Where to Next - after Angiogram & Echo

[gcmozart]

I had coronary angiogram today at William Harvey Hospital - the whole process was well managed and not as traumatic as I was expecting. It was done in less than 25 minutes with only the odd moments of discomfort.

This followed the Echo on Sunday.

Consultant said there was nothing obvious in either to suggest cause of PAF and other symptoms (chest pain, breathlessness & constant tiredness)

He said I have some myocardial bridging & ectatic (sp?) coronary vessels. He has advised aspirin for ectatic vessels - I questioned him about this and he said it is not to prevent clots, but to help blood flow so rang true.

He has suggested further tests to try to identify possible problems.

catecholamines 24 hr urine sample, Cardic MRI, Exercise stress test, 24 hour blood pressure monitor, 7 day ecg monitor to catch AF, Sleep Study

So I am happy that the tests have not found anything seriously wrong with my heart. However I still do not have a reason for the symptoms - I guess it could be the AF itself that is causing the symptoms - hopefully the 7 day tape will help identify how often the AF is occurring without me knowing.

On the plus side I got weighed today and have dropped 8 kg since last weighed which has got to be a good thing.

[JonathanPittsCrick]

With a normal echo and near-normal angio you can be confident that there is nothing dangerously wrong with your heart. A possible problem, often associated with AF, is that your natural pulse rate is too slow and doesn't speed up enough with exercise – this is called sinus node disease (SND) and the heart recorder should identfy this. The treatment is a pacemaker.

I'm not clear from your posts whether by tiredness you mean physical fatigue stopping you doing strenuous things, or sleepiness. If it's sleepiness (and you don't have SND) then sleep apnoea is the most likely cause – and your successful diet will go a long way to improving this, especially if combined with a gentle progressive fitness programme. You could also try the traditional remedy of sewing a toggle into the back of your pyjamas – this will discourage you from lying on your back which is often the cause for sleep apnoea. But if this doesn't work and the sleep study shows you do have this problem then it's well worth trying the CPAP machine even if it's a bit off-putting at first.

If the problem is exertional fatigue it could be just loss of general fitness due to your reduced exercise level or you could have the "fatigue syndrome" that can follow a viral illness – either way a fitness programme should help. Unfortunately the beta blocker (e.g.bisoprolol) treatment often recommended for AF can make it worse so it would be worthwhile asking for a specific anti-arrhythmic drug such as flecainide to prevent the AF.

[gcmozart in reply to JonathanPittsCrick]

I love this place I am learning stuff from every post

I am getting exertional fatigue. I was exercising perfectly happily until two weeks ago and have always been a physically active person with good levels of fitness so I am sure it is not a loss of general fitness.

A few of the healthcare professionals have mentioned the possibility of it being virus based problem and I must say it feels rather like the tiredness I have had in the past with flu and colds. My cardiologist mentioned that a virus can affect heart and does not always show up in blood tests. However I have not had any other viral symptoms that I know about - no temperature, no sore throat, cough, diarrhea, stomach pains

[JonathanPittsCrick in reply to gcmozart]

Yes, a virus that upsets your heart or causes fatigue syndrome does not necessarily cause typical "cold" symptoms so you may not know about it. The good thing is that your normal echocardiogram shows that there has not been significant damage to your heart caused by the virus so it should all get better with time.

Have you checked your heart rate? As a rough guide it should be at least 100 bpm when you are walking around.

Obviously if you are in AF most of the time this will make you feel fatigued but I am assuming, from what you said, that you are in regular rhythm most of the time with just some attacks of AF. The heart recorder should reveal all!

[gcmozart in reply to JonathanPittsCrick]

no my heart rate does not get that high walking around. It does not get above 80 and even at that level i am feeling very fatigued - light headed & aching limbs & getting towards breathless.

I cannot always tell when i am in AF. I have been on ECG and shown a short AF episode without me being aware at all. The two people looking at the ECG machine could not believe I just kept chatting away while the ECG went mental for 30 - 40 seconds.

As you say the 7 day tape should capture if these episodes are occurring regularly.

Obviously if it is viral and it does get better with no heart damage that would be bloody brilliant, but I am not glass half-full enough to be banking on that just yet.

[MarkySmith in reply to JonathanPittsCrick]

I had shingles just st the point PAF was diagnosed? Could this have been a factor?

[PeterWh in reply to MarkySmith]

I'm not a medic but I would say yes that is a distinct possibility. Apart from my persistent AF I have a few other comorbidities and I find that catching something can easily affect one or more of them because obviously the new thing affects the body balance (and it is probably more sensitive in those of us with afflictions than for a normal healthy person). So for instance when I had a very bad cold and cough my foot and ankle went worse which was probably due to the circulation not being as good and the antibodies fighting the bad cold and cough.

[JonathanPittsCrick in reply to MarkySmith]

There are 2 ways it could be related:

1) shingles (a re-activation of the chickenpox virus) usually happens when you are run down – and that may have been caused by another virus that also upset your heart.

2) if the shingles affected the left side of your chest it could also affect the pericardium (the lining around your heart) and that inflammation could directly trigger AF.

[MarkySmith in reply to JonathanPittsCrick]

Wow! The shingles affected my left nipple and radiated out across to my left shoulder blade. Plus I'd felt very stressed and tired for weeks. Many thanks for your insightful reply.

[JonathanPittsCrick]

Not going above 80 bpm is really not enough and this could be the reason for the fatigue. Are you taking beta blocker medication regularly or have you always had a slow pulse, or is this a new problem?

[gcmozart in reply to JonathanPittsCrick]

Nope no beta blockers only on aspirin for ectatic cardiac vessels. I presume the exercise treadmill test would show this up.

Past few days I have felt good in the morning and gradually faded through the day. I went for a short slow downhill walk yesterday (100 - 200 yards) and it absolutely knocked me out. Started getting a headache, legs ached.

I had a sit down and the headache went, but the tiredness in my legs took much longer to go, HR was only 76.

[JonathanPittsCrick in reply to gcmozart]

If there are no other reasons for a limited pulse rise (e.g. underactive thyroid) it sounds like you do have sinus node disease (SND) and it can cause "chonotropic incompetence" (failure to speed up enough with exercise). The sinus node is your natural pacemaker and it can be affected by the same problem that causes AF, so SND and AF often go together.

The treatment is an artificial pacemaker which could restore your former energy. It may also help to keep the AF away and allows the use of meds to suppress the AF with no danger of slowing the heart down too much.