Sunday, December 16, 2012

A Visit from My Friend A-Fib

I almost didn't realize, but this is my first Christmas with a-fib.    Cozy !

    I have been doing so well.  Although I accept that I will likely need a cardiac ablation for my paroxysmal atrial fibrillation eventually, my cardiologist who is a world expert in electrophysiology is not in a rush.  I never had atrial fibrillation before this year, and then in February, during a cold with chest congestion, I laughed during a movie, and pop, I was in a very uncomfortable heart rhythm, which as a nurse I recognized instantly. A quick assessment of my pulse yielded a probable atrial fibrillation.   In all, seven episodes of this happened this year, before this one,  and many of them necessitated hospitalizations until an effective home plan for conversion could be crafted.
                   All a-fib is not alike.  Mine is particularly erratic and does not result in good perfusion to my brain and organs. I cannot walk, and I feel faint, as my heart does a dance like a large flopping fish. I have a monitor which I put on, and it tells me what is going on in terms of rate and rhythm.  Then I take two Flecainide, and sometimes an extra beta blocker and extra potassium.  Then I wait the hour or so that it usually takes to convert.  This almost always happens at night during dreams, and I wake up immediately. This leaves me not feeling well for a couple of days after such episodes.
                  An acceptable first line treatment which is gaining ground for some types of even initial a-fib is cardiac ablation, or in my case, a type of cardiac ablation called PVI or pulmonary vein isolation. The short version of what an ablation is, is a procedure in which multiple catheters are threaded through the groin and other arteries which map the interior cardiac conduction system.  When the problematic collection of nerves is isolated, and arrhythmia is intravenously induced, it is burned, as if cauterized.  The procedure can take many hours and benefits most patients with this issue..   My cardiologist has not made the jump to this because he thought that control of my new onset asthma in February, and supplementing my perennially low magnesium and potassium levels might do the trick all by itself.  He also thought that since I take both types of thyroid supplementation, both liothyronine (T3) and synthroid (T4) that it made sense to send me back to the endocrinologist and see if some adjustments in these drugs would stop the a-fib, so that perhaps it will not be seen until my seventies or eighties. (I am almost fifty and as yet, pre-menopausal, and this is important because there can be a hormonal interplay in causation.)
                  In a-fib, an extra collection of nerves in another region of the heart is sensitive enough to episodically spur an additional heartbeat which occurs in addition to the normal and expected one. This syndrome can be familial.   The result is a heartbeat which is double or more your normal one, and is irregular and erratic.  In addition, the heart is beating at times when it is not full, and the result is pumping at least to some degree, poorly oxygenated blood.  Additionally, erratically pumped blood leads to potential blood clots forming in the heart and resultant strokes, although I have been told that this is unlikely during episodes of a couple of hours or less.  And yes, they have me on an enteric 325 mg. aspirin daily.
                 The odds are actually against me here though.  My father passed in his eighties from atrial fibrillation which occurred in his fifties.  At first, it could be converted to normal rhythm, and as time moved on, it could not. Eventually, over time, it caused a remodeling in his heart and the cardiac damage which eventually brought heart failure and his passing.   My youngest son died suddenly at 12 1/2, and with a clean autopsy. The teams which did and redid the autopsy believe he had a spontaneous heart rhythm disturbance which could have begun with a-fib and moved quickly to a fatal ventricular arrhythmia.  He may have died the very first time he has a heart rhythm disturbance.  After that, a decision was made to look over our other children with a fine tooth comb.  Although the others seemed fine, our eldest son was referred for an ablation at age 25.  The procedure was difficult, but he is without a-fib now.
                  I was content to let this play out for awhile, and see if this could be brought under control with some medical management strategies.  Like any good critical care RN and college instructor, I did my research, but I do not like the results. Most people, after about  a year of a-fib, don't respond to episodic medications anymore. The disease moves on, and becomes resistant to conversion.   Women with a-fib fare far worse statistically than do men.   Women with a fib are much more likely to have strokes and much more likely to die of sudden arrhythmias than their male counterparts.  The long term result of being stuck in a-fib may also be dementia, especially for women.  So, I am unlikely to do as well as my father did, and he was severely limited by this disorder in the last twelve years of his life or so. Cardiac ablation statistically improves those odds substantially, especially for women.
                 With eight episodes of erratic paroxysmal atrial fibrillation, one of which cancelled my trip to our other home in Canada and left me unable to fly for the rest of the year, it looks like I am going to have to cough up the big bucks and have the procedure and the aftercare done.  This cost my son 67K.
                  Tonight, I went to bed perfectly happily.  I had not had any a-fib for a couple of months, and I passed right by the November date in which my youngest son died, without falling into it.(It's forever a difficult day emotionally.)    I love chocolate, but don't eat much anymore because the methylxanthines in chocolate are known to cause arrhythmia in some. (This is the chemical which can kill dogs or cats if they ingest chocolate.)    Late this afternoon we had some Cadbury chocolate, my favorite.   I ate a fair bit, but having cut out any other caffeine from my diet, no tea, coffee, or brown sodas, I thought I would be fine.   I was fine when I went to bed.
                   Around one am I began to have an elaborate dream.  I had two friends, a man and a woman who were both becoming physicians and were in medical school.  The woman had a lovely voice and perfect pitch.  I encouraged her to enter a contest in which the prize was a job as an opera singer.   She wondered if perhaps she should give up medicine and let her husband amass the med school debt rather than both of them.   I went with her to the contest.  The contest was not just about subjective singing and sightreading.  There were difficult and complex exercises and the contest tested her ability to sing a particular note on demand.  She was doing very well.    During a break she told me that she was nervous, and said "feel my pulse".   She was in a-fib !  I told her that we would deal with this right after the contest.  A few minutes later, she won the contest.  Then, I awoke to find that I was the person in a-fib !
                     So here I sit, in the middle of the night,  waiting for flecainide to do it's magic as I shiver at the computer with rain dancing on the skylight above.

UPDATE:   I converted to regular sinus rhythm at 4:10 am.   This means that I was in atrial fib for a total of 2 hours and 20 minutes.  It looks as if part of my readiness and preparedness plan should be an ablation in 2013.    Are there any dental or medical procedures that you need and have been putting off, for good or not-so-good reasons ?

More information on atrial fibrillation courtesy of Healthline


Kathy Felsted Usher said...

It's fortunate that you are in the medical field and experienced in handling situations like this. Please take care and keep us informed on how you are progressing.

JaneofVirginia said...

Thanks Kathy, Let's hope my being a medical person doesn't act as a barrier to what I should do fast enough. Sometimes being a medical person can be a barrier to the right care. Thanks for your kind words.

Matt said...

I'm getting over a case of chocolate whatever you called it. Happened about 3 weeks ago. It's the first time chocolate has done that to me and I don't understand why. It gets better and on two occasions I've had chocolate again the skipping or what ever it is has gotten worse. It's finally gotten down to "almost gone"

I hate it because I love chocolate and don't understand why it just now turned against me

Gorges Smythe said...

I'm sorry to hear of you having such problems. I guess no more delicious Cadbury. I will pray that things progress in an orderly and manageable way for you. God bless you.

JaneofVirginia said...

There are several reasons why this occurs. One is that chocolate contains methylxanthines which causes arrhythmias in dogs and cats, and in some humans as well. (I always have privately told my husband I am a bi-otch) Secondly, chocolate causes the release of catecholamines which can race the heart. Third, even if you haven't been allergic to chocolate in the past, it is a food to which many people eventually develop an allergy. Ingesting a food to which you are mildly allergic causes a release of your own adrenaline and can race the heart. Lastly, as we age, a simple sugar rush can occur with chocolate. I know all this, and it's still my "drug of choice"!

JaneofVirginia said...

Thank you Gorges, I will miss the delicacy of Cadbury's. May God bless you and your family also.

lotta joy said...

I've been in constant a-fib for most of my life. I was advised an ablation wouldn't help since it was at the BACK of my heart. Since then, when the A-fib becomes almost violent, I break into a sweat, things turn "white" and I mentally can't focus very well. I've now been assessed with V-fib. What's the difference?

JaneofVirginia said...

Lotta Joy, A great deal of progress has been made in cardiac ablation in the last few years. Although not every patient is a candidate for ablation, the back of the heart can indeed be done. University of Virginia does it routinely. My son who was 25 at the time had a large portion of the back of his heart ablated, and has not had a-fib since. (This is better than most people post ablation do though) Cardiac ablation can actually be CURATIVE.
People whose atrial fib has progressed to episodes of v-fib should be followed by a cardiologist in order to avoid potential episodic collapses. This CAN be treated.