting, diarrhea, psychoses, and fatigue. Perhaps the most disturbing finding in the study is that in 73% of all cases the reason for prescribing the digitalis in the first place was unclear or weak. The researchers also point out that the high level of hospitalization for adverse effects of digitalis is, to a large extent, due to inadequate monitoring of patients taking the drug. It is also of concern that for the period in which the researchers uncovered data for the 200,000 hospitalizations only 577 adverse events involving digitalis were reported directly to the FDA by doctors or hospitals[15].
Other researchers have noted that digoxin is often prescribed seemingly for no good reason. Dr. Wilbert Aronow of the Mount Sinai School of Medicine found that 19% of patients admitted to a nursing home had been prescribed digoxin. A thorough medical examination and evaluation concluded that 47% of these patients should not be taking digoxin at all. Dr. Aronow also noted that 18% of the patients receiving digoxin had been misdiagnosed as having congestive heart failure even though they were in normal sinus rhythm and had a normal ejection fraction. These patients had originally presented with edema or dyspnea (laboured breathing). Digoxin therapy was safely discontinued in the 47% of the patients for whom it had been inappropriately prescribed[16].
Not only is digoxin highly toxic, but it can also interact with herbs such as Siberian ginseng and with antiarrhythmic medications such as flecainide (Tambocor), propafenone (Rythmol), and amiodarone (Cordarone)[17-19]. These drugs all increase blood levels of digoxin thus making a toxic reaction even more likely unless digoxin dosage is adjusted[18,19].

Digoxin & Atrial Fibrillation
Digoxin is still routinely prescribed for patients with atrial fibrillation even though there is no evidence that it is beneficial and growing evidence that it may actually be harmful. Digoxin does not convert atrial fibrillation to sinus rhythm[19,20]. Its ability to slow the heart rate during an atrial fibrillation episode is doubtful[21] and there is no evidence that it prevents future episodes of paroxysmal atrial fibrillation[23,24]. Dr. Rodney Falk, MD of the Boston School of Medicine sums it up, “Digoxin is probably not of value for preventing tachycardia (rapid heart beat) at the onset of paroxysmal atrial fibrillation and its use as sole agent for this indication, although widespread, has no basis”[22].
Not only is digoxin useless in the prevention and treatment of atrial fibrillation it can actually be detrimental. Dr. Philippe Coumel, MD, head of the cardiology section of the Hopital Lariboisiere in Paris says, “Not only are beta-blockers or digoxin not indicated in vagal atrial fibrillation, but they are definitely contraindicated as they tend to promote the arrhythmia and may block the action of conventional antiarrhythmic treatment”[3]. Dr. Coumel’s statement has been endorsed by the American Heart Association[5].
Researchers at the University of Michigan Medical Center go even further in their condemnation of digoxin. Their conclusion from a recent clinical trial, “The results of the present study suggest that digoxin may facilitate or promote early recurrences of atrial fibrillation after conversion to sinus rhythm not only in patients with vagotonic (vagal) atrial fibrillation, but also among the general population of patients with atrial fibrillation”[6]. It is now also clear that digoxin may not only prolong the duration of episodes, but may actually convert the paroxysmal (intermittent) form to the permanent form[6,23].
As if this is not enough, researchers have also found that digoxin can cause visual problems even at dosages normally considered safe and may significantly aggravate asthma symptoms[24,25].
Digoxin may truly be the medicine from hell and it certainly should never be used by people with lone atrial fibrillation. If a medicine is needed for the control of heart rate then calcium channel blockers such as verapamil or diltiazem or beta-blockers like atenolol or metoprolol would be a better choice.

Quote

Digoxin is still routinely prescribed for patients with atrial fibrillation

Only by general cardiologists who haven't kept up with their continuing medical education. I haven't heard of an EP prescribing digoxin in the last 15 years. I would refuse it.

As you are hearing NO DIGOXIN is suggested in spades + i totally agree + for that matter i am not a fan at all of ANY daily intake of anything like your Met. as an example with the exception of Blood thinners + that tends to be over used also by docs to their patients but i will leave that 1 for now.

Vit A is super easy to get on just about anyone's diet plan but if you want to take it in pill form also don't take the popular 10k mcg version as A builds up in your body + could you headaches + or stomach conditions as an early warning system to more serious ailments. Take a lower dose of A + maybe only take it every other day or twice a week...that is my suggestion.

L-Cit. converted to L-Arg. in your kidney's + has a better absorption rate in your body then taking L-Arg. directly.
L-Cit. creates more L-Arg. then taking L-Arg. directly.
L-Cit. expands your blood vessels better then taking L-Arg. directly.
L-Cit. is easier on your stomach + digestive system then taking L-Arg. directly.

If you want to keep your Mag. intake at 400mg or less i would do 1 of 2 things

1....Go into your Mag. stash shelf + measure out best you can around 65-70mg each of Glycinate/Malate/Taurate for a total of 200mg + take that early morning as you rise + do the same 1/2 hour before bed to equal that 400mg you are looking for. I personally use KAL brand for the Malate + Taurate + i use a liquid form of Glycinate (CanPrev) dividing them up similarly to this.

2....Buy a new product called NATURAL RHYTHM TRIPLE CALM MAGNESIUM...it has all 3 Mag. described in a 1x150mg pill. You can buy directly from their site NATURAL RHTHM.CO or get it on Amazon (check out their reviews on this product as they blew me away + i made 1 of the best decisions of my life getting this stuff) however the price is around double last i looked on Amazon so i would go to NATURALRHYTHM.CO + buy it there. Take 1 in the morning + 1 before bed + if you want take 2 before bed but that would surpass your 400mg limit by a little only but i suspect you would not need that much after reading the reviews as many get great results for the heart, general well being + sleep quality by just taking 1 before bed.
I have taken just 1x150mg pill many times only before bedtime as my only daily dose + usually that's enough for me but that is just me. Any day now i am going to order 5 more 120x150mg bottles myself again as my last order was in feb.

Some days i take only the KAL + CanPrev 3 Mag. x2 or sometimes i just use the triple calm brand that day x2 or i take each 1 of those 1 time each as it does not matter as your getting your 3 Mag. either way twice a day.

Anymore Questions we will be glad to give you our opinions for whatever that is worth.

All the Best

Vanlith, thanks for answering my earlier questions. I will check out the product you mention. It DOES sound good. / I like the idea of the 3 mags and only wish I knew why Taurine always gives me intestinal gas. I assume it's the sulfur, and I must have sulfur pathways issues.

I saw my general cardiologist this afternoon as a follow up to a stress test and echocardiogram, and for clearance toward knee surgery Sept 8th. I plan to write a new post on this shortly.

Calgal