Where to now?

[momist]

My story so far, in brief. I'm a 67 year old man who four weeks ago had an 8 hour AF event (my first, to my knowledge) which I did not recognise, and I wondered if I was having a slow heart attack. I have described elsewhere the events that led up to this, and how I laboured on through the weakness and shortage of breath until I got scared enough to dial 999. The paramedics identified AF, and that resulted in 10 hours in A&E where it reverted to NSR after a couple of hours on a trolley/ECG. On discharge, I was referred to the cardio/respiratory clinic but the appointment for that was delayed a little by my social commitments.

Today, I went to the clinic for ultrasound echocardiogram scan of my heart and an exercise stress test/ECG, two hours apart. After my scan, I was called back into the same room for a repeat of part of the procedure by the physiologist in charge, as the more junior man had spotted something he was unsure of. The physiologist then referred me to the CT scanner attached to A&E, for a CT scan of my torso. This procedure included an injection of a transparent 'dye' into my blood, to enhance the images.

On return to the cardio/respiratory clinic, I had missed the slot for my physical exercise stress test, but was rescheduled for a later slot and went through that procedure. I reached level 4 of the 7 stage Bruce protocol, and reached a heart rate of over 200 and 102% of the BP target. After examining the ECG, the physiologist then said he could find no fault with my heart or circulatory system, and the CT scan had shown that they were mistaken about the artifact they had observed on the ultrasound scan. He suggested that it was likely to be just a normal variation in the 'structure' of my body.

He also suggested that the AF event I suffered may be "just that I was unwell that day" and that it may not recur. I should only worry if I have more frequent similar events. He has sent me home with a report to my doctor and to the consultant, who I have never seen.

So, where do I go now? I bought the Kardia device a couple of days after my experience, and hope to be able to 'catch' any further AF that I may get. There has been no suggestion (yet) of any drug treatment, not even for anti-coagulation. I expect that I might hear from the consultant, but I bet I only get a letter saying everything's fine. Has anyone any suggestions? It seems that I am lucky enough to have a 'normal' heart and am reasonably fit for my age.

Meanwhile, I intend to carry on as normal, and hope for the best. Thanks for all your support and advice in the last few weeks.

[UScore]

Most of this seems reasonable. There's no much else you can do but get on with things as normally as possible.

The only question I'd raise is anti-coagulation. At the very least you should discuss this with someone.

I have my echo cardiogram on Tuesday. I haven't been offered the CT scan or exercise stress test yet.

[momist in reply to UScore]

The CT scan was an unexpected extra, and despite their attempts to shrug it off I found the need for it quite worrying at the time. Seems there is something in my body that confused them a little? Anyway, it was nice to see the 'head honcho' in charge of the department!

I'm surprised that you haven't been invited for the treadmill. This is the second time in my life I've done that. The first time, many years ago, included the breathing mask for VO2 measurement, which they didn't bother with this time. That was for chest pains which might have been respiratory, digestive, or heart related. It didn't find anything.

[UScore in reply to momist]

I did do it years and years ago, when I went into A&E with chest pains (it wasn't like AF tho, and although nothing was found at the time I think it was indigestion related).

I haven't had an appointment with a cardiologist yet, it might be they suggest the stress test. I think my GP was just reading from the checklist of what to do when AF is first presented - which is thyroid blood test, echo, beta blocker PIP, and anti-coag chat.

Good news on your heart being 'normal'. I hope you never get stupid AF again.

[Finvola]

You've certainly had a thorough checking, momist and it's really good news that all the cardiac plumbing is in good order.

Mental and bodily stress may have been factors in causing your episode and it could have been a one-off occurrence. In your situation, I would take it as a warning and work to minimize the chances of a recurrence. Your Alivecor/Kardia was a good investment I think, as you are armed to catch anything untoward, should it happen.

Lifestyle changes are proven to be helpful in lessening the impact and frequency of AF and there is a wealth of advice and information on the main AFA website.

Very briefly it is advised that we should eat a well balanced diet without processed food, artificial sweeteners, colourings and flavourings. Possibly limit or stop alcohol, caffeine and sugar. Lose weight if we need to and get other health problems such as dental, diabetes, BP and sleep apnea seen to. Most important is to cut out stress, enjoy a hobby and take moderate exercise. Check up on your CHADSVASC score and inquire about the need for anticoagulation.

It's great that you have such a good mental attitude - it's a great help for me (when I'm able to do it!).

I hope all goes well for you.

[momist in reply to Finvola]

Thank you Finvola. You are preaching to the converted regarding exercise and diet, although I disagree about coffee, tea and alcohol. I'm not too keen on sugary things, and avoid sugar where I can, but believe that sugar is less harmful for us than any artificial sweetener. I do believe in moderation in ALL things, including moderation.

[Carolewick]

I agree with UScore. Perhaps you do need some treatment if you continue to get AF. . When I had my first AF when I was 60yrs And saw a cardiologist I refused to have Warfarin. ( i Was stupid) when I had further attacks I was put on Flecainide and for the next ten years I was AF Free. The AF returned when I was 72yrs. The consultant I saw said immediately I should go on Warfarin. Im glad I did as the AF came back fairly frequently and I was protected from a potential stroke with the anticoagulants. I subsequently had 3 ablations and I have been AF free for 18 months. I changed from Warfarin to Apixaban after 1 Year. My personal thoughts would be that if you get further occurances of AF ask to be referred to a cardiologist and take the advice. Don't put up and shut up.

Best wishes Carole

[momist]

Thanks for your post Carole. I agree, I will indeed pursue some suitable anticoagulant medication if I suffer any further attack of AF. I might even mention this next time I see a doctor anyway. I dropped the report in to my GP's surgery yesterday, and I'm still waiting to see if they are interested enough to ask me to see them. I might of course get a further appointment with cardiology yet, as the report was directed to the 'consultant' who will be responsible for my case and might want to see me (I rather doubt it).