Random sternum chest pain and hoarseness after converting

[BobsBeat]

Hello All,

I was in an AFib event lasting 8 days early May. On the 3rd day I was given EKG and put on Eliquis and 50mg Metoprolol by my Primary. My HR was erratic and averaged 126 on EKG prior to medication. After medication it was averaging 115 at rest and lower at night sleeping (probably 80-110). Any activity and it would spike to 150 - 180 (walking dog, gym not knowing about Afib, etc.). On the 7th day I went to the ER because I thought my rate should be lower. Within two days I converted to NSR chemically(took 24hrs to convert) and got discharged.

Once I got out of Afib I started to notice a hoarseness/scratchy throat and random chest pain, mostly in sternum area. The symptoms are hard to replicate but I'm pretty sure it's NOT Coronary Artery related. My stress test after the hospital was normal and during the hospital my Echo, EKG (after conversion), Cardio Blood Work, Xray were normal.

I'm concerned I may have caused some heart damage during the week of AFIB. I read today that an enlarged left atria can press into the esophagous, which may cause these symptoms. I asked my cardiologist today about that and he reviewed the Echo and other tests again and said they were normal (not enlarged). I'm going to request these files so I have more information on hand. The Echo was done while I was still in Afib.

The cardiologist today is taking me off of Amiodarone and Eliquis as I've been in NSR, in case they play a role.

If anyone has any thoughts I'd appreciate it as well as further testing that may be helpful. It has been very nerve wracking thinking I may have done damage when I didn't even know what Afib was, let alone how to treat it, who to see, HR concerns, etc.

Thanks for reading!

Bob

58yo male, no other cardiac issues, recently lost 20lbs another 10+ to go.

[BobD Volunteer]

I very much doubt that a week or so of AF would cause any measurable damage. OK if a person is in permanent uncontrolled AF then some enlargement of the left atrium may occur but only over time. Try to avoid Dr Google as that way madness lies.

As a first guess I would suggest the amiodarone a more likely cause of any chest problems as it is such a toxic drug and can affect some people quite badly.

Be assured that your tests all came back normal and AF won't kill you. Go easy on any exercise (you must be able to walk and talk at the same time). stay well hydrated and keep up the wieght loss. A BMI of less than 26 is a good aiming point.

[BobsBeat in reply to BobD]

Thank you for the reply Bob. I really appreciate it. I'm currently focusing on getting in front of a top EP at MGH in Boston for long term management, but looks like that's a few weeks out.

I also was just reading about an interesting connection between Vagus nerve and Esophagous and Left Atria being so close that it can cause throat and chest pain if irritated. Interesting video by Dr Gupta on this.

[etheral]

Hi, I would be concerned about stopping the Eliquis, since your risk of stroke is still approximately 5x normal even if you are not currently in afib. As Bob said, Amioderone is a dangerous drug with a list of unwanted effects too numerous to get into now. Ask your consultant at Mass Gen about dofetilide ( Tikosyn) as it has worked well for me. Best of luck, your neighbor to the north, etheral....

[BobsBeat in reply to etheral]

Thank you etheral. I will check out Tikosyn as an alternative AAD. My current cardiologist won't give another AAD yet, even as pill in a pocket, because the Amiodarone will probably be in my system for another month or two. I believe Tikosyn may also require a hospital stay to test and administer.

Regarding the Eliquis, he took me off of that because my ChadVasc score is 0, and I could get cardioverted within 24hrs without it but I am concerned about it. I will definitely bring it up to the MGH EP in a couple weeks.

[Knitmore]

I've been in AF permanently for over 2 years now so I don't think you'd have caused much damage in a week. The amiodarone however is a particularly horrible drug so I wonder if that may be a cause of any discomfort you feel. I had amiodarone in a 24hr IV in the attempt to convert me 2 years ago. The plan was to have another 24hr IV if that one didn't work only my arm became so excruciatingly painful from it it was taken out. The Sister in charge said that she hated the stuff, that it was a nasty nasty drug! I never took it in tablet form but can't see why it would be any less toxic. If it were ever to be offered to me again I would certainly refuse it. I expect time may answer you if you've now been taken off it. I don't know how long it's half life is so how long you'll have to wait for any changes but I hope you start to feel better very soon.

[BobsBeat in reply to Knitmore]

Thank you

[Singwell]

Just wondering from my background if the hoarseness is due to links between the vagus nerve and larynx? I was hoarse after my RF ablation as it happens. It went away after a few days. The recurrent laryngeal nerve is a branch of the vagus, wraps around the heart and serves the small muscles of the larynx (intrinsic muscles) including the vocal fold (vocal cords). So it's possible this nerve connection got upset while you were in AF. If the hoarseness continues for more than 3 weeks, ask for an ENT appointment.

[BobsBeat in reply to Singwell]

Thank you

[Bolander]

I have suffered from a persistent cough after a failed chemical cardioversion with Amiodarone and a successful DC cardioversion, followed by six months on Amiodarone before I could persuade a doctor to change me to Sotalol. Other people have reported lung problems from taking Amiodarone so the hoarseness you are experiencing might be related to taking that drug.

[BobsBeat in reply to Bolander]

Thank you

[Terjo]

I'm on digoxin , 'horses for courses' as they say . Goodluck!