Newly diagnosed with an anxious question or two...

Hi all, I'm a 47 year old male - active and generally fit albeit carrying a bit of timber down to poor diet choices which I am no reversing. Chadsvasc score 0, Echo all clear - heart on good condition otherwise. Managing with 5mg bisoprolol and PIP (was 2.5 but had a couple of episodes of escape). Acohol and caffeine have been easy triggers to cut out but stress less so and I think this and general anxiety may be a trigger - however, I'm also now anxious about my AF, which can become a bit of a spiral. My question was really - is it normal to feel hyper-aware of every beat and twinge and ache now? Because I do. I've been back to my doctor and the ER (A&E in the UK) and they've done all the tests and assured me that there's nothing urgent happening so to speak and to try not to worry too much - they've also prescribed me sertraline to manage my anxiety.

I guess what I'm really saying is - it normal to be anxious and to feel all these things, and if so, will such feelings fade over time / with management?

Right now, it's a little overwhelming. Thanks!



Edited 1 time(s). Last edit at 09/12/2023 11:48AM by SJU1976.

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SJU1976
I guess what I'm really saying is - it normal to be anxious and to feel all these things, and if so, will such feelings fade over time / with management?

Yes, it is normal to be anxious and to have hyper awareness. I've had afib for over 19 years, starting at age 49 and I'm now 68. I had a 2.5 month episode in at the end of my first four months. Chronic endurance fitness was my path to afib.

Having a working plan makes a huge difference in anxiety. I created a plan in the midst of my 2.5 month episode. My EP accepted it and, with tweaks have been following the basic outline of the plan since. In the first 4 months, my AF burden was 57%. I just checked my stats for the last year and the AF burden was 0.13% (5 episodes totalling 696 minutes, averaging 139 minutes/episode). You mention PIP, is this just with the bisoprolol? I have successfully used flecainide as PIP and it has been very useful (and has never failed to convert me).

George is also a savvy user of magnesium and potassium supplementation, particularly the former, which he documents at length in other threads. Most people are depleted of useful magnesium. particularly if they don't eat leafy greens or other natural and good sources.

Anxiety triggers a stress response, notably the production of chronically elevated levels of corticosteroid and adrenaline/epinephrine. A great many AF sufferers are triggered by adrenalin because of adrenergic receptors.

More than you want to know, probably, but...

[www.ncbi.nlm.nih.gov]

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SJU1976
I guess what I'm really saying is - it normal to be anxious and to feel all these things, and if so, will such feelings fade over time / with management?

Yes, totally “normal”—most of us went a bit nuts with hyper vigilance and anxiety when first diagnosed—particularly if we were very symptomatic. A good EP and a good treatment plan make all the difference.

Yes - so far it's just Bisoprolol. Will investigate further on flecainide. Thank so much for replying - it definitely helps reading the experiences of other.

Thanks - will check out the link for sure - I'm taking magnesium and that seems to help with sleep at night as well. I should check my potassium levels - I took a supplement early on but it made me feel very sick. Or maybe that was something else.Thanks again!

Thanks Daisy - good to know I'm not alone. Appreciated!

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SJU1976
Yes - so far it's just Bisoprolol. Will investigate further on flecainide. Thank so much for replying - it definitely helps reading the experiences of other.

The Bisoprolol is a rate control drug. It won't convert, just keep your rate hopefully under 100 BPM. There are two potentially bad issues from afib. One is stroke & a Chads2 Vasc score of 0 means your stroke risk is low. The other is cardiomyopathy (or enlarged heart) leading to heart failure from too high a rate in afib for too long (many days/weeks). The Bisoprolol is to lower that risk. If your average afib resting heart rate is less than 100, than no issue. 110 if not too long. How long do your episodes last? How often do they occur?

Here is the original paper on flecainide and propafenone used on-demand (they are both the same category of drug). Note that the max dose on flec is 300 mg/day for those weighing over 70 kg/154# and 200 mg/day for those less. Flec can generally convert in 1 to 8 hours, depending on the person and the day. I converted my 2.5 month episode with flec, but took 20 hours. However it was a 2.5 month episode and the EP didn't think it would work.

Taking electrolytes assumes you have a healthy kidney function. Magnesium to bowel tolerance (very individual) is my metric & I have a very abnormally high tolerance. Potassium citrate powder is what I use, I find it easy on the stomach. I dissolve a couple of tsp in a liter of water and consume over the day. Potassium taken a lot at once will get urinated out quickly. I also have found that limiting calcium to 400-500 mg/day from food is useful Lastly, I've found a couple of grams/day of taurine (a conditionally essential amino acid) is useful. On the exercise piece, I found that long duration exercise over a Zone 2 level is a trigger for me, though short duration, high intensity is OK. Zone 2 can be approximated with nasal breathing. More info on it in paragraph 2 in this post.

Avoiding alcohol, which is a common trigger makes sense, as well as getting as healthy as possible overall.

Daily, low dose propranolol (10mg) has given me significant anxiety relief over the years. No side effects for me, also keeps my heart rate mellow. Good luck, its a process... Jeff

That's interesting about the Bisoprolol - so far my episodes have been brief - 20 mins, 2 hours, 10 mins, 70 mins - and each time I thought the bisoprolol is what brought me back around (I was up to 130, 150, 120, 130). interesting on the exercise front too - I guess I need to just test the waters gradually and see where I can cope. Thanks again.

Cheers, Jeff!

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SJU1976
That's interesting about the Bisoprolol - so far my episodes have been brief - 20 mins, 2 hours, 10 mins, 70 mins - and each time I thought the bisoprolol is what brought me back around (I was up to 130, 150, 120, 130). interesting on the exercise front too - I guess I need to just test the waters gradually and see where I can cope.

So at this point, you are converting on your own quickly. This is good. No med like flecainide needed.

In terms of exercise as a trigger, there are roughly two categories: vagal (parasympathetic) and adrenergic (sympathetic). The way I think about these is that if you've gone for a two hour run or bike ride that is pretty hard (breathing heavily) & you come home & then some hours or longer later, you go into afib, that would be exercise as a vagal trigger. An example, I was training for a high altitude race (13.1 miles/21 km gaining 7800'/2377m). I did a training run up a 14000' mountain. I had my first episode a day or two later (a long delay) as a vagal trigger. Other vagal triggers have to do with digestion issues. On the other hand, if you go to do something like lifting heavy & you go into afib, that would be an adrenergic trigger. For example, a friend was deer hunting. He killed a deer and started packing it out up a steep hill, that was his first afib episode. More info here.

Oh, OK - that's good to know about where I'm at on this whole journey (for now) - thanks.

Re vasal / adrenergic - I'll need to keep a log. I'd figured I was more stress/ caffeine/ alcohol triggered but perhaps it was exercise a day or so before. Thanks again for the info. Very much appreciated.

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SJU1976
I'll need to keep a log. I'd figured I was more stress/ caffeine/ alcohol triggered but perhaps it was exercise a day or so before.

The log is a very good thing, though afib can be hard to figure out sometimes. My now 37 year old son in law has had afib for ~7 years now. Maybe 3 or 4 years ago, he got serious and kept a log. In his case it was obviously excess alcohol and perhaps some digestion issues. He's in the military, so has to maintain conditioning. Training at a Z2 level has been very good for him. He's an officer and in his job, he does his own training, not with a unit. He's found that he can consistently do much more work (speed or whatever) at his Z2 heart rate now. He does use the PIP flec to convert, but doesn't have many episodes if he maintains his lifestyle. He's also noticed that eating "cleanly (unprocessed, whole food)" helps. The data suggest that caffeine isn't an issue, however over the years people have said coffee was an issue, but some of them said that organic coffee was OK. So perhaps not the caffeine, but maybe pesticides & so on.

Stress can be a trigger.

{edit} Years ago was chatting about afib with my GP neighbor. He told me that the only afib he ever saw was "Holiday Heart, " meaning overconsumption of alcohol.



Edited 1 time(s). Last edit at 09/13/2023 04:40PM by GeorgeN.

Yeah, I think a switch to lower intensity training is probably where I'm headed but will monitor how it all goes.