mum is 83 poss atrial flutter?

[badsgal]

hi folks mum off for echocardiogram today shes worried as not been in hosp for 44 yrs when she had me! Doc advised A&E last mon aft she was summoned to him for ecg...showed heartrate of 180 bpm and irregular pulse she was given bisophrodol at hosp which worked to get it back down to approx circa 70 bpm but since then hands very cold n she looks pale yest looked healthy last week, no chest pains or other symptoms really memory fine .think shes been in denial about exerting herself carrying shopping upstairs but need to know whats caused this? her waves are normal i saw last week said hemiblock was a possibility due to left axis deviation.....your advice is welcome scan at 2.30pm thanks guys, see brief overview from last wk below:

problem essential hypertension

11th Oct - blood pressure reading 117/96 mmHg

reason for ecg irregular pulse found on hypertension review

regular narrow complex tachycardia difficult to be sure of the exact mechanism but this may be atrial flutter, atrial tachycardia or a re entrant tachycardia

good r wave progression throughout the anterior leads

left axis deviation, suggesting that a left anterior hemiblock is present

p waves are normal

t waves are normal

no pathological q waves seen

[badsgal]

forgot to say shes been put on Apixaban x 2 daily, one bisphrodol, and been on Candestatin for a year or so....she hates taking drugs!!

[jedimasterlincoln]

BP looks good! We're not medically trained on here but I hope she gets some answers!

[CaroleF]

Bisoprolol is almost certainly the culprit where cold hands are concerned. It's a known side effect - and there are others eg. walking feeling like wading through treacle, lack of any energy, feeling like a zombie. My hands were absolutely freezing when I took this medication.

There are other beta-blockers that can be tried and I now happily take Diltiazem (a calcium channel blocker) - though this too can have unwanted side-effects for some and your Mum's BP doesn't look particularly high to me. Mine is and that's one of the reasons why it was prescribed. (NB I am not medically qualified).

[badsgal]

all seemed well yesterday on scan...so nurse said, so will see what comes back from the report, but she feels more reassured..shes been carrying heavy shopping i reckon being a trooper, dragging trolley upstairs to flat so told her thats stopping and i clean n shop from now on!! thanks for replies guys...

[Hidden]

Digoxin may be a good alternative. However it might equally be contraindicated because of the ECG report. That would possibly need a consultant opinion.

Beta blockers can also be a problem if there is evidence of heart block. How much bisoprolol is your mother taking?

[badsgal in reply to Hidden]

shes on 2.5mg or one tablet daily, 5mg tabs x 2 of apixaban, thank you!

[Hidden in reply to badsgal]

If your mother continues to have problems with Bisoprolol, Nebivolol might be better for her even at this relatively low dose of Bisoprolol.

The data sheet for Apixaban says her current dose of 5 mgs twice a day is correct, which surprises me at 83.

However if her weight is below 61 kgs or her kidney function is poor, the dose should be reduced. The consequences of over anticoagulation can be fatal, particularly in a very elderly person.

This is another reason to push for referral to a general cardiologist for a proper assessment and management plan, in my opinion.

Please do check with her GP that she is on the correct dose of Apixaban.

[badsgal]

her weight is 82kgs, kidneys fine as far as im aware, she has regular blood tests and that wouldve showed up otherwise im guessing? but yes will check with doc and thanks so much for your advice on this, all new to us, need to see what this report from the echocardiogram says too, based on that, im presuming a follow up assessment after a month on the medication will be in order? best, Karen

[Hidden]

Well I would also ask about an alternative beta blocker to the Bisoprolol, possibly Nebivolol which many here prefer. I have not tried it myself.

Knowing the echocardiogram is normal is a big positive. I would hope that there might be some scope for lifestyle changes together with gentle medication to manage the AF. There are some fairly nasty drugs used for AF and even cardiac ablation, which are best avoided at 83 if at all possible in my opinion.

Perhaps the best thing she could do is to manage her weight so that her BMI is in the normal range. Losing weight, if necessary, can make a huge difference, though easier said than done at her age.

Has underactive thyroid been ruled out?

[badsgal]

sorry Oyster and co, realised id not responded, not been on as mum seems ok now on the 2 meds Apixaban and Bisopholol although shes reported being slightly out of breath so ive asked her to write down when this occurs ie: after walking too far or carrying shopping etc know its a side effect of either bisoprolol or apixaban forget which now, but im more worried about upcoming assessment at hospital on 24th Jan where they will put her on a treadmill and gradually speed it up getting heart working, she has flat feet and a side effect of the testing is possible heart attack although rare it said on the form!! i dont want her to have the test but realise they have to find root cause of why she had the AF for first time ever back in Oct 18..Has anyone else had this test? Underactive thyroid not sure will try and find out, but im sure they wouldve found out from tests if that had been the case, thanks, take care, Karen