Type 2 Heart attack from Atrial flutter

[sandoval22]

I was in A&E for the 6th time in as many weeks for Atrial Flutter and they took the usual blood tests (before the usual Magnesium drip) and said my Troponin was very high. I never actually saw a Cardiologist but the main doctor said I probably had type 2 heart attack from the heart fluttering so much which causes a lack of oxygen and chest discomfort. I've never seen it mentioned here before so was wondering if anyone else has had the same thing. Makes me think palpitations are a lot more dangerous than I previously thought.

[BobD Volunteer]

Never heard of type 2 heart attack to be honest but many people do get chest pain and raised troponin from AF events.

[Jalia]

I had a long run..7 weeks...of tachycardia/ A flutter and AF with some very fast rates and several visits to A&E which culminated in dc cardioversion very recently. I've never heard of type 2 heart attack either.

My bloods were all normal each time including Troponin, magnesium and potassium levels.

[Hidden]

Dr Google says...

The different kinds of heart attack. Not all heart attacks are the same. The task force that redefined the diagnosis of heart attack also identified six different types, as follows.

Type 1, the most common situation: A heart attack occurring from a blood clot or other blockage in blood flow through an artery in the heart. The person usually has coronary artery disease. This is an oxygen supply problem, due to reduced blood flow.

Type 2: A heart attack occurring when the heart needs more oxygen than it can get. This type of heart attack is an oxygen demand problem, resulting from higher need for blood flow.

Type 3: A fatal heart attack that causes death before the diagnosis can be confirmed with blood tests.

Type 4a: A heart attack that occurs during angioplasty, a procedure in which a blocked blood vessel is opened with a balloon on the end of a flexible tube inserted in the artery.

Type 4b: A heart attack that occurs when a clot blocks blood flow through a stent—a small metal mesh tube that has been inserted in the artery during angioplasty to keep the artery open.

Type 5: A heart attack that occurs during coronary artery bypass surgery.

This is from an American medical website.

_

[Jalia in reply to Hidden]

Thanks....that's interesting.

[sandoval22 in reply to Hidden]

I would have thought most of us need more oxygen while having an Afib episode so I'm surprised these T2 heart attacks don't happen more often.

I really struggle walking up the stairs and QOL is dire . Hopefully ablation will help.

[Gincalpe in reply to Hidden]

Thanks had not heard of the Types before

[Ppiman]

I was very poorly indeed when I developed persistent flutter. Last June, I had an ablation and apart from an episode of Afib just after the op, I’ve been in NSR since. My cardiac enzymes were never raised, however, my ejection fraction was reduced to about 40. Even now though, I do have a less energy than I think I should have at 66, and plenty of ectopic palpitations.

If I were you, I’d ask for an echo scan or, better, a cardiac stress MRI, just to confirm the heart muscle is all as it should be. I had both and the results were fine, thankfully.

I was told that in some people with flutter the reduced cardiac efficiency it can cause can make life difficult - hence, I suspect, my feeling so poorly when I had it.

Steve

[Jalia in reply to Ppiman]

I agree Steve. I have a very long history of AF and flutter and certainly found flutter hard to deal with as it was unrelenting

[Ppiman in reply to Jalia]

Hi Jalia. That was my doctor’s view, too. He said that flutter was the “best” to have in the sense that an ablation was almost always a cure, but that it was often far worse to have in terms of quality of life and symptoms. He also said it was difficult to treat other than by ablation - which is what I found.

Steve

[Hidden in reply to Ppiman]

I'm getting flutter, but only occasionally. I assume it's flutter as it's a very fast (guessing 180bpm), very light in feel and totally regular like a machine gun. It usually goes away after 10 minutes or sometimes I can get it to stop by holding my breath. It only occurs when I first lie down.

I was wondering whether an ablation would work as it's so occasional. Maybe I'd be best to wait and see if it develops further and starts to happen more often. But on the other hand, with NHS waiting lists, maybe best to get it sorted now?

I was just wondering, having been through it what would you do?

[Ppiman in reply to Hidden]

That might be tachycardia that you're noticing rather than atrial flutter (which can only be seen on a 12-lead ECG, I'm told).

As I understand it, flutter can't be "felt" as it's a rhythm that's only at the top of the heart and doesn't get transmitted into the pulse directly. It occurs in the upper right atrium which is "fluttering" instead of "beating" owing to an electrical conduction disturbance in the heart's nerve supply. This "flutter" is always at or around 300bpm (instead of the usual 72 or so).

I gather that the sino-atrial node receives these overly-fast signals from the atrium and tries to normalise them but can only do so in a fixed ratio of 1:2, 1:3, 1:4 and so on. Thus, when in flutter, a person's heart beat will be some ratio of 300, say, 100 (mine varied between 150, 105, 65 for example). In other words there is no slow increase or decrease, only a step-wise change in beat.

Steve

[Hidden in reply to Ppiman]

Many thanks for that.

My 180bpm was probably an underestimate, it's more like 4 beats per second, and they don't feel like beats. And when I say I can feel them, it has to be very quiet and I can only just notice them and they have no effect on me that I can detect, I feel fine.

Anyhow, after reading your and other posts think I'll book in to see my EP and get it checked out, soon as coronavirus has, hopefully, died down.

[Ppiman in reply to Hidden]

I think we're in for a long and difficult period with the Corona virus, financially and socially if not from a health perspective (depending on age, of course). Thank goodness it isn't affecting the young or I would be much more concerned than even I am.

I just wish this Tory government gave me more confidence. They say they are listening to "experts" but I suspect they are more attuned to top-end financiers than to the needs of folk like us.

Steve

[sandoval22 in reply to Ppiman]

My pulse seemed to always be 157 to 165 and it was more a chest discomfort than a noticeable fast pulse. Without an oximeter I would be ignorant of the speed of my pulse. Most times at hospital they said it was too fast to know what type of flutter it was.

[Hidden in reply to sandoval22]

Flutter typically shows itself as a kind of tachycardia.

The top chambers are going like the clappers about 300bpm

Depending on how much blocking your heart is doing you could have a HR of 150 BPM if you have 2:1 blocking or 300bpm with 1:1

2:1 is hard work over a period of time, my highest HR in AF was 240 BPM which was uncomfortable, 300 must be very scary

[cuore in reply to Ppiman]

Flutter can also occur in the left atrium -- peri-mitral atrial flutter.

In the right atrium -- cavo-tricuspid atrial flutter.

I have had ablations for both.

[Buffafly]

Based on the info above I have had one - raised troponin level, chest pain - but I was told the symptoms were caused by artery spasm as an angiogram didn't show a blockage. My ECG sometimes comes up with 'previous MI?' so seems there was a long lasting effect.

[Jalia in reply to Buffafly]

Buffafly, i too have seen ....? previous MI.on some of my ECG s. I'm told that this could be attributed to scars from previous ablations or even incorrect positioning of electrodes by operator!

[Buffafly in reply to Jalia]

I haven't taken too much notice as it is too late to worry now and as you say ECG results can be wrong.

[Hidden]

When I visited A+E with chest pains whilst in AF/AFl they carried out the Troponin test and my results came back raised too.

From my understanding this is an indication of stress in the heart which in my case was because my HR had been 195+ for several hours. There was no suggestion that I had had a heart attack of any kind, infact the consultant reassured me that I had not had one