Is AF a cause or effect: I have posted a... - AF Association

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Is AF a cause or effect

ian16527 profile image

I have posted a while ago about my AF. Sorry for the long post but I bottle it up.

I dont get many episodes, one on Monday at 1am lasting 7 hours - 2 x flecainide straight away, but it never subsided until 7am, an hour after taking 5mg of bisoprolol ( I usually take 2.5mg). Previous to this, last August 2020 and before that in March 2020.

I now have pains in the chest, neck and upper back. Feel knackered basically.

This started 11 years ago with a ache in my sternum with ectopics, a modified ECG with something under the midline so my GP sent me to CCU. They said I had chrostocondritus (sp)and kicked me out then in 2012 had my first AF attack.

So I wonder if the AF is an effect of the chest inflammation or the other way around. In the last few years if i pull, carry or do any slight straining of my upper torso, then I feel rough, sweaty and sometimes go pale. No pain though. I think this may be a vasovagal type thing.

But if i do this I have a fair chance of an AF attack within 4 to 8 hours, and then after this subsides I get the chest pain, and sweats if I do even a little bit of physically activity. This can last for months, gradually reducing to a background level. I also have fatigue with it.

The funny thing is, I can walk for miles, up and down hills with the dog, and no side effects. If I stress my chest muscles in any way, then I feel weak and rough.

So is it a cause of my symptom's or and effect of something else. Anyone suffer the same type of thing. I am 56 but was 47 when this started.

Not sure where to turn to now as its affecting my normal life quite a bit. I feel a downward trend in myself and a bit depressed.

41 Replies
BobD profile image

Any inflamation can aid AF starting.

My first hospitalisation some thirty years ago came after I had tried to pull 160 ft lbs torque on a machine I was rebuilding and strained all my intercostal muscles. Pain sarted at 3 am and thought heart attack but nothing found. Over the next 14 or so years had a few funny turns wongly diagnosed until 2004 when AF finally flagged up. Coincidence? maybe.

ian16527 profile image
ian16527 in reply to BobD

Thanks Bob, its certainly connected, just not sure which way round.Doctors just look at me if I am not a full shilling when I try to explain it.

Ducky2003 profile image
Ducky2003 in reply to BobD

Now that's interesting. I had Achilles tendonitis and was on crutches at the time my AF decided to introduce itself, so , with the inflammation idea, I put it possibly down to the Achilles. However, I did have a bout of costochondritis a couple of months before (Deputy manager in a charity shop dragging donation bags in and out of a deep storage pen) but never connected the AF with that. Now I'm wondering 🤔.

The association of Achilles tendonitis , costo and afib rings loud alarm bells to me . Is it possible that in the months prior to these problems kicking off you were treated with a Fluoroquinolone antibiotic for some minor infection?. Achilles tendonitis can occur months after exposure as FQs are known to have delayed effects.

Nope, no antibiotics of any kind. I had the costochondritis flare up about 4 months prior to the Achilles and it settled after about a month with painkillers and lighter duties. The Achilles then flared up about 3 months after the costo settled but that improved after rest and wearing footwear with a bit of a heel or heel cups rather than being in completely flat shoes all day.

Hello Ian, how long is it since you have seen a specialist. If you have been coping reasonable well up until recently, then maybe now is the time to seek professional guidance to determine the best route forward for you. We know that AF is generally a progressive condition so given your age and worsening symptoms it would make sense to seek an appointment to see an EP. Under the current climate, this may be difficult so for peace of mind, perhaps if possible, a private appointment might be worth considering. Of course there may be non AF related problems causing your symptoms so try talking to your GP, maybe have some blood tests but I expect you will have bang the table (politely) to get things moving.......

ian16527 profile image
ian16527 in reply to FlapJack

Thanks FlapJack for your reply. Yes, usually the blood tests come back fine, although after an AF attack the has been some inflammation from the heart muscle. The echos were fine too, although its 3 years since the last one.

Last time I saw someone was about 2 years ago, so think its time for another visit. I offered to pay privately to see someone, but the GP wasnt sure who to refer me to. My last Cardio wasnt the best, but I would have to go out of area for a 2nd opinion, which my GP was willing to do.

Its a bit soul destrying when your doctor admits he hasnt a clue.😒

I have even asked my Gastro Consultant for her opinion. I think we all leave things if its not causing to much problem, but it is now becoming an issue and affecting me alot more.

I now have stopped doing manual things as everything seems to be a massive task. I would like a second opinion, but getting an appointment is going to be difficult in the near future.

I am going to sell my caravan, as this attack was when we were away and I was unsure if I would get home or have to go to A&E. It seems to much work now to move it about and my wife thinks its a trigger.😢

Hylda2 profile image
Hylda2 in reply to ian16527

You’ll have to get a motorhome. Flapjack has one and so do I ! 🙄

ian16527 profile image
ian16527 in reply to Hylda2

Yes thats the next step when I retire, but prices are shocking at the moment. Theres alot of work with a caravan, more than a MH

Jetcat profile image
Jetcat in reply to ian16527

Hi Ian. Motor homes are doing stupid money at me moment, Iv seen prices go silly this last 12 months probably because of the situation we’ve been in.? It’s a lot cheaper to buy a van and convert it yourself if your able.

Do you have a mover? At least you have a car on site xx

ian16527 profile image
ian16527 in reply to Hylda2

Yes I have a mover, I couldnt shift it without it,

Thats the problem mainly, any physical exercise in the upper torso is a trigger, so even fetching water puts strain on me.

Theres always the car compromise, but it will have to be a smallish MH.

Incidentally I used to work in the R&D department of on of the UK Caravan/MH makers designing a couple of their models and camper vans

Hylda2 profile image
Hylda2 in reply to ian16527

Sounds brilliant. Hate to admit it but we have a Hymer

ian16527 profile image
ian16527 in reply to Hylda2

I worked for their subsidiary. - who were Victorian in their attitude to employees, hence why I didnt stay. Hymer have a good reputation but didnt exert much pressure on their UK operation at the time

But I did have Bupa then so should have used it to try to get sorted privately but never did at the time.

FlapJack profile image
FlapJack in reply to ian16527

I’m saying nuffin other than I’ve got a clapped out Autocruise called, would you believe, FlapJack 😂. Take it easy Ian, make sure you get the help and support you need, far too young to feel like my FlapJack!!!

Just had a great idea, all 3 of us should meet up and visit BobD , it would make his day 😤😤😤😤😤

BobD profile image
BobDVolunteer in reply to FlapJack

I doubt you would get up my drive but welcome to try. Hppe you are good at reversing as you won't turn round at the top!

Jetcat profile image
Jetcat in reply to FlapJack

I’d visit Bob anytime.😂 he always replies with good answers to any questions asked.👍👍

Hylda2 profile image
Hylda2 in reply to ian16527

Was that Travelworld where we bought both our vans

It's a good question, ian and the answer is probably circular - chicken and egg problem. Inflammation anywhere in the body is likely to trigger AF but we need to be susceptible to AF in the first place, so it might appear that the dormant AF is there first.

Don't be too hard on your GP for not having a clue - AF and its vagaries are specialist areas and sometimes - as you say - even cardiologists are not quite up to the task. Do your homework and find the most up to date EP that you can - perhaps members on this forum can help. Dr Sanjay Gupta in York springs to my mind as someone who has investigated many aspects of AF and is highly thought of.

I agree with Flapjack regarding a private appointment to get the ball rolling. Best wishes.

Thanks for all your replies

I had a terrific pain in my chest after going to a keep fit class for a few weeks. The doctor told me it was costochondritus. Not long after l went into a.f. and a week later had a stroke. One of my friends went to hospital with the same pain. She thought she was having a heart attack but was told it was costochondritus. Not long after she had a mini stroke. Coincidence, maybe.

I know issues with your back will cause heart issues. The brain needs to talk to the heart somehow and it is not telepathic. If you can find a competent chiropractor who knows this, you might find something that helps.

Hey Ian, I feel for you in the situation you’re caught in - how easy it is just to leave things that don’t seem critical or aren’t easily identified until somehow you feel absolutely rotten both physically in your spirits. It’s a path I’ve been on and am on myself.

Great advice from everyone. I’d agree one of the problems is knowing who to see (even privately) and I personally would agree with Finvola that a telephone consult with Dr Sanjay Gupta could be a good first consult, as he has such a great holistic view of our bodies and health. That’s what I did and honestly he’s worth his weight in gold! :) He may even be able to recommend what/who to ask to be referred to, including an EP.

Definitely make sure you have all your history (however weird or disconnected it may sound) for him (or whoever you decide on) and have your questions ready.

I would totally agree with EngMac about the benefits of finding a good chiropractor/osteopath. Mine treats my horrendous chest/upper back pain and also works brilliantly on all areas of the vagal nerve and its effects (neck, migraines, digestion, AF, Ectopics, diaphragm, high blood pressure etc etc.) If you live near enough to get to an appointment in North London or Essex I’d gladly recommend him to you, he’s amazing :) Jx

Definitely agree you should see a specialist. Since there are some interlinking issues here I'd say Dr Sanjay Gupta is a good idea. Don't know why I never did it myself but recently took the ablation route. The response to lifting - sweating, feeling rough and going pale is something to look into. Are you on anticoagulants? Maybe after Dr Gupta and depending on what he advises, you should see an EP. Keep us posted.

momist profile image
momist in reply to Singwell

+1 for Dr Sanjay Gupta!

Regarding referral, don't be too worried about going 'out of area'. It's officially permitted. There are lists of EPs, and centres of excellence, somewhere on this site.

Singwell profile image
Singwell in reply to momist

True, if you're in England! Sadly, not in Wales. The funding works differently and my GP refused point blank to refer me to anywhere that wasn't directly funded. I struck lucky that Hereford cardiology has no EP so their visiting one is QEH Birmingham - centre of excellence!

ian16527 profile image
ian16527 in reply to Singwell

I cant afford to go private for investigation, but I could pay for an initial consultation.

Not on anticoagulants, as I only score 1 ( or did) on the CHADS... score for HBP treatment, although that's well under control at around 128/85 ish normally. I think this will go up when I turn 60

Its effect, or at least I believe its effect in more cases that not. The problem is getting to the root cause of what it is. Electrolytes are a good start, nervous system another or any of the many hundreds of transducers in your body the will effect your heart. Unfortunately there is no easy answer and finding one is not plain sailing as your body reacts to fix itself and this can manifest in false or misleading outcomes.

You could be right as in my case I do believe that my AF is triggered by inflammation in the chest area. I have a hiatus hernia and suffer from acid reflux in the oesophagus. For this I take Omeprozole which I don't like taking as they are only supposed to be used on a short term basis. However every time I try to stop taking the Omeprozole and the pain or discomfort in my oesophagus returns, I begin to have AF episodes...I have kept a diary for months as a form of proof to myself.So, although I am not too happy about the long-term use of the Omeprozole, it is the lesser of two evils!

ian16527 profile image
ian16527 in reply to rothwell

Funnily enough, my GP did try that treatment in 2018 in case it was gastric orientated. I was complaining about ectopics as these were on a lot. At the minute not so much though.

Another factor is I have Crohns Disease, which is another inflammatory disease which coincidentally is no problem when the chest problem is flaring. When the chest dies down, the CD comes back a bit.

I also had major surgery for this 35 years ago, and they inserted a central line in ITU, which went too far into my heart. This caused it to go into VFib when they moved my arm. They pulled it back out a bit to stop this.

I feel this could have caused some scar tissue in my heart as I have had ectopics for quite a while afterwards, on and off since then.

This theory was also discounted by the Cardiologist.

Do you need a GP referral for Dr Gupta?

AussieHeart profile image
AussieHeart in reply to rothwell

You have to wean yourself off PPIs to avoid rebound reflux. I hope you can access this link: ... I suffer with erosive gastritis and every two years go on PPIs for 2 months to heal it and spend about another 3-4 months to get off it! But it’s worth it.

Interesting. My first attack came when looking after my 98 yo Mum. ILL equipped and under stress as she wouldnt settle. I remember lifting a rocking chair hoping she would sit still for a few minutes. Chair was heavy and wide. Liffting by the arms put strain on my open arms and chest. Bingo . Afib started. Cause or effect?

ian16527 profile image
ian16527 in reply to Tryfan

I used to experience ectopics when carrying something, for example a cardboard box for a while. Now I try not to pull or sling things about. The AF attack last March was caused by trying to heave some wire mesh buried in some weeds in my allotment.

I suffer from cartilage degeneration in my ribs which results in both costochondritis and pain in the side of the ribcage. This started before the afib . Sometimes the pain in the chest brings on the sweaty unwell feeling but I have decided that this is being caused by anxiety about the chest pain. Though I know I have costo and have had it on and off for more than 20years ( and am still here !) it's like a little voice whispers " suppose this time it's something worse". What I do know is that both the costo and the afib started after exposure to Cipro. I have to be careful about carrying heavy stuff. Full watering cans are a no no. Bending over can be problematic too .

ian16527 profile image
ian16527 in reply to Auriculaire

Mine experience seems similar to your own, but costo was ruled out as there is no pain when pressed. I am experiencing pain down my neck/upper back.sternum now.

The sweats are certainly not anxiety in my case, they happen with any slight physical work, and yes, bending down seems to be bad as well. Putting some flowers in the garden was a chore yesterday

I get out of bed and feel worse than when I got into it, at the moment.

I think the 'whispers' are always there too. I feel frustrated more than anything

I feel your pain...pun intended.Having Drs not finding reasons for it is frustrating and demoralizing.

I woke up one morning with a painful shoulder. It only got worse...lasted for 2 .5 got better, but the other shoulder suffered from overcompensating. In total, I was out of action for 5 years. And considering, like yourself, I am a very active guy who uses the upper body for everyday tasks, clearing brush, snow removal...#Canadian winters, and stacking firewood etc. I couldn't even pull start my chainsaw, mower, etc. I.was.bummed. Specialists, surgeons, MRI's, x-rays, CT scans..nadda, zip. Basically, the verdict was..."so sorry sir, we'd love to fix you, but we can't see what is causing it. What I DID learn, is that the rotator cuff, is an incredibly complex group of muscles, tendons and ligaments.

Anyway, after 5 years of being Idle, They slowly...oh so slowly healed.

My PAF had no relation, but would be disconcerting if it did.

Keep searching.

This is the way I see it - I'm no medical expert but it just feels convincing to me. My heart has become more sensitive over the recent past. Don't exactly know why. If I do something which triggers it then it's very possible Afib might rear its head. Like a few other posters lifting stuff or engaging the chest muscles can be problematic. I once did an exercise in the gym where you bring your forearms together across the chest with weight resistance. The weights were far too heavy for me and that triggered an episode. My heart doesn't like being squeezed.Any gastric problems are also trouble. I have a small hiatus hernia so can get acid reflux. I eat small meals and nothing after about 6.30. Again I think it's the squeezing thing. If I lie down with much in my stomach area it is very likely to have an impact on my heart.

Your experience sounds very similar to mine. Thoracic pressure was my trigger. I dealt with AF events that got progressively more frequent over about 5 years. I had “pill in the pocket” treatment over that time but AF events went from once every couple months to once a week. The condition is in fact progressive. I got fed up with the anxiety and feeling poorly from the medication and finally decided on an ablation. That was 5 weeks ago. After a couple weeks recovery, I’m now back to full exercise and hard physical work. My experience was filled with questions similar to yours—but I eventually came to realize that I developed “alternate circuitry” in my heart (whether from genetics, sleep apnea, too much alcohol, high blood pressure, or whatever). I needed an electro cardiologist to fix it. I was done with self diagnosis and medicine that made me sick. I had the PVI and it’s fixed.

Btw, I knew thoracic pressure was my trigger—to the point where I practiced exhaling every time I pushed myself out of a chair or stressed my upper body, just to avoid triggering. It seamed to work, but the anxiety isn’t worth it. The thoracic pressure was activating the weird circuitry in my pulmonary veins, leading to AF. The ablation isolated all the bad electrical signals and now I’m good. Hope things work out for you Ian. All the best.

ian16527 profile image
ian16527 in reply to seasicksurf

Thanks for your reply, sounds just like me. I have asked my GP's to refer me, even offered to pay privately for a consult, but I loose stamina and when the symptoms die down, I leave it and try an get on with life.

Its hard enough to get an appointment in normal times but have put off going with COVID about. I think when the Gp's see you with the same complaint time and time again, I feel they think you are imagining it all.

At the recommendation of my cardiologist, I bought a "Kardia" ecg device after my ablation (about $100 on line). With this device you can record your ecg directly to your smart phone. Might be worth it for you to have a recording(s) of your heart activity (when in AF) for when you see your doc.

Well, just had the 2nd attack in a week, one last Wednesday at 3pm lasting till 1am, and last night at 10pm finishing at 12am. Both times taking 2x Flec, but a lot shorter episode last night.As usual, the after effects are sore sternum/upper back which aches but hurts when moving about.

Not sure what yesterdays trigger was, but last week was probably digging 3 small holes in the garden.

Got a GP tel appointment last week so off for bloods and ecg again on Wednesday, but I complained about the fatigue and sweats more than the AF.

Has anyone got these symptoms when not in AF? I know we are all different but any information helps.


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