recent episodes/Gas-X

I have a history of one episode of afib each year. In fact, I just went 26 months without an episode. These episodes lasted 45 minutes- 7 hours and symptoms were quite dramatic with very fast heart rate, breathlessness, chest and jaw pain, and I always ended up in ER via ambulance. I was treated with diltiazem drip due to low blood pressure. I stopped taking it at home because it made treatment decisions more complicated.

Recently I have been having more frequent episodes, 8/30, 10/5 and 10/13 with heart rate up to 194, short of breath, chest pain etc. On 8/30 I called the ambulance as usual but it resolved as we reached the hospital- about 40 minutes total. They kept me there because I had ST depressions and rising Troponin. I had taken Gas-X when the episode started and I believe that helped. I have been suspecting GI gas as a trigger for some time.

For the other two episodes I also took Gas-X but did not call an ambulance. After belching, the episodes actually stopped after about 20 minutes. Heart rate decreased a little more gradually but pretty quickly got to 75.

The common factor is lifting (I have been moving), and eating afterwards. I have several spinal fractures and after lifting, my chest feels tight, and my digestion suffers, causing gas. Is it also possible that since the space inside my torso is decreased by spinal fractures, that gas is somehow pressing on my heart or a nerve connected to heart function?

Usually after an episode my heart is pretty stable. But after the recent episodes my heart feels wobbly and I am still short of breath, relatively speaking. My Kardia tonight said normal sinus rhythm but as I watched, there was a beat, then two or three very quick beats, then regular beats, with the fast two of three beats occurring here and there. 

I saw my PCP last week before this third episode and am doing a two week patch monitor starting on Monday. Cardiologist appointment is not until 11/28 though maybe I could get PCP to push harder. Wondering why my heart is not recovering as well .

I am on Tymlos for bones (finishing two years), an injection that I do every morning that lowers blood pressure and speeds up the heart. If I stop it I would do Reclast of Evenity to avoid losing gains. Neither is great for the heart. Cardiologist doesn't know these meds and endo doesn't know heart!

I am not on a blood thinner but will of course consider if this keeps up. Anyone else with GI gas as a trigger and do you use simethicone?



Edited 4 time(s). Last edit at 10/15/2023 01:55AM by windyshores.

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Windyshores
I am not on a blood thinner but will of course consider if this keeps up.

An urgent comment: please talk to your PCP pronto about getting on an anticoagulant—with your increase in episodes, your stroke risk has increased. This discussion would be better with your cardiologist, but if you can’t get an appointment sooner, you could start with your PCP.

WindyShores...

GI gas can be related to a dairy sensitivity and/or lack of appropriate natural production of enzymes that manage digestion of dairy and cause a lactose intolerance issue.

Remedy options include eliminating all dairy consumption... read labels on packaged foods, etc. for dairy ingredients. ( even some supplements contain dairy).

A less-restrictive remedy would be to start by taking a product such as a Lactase enzyme or Dairy Relief whenever 'obvious' dairy is consumed. Note... often the 'hidden' dairy element in prepared/processed foods can also be the culprit.

Jackie

Your story is a lot like mine: belching after meals, some reflux, particularly when bending to tie or to remove shoes (I had put on weight due to inactivity, and that was due to episodic AF brought on even by laughing during sitcom viewing, if you can believe it....). Any time you tense and use core strength to lift, it can bring on AF.

Also, the new more frequent episodes, possibly lasting longer and longer, is also my history. Eventually my cardio offered to refer me to an electrophysiologist. It took 8 months before I got my index/first ablation, and that unfortunately failed. Second one, this past February, was a charm. You can control AF to an extent with medications, but they all seem to weaken in effect over time and you'll need another solution. It can be a truly miserable experience, so I would advise seeking out a really top notch EP as soon as you can.

Heed the advice about diet. Caffeine, alcohol, dairy, some preservatives....they all have an effect on our systems.

Marco shared some excellent links linking GI to afib. You should search his threads.

Thanks all. I gave up dairy, caffeine, alcohol a long time ago, and gluten, other foods as well.

Although the frequency has increased, the length of episodes has drastically decreased apparently due to my use of Gas-X.

Every episode is tied to moving stuff into or out of storage.

I am wearing a patch monitor but it ends on 10/30 and I move again on 11/1! I am going to ask for another one week patch!

I have been having extra beats for a week after each episode.

I do not have an EP. My cardiologist cannot see me until 11/28. I have seen my PCP after each episode.

I do not yet want anticoagulants for episodes that last 20 minutes. Prior to this I went two years without any trouble.

Another factor is that I am finishing Tymlos, which speeds up the heart, but my two years on that coincides with two years without afib! I now am deciding between Evenity and Reclast, both of which may pose risks.



Edited 1 time(s). Last edit at 10/17/2023 10:03AM by windyshores.

One more thing: In 2021 I fractured 3 lumbar vertebrae. Added to 3-4 thoracic spinal fractures from 2006 from a traumatic fall. There is less room inside my torso. When I lift, or open a window etc., it feels like my insides move up. That is the feeling. Then when I eat there is pressure and gas. This even happened when I went back to tai chi. I had one afib episode of about 5 minutes after tai chi (raising arms) in May which I forgot about.

It seems mechanical rather than electrical in oriigin. Just contacted PCP for EP referral in addition to cardiologist 11/28.

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windyshores
I do not yet want anticoagulants for episodes that last 20 minutes. Prior to this I went two years without any trouble.

How long they last doesn't matter. What matters is your CHADS-Vasc score. And you need to find an EP either way. Neither your PCP nor a general cardiologist are trained and prepared to treat you appropriately.

'I do not yet want anticoagulants for episodes that last 20 minutes.'

How long would you guess it takes for a clot to form in pooled blood not being moved by a fibrillating atrial appendage? Ten seconds, fifty....five minutes? Still a long way below your 20 minutes of AF. It's not how long the fibrillation episode that matters, it is THAT YOU HAVE AF that matters. It's a lot like how long you've had exposure to Ebola that matters, but that you HAVE Ebola......

I have been told 5 hours. With an episode lasting more than that, I had an echo to check for clots. My CHADS2 score is okay (once gender was removed. CHADS-VASC still has it) Not a single doc or cardiologist (I have seen 3) thinks I should be on blood thinners.

I have both a cardiologist and EP appointment, scheduled for late next month. I am wearing a two week patch monitor to see if afib is happening that I don't know about. I just went two years without any afib. There are risks to blood thinners too. Until now the risk/benefit ratio pointed to no meds.


Once again I find the tone here to be harsh I participate in a lot of health forums and this one is unusual. I had no reason to see an MD with no afib for two years. It takes 6 weeks to get an appointment around here so I came on his forum again. I have called both cardiologist and EP.

Last time I came on I was chided for calling an ambulance. Now, for the two recent episodes, I did not call an ambulance. Now folks here want me on blood thinners. Well, the only way to even discuss that is to wait 6 weeks for an appointment- or..call an ambulance.

There is a lot of info on clot forming with afib: here is one [a-fib.com]

From Harvard: The study included nearly 2,000 people who wore a small skin patch that continuously monitored their heart rates for 14 days. All of them had paroxysmal (intermittent) afib and were not taking anti-clotting medications. Researchers then tracked the participants' incidence of stroke over the following five years. They found that afib that lasted more than 11% of the total monitoring time was associated with a threefold increase in stroke risk.



Edited 3 time(s). Last edit at 10/18/2023 11:25PM by windyshores.

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windyshores
I have been told 5 hours.

Yeah, and it used to be 48 hours then it was 24 and now someone's telling you 5 hours. You know what? You don't have to be actively in afib at all to have a stroke. That's been a big mystery for EPs for a while: Why do people with afib have strokes even when they've been in NSR for months? No one knows the answer, but the answer slowly being accepted by the medical community is afib heightens stroke risk even when not in the abnormal rhythm. There is no safe period of time.

As much as you may not want to be on an anticoagulant, I promise you that you want to not have a stroke far, far more. Death isn't the worst outcome.

I hope my post wasn't the one that drove you to state that it's harsh here. I'm sorry if my caps made you uncomfortable. We mean well, but maybe could use some help with tone.

This topic, AF, is still filled with mystery, more than most of us would like. It's probably a lot worse for the professionals who do their best to treat it, and still find that they fail to quell the fibrillation close to 40% of the time. As you know only too well, it's exhausting, consuming, and filled with anxiety and emotion. And that's just us....not to mention the people who live under the same roofs.

This forum can get hectic at times, quite busy. The people who find us are often very frightened, disbelieving, often at their wit's end, and they need a lot of hand-holding. This gets exhausting for us, but we have to think our responses through to make them detailed, comprehensive, and encouraging. Maybe we fall short on that last bit.

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windyshores
Last time I came on I was chided for calling an ambulance. Now, for the two recent episodes, I did not call an ambulance. Now folks here want me on blood thinners. Well, the only way to even discuss that is to wait 6 weeks for an appointment- or..call an ambulance.

I'm sorry if I came off as harsh. I don't think I chided you or at least I didn't intend to; I simply pointed out that afib isn't a life or death emergency requiring an ambulance. And suggesting you need to be on an anticoagulant (if your CHADS-Vasc score warrants it) is simply an expression of concern for your well being. We're just trying to help.

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gloaming

It's not how long the fibrillation episode that matters, it is THAT YOU HAVE AF that matters.

Certainly one point of view but not shared by all. Going back a bit in time, I was always asked in the ER how long I had been in afib. If the answer was under 48 hours, they would go ahead with a cardioversion even if off thinners. If it was longer than 48 hours, they would offer to either send me home on thinners for several weeks before cardioverting me, or cardiovert then with a TEE. So here, the proposed cut off was 48 hours. As far as I know, this type of screening still goes on, but I stand to be corrected because fortunately haven't needed an ER cardioversion for many years.

More recently, some studies suggest shorter episodes may not require thinners. This one very study review by Dr. John Mandrola suggests strong evidence against using thinners for short duration afib episodes. It has excited Mandrola enough to make it actionable in his practice right away. And if you're familiar with Mandrola, he does not impress easily

[www.medscape.com]

There will be other studies on this and one very important one the large multi-center trial REACT-AF which just started. Headed by Dr. Rod Passman and in conjunction with Apple Watch, the concept of PIP thinners will be trialed for selected afib populations with CHADS scores 1-4. Conceptually, only episodes over 9-10 hours will require thinners. Shorter episodes will not. (The trial stipulates "60 minutes, not 10 hours, however that is to compensate for the fact that many may not wear the watch overnight).

Jim



Edited 1 time(s). Last edit at 10/24/2023 04:36PM by mjamesone.

Your story is similar in many ways to my story and so many others I've read. The gastro/afib connection is well known. Combine it with upper body lifting, twisting, compression and many of us have trouble I've tried Gas X, other antacids, PPI's as well as dietary interventions, including the FODMAP diet. I'm not saying they might not help short term, but afib is a persistent beast and loves to reinvent itself.

Of course, you have to stop lifting/moving however, with the frequency you're now getting, really need a better plan than running to the ER. Last time I went to the ER with afib was over 40 years ago. Since then I've had a home plan using either rate and/or anti-arrhythmic drugs to either safely settle things down until I naturally converted, or convert me within hours.

A cardiologist may be helpful here, but once you get to the anti-arrhythmic drug territory, an ep might be a better choice. Or better yet, consult with both, and see what each offers.

Someone wiser than me once said that chasing afib triggers is the road to madness After many years of doing just that, I finally doubled down on meds and then more recently an ablation. I still get gas/heartburn, especially when lifting, etc, but it no longer puts me in afib.

Jim



Edited 1 time(s). Last edit at 10/24/2023 08:58PM by mjamesone.

The last two short episodes I have not gone to the ER and used Gas-X. Unusual for me to have 3 in 5 weeks.

Previous episodes over the years (once a year or even two years apart) I went to the hospital with heart rate close to 200, shortness of breath chest pain but also because of my low blood pressure. Diltiazem lowers it quite a bit more. The city hospital put me in the ICU.

I have only had one episode longer than 5 hours. It was 7 hours, and they did an echo to check for clots. I think 48 hours is way too long as a criterion!

I have read about short term anticoagulation for cases like mine. I always ask if I can have something in the ER to prevent a clot and am always told no. A PIP sounds great, but I would be happy with the protocol studied of one month of anticoagulation after an episode longer than 5 hours.

I have an appt. with a cardiologist but my problem spans spinal issues, GI issues, pulmonary and heart. I also have an autoimmune disorder that can affect all of the above. I also have a call in to an EP but cardiologist may be enough at this point.

This situation is motivating me to stop renting!! Too much moving around!

Waiting for patch monitor results. I only wore it for 4 days out of 14. I seemed to be allergic to it. If is shows afib that I am not feeling or aware of, I will consider anticoagulation for sure.



Edited 1 time(s). Last edit at 10/24/2023 07:12PM by windyshores.

Patch monitor for 4 days: no afib so I am apparently always aware whenever it happens; I was concerned I might be having some that I don't know about....so I don't need an EP yet, right? Or anti-coagulation.

Predominant rhythm: Sinus

Average heart rate: 63 bpm

7 Supraventricular Tachycardia runs occurred, the run with the fastest interval lasting 6 beats with a max rate of 179 bpm, the longest lasting 10 beats with an avg rate of 95 bpm.

PACs/PVCs were rare (<1%).

Patient triggered events correlated with: Sinus (57-76 bpm), SVT (122-179 bpm), PACs