First of all thank you for responding to my recent posts and also for the information provided.
I had my appointment with the cardiologist following the Echocardiogram. This was a private appointment as the waiting list was 14 months!
By way of background I had a 24 hour holter which showed "sinus rhythm with frequent ectopics/episodes of atrial fibrillation.
In total, 9279 atrial ectopics were recorded in 24 hours, including isolated beats, couplets, consecutive beats and episodes of an atrial trigeminy" Also stated there was one episode of sinus bradycardia (short duration).
In addition, after the holter test, I had a follow up ECG by my GP which showed 'absent P waves'.
The cardiologist I saw privately has concluded that the AF diagnosis is 'questionable' as the holter record indicates they were not long enough in duration and he said that depsite the printout which stated 'absent P waves', there were 'some P waves' on the ECG. He concluded I don't have AF at present.
The problems are due to 'faulty electrics' and that whilst I am at high risk of AF, at present he does not recommend any treatment. Time enough to look further when I'm 65 - in 5 years time.
So, in the meantime, I guess I learn to live with the frequent PACs and keep close contact with my GP should anything change?
I would appreciate your views on whether this is a reasonable and sensible approach? Or should I push for anything else by way of investigation?
Many thanks.
Written by
Valbun
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Hmm - that's good news and bad news Valbun. The good news is that the cardiologist isn't overly concerned and the bad news is that the cardiologist isn't overly concerned. That leaves you in the middle with no firm diagnosis.
My layman's reaction would be to try to get a more definitive diagnosis than faulty electrics. We all have faulty electrics but to what degree and how does it affect our lives? Regarding PAC's, we all have the darned things and they really are debilitating but are usually described as benign. You have some P waves - that means on some beats you don't have P waves - which means that your atria are not involved in those beats.
You could follow his advice and implement lifestyle changes regarding diet, weight loss if necessary, stress levels and many others which are listed on the AFA website. My personal opinion (which I would probably follow after some thought) is that I wouldn't wait five years for things to get worse but would seek a second opinion from an EP. I would especially want to know about the absence of P waves and the presence of some AF. Also, having no AF at present means absolutely nothing - it's the best at playing hide and seek that I've known. My AF hid from diagnosis for six years, despite ECG's and holter monitors
I'm sorry you didn't get a handle on your symptoms from the cardiologist - wait and see isn't my strongest point and I would be inclined to follow this up. I remember you said that your GP was very supportive - perhaps that somewhere to start. Best wishes.
I really appreciate this advice. I will definitely give a lot more thought to this before I let things drift. It does seem a little neglectful (in my mind) to simply wait and see what happens in the next five years - given there is a fair degree of ectopic activity and as you say the confusion over the P wave activity.
The problem with GP generated ECGs is the the computer algorythms used for diagnosis are rubbish. I hvae frequently had such tests which gave spurious results which even I could see were wrong. For example diagnosis of AF with clearly evident p wave which actually showed atrial tachycardia!
Ectopic beats are a really nasty arrhythmia and it is no comfort that they are benign! Life style can help a lot as can the slow deep breathing technique we have described many times. I would say trust your cardiologist for now but keeop an open mind. Above all dont focus on it!
Many thanks Bob. All very good advice and I'm already beginning to try and 'ignore' the odd beats, etc whereas before I would be wanting to check my pulse, etc.
That's interesting about the GP ECGs. Would that also apply to the Holter test as well?
No, Holter monitors are usually interpreted by specialist ECG readers in the hospital NOT by GPs. I am told that it takes many years to become proficient in the art. I watched a presentation a few years ago by a professional talking to a room full of GPs. He put up a series of traces on screen and asked for diagnosis. Everyone got ever one wrong and he then proceeded to explain why. That is why I only take notice of what my EP tells me.
Interesting that the cardiologist hadn’t looked st the printout of the Holter test but said he would before writing to my GP. The Holter did report episodes of AF. Anyway...🤷♀️
Yes quite. Around 200 a day is normal for everybody but once they reach thousands level they do start to intrude.
I know how horrible ectopics feel, especially if they come in runs. Trigeminy and bigeminy are awful to experience and I did seriously think that I had gone back in to AF when I first experienced them.
For me the biggest trigger of these episodes is stress, not easy to avoid when you have two teenage daughters and a full time job.
Make sure that you take time for yourself, do some exercise, and avoid the triggers that you can.
Also I take magnesium which I really do believe has helped to reduce the number of ectopics I have. And I am someone that doesn't believe in snake oil cures
Thankyou Mike, I notice the symptoms more when I sit down or when I'm resting. When I'm walking (which I try to do most days), I tend not to be conscious of them. Take care.
This is probably what did it. Try it and you will see.
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer. If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
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