Trebuie anticoagulant

[Pearipile-55]

Hi! after a 24-hour holter, thousands of ventricular extrasystoles were detected. Because they are symptomatic (I have strong palpitations at night) I was prescribed beta-blockers and ACE inhibitors. Do I also need anticoagulants? I have a pacemaker, I had bradycardia, my heart is healthy, the mitral valve does not close well, that's all. I forgot to ask the doctor.

[CDreamer]

It is a discussion for you and your doctors and indicated or not by 2 scoring systems known as CHADS and HASBLED. CHADS is a calculation to assess your risk of stroke caused by AF. HASBLED is a score of if you are on anticoagulants - how likely are you to have a bleed. The 2 risk factors need to be balanced.

Link to a Patient Fact Sheet with good explanations as to the factors that go into deciding:-

heartrhythmalliance.org/res...

A score of 2 or more would strongly indicate anticoagulants. 0-2 it is an option to be considered and often personal preference.

See what your score comes out at and then go and discuss with your doctor. Where in the world are you living?

[Pearipile-55 in reply to CDreamer]

Thanks for the answer, I live in Romania, I don't like it but that's it! I did the scoring and it is 2: woman and over 65 years old..

[Hidden in reply to Pearipile-55]

Just in case you are wondering, I believe the additional point for being a female is linked to a change in hormones after the menopause. I don’t know the details, being a bloke, I was afraid to ask......😉

[Buffafly in reply to Hidden]

I wonder if that is why/because microvascular angina/coronary artery spasm tends to occur in ‘women of a certain age’ (how it was coyly put to me 🙄)

[Hidden in reply to Buffafly]

Pass.....😉

[Auriculaire in reply to Pearipile-55]

The European Society of Cardiologists latest guidelines recommend that if the two points are for being over 65 and female sex ie no comorbities anticoagulation is optional. Often different doctors have different approaches. My own cardiologist said I did not need an anticoagulant after having being prescribed one by the hospital cardiologist - I went into afib after major surgery. I stopped taking it. A year later I had a mild TIA putting up my CHADSVASC score to 3. Back to the anticoagulant immediately. The TIA was 6 months after my last afib attack.

[Hidden]

Ați avut înregistrări ECG care confirmă fibrilația atrială în trecut?

[Pearipile-55 in reply to Hidden]

only once on the ekg was flutter seen, which was paroxysmal. Fibrillation was not confirmed, but I told the doctor that I had fibrillation because I thought so, in fact it turned out to be ectopic in several forms.

[Hidden in reply to Pearipile-55]

So no confirmation of atrial fibrillation, but one run of atrial flutter documented on ECG.

Do you have sick sinus syndrome? [sindromul sinusal bolnav]

[Pearipile-55 in reply to Hidden]

the doctor didn't find the sick sinus syndrome, but anyway I have an implanted pacemaker that would solve this problem, right?.

[Hidden in reply to Pearipile-55]

Well that would depend on why the pacemaker (PM) was put in, and how it is programmed. If it was for bradycardia, and atrial flutter has been documented, that could be sick sinus syndrome (SSS).

If so, it then would follow that you may have episodes of tachycardia including atrial fibrillation and/or flutter, of which you are unaware, for example at night. And if yes to that, then anticoagulants would definitely be considered along with anti-dysrrhythmic treatment.

Since you have recently had an holter monitor, I imagine your PM can not transmit data. An implantable 3 year loop monitor would resolve this.

I note you asked much the same question 12 months ago in another place. Have you seen an electrophysiologist (EP) at some stage?

[Pearipile-55 in reply to Hidden]

Thank you for the answer, indeed PM was asked for bradycardia, I had episodes of tachycardia but I think it was drug-induced. of anticoagulant for fibrillation, now I ask for extrasystoles, I felt fibrillation but it was not confirmed on ekg. Do you think it may be Sick Sinus Syndrome?.

[Hidden in reply to Pearipile-55]

SSS is also known as brady tachy syndrome which describes it’s features of bradycardia and tachycardia. I have read that the underlying sinoatrial (SA) disease can be associated with atrioventricular node (AV) dysfunction, leading to ventricular tachydysrrhythmias.

I don’t know whether AV node dysfunction is associated with ventricular extrasystoles(VE)

In final summary, in your position, I would consult an EP for an opinion about the possibility of SSS, a link to AV node disease and VEs.

And most importantly, my need for anticoagulants.

[Pearipile-55 in reply to Hidden]

thank you once again, I wish you all the best and health.

[Diver2 in reply to Pearipile-55]

Only if the sick sinus syncope results in slow heartbeat. Before or after the heart stops

[Diver2]

Since your valve does not close properly.... that is a structural problem .... you should check with your cardiologist.

[Pearipile-55]

opinions do not coincide, one doctor says that anticoagulant is needed, another says that is not the case ......