Treating Concurrent Asthma Flares and Atrial Fibrillation

Didn't this whole thing START for Valentine's Day last year ?     (Picture: eternalspiralbooks.com)

                   

    If I can spare even one person from the awful week I have had, then that would be a lofty and worthy plan.   As some of you know, I developed an occasional and episodic atrial fibrillation about a year ago, which troubles me for about an hour every other month or so.  Atrial fibrillation is the most common of heart rhythm disturbances, and since in a-fib the heart is filling and emptying inefficiently, it predisposes sufferers to throwing clots and having strokes.  Improperly treated a fib can also lead to a remodeling of the heart muscle, heart failure and even vascular dementia. Since statistically women with a-fib fare in the long term much worse than men, a cardiac ablation should probably eventually be undertaken.   My interventional cardiologist is a friend who is one of the top in the country and possibly the world in his specialty.  Sadly, our knowing him was not enough for me, to recognize that my youngest son would develop a heart rhythm disturbance, and pass at 12. It was enough to have him diagnose and treat my eldest son with a cardiac ablation.  My eldest son no longer experiences a-fib.
                    About two weeks ago I had a decided uptick in my asthma.  Asthma seems to lead to atrial fibrillation, at least for me, so there is great interest in controlling this. I have a great allergist immunologist who has provided both a bronchodilator which will not race my heart, and an inhaled steroid, both of which are given via nebulizer every few hours.  This should have been enough to manage the asthma.   The allergist-immunologist was quick to tell me that he could not give me an oral steroid because it would complicate my case.  Recently, one of my son's doctors expressed that she thought our entire family may have Gitelman's Syndrome, which is an issue in which we have trouble properly regulating potassium, magnesium and other electrolytes. Tell us something we don't know, we said.  We almost always have abnormally low electrolytes during heart rhythm disturbances, and this is why these are supplemented now.

               A few days later when I was a bit worse, I wound up at the emergency room in a city far away in the middle of the night. The ER resident physician saw nothing else to do but start me on high dose oral steroids (prednisone) for the asthma.   I explained that the allergist had been reluctant because he felt it would complicate management of some other issues, but he assured me that this was all we could do.  I had three days of glorious relief and energy as I took the high doses.  I expected to feel badly when they were abruptly discontinued, however I did not expect to have my heart forget it's normal rhythm !   I fell into a-fib rather easily just after missing what would have been the fourth day of high dose steroid, had it been ordered that way. I took the emergency med which converts me in an hour, only to find it having a difficult time doing so.   I eventually converted to a regular rhythm, but felt awful, and retired to bed.  The following day, I flipped right back into atrial fib at the first opportunity.    It seems the allergist-immunologist with forty years experience was right. Oral steroids might benefit asthma, but they complicate rhythm disturbances when they are withdrawn.  Apparently, when I looked it up, the mechanism is unclear, but the potassium movement within the cardiac cells is changed by the steroid and this make equilibriation afterward challenging.
             So, late last night I spoke to the partner of my friend the cardiologist.  He reiterated this, and told me that for a few days, I will need to take regular doses of the drug which ordinarily calls me back to a regular sinus rhythm.  He didn't think this was truly an indication that my rhythm disturbance issue has worsened, but that the steroid complicated its treatment, and will for a time.
            I know atrial fibrillation is a familial issue for a number of us in our family.  For someone as young as myself to be troubled so consistently by this is concerning.  As time goes on, it seems less likely that I will be able to avoid a cardiac ablation. I am also unable to travel or fly until we have a better resolution to this issue.


There is a great book on a-fib for both those who experience this, and for any healthcare worker, physicians included:

"Beat Your A-Fib: The Essential Guide to Finding Your Cure"  by Steve S, Ryan, PhD"

This is an excellent book which explains a great deal. Dr. Ryan is somewhat pro-ablation, but after reading some of the statistics for those who elect not to have one, so am I.

This is his website:        http://a-fib.com/