Vagal AF, kind of. & metabolic acidosis connection

[Orbitolina]

Guys, I love you! Why were you so difficult to find?!

So basically, I've had most symptoms of vagal AF for quite a few years. Happens at night after an evening run: check. Sometimes at daytime in ultralazy afternoons preceded by a period of very low heartrate: check. After dinner: sometimes. A proper dose of adrenaline, or just jumping around helps: check. ECG in high adrenaline hospital setting normal: check. Male: ehm.. nope. Endurance athlete.. well, hear me out.

The odd thing is though: I can't say I actually notice an irregular heartbeat. Well, not during day anyway as I don't hear it. During night, sleeping with earplugs I hear something odd sometimes but I can't quite put my finger on it. Sometimes it feels like a disturbance in the two heartsounds. And if it's really bad I might wake up to utter silence: can't hear nor feel my heart. Obviously I'm getting closer to fainting. At that moment I feel my heart slowly become faster and clearer again. Which is the moment where I jump out of bed and jump around like crazy. Thus this all becomes more prominent the more I do endurance-type sport.

And there's a second trigger, and I can't figure out why. So I'm born with exercise intolerance that mainly manifests in the muscles. When I don't measure my exercise intensity carefully I might get a lactic acidosis. The only working theory left my doc has at the moment is some kind of mitochondrial myopathy. Well, this is often followed by a very long period of daily shortness of breath episodes that behave above, and nightly waking up, recovering quickly, falling asleep and experiencing the same right away again. It's very difficult to get my heart racing or to get a panic attack then (I wish, as I know I'll feel better quickly). I honestly have no idea why this happens, but it usually means weeks of very little sleep, and days where I only feel good as long as I stay active, which I shouldn't due to the recent acidosis. Btw, magnesium does help. yay, that's something.

So, I had quite a few useless ECGs which showed nothing as I wasn't relaxed then. But glad ECG and ultrasound were normal (well, I know they are). I had a sleep study this week, which was useless as well as i could not sleep in a relaxed manner with all this stuff. Now I'm waiting to get a holter monitor for two days. Maybe that one will pick something up.

so, welcoming any comments on any of the things I mentioned.

[Hidden]

48 hour and 7 day Holter monitors are often normal. KARDIA one lead monitors are useful if you are aware of palpitations and the run is long enough to be captured on the device and phone/tablet.

In your situation, an implantable loop monitor may be necessary. These are typically left in place for up to 3 years.

[Orbitolina in reply to Hidden]

Yeah, probably. I've not discussed this with my doctor yet, but I literally move to a different country every 1-2 years. And it's time to move again soon. I'm not in the UK anymore, thus no idea what was possible there. Here, I'm glad I convinced the doc to do 48hrs due to the sleep study debacle. Maybe a day of getting used to it is sufficient to catch something.

At the moment I'm trying to figure out if anything unusual happens before I wake up with this massive shortness of breath and the odd heart rhythm. I know I just keep on breathing normally before I wake up from filming myself. No snoring, breathing doesn't stop, nothing. So now I'm trying to run my running HR sensor over night. Though of course every time I ran it before nothing happened and hence the thing didn't record anything. I want to know whether my hr drops before I wake up with shortness of breath, similar to what happens at daytime. Not sure what to do with that to be honest, but hey.. it's something I can do

😛 and if this prevents me from having these attacks then it's worth it.

🤣

[CDreamer in reply to Orbitolina]

Can you measure your HR O2 sats overnight? Apple Watch will do both.

[CDreamer]

Quite a cluster of seemingly unrelated symptoms but as I believe that everything is linked to everything else, keep on seeking answers. It’s really difficult to get anywhere in modern medicine because everything seems to be so specialised - you get a referral - test come back negative and back to square one.

Have you been tested for adrenaline insufficiency? Have you been referred to Endocrinologist? It’s really hard to get a diagnosis and if I were you, I would request referral to a specialist in Endocrine/Autonomic dysfunctions and/or specialist dsyautomnia cardiologist - someone experienced in connecting the dots.

Mitrochondria is a possibility in which case look at nutritional/ecological medicine. Before I was first diagnosed I suspected Mitrochondria and learned a lot about from Dr Sara Myhill’s book - It’s Mitrochondria, not Hyperchondria - quite a lot of information on her webpage drmyhill.co.uk/

I have autoimmune with autonomic dysfunction and spent many years trying to get to the bottom of various seemingly unrelated symptoms which include AF. no-one has still not connected all of the dots, I was eventually diagnosed with Myasthenia gravis - there are other types of Myasthenia antibodies which manifest in young women - which explained the exercise intolerance and muscle weakness and I get lacto acidosis just holding my mobile phone for more than 2 mins - ridiculous! Also have PoTS with low BP - autonomic dysfunction and AF which explained slow/fast HR triggering AF and syncope and pre-syncope, fatigue and breathlessness. I’m also hyper mobile which goes a long way to explain the low BP suggesting mild elhas-Danlos Syndrone.

Whereas you seem to need to induce adrenaline, I’m the opposite and need to curtail adrenaline and need to be really careful with any med containing adrenaline.

Most of my symptoms are mostly controlled with medication, rather a lot unfortunately and pacemaker but I am experiencing exacerbation of Myasthenia after about 5 years of being fairly well controlled and stable, Just developed a whole new set of symptoms which are currently being investigated.

I find I need to be really careful to pace myself and never over exert myself - the most difficult lesson of my life as I’ve always been full on or full stop sort of person. Keep very well hydrated and consume at least 6g of salt daily and avoid all oral forms of Magnesium supplements as it exacerbates the muscle weakness.

I’m not saying you have any of the things I have, indeed I sincerely hope you don’t, but do hope it may give you a few pointers to do some further research and hopefully finally answers and treatment.

[Orbitolina in reply to CDreamer]

Hi CDreamer,

thanks a lot for your thorough answer. I have no idea what's going on and what the connection is. My guess is that an acidosis causes an imbalance of electrolytes, and too much of this or too little of that can cause afib. I know that magnesium helps to a certain extend, and I am getting better slowly. But outside of this I'm still sensitive to something that causes these problems after exercising. If things get too bad at the moment then I use an asthma inhaler as it contains adrenaline.

Mito is not something that a naturalist can treat but a rather serious, rare disease. It's related to how the body accesses energy. There are people who don't have access to energy from gycogen (you run out of quickly accessible energy quickly), or from fatty acids (that's bad as fat ends up in the blood stream and clogs blood vessels instead of being used for energy), and people whose muscles don't take up enough oxygen and thus movement is largely anaerobic - which creates lactic acid. My doctor thinks I might have this type as I have high lactic acid levels after very minor movement. Many children born with this don't make it to adulthood, thus I guess I'm lucky if this is it.

Yes, all the adrenal things, addisons, acth, aldosterone, etc were stimulated and tested. No related tumor either. But at least my doctor is not giving up. One more test and then he'll refer me to an academic expertise center.

[CDreamer in reply to Orbitolina]

Good idea to refer you to an academic expertise centre. Where in the world are you now living? I note you were in Scotland.

[Orbitolina in reply to CDreamer]

Now in western continental Europe