Could it be flutter?

[Alan_G]

I was diagnosed with lone PAF back in 2012. Since then I've averages 2 or 3 episodes a year all lasting no more than 18 hours, some quite a bit shorter.

However, I've had the odd night when I've gone to bed and had 'that feeling'. I've done my deep breathing and my pulse has remained steady, but I've still just not felt totally right. The feeling has either passed within an hour or I go to sleep and then awake feeling fine. The fact my pulse remained steady made me think I'd held of an episode of AFib, but I'm now starting to wonder whether I'd experienced an episode of atrial flutter instead. I've recently acquired a fitbit watch that shows your heartbeat, and when I'm relaxed in bed mine is low 50s to high 40s. Do my suspicions seem possible and is a way to test it next time it happens to see if my pulse increases a lot, even though it is steady? I've never put flutter on the menu, but now I'm starting to wonder.

[jeanjeannie50]

Hi Alan - I have atrial flutter and its more of a regular high rate beat. Starts off really high then settles back to around 130 or 150 and stays there, you'd certainly know if you had it.

What the pulse in my wrist says doesn't always match what my heart is actually doing. Once I felt really ill, faint and sick, my pulse in my wrist felt normal when I checked and also when paramedics came, then they discovered my actual heart rate was sky high but going too fast to register in my wrist. I bought a stethoscope and use that now, sometimes I can hear that the beat just isn't quite right although my heart rate is normal. So your heart rate could register as normal, but heart is still not beating right.

Jean

[Mercurius]

Hi Alan,

Yes the pure flutter (as mine) results in regular pulse rate and heart rate. Moreover flutters similarly to the fibrillations might be driven by the sympathetic or by the vagal tone. With high vagal tone the pulse rate and the heart rate is low. In my case the resting heart rate in bed is 50-55 and during flutter it goes up to 65-70. During normal walking hardly goes above 80 bpm. Important to mention, that the pulse rate and heart rate during arrhythmias might be differrent. The procedure suggested by jeanjeannie50 exatly what docs do when they dont have ecg (pulse rate measured direcly by hand, heart rate measured by sthethoscope). You can use a cheap cyclist heart rate monitor instead of sthethoscope. (Not polar or other brand, because the high quality monitors not works during arrhythmias, rather extarpolates a supposed heart rate.)

During the next suspicious occasion you may experience one of the followings:

- the wrhist pulse rate and the heart rate is equal, but the but both of them is increased ~30 percent (best choice for the check is the resting state in bed). In this case you have pure flutter.

- the wrist pulse is lower than the heart rate and you have pulse deficit. Then it might be mixed (flutter plus fibrillation) fibrillation or other even more serious arrhythmia (block for instance). Anyhow, in this case ECG is needed for identifying the type of arrhythmia.

Two important notes:

- If you are on medication, then some pills may convert your fibrillation to flutter (so if you was diagnosed with fibrillation still not excluded that the medication trasnformed it into flutter).

- some antiarrhythmic pills side effects may results in arrhythymias. If you got bradicady, then worth to inform your cardiologist wthether you should change medication.

[Alan_G in reply to Mercurius]

Thanks both for interesting replies. I've ordered what I consider to be a reasonably priced stethoscope. I didn't notice an increase in pulse because I was basing everything on whether it was steady or not. I now know to ascertain whether it goes up when I have one of these 'episodes' again.

[BobD Volunteer]

Why not just get a Kardia and be sure of what you have? You will also then have a record of it to show to your EP.

[Alan_G in reply to BobD]

Sounds a good idea. I'll look into it.

[jeanjeannie50 in reply to BobD]

Bob, if the pulse in the wrist isn't right will it be with the Kardia? I think that takes a record from your finger tips. I didn't go for Kardia because I thought the reading may not be right for me.

Jean

[Alan_G in reply to jeanjeannie50]

Good point. I'll use pulse and stethoscope next time it happens to see if there is a difference.

[BobD Volunteer]

Not sure how it works Jean but it needs conduction through your skin. Maybe others or Dr Dave can explain how it works but It isn't recording your pulse from your fingers. This is why you need damp fingers to get good conductivity in order to obtain a decent reading. It records the electrical activity in your heart. Why do you think it gives an ecg type trace? Your pulse doesn't look like that.

Whilst I agree that your heart may sound different to your pulse, what you feel at the wrist or carotid is the ventricular contractions forcing "plugs" of blood round your body. This is the true amount of blood being pumped. Extra contractions such as ectopics do not move blood so are not felt. That is my engineers take anyway maybe a lurking doctor can confirm or deny?

[daved525]

Kardia is a 2 lead ECG. It measures the voltage between your hands. It gives a much better indication of what's going on than optical techniques (Fitbit, O2 Sat, etc) which get confused by arrhythmias. I've used mine in the hospital and it always agrees with the "rhythm strip" from the fancy 12 lead ECG there. Best $99 I ever spent.