Atrial Fibrillation

[Sarah Ibarruri]

My mom ended up in the ER, was admitted, tested and diagnosed with atrial fibrillation, and I'm pretty scared. The doctors have terrified us, as if somehow it's our fault she has atrial fibrillation. Yes, I've read some things but I'm still not sure what to think.

Anyone know more about this than I am, or at least have a more hands-on experience perspective about atrial fibrillation?

Thank you much!

[elleng]

1. Don't worry.

The result is an irregular heartbeat which may occur in episodes lasting from minutes to weeks, or it could occur all the time for years. The natural tendency of AF is to become a chronic condition. Chronic AF leads to a small increase in the risk of death.<2><3>

Atrial fibrillation is often asymptomatic, and is not in itself generally life-threatening, but may result in palpitations, fainting, chest pain, or congestive heart failure.

http://en.wikipedia.org/wiki/Atrial_fibrillation

[Sarah Ibarruri]

4. Thank you! That's a relief to hear.

Doctors are not too clear when they explain things and often contradict themselves. In fact, discussing the stress test (which mom finally took), when she was trying to determined if she wanted the test done at all, they behaved as if she had been the cause of her own problems, and trying to exacerbate them!

We've been going through a lot of anxiety over this, mostly from the doctors.

Thanks again!

[SharonAnn]

49. My husband has it and been treated for it for 20 years. Meds are a big help.

[katkat]

51. it only leads to congestive heart failure

if it is untreated, that is, if the heartrate is allowed to be very high for months. Nowadays meds control that.

the last time I looked at the wikipedia article it was inaccurately alarmist and very out of date in terms of current treatment.

[dflprincess]

2. My mom landed in the ER last summer with this

It really depends on what the cause is. In my Mom's case it may have had to do with anxiety as much as the diastolic dysfunction(aka heart failure) they discovered she had - in fact the AF the paramedics heard may have been a blessing in disguise (I called the ambulance when she told me she had "funny feeling" in her chest). My mom is 85 and this form of heart failure is common in elderly woman. Fortunately, they have been able to control this with adjustments to her blood pressure meds.

[Sarah Ibarruri]

6. Thank you. It's a relief to hear that it's not an unusual condition, and that people can live with

AF.

I'm so glad your mom is okay. Many blessings to her and much good health.

Thanks so much!

[Warpy]

3. Sure, it's pretty common and nothing you did caused it

A great discussion is at http://www.mayoclinic.com/health/atrial-fibrillation/DS00291

Many people can be converted into a normal rhythm chemically. Other people can stay in that rhythm but go on anticoagulants to make sure they don't grow clots in their atria and have strokes. As long as the ventricular heart rate isn't too fast, most people do quite well.

If your mother ended up in the ER, she's probably got a fast ventricular rate and that is making her feel pretty rotten. However, once that rate is controlled, she'll be fine.

You didn't do anything to cause it. It's not caused by nerves or family fights. It's caused by a disease process in the heart and could have happened at any time.

It is lousy timing, though.

[Sarah Ibarruri]

8. It is awful timing. Thanks for the reassurance.

I spent quite a few minutes hiding in the hallway of the hospital crying, then mopping it up and walking back in her room with a smile (plus I slept in her room).

[laughingliberal]

5. Many people live with it with no perceptible change to their life

There are medications used to control it and, sometimes, doctors will try to reverse it with a procedure called cardioversion which involves shocking the heart back to a normal rhythm using a defibrillator. You may recall the 1st President Bush had atrial fibrillation.

[Sarah Ibarruri]

9. The 1st Bush had A-F? I never knew that. I'll tell mom, tho she can't stand the creature

lol

Thanks much for the info. I'll report it to her.

[laughingliberal]

10. yw

:)

[aquart]

30. And is still breathing.

[MannyGoldstein]

7. Sorry To Hear It! Pretty Common, See An Electrophysiologist.

Afib is an electrical issue. Electrophysiologists (EPs) are cardiologists that specialize in electricity (most cardiologists are plumbers). Find a good teaching hospital near you (I'm in Boston which is crawling with them), and get an EP. EPs are the nerds of the medical world, and they are almost all very good.

I don't believe that Afib is life-threatening itself, but it increases the odds of other things happening over time. There are some interesting interventions that can be done, and there are a number of more devices coming to market to treat this.

I can't imagine that it's your fault: there are some predisposing factors, but in reality thare's not much that we can do to change genetics. We are what we are.

Mayo Clinic is the possibly the best hospital in the world, here's what they say: http://www.mayoclinic.com/health/atrial-fibrillation/DS00291

Good luck!

[Sarah Ibarruri]

12. Very interesting what the Mayo says about it.

At first, we were thinking it was a hopeless situation, and there was no reason to have any hope. Now we don't think quite so negatively.

Thanks much! I'll tell mom what I've learned.

[Fire_Medic_Dave]

13. Even if it becomes chronic it's quite manageable.

[Sarah Ibarruri]

15. I appreciate your help in this! I've dried up my tears and have more hope nt

[Fire_Medic_Dave]

19. My best to you and your mom. Enjoy the holidays together.

Hopefully I'll be able to go see my father in the hospital tomorrow. I've spent over 40 nights in the hospital with him this year but I was too sick the past 2 days fortunately my brother was able to stay.

[Sarah Ibarruri]

22. I am so sorry about your father. :( Is he going to be all right?

I'm not big on religion and stuff but I have a very lib sister who is. If you ever need me to give her your dad's first name to be put on her church's big prayer list, just email.

My best to you and your dad. May lots of good health rain down upon you both.

[Fire_Medic_Dave]

26. Thanks. It's been touch and go. He's doing better though.

His name is John. Many thanks.

[Sarah Ibarruri]

29. He'll be on her church prayer list starting tomorrow a.m. nt

[Fire_Medic_Dave]

27. dupe. self delete.

[Fire_Medic_Dave]

11. Fairly common in the elderly.

Basically instead the the upper part of the heart pumping in a rythymic pattern it quivers. The main problem is that some of the blood stays in the upper chambers of the heart and can start to clot. Needless to say that is a problem. There are several good options get a good cardiologist and discuss it. Hopefully she is on blood thinners in the mean time.

[Sarah Ibarruri]

14. She was on Heparin for a few days in hospital, and now started on

aspirin + Plavix and she'll be monitored. Coumadin was suggested but not strongly encouraged. I asked the cardio, "What would you do if this were your mom?" He said, "Non-professionally and a case exactly like your mom's?" I said yes, non-professionally and a case like hers. He said, "I'd NOT put my mom on Coumadin with a case like hers, but we are encouraged to offer Coumadin as protocol with such a diagnosis."

[nadinbrzezinski]

16. Pretty common, but once diagnosed it can be treated with meds

or at times a little machine that will shock the heart into normal rhythm. Patients who have these things called a defibrillator, say it feels like a kick, a mule kick. But it can save their lives.

ER doctors are at times hard to explain things... hell medical pros forget most people don't know what they know.

If you can see a specialist, and decide whether meds will be enough.

[Sarah Ibarruri]

18. Interesting! You know, it always amazes me about doctors...

They suddenly see some people, scared, maybe crying, upset, and they've got to know these people are scared, why on earth not treat them gently? Sure, it takes longer but my goodness, it's part of their job (or ought to be) to treat people humanely. If their intent is to put terror into people who are already scared, they're no longer in the field of healing or doing no harm.

[nadinbrzezinski]

21. My dad needed a few units of blood last week

and this was a perfect example. He is 85 for god sakes. They needed to put a Hep Lock while waiting for the lab results to come in. So they say Hep Lock...so I translated this to simple Spanish, they are leaving a tube in your arm with a little chemical to make sure they can give you more if they need to.

This was at a Mexican Hospital in Mexico City, this is not just the US. It is what I like to call... the professional bubble. They start speaking in medicalese not out of malice, but forget most patients don't understand it. I used to translate it to patients with even less education than my father as a medic, so I guess I am still in practice.

The best to your mom. My mom takes meds for it, and has done fine for the last ten years. But when she got it she felt like crap.

[Sarah Ibarruri]

23. Yes, mom felt like crap too, and was scared, then the doctor came in and had zero bedside manner...

then she felt a million times worse. He was like a cold fish, and spoke to us as if mom were an object to be treated, a piece of plastic that didn't need to know the procedures of anything that would be done to her.

[nadinbrzezinski]

25. let me guess, she is in her seventies?

Or so.

For some reason doctors like to talk AROUND the patient, when they are of a certain age. Called a few on that.

[Sarah Ibarruri]

28. Yep! How did you know??

And I have no idea how the doctors could talk around us. I had my eyes on him like a hawk and was making some very pointed questions. Then he solved it by saying to my mom, "You have a VERY sick heart" which freaked me out. After he left I tried to keep my cool, then I told mom I was going to the bathroom (nurses were with her), and I cried. What an A-H to scare the patient when she's most scared.

[Warpy]

42. Cardiologists often have the bedside manner of puff adders

but you're not hiring them for entertainment (good thing, too).

What you can encourage your mother to do is ask her nurse questions. Nurses are trained to talk to mere mortals and to translate the doctor's medicalese.

[Sarah Ibarruri]

46. We talked to nurses, but they are hesitant and scared to comment...

Generally they said to ask the doctor. Don't get me wrong, they were nice, they were helpful, but they were scared to discuss anything related to the condition.

[Fire_Medic_Dave]

24. Some are socially under developed.

Some are very good. I had a 26 year old doctor tell me that my dad wasn't getting good care because "It was the weekend!" as if he could help having a stroke on Friday night. I literally almost beat the *%$# out of him. He left quickly. Fortunately security never came. I also had an ER doc tell me to arise and whine after they figured out I hdan't broken my back after falling off a 2 story deck at a fire. My wife almost beat his ass. Sorry for the bad experience as you can see though it is quite common.

[Sarah Ibarruri]

32. ROFLMAO! What an idiot that doctor was! I guess they're human, but honestly...

they know better than to act like asses.

You know, when I was 20, I was diagnosed with mitral valve prolapse. I was in college, and it was quite late and my boyfriend was off in med school really far away, my family lived far away, and my dorm roommates were all gone. SO I drove myself to the nearest hospital ER. It was 3 a.m. or so, they admitted me instantly, and connected me to an EKG. In walks the doctor, a very, very young doctor. He takes one look at the erratic pattern on the EKG monitor and what does he do? He literally stutters, puts his hands over his mouth and says, "I'll... I'll be right back. I'll be right back!" Then he RUNS out of the ER room. My hair almost stood on end!

Anyhow, he came back only to peek into the room, and barely whispering told me the cardiologist had been called and would be in any minute.

The cardio walks in within minutes, smiling and grinning. He looks at he pattern, and says, "So how are YOU today, young lady?" And began to check me over, then said he wanted to admit me and just run a test or two, that he thought it was MVP and explained that, and said not to worry at all. I felt so comfy with him. A take-charge, kind doctor can make all the difference in the world.

[Speck Tater]

17. I have had atrial fibriliation off and on for 20 years or more...

and maybe even longer. It was 20 years ago that I was actually diagnosed with a-fib even though I had had the same symptoms once and a while from the time I was a teenager 50 years ago.

I won't give medical advice, of course, but I can repeat what I've been told by my doctors.

What various doctors have told me is that it is very frightening, terrifying even, but pretty much harmless. There is, however, a slightly increased risk of blood clots forming that can cause a stroke, so atrial fibrillation patients are usually advised to take aspirin or another blood thinner. One ER doctor 10 or 15 years ago told me that he himself had bouts a-fib but he didn't let it stop him from mountain climbing. A fire fighter acquaintance of mine also has bouts of a-fib now and then, but is still a working fireman.

My fibrillation is well controlled by a low dose of beta blocker. An aunt of mine, who suffered from a-fib for decades (she died of cancer at a very advanced age) was told that there is an outpatient procedure called ablation (or something like that. I don't recall exactly) that uses a catheter to somehow fix a nerve bundle near the heart. I was told it's very successful, but since mine is controlled with a little white pill every evening at bed time I haven't even considered that procedure.

My mother in her 80's also has occasional a-fib, and I think she also takes a beta blocker for it.

Another option is something called cariodversion. They put the patient to sleep and zap the heart with electric shock. I've noticed a lot of ER docs seem anxious to perform cardioversion. Other doctors have told me cardioversion should be a last resort after beta blockers don't work. I was talked into cardioversion once many years ago, and it left me with serious burns on my chest and back. And to top it off, it didn't stop the a-fib. After that failed attempt (5 shocks, actually) they gave me a beta blocker and that took care of it, even though it took half an hour to take effect. It was after that experience that a couple other docs told me beta blockers first and cardioversion as a last resort.

Again, not medical advice, just repeating what my docs have told me.

[Sarah Ibarruri]

20. Thanks so much for relating your story to me! I am, of course, going to let mom read what you

wrote. This is a relief to me and will be a relief to her. At first, yes, it's quite scary. As we find out more about her treatment I will post it on here.

Bless your body and may you be very healthy.

[winyanstaz]

33. Let your mom know that the more she relaxes and smiles again...

the faster she will heal.
My husband lived another nine years after being given up on and sent home to die..and they were nine happy years with family and friends.
Your mom will get stronger with care and can live many more years. Drs dont know everything.

[Sarah Ibarruri]

36. You're so right that doctors don't know everything.

And some have no bedside manner.

Bless your husband for living so long after being sent home that way. My goodness. And thank YOU for your kind and encouraging words!!

[winyanstaz]

38. Your welcome :) Peace & Joy to you and yours...

[Fire_Medic_Dave]

35. The pesky little problem with cardioversion is that it actually stops the heart.

Almost all the time, the normal electrical activity or whatever was there before fires back up and things resume. On very rare occurences though the heart doesn't start firing again then they have to put in a pacemaker, etc. Fewer serious complications with meds. Cardioversion is very safe. Paramedics cardiovert patients all over the country when the present with certain unstable rythyms. There are also drugs that can cardiovert patients. Wiki is pretty understandable on the subject.

http://en.wikipedia.org/wiki/Cardioversion

[lapfog_1]

41. Yes, to all of your advice.

I had the catheter ablation surgery. They made two incisions, one near my groin and another on my neck (to get at two major veins). They insert a number of catheters into your heart using those incisions. In my case, they used five catheters. Some have tips for monitoring electrical signals inside the walls of the heart, others have electrodes which can trigger abnormal heart beats, and 1 has a microwave tip. They locate areas in the heart where they would like to interrupt the electrical signal which may be causing the atrial fibrillation, and then they create scare tissue over that area by burning the inside of your heart muscle. The burn area scars over quickly (there isn't any pain at all) and that stops the heart from going into arrhythmia. I had that done about 14 years ago when the beta blocker drugs stop controlling my condition.

The surgery was cool. I was on the "operating table" with a large imaging system over my chest. There was a monitor overhead that I could see them snaking the catheters though my body and into my beating heart. The doctors were all clustered around another table where they were using joy stick like devices and another monitor to guide things. Because of the number of spots that required "welding" in my heart, the surgery took about 4 hours (normally it would be 1 to 2).

It was worth it to me to have this done. I've only had a couple of episodes since then (previously it was up to about 2 a year). However, the day I got home from that surgery was the last day that I've had health insurance. I remember the cost was about $40,000, of which I had a deductible of around $1000. However, my cardiologist and my insurance had previous agreed to a price tag of $32,000 (he added another assistant without consulting with them). Guess who got stuck with the bill for the difference... and then they dropped me lot a hot potato.

Sigh. Hope the new health care bill fixes this...

[amborin]

47. my

husband has a-fib

not giving medical advice, either

his docs said the downside of all treatments to restore to normal sinus rhythym is that the a-fib can come back; and, it's hard to prove a negative....

so, for him, the first line of treatment is a rate control med, in his case, a calcium channel blocker (the beta made him logey), as well as coumadin to prevent clotting

[lapfog_1]

31. I've had something called Wolfe-Parkinson-White Syndrome

all my life, and it started affecting me in my teens. It has many of the same symptoms as atrial fibrillation (rapid heart beat, low blood pressure, shortness of breath, risk of heart failure), though, technically, WPW is not atrial fibrillation (where the upper two chambers of the heart fail to sync with the lower chambers, with WPW the entire heart is "fluttering").

Yes, it can be dangerous, especially when combined with other risk factors for heart attack.

However, unlike WPW, I believe that many cases of AF can be treated with either beta blockers and/or pacemakers. Unlike AF, WPW can be corrected via heart surgery (like I had a few years ago), which MOSTLY fixes the problem.

What I can tell you is that any irregular heart beat is terrifying, but actually not as immediately dangerous as one might suppose. Terrifying because we normally take our hearts for granted, even to the point of not feeling them beat. With arrhythmia, you become acutely aware of your heart and it's failure to beat normally. OTOH, I've often driven to the ER myself (after onset), parked my car, walked (very slowly) into the ER and up to the nurses station. Once I tell the nurse that I am having an episode of WPW, well... you've never seen nurses move so fast. But after all that, it turns out to be an annoyance, admittedly a dangerous one, but just an annoyance. I can still do almost anything I could do before.

BTW, I've lived with it for 35 years (really all my life, but it never affected me as a child.

Oh, tell your mom to ALWAYS have an aspirin or two handy, if she has an episode, the first thing she should do is take the aspirin, they won't stop the atrial fibrillation, what they will do is lessen the chance of a stroke from blot clots that can form in the heart and be thrown into the brain, the clots can form because of the lack of blood flow through the heart chambers. Ask her cardiologist.

If she needs to go to an ER for cardioversion (convert the heart back to normal sinus rhythm), it can be done two basic ways, one via shock paddles (like you see on the TeeVee) and a second method using drugs. I've had the shock paddle treatment twice, I wouldn't recommend it. Oral drugs, if they work, are the best. Pop a pill, wait for your heart to go back to normal, maybe no trip to the ER. Stressful, but really not that bad. Unfortunately, this method quit working for my heart some 15 or more years ago. The second drug (Idenocard - but I may not have the name right) is delivered as an IV drug. They start an IV, inject the drug through your vein, and also a saline "push" injection (done at the same time to get the drug to your heart). This is a COOL DRUG. It stops your heart. Literally. It's like an elephant sits on your chest. Huge amount of pressure, but not much pain, and then it's over. Your heart reboots and starts beating normally. 15 minutes later and you want to go home (they tend to keep you for an hour or longer just to make sure everything is fine). Very cool. Very weird. It's hard to describe. It's a little like dying, I think.

I'm sure you've done some web research, but this site is really good...

http://www.mayoclinic.com/health/atrial-fibrillation/DS00291

[Sarah Ibarruri]

34. Wow, that's a scary thing (that drug that stops your heart and it reboots)

Sheesh! Thank you so much for your explanations. They were super helpful to me. I'll let mom know what you explained.

Also, I hope LOTS of health rains down on you! Lots!

[Fire_Medic_Dave]

40. Very close. Adenosine or Adenocard.

Quite nerve racking to give it as well. Those few seconds it takes the heart to restart are scary for all involved. I haven't ever heard of a death from it though (doesn't mean there hasn't been one). I have seen it not work on a few patients. I would far rather use adenosine than electrically cardiovert a patient.

[katkat]

52. NO Adenosine or Adenocard

These are absolutely not supposed to be used for just afib. Absolutely not. More serious conditions perhaps but not afib.

We had someone in the yahoo group go to her ER and they did that to her and her regular cardio just about went ballistic when he found out, he was so angry at the ER.

[Fire_Medic_Dave]

54. It really helps to follow the thread before you respond. It will make you seem wiser.

I wasn't saying it was given for A-Fib I was correcting the poster about the spelling. Lapfog was talking about WPW and cardioversion in general, not giving specific advise about A-fib.

[Dappleganger]

37. Knowledge is power.

You can be strong for your mother by helping ease her fears with facts gathered from reputable sources. Be careful what you read on the internet as case studies are usual 'worst case scenarios.' I'm glad your mother is still with you and hope she has a long and blessed life.

[Sarah Ibarruri]

39. Thanks! I appreciate that! I hope good things for you as well. nt

[MiniMe]

43. My dad lived with atrial fibrillation for years

While it needs to be monitored, in general, it isn't a life threatening condition.

[Justitia]

44. My husband has had AF for probably 20+ yrs. It's not as scary as it sounds.

It was found during a routine physical. Because he has had it so long, his various cardiologists decided cardioversion / ablation is probably not beneficial, because his heart has "learned" this chronic condition as "normal". In other words, he would most likely just go back out of rhythm again.
Of course you need to consult with your mom's docs to understand the degree of her AF.

He takes coreg (to slow the beat down) and coumadin to thin the blood to avoid a clot (as others have mentioned).

He really feels no difference. He has reported that there have only been a few instances in his adult life where he could feel he was seriously out of rhythm and it resolved on it's own.

Here is a cool animation of AF from the American Heart Assoc (click "forward" to start, then tabs below heart to see normal vs AF):
http://www.americanheart.org/presenter.jhtml?identifier=3056834

Best of luck to you.

[Marlana]

45. My grandma was diagnosed with a-fib a couple weeks ago.

It started while she had pneumonia, she's 74, BTW. The cardiologist she saw at the hospital basically said the same things that other people have posted about it, that she could live a normal life with it, that it might not ever cause her any noticeable problems. They put her on Coumadin, a blood thinner, and she has to go back and have some tests done in a couple weeks but they made it sound like it won't be that big of a deal. Good luck!

[Sarah Ibarruri]

48. Thanks! nt

[katkat]

50. afib - come see us in the yahoo afib group

I have to leave, but quickly:

If all that's wrong is afib, your Mom's life expectancy is unchanged if she gets put on the correct meds to keep her heart rate in the normal range and (only if needed) an anticoagulant like aspirin or coumadin

There is a good yahoo group for afib:
http://health.groups.yahoo.com/group/P_Atrial_FibSupport/

Hop on over and people will be happy to discuss this in more detail.

I've had afib for nine years and counting, and except for the anxiety (it screws you up that way because it is hard not to get anxious when you heart is acting up, even if the doc has said leventy leven times it won't change your life expectancy) and being a little careful to avoid triggers (common ones are caffeine, alcohol, yes - stress, very cold foods or cold drinks, dehydration, lack of sleep - all these may or may not cause an episode) things are pretty much normal. I take a beta blocker and don't even need to take aspirin, let alone coumadin.

The beta blocker does cause some lethargy and a slight tendency to nightmares or also a slight amount of thinning hair, for some people. If they want to put your Mom on a more serious med, ask about the beta blocker as a first try instead. I am not a medical person, but why mess with stronger meds if not needed.

cardioversion - does not tend to keep people out of afib very long

ablations - can be very successful, a second touchup one may be needed but then the cure rate is 90% with a good doctor. however it is not without risk to do this procedure.

[katkat]

53. you need a new doc

One with some people skills.

Also, one thing they will do is check if your Mom has other heart problems. Usually people with afib don't, but it's standard practice to test.