Atrial Fibrillation

[Ted]

I went to the er on 10-12 with atrial fibrillation. I knew that I had a minor arrhythmia for years, but I had never gone into a-fib I self corrected with IV medication. A week later I had a stress test and echocardiogram. Results were normal, but I have been short of breath ever since leaving the hospital. The problem is worse when I exert myself. In fact, I returned two days after my initial visit because of the breathing problem. The ER doc ran the standard tests and came up with nothing. He mentioned the possibility of "air hunger" due to anxiety. I am a 65-year old male--smoker and overweight. I have noticed my voice getting raspy and I find myself constantly clearing my throat. I am concerned because these are symptoms of COPD but I don't know why this started the same time I went into a-fib Perhaps I picked up a bug in the hospital? I haven't had a cigarrette since I left the hospital. I will be seeing my cardiologist later this week, but I spoke to him on the phone and he sounds like he's clueless at this point. I would appreciate hearing from anyone who might have an idea what's going on.

[Cameron]

Ted, I just joined this Forum and I seem to have a problem similar to yours. I was diagnosed with Afib a couple of years ago but it was pretty sporadic and mild and seldom bothered me. Recently, I had a pretty intense flu which affected my upper respiratory system which led to the onset of my being in Afib constantly. My Afib manifests as shortness of breath and weakness whever I try to exert myself. I've had a stress test and an echocardiogram which my cardiologist tells me was normal and didn't show any underlying heart disease so he attributes my shortness of breath and weakness to Afib. I was interested in your post because I haven't found anyone who cites breathing problems as a major symptom of Afib. Mostly when Afibers talk about it, it is described as something weird going on in their chest like pounding or palpitations which I don't have. So just as you were mystified with the breathing problem after your hospital stay I'm wondering if the flu I had back in Feb. could have messed up my breathing and caused my Afib to intensify. Has anyone shed light on your breathing problem since you posted it? Would like to know how you made out.

[Ted]

Cameron, nice to hear from you. You're the first person to respond to my post, so it appears that shortness of breath is not a major problem for other a-fibbers. I drafted a long response to you a short while ago, and I'm pretty sure I "lost" it before finishing it. If you see two replies, that's why.

It sounds as though our problems are a little different. If I understood you correctly, you have been in a-fib constantly since you had the flu. If that's the case, then I believe that your being short of breath could easily be explained by the fact that your heart remains in a-fib all the time. I'm not a doctor, but I certainly felt more out of breath during the times that I was in a-fib. The blood tends to pool in the atrium during a-fib. When this happens, I suspect that oxygen isn't being carried to other parts of the body as efficiently. Check with your cardiologist to see if that's correct.

In my case, I have had only two recognizable episodes of a-fib--one in October '07 and one around the end of February '08. The a-fib in October was corrected with IV meds I received in the ER. In February, I self-corrected. Aside from those two incidents, my heart has remained in normal sinus rhythm, but I am still short of breath all the time. A few weeks ago, I saw a pulmonologist who said that I "might" have asthma, so I will going back to see him this week. My problem is understanding how I got asthma at the same time I went into a-fib.

Do you regularly check your pulse to make sure that you are always in a-fib? If you are in fact in a-fib
all the time, I'd be very curious to know what your cardiologist has done in an attempt get you out of it. Has he tried medication? How about cardioversion? I don't mean to scare you, but you probably know that people with a-fib are at a higher risk of strokes. If you are constantly in a-fib, I'd be surprised if your cardiologist did not have you on coumadin. I'd be curious to hear more details about your problem and the treatment you've received thus far.

[Cameron]

Hi there Ted. Thanks for your reply to my post. I found it very helpful by you pointing out that being in constant A-fib could make one breathless and fatigued. Now that you've pointed it out, it seems pretty obvious. I've been in A-fib before without any of those occurances and it always self-corrected, so with the breathing problem I began to think I had something more serious like congestive heart failure in spite of my stress test and echocardiogram which concluded that my heart was normal. So I'm somewhat relieved to know that being in constant A-fib could make me feel so debilitated. I'm probably going to have a cardioversion done but I've been resisting taking Coumadin which my doctor tells me is a requisite. I'm sort of an anti-medication person and though I'm on a beta-blocker now for my high blood pressure I don't want to get caught up in a feast of drugs. So thanks for your input. Sounds like your A-fib hasn't been too big a problem but the shortness of breath as in my case must be worrisome. The heart and lungs are so inter-connected that it's hard to know where the problem stems from. I'm not too well versed in pulmonology so I can't offer any advice but to confer with your pulmonologist and run the necessary tests but I wouldn't rule out the heart either. A-fib is sometimes attributable to underlying heart problems which in turn could cause lung problems. Have you ever had a stress test or an echocardiogram? Might be a good idea to look into that. Wishing you well.

[Ted]

Hi Cameron,

Glad to be of help. My bill is in the mail. :-) Seriously, I'm not positive that my "diagnosis" is correct. You should discuss this with your cardiologist.

I'm pretty sure that beta blockers can also cause fatigue and shortness of breath. You mentioned that you are on one, so I would try to find out if it's contributing to your symptoms. Before my cardiologist had me thoroughly checked out, he put me on a beta-blocker called toprol as a precautionary measure. I not only had an echo and a stress test, I also had an angiogram because of my chronic shortness of breath. My cardiologist seems to be super cautious. All my results were normal. I was having a lot of unpleasant palpitations and chest pain while I was on the toprol, so the doctor took me off of it after my test results started coming in. I was extremely fatigued and short of breath during my stress test. The nurses and techs told me that beta blockers add to these problems during exertion. That's not the only time I've heard this. You might Google the name of your beta-blocker and check out side effects if you haven't already done so.

I've been checked out by a pulmonologist and my test results were normal, except for the possibility that I have a slight case of asthma. He suggested trying some medication, but I'm like you when it comes to meds...the fewer the better. Given the fact that I had allergy-related asthma as a teen, I think that my next move might be to consult an allergist.

I can certainly empathize with your not wanting to go on coumadin. I have an 88-year old mom who had surgery for a large blood clot in her leg several months ago. A couple months later, she went into a-fib...maybe it runs in the family. She might have been in a-fib prior to that , but who knows? She was admitted to the hospital where she had to have cardioversion. They first tried IV meds to correct her heart rate, but they didn't work. She's now on coumadin and pacerone, a drug that's supposed to keep the heart in normal rhythm. She was very lucky that the clot went down to her leg and not upward where it would have been a much bigger problem.

Cameron, I recommend that you seriously consider doing whatever is necessary to get out of a-fib. This is not something you should take lightly. Have you been told how high your heart rate gets during a-fib? It's possible that the more erratic the heart rate, the greater the probability of the heart throwing a clot. Ask your doctor about this. In the meantime, I hope you're taking a daily aspirin to help thin your blood. You didn't say whether or not your cardiologist has tried meds (IV or oral) to get you out of a-fib. There are oral meds to keep you out of a-fib, but I don't know if there are any oral drugs that will actually get you out of a-fib once you're in it. When I first went into the ER, I was given digitalis and cardezem intravenously and I corrected after 2-3 hours. For all I know, I might have corrected without the drugs.

Thanks for your good wishes--I'd like to convey the same to you. By the way, I'm in Southern California. Where are you?

[Cameron]

Hi Ted, I've referred your "bill" to my account and he said to tell you that the check is in the mail. (kidding of course). Seriously though you've given me a lot of perspective on my predicament. I almost fell off my chair when I read your Toprol episode. Guess what I'm on---Toprol XL!! Now when I was diagnosed with A-fib a few years I was put on 25mg and it had no noticeable side effects other than a little fatigue which was no problem. Then it was increased to 50mg and again no bothersome side effects. But after my flu in February I apparently went into constant A-fib and my cardiologist said my pulse was running very high so he increased the dosage to 125mg. I was experiencing that breathless feeling before he increased it and it did bring my pulse down but I'm thinking it might be a factor in sustaining it. So call it coincidence or luck, when you mentioned the effect it had on you it really rang a bell. Of course, I'm going to discuss all this with my cardiologist when I see him this week. Incidentally, I had the same reaction as you to the stress test I took about a month ago. I don't think I did more then 5 minutes and became extremely fatigued and breathless and had to stop. And yet the results were normal. Go figure it! If I decide to go the cardioversion route I suppose I'll have to go on coumadin. He told me that's a prerequisite.

So it appears that you're making some inroads into your problem. I think if I had a choice, I'd choose asthma (especially if it's slight) over heart disease though nothing replaces good health. I don't think the meds for asthma are as potentially harmful as heart meds. I'm sure you're as anxious to get rid of that breathless feeling as I am. It's damned uncomfortable.

Say, kudos to your mother for her longevity and my best wishes since it happens to be Mother's Day. Oh, since you asked, I'm on the east coast in the New York area. The miracle of cyberspace!

[Ted]

Cameron,

Interesting that you're on Toprol--and a high dosage at that. I'd be willing to bet that the Toprol and/or your chronic a-fib are causing your shortness of breath.

Don't know if I'm making inroads myself...more like resorting to self-diagnosis since the doctors I've seen haven't been much help.

I have a couple NY connections. My employer is based in Elmsford (Westchester County) and I have a sister who lives in Queens.

I'm very curious to hear how your situation plays out. Keep me posted. Take care.

[Cameron]

Hi Ted,
Been out of touch for awhile but I thought I'd give you a quick report on present health conditions in case they might be helpful to you. There's been a very positive change in my a-fib and breathiness problem and I think it's due to a change in my medication. As you know I was on a rather high dose of Toprol while I was feeling all those symptoms I had related to you. In fact the doctor was suggesting a cardioversion if things didn't improve. Well I got him to change my medication from Toprol to a med called Diltiazem and my symptoms quickly diminished. I can't say I'm 100% but I'm able to excercise and do many outdoor chores that I couldn't do before and though I still have a mild a-fib condition it's something I can live with. I only take the Diltiazem once a day and it seems to work. I've even been able to ride a bicycle. Also, I didn't mention it before but I'm taking fish oil supplements and I think they may have a part to play in this. I'm a great believer in supplements.

So all is well for the moment and I hope you are experiencing the same.

[Ted]

Hi Cameron,

Nice to hear from you. I am pleased to find out that you're doing better.

Wish I could say the same. Still something weird going on with my breathing. I might have a slight case of asthma. Saw an allergist and will be tested for allergies. In the meantime, the doc gave me samples of Singulair. Have taken it for a week with no significant improvement. Will try them for another week. If I can't figure out something soon, I will get serious about dropping some weight and getting into better shape, although I don't think that's my problem. I was in decent shape and weighed a lot less when the breathing problem started.

At any rate, I'm very glad you're able to return to some semblance of normalcy. Also glad you don't have to go through cardioversion. That's a fairly common procedure, but the thought of it creeps me out quite a bit. Are you able to stay off coumadin as well?

Regards,
Ted

[psteach]

Hello. I'm new to this forum and I have had problems with a-fib off and on for ten years. Ten years ago I was treated with medications, cardioversions, and finally ablation. The ablation worked for me for nearly 10 years. Last December 2007, I had to have a pacemaker implanted due to my heart rate dropping down to 30 bpm. After the implant, I still was experiencing shortness of breath, extreme fatigue, swelling of the ankles and legs, and after many tests, the doctor diagnosed me with heart failure. On March 13, 2008, I had a 3 lead pacemaker implanted. I am 58 years old and a school teacher. I was unable to return to work this year because of the afib, fatigue, and shortness of breath with any exertion. At my last doctor appointment, he told me that I am having frequent bouts of a-fib and said we could try different medications and then mentioned a new ablation treatment. He said it would take between 6 - 8 hours, with a 70% success rate. I would like to know which medications you have used that had the least side effects. I have to go back to work in order to keep my insurance. I really don't know if I am going to be able to hold out all day long with 100 middle school students or not. Right now, I can rest at any time that I need to. The doctor told me to think about what he had suggested (medications or ablation) and call him back. I really would love to be able to find a medication that would get my heart back in ryhthm without the ablation procedure. Please let me know what you have found to be the most successful for you. I have to work for about another year and a half before I can retire. The doctor said it was all about the quality of life. He said that was what he was trying to help me find the best solution to give me a better quality of life. I just know that right now, I am unable to do much of anything without becoming exhausted, and short of breath.
Thanks for any suggestions!
Pat