Pandora's box

[Melleray]

Well, the last post I wrote spoke of PVC's I was experiencing. I'm afraid it escalated into one horrific episode one night, when I suddenly went completely dizzy and very nearly lost consciousness. Just managed to hold on until I could get to a phone and call the ambulance. The attack subsided and the paramedic took me into Bristol Heart hospital where I remained for the next 5 days.

The pacemaker was interrogated and it showed an episode of Ventricular Tachycardia. Never had that before, but it was far worse than any AF I have experienced. While I was there I had an ECHO which showed my ejection fraction had dropped from pre pacemaker 51% to 41%, meaning my heart was now compromised and pumping less well. My blood pressure is also much lower than it usual.

Meds were changed to Bisoprolol, which to cut a long story short, made me feel totally lightheaded and shaky. The dose was reduced and reduced and finally stopped.

I felt so traumatised by the whole thing that I paid for a private appointment to speak to the cardiologist who treated me on admission. This was helpful and she decided to raise my base rate back up to 80 bpm as I had been doing better then, and also said I could restart my usual Sotalol, but at 40 mg, so half my previous dose.

This has been okay for the past couple of weeks, but on Saturday, I was at a market, when my heart suddenly started beating at at least 150 bpm. I immediately took a dose of 80 mg Sotalol, but the episode continued for another hour. Thank goodness one of my family was around and we set off for the hospital when my pulse suddenly slowed to 80. It had all the hallmarks of an AF episode except that it was very regular, and I am not supposed to have AF episodes. This must have been another VT attack, but not as severe as the previous one, where I nearly blacked out.

So, I am going to ring the Arrhythmia team in the morning. I feel utterly despondent about it all as you can imagine.

[BobD Volunteer]

Melleray I am sorry you had this experience which I know can be very traumatic. Pre syncope is frightening for sure. I have no knowledge of ventricular tachycardia but do experience atrial tachy with rates around 140 which on occasions has lasted for many days whist waiting for cardioversion. I find it hard to reconcile tachycardia with passing out which is normally caused by either very low blood pressure or the heart stopping for longer than usual but obviously your PM should be dealing with that side of things. I do hope that you can get some answers tomorrow and that you have a peaceful night.

Bob

[Melleray in reply to BobD]

Thanks Bob - the tech team told me that when I nearly blacked out, my heart was beating in the ventricles at 220, so disrupting the blood flow to the brain. Causing as you said 'pre syncope'. Horrible experience! I have been given an emergency appointment with the device clinic tomorrow. One good thing about the pacemaker is that it records events, so they should be able to see what happened with the episode on Saturday.

[Shepheart]

Hi Melleray, I’m sorry this is happening to you. It must be very difficult after all you have gone through. The new normal is kind of that there is no normal for us with this condition.

Did the doctors ever confirm that you were having Pvcs? Or was it always short runs of VT? I’m interested in the relationship between pvcs and v tach. A medical website had this to say—-

“Premature Ventricular Contractions (PVCs) are single beats originating from the lower chambers. Any time there is more than 3 beats in succession this is defined as ventricular tachycardia.”

It sounds like our cases are kind of similar so I’m very interested in what you are learning/experiencing. I have short episodes of what I think are runs of pvcs but when I check my pulse it is about 40 bpm, which seems weird because my base rate is set at 60. (There’s lots I don’t understand). I had hoped that with the av node ablation these arrhythmia issues would be gone.

I have a pacer checkup in 2 days so all this is helpful to me in formulating better questions. I sure hope you get feeling better soon.

[Melleray in reply to Shepheart]

Thanks Shepheart - yes it seems that a run of PVC's (and mine were confirmed as this) is classed as VT. I was having multiple runs a day of about 4 missed beats at a time. I knew something was wrong. But when the horrible VT episode happened at home and I nearly passed out, I had absolutely no warning at all. I was sitting at my desk writing an email and Bang it all started. I was told in hospital that runs of PVC's are part of the VT syndrome, so if I start getting them again, I will be on alert. The tech team should be able to explain your symptoms. Good luck.

[Shcldavies]

I know this is very frightening for you VT is not good at all. I suffered from Aflutter (atria going at 240 with ventricles going at 120). In A flutter I had to lay down or I would collapse. When in hospital with it in December the "crash team" were automatically called when I stood up and started to collapse (never see so many people come in so short a time), apparently my monitors were showing that I was in cardiac arrest. Thankfully I was not and it must of been some sight with them trying to put pads on me and at the same time I was taking them off saying I was alright LOL, this was resolved by Cardioversion 4 days later. The EP thought that the A flutter was brought on by the Flecainide he had prescribed 4 months earlier, the good news was that he then put me to the top of his EP study/ablation list which confirmed his thoughts and he also said that I had MAT which would be treated with Meds. Apart from the slow recovery and some episodes of tachycardia, possible AF, PVCs and ectopics for a couple of weeks post ablation I now feel fine and only on Bisoprolol 1.25 (will give my 6 month post ablation post on 19 August).

The reason I mention my condition is to demonstrate that getting the right medication is the key, too much, too little or the wrong type can make things much worst. Getting the right Medication can be a process of trial and error (I wish I had known that flecainide could have caused such an arrhythmia in my ventricles). In fact I believe that I had been suffering from A flutter (triggered by my MAT) since the Bisoprolol dose was increased from 2.5 (was on this dose for 10 years) to 5, only I was not so symptomatic, but still needed to lay down to prevent collaps. EP doesn't to think so but once you have had ventricular tachycardia, you know what it feels like so I am quite sure too much of many arrhythmia drugs can cause ventricular problems.

The good news is that the EP told me that an ablation to block the signals for ventricular tachycardia is the easiest, has the least risk and is the most successful with over 97% success rate (albeit in my case he could not fix the atrial problem of MAT). Its easy for me to say now but do not despair the treatment is there, it may take a little journey to get there, but you will.

[baba in reply to Shcldavies]

Define "MAT" please

[Melleray in reply to Shcldavies]

Thanks for your message. Having had AF for many years and experienced atrial fibrillation of 250, I know I sympathise with you. I was sometimes given Flecainide as an infusion in hospital to restore sinus rhythm, but I could not tolerate it as an oral tablet, as it caused arrhythmia. So as you say it is all about finding the right meds sometimes.

[Shcldavies]

Sorry, MAT is Multifocal Atrial Tachycardia, it's where there is more than one focai in the atria that triggers a pulse. Where there are many focai it's difficult to ablate them all so they just do the main bits and treat the rest with drugs. Many believe it's caused by an electrolyte sortfall in the heart cells.

[baba in reply to Shcldavies]

Thank you.

[Ianc2 in reply to Shcldavies]

An electrolyte shortfall - can you expand on that, along with possible causes?

[Shcldavies in reply to Ianc2]

Yes, the key electrolytes for you heart are calcium, potassium and indirectly iron as they chemically produce your electrical signals that keep your heart beating, magnesium does the orchestrating to ensure we maintain the right electrolyte balance. Whilst most of us have enough calcium, many diets do not give us enough of the rest especially magnesium and we need vitamin D (a vitamin that many of us have low levels of especially if you live in the less sunny climate) to absorb the magnesium which is also potentially difficult to get to the cells of your body (you could be fine in your blood but that does not indicate its in you cells.

Magnesium can be the key as if you do not have enough it cannot keep the right balance of calcium and potassium and that can lead to the electrical signals of your heart doing funny things. We tend to all have a shortage of magnesium as it has become depleted in our food/soil. When we do get enough it still may not get to your cells as it needs a normal acidic stomach (those that take PPIs will not get it absorbed) and good levels of vitamin D, alcohol and stress depletes magnesium fast. It also normally takes many months to develop in your cells. Likewise if you do not have the right levels of Calcium and Potassium, no amount of Magnesium can keep the right balance

Normally you can get enough potassium by including a banana a day into your diet, iron is in many food especially lean meat and spinach for example, avocado will provide magnesium but normally a supplement is needed (there are many types, normally Taurate and Citrate are best but do not take Oxide - I have always found that an Epsom's salts bath for 20 minutes using half a bag or 4 cups to be good for magnesium absorption but technically it should not work, but who knows!).

[Hidden]

Hi Melleray, Bisoprolol Sotalol and the hosts of medications tried on me at different quantities over the last good few years sent me on a course of bewilderment. When in hospital they would change dosages higher then on going to my GP he would contradict there judgement and take the dosage down again, saying that was too high etc, until I became so confused that I came to the conclusion that I was unlucky to be living in an area that needed to update there training where Atrial Fibrillation was concerned.

Because of this I ended up with a stroke, and discovered more about the reasons I was fainting and walking around lightheaded. I was told I had Heart Failure, which simply means my heart is loosing the ability to pump the blood to the brain as it used too, meaning dizzy spells, feelings of collapse,fatigue, breathlessness etc. I was told that my heart does not expand fully to enable oxygen to circulate within the blood thus making walking very difficult. My legs and ankles are swollen which they call Oedema, so in order to help assist circulation I wear compression stockings, and take water tablets to reduce the fluid by passing water during the day and night frequently. Please forgive me for not be able to answer your query fully, but I would ask you to ask as many questions as possible, I am still in A/F permanently since September 1998. I have not been lucky due to where I live, plus I have been very courteous towards my peers, and have not asked enough questions, ask! And if your not happy with the answer Ask! again.

[Melleray in reply to Hidden]

Sorry to hear that you have had so much to deal with, and it is very poor that your location should have such a negative effect on your health. Best wishes