Engine "hunts at idle"

[PlanetaryKim]

This is an auto mechanic's term that I know because my brother is an auto mechanic. But it feels like what my heart is doing lately. It's not the wildly erratic and uncountable rhythm of Afib (which I have also experienced and been diagnosed with). But listening to my heart with a stethoscope, I hear and can count a fast run (100 bpm), then it drops down to slow in an instant (60 bpm or lower), then back up to fast in an instant. Holding each of these positions for a few seconds. I have shortness of breath when this happens. The rhythm is more or less steady at each of its rates. It just can't settle on what rate to run at.

I am currently using the Pill-in-the-Pocket approach (metroprolol & small amount of digoxin) when these episodes occur. This is the second episode this month so far. So happening once every couple of weeks.

Just wondered if others experience this sort of "rhythmic" arrhythmia. (lol!)

Also, I think my AF is Vagal AF. I think this because it seems to be affected by my position. Bending down to weed can definitely trigger irregularity, as can large meals, sitting in recliner... All things that may put pressure on vagus nerve.

My cardiologist just wants to prescribe pills and not have any discussion or answer any questions or explore possible underlying causes that could maybe be addressed. He just says "I'm not going to argue with you" when I ask questions.

Should I try to see an electrophysiologist for a 2nd opinion? I have heard they are more focused on finding precise cause of the AF, or identifying what type of AF it is, or whether there are other rhythm irregularities co-existing with the AF.

Thanks all!

kim

[BobD Volunteer]

Yes see an EP as your cardiologist does not sound too helpful. Re your "hunting", I do hope you haven't fitted long duration cams.

[PlanetaryKim in reply to BobD]

hahaha! about the cams.

[momist]

Well, I would definitely go to your GP and ask to be referred to an EP. Do a little research first, to learn about your nearest specialist heart centre and the EPs available there. You are entitled to ask to go 'out of area' and see a specialist in one of those centres.

It also sounds as if you would benefit from your own personal ECG device. I would suggest the Kardia, Apple watch or Withings MoveECG. These all work through your smart phone or tablet and give you a two lead or more trace of your heart's activity which you can learn to read and understand. Arming yourself with that knowledge will somewhat short circuit some of the hoops you will need otherwise to jump through.

[PlanetaryKim in reply to momist]

Thank you very much for this suggestion of a device. I would like such a device. From everything I am reading the Kardia 6L is the best, and some people are emailing the results directly to their EP, who finds it useful. My problem is I don't own a cell phone, and don't want to start. (I am anti-wireless radiation and have no such devices in my life or home.)

But I would like to be able to record my own ECG and learn how to interpret. I am hoping Kardia 6L can communicate with a tablet. i would be willing to get a tablet for this sole purpose.

[momist in reply to PlanetaryKim]

Yes, a tablet with wifi only (no cell connection) will work perfectly well with a Kardia.

Proviso's: It must be an Android device (or Apple iPad) and have Bluetooth for the Kardia. Most modern versions and many old ones will work well. For instance, I have an old Tesco Hudl2 tablet which works fine with the older two lead Kardia. In fact if you are in the UK, I could sell you that for the cost of the postage and insurance. Postage to the US I wouldn't want to mess around with. Such a tablet would only need to be turned on for long enough to take the recordings, but if you want to save them and show them to anyone you will need a WiFi connection and a cloud service to save them to. I put mine in my Dropbox account, but the Google cloud or any other would do the same. If you buy a new iPad, Apple will provide the cloud service I think. The cheapest option would be Android though.

Message me privately if you need more information.

[PlanetaryKim in reply to momist]

Thank you very much for this explanation! I may message you later once I have done enough research to even know what I am considering buying. I am in Canada. And would like to buy the 6-lead Kardia.

Will message you.

[momist in reply to PlanetaryKim]

BTW, as well as the two lead Kardia which I no longer use, I have the Withings MoveECG which is a nice looking watch you wear on your wrist and it counts your steps as an exercise tracker. This also need an Android device to communicate to and display the ECG on, and needs the same things as the Kardia. I prefer it for convenience and appearance, and is does what the two lead Kardia does. The claimed one year battery life is false, they tend to need a new battery every few months.

[PlanetaryKim in reply to momist]

I wonder if either/any of these devices can sync with my desktop iMac via bluetooth? If so, then maybe that's all I need.

[momist in reply to PlanetaryKim]

You might have to ask the manufacturers about that. As far as I know, the iMac couldn't run any of the apps available for them, as they are aimed at the phone/tablet market.

[Buffafly]

Mine does that, diagnosed by my EP as ‘signs of tachybrady syndrome’. I am 75 so fair enough, my sinus node is wearing out a bit. However you should not jump to the conclusion that this applies to you. It may just be your AF trying to break through. Definitely see an EP, preferably privately if you can afford it and pick the person carefully, because EPs can be equally dominating 🙄 💜

[PlanetaryKim in reply to Buffafly]

Thanks for this advice!

[marcyh]

Diagnosed with AF in the past year and a half, I relate. My heart rate (HR) jumps to 150 or more in clusters . I am incapacitated by my shortness of breath and must lie down until I convert. I am on propafenone (2 at onset and 3rd in an hour) as a PIP. I'm back to sinus rhythm after 2-3 hours.

I have an oximeter (clips on your forefinger) which I've found very useful in quickly checking my HR as well as rhythm pattern. No wifi needed, check your local pharmacy.

I have recently had a consult with an EP which may you may be able to access. I will PM you.

marcyh

[PlanetaryKim in reply to marcyh]

Hi Marcy. Thanks for info. I have the pulse oximeter. In past I have found it to NOT be accurate on heart rate during afib. And I mean ALL fingertip pulse oximeters. I have twice laid in ER bed with ECG electrodes on my chest showing heart rate of 120-160 bpm, while pulse oximeter on fingertip just registered 70-80 bpm at same time. But that is in full-on Afib. I suspect with this current situation of a regular rhythm but ever-shifting rate, the pulse oximeter is probably pretty accurate!

Thanks for your PM with name of EP. I may try him!

[marcyh]

That's interesting, thanks. I've suspected that mine isn't always accurate but it's better than my BP machine! Which is supposed to be a model that registers AF. I haven't thought that I need to confirm with Kardio if I'm in AF because it's very apparent. So I haven't invested in it. I could be missing some brief episodes but I'm not sure I always want to know. I'm open to advice, however.

[PlanetaryKim in reply to marcyh]

I would like to get a Kardia machine in my case because I have a variety of different heart irregularities happening, from atrial flutter and afib, to this (possibly) "tachybrady syndrome" that may be the thing I am currently experiencing of ever-shifting rate, and also PVC's which are quite distinct and also leave me short of breath. And since I am just doing PIP approach without support of doctor for that (he wants me on daily pills), and no cardiologist I can have a productive conversation with... I feel I have to "self doctor" more than ever. I am always self doctoring (researching like crazy and making my own medical decisions rather than obediently doing as told). But I like to have a specialist who will help me sort things out. And right now I don't for cardiac matters.

I am not even sure the metoprolol is best drug for the PIP approach. It doesn't seem to convert the arrhythmia. And it does make me even more short of breath and exhausted than I would be without it. And also depresses me psychologically (because it suppresses dopamine).

So I feel I am operating with a large information deficit about what specifically is happening with my heart. And I think the Kardia would help correct that.

[marcyh in reply to PlanetaryKim]

You definitely have valid concerns about the metroprolol - and other important issues. I hope Kardia gives you the clues you're looking for. I'm curious as to how it goes. An EP may be the next option. Mine changed my PIP, took me off propafenone and started me on sotolol (which didn't work so I'm back on prop). After my appointment he gave me the number of his AF clinic as my first contact from then on. That has also been another way for me to get answers to my questions. So that could be a good option for you as well.

[Magson]

My view is that Cardiologists are plumbers and EPs are electricians. AF is an electrical problem. Cardiologists will diagnose and prescribe medication. Taking pills everyday works for a lot of patients but not everyone. There are all sorts of side effects involved. Go and see an EP. It worked for me.

[PlanetaryKim in reply to Magson]

Thank you very much for that analogy. It helps me see what I need to do at this point.