Just out of curiosity ........... at the time of or around the time of diagnosis of any one of a myriad types of AF has anyone been described as " asymptomatic". Further, what ranking of medic used this term, i.e. EP, Cardiac Consultant or a bog standard Dr.
Further again, are you aware if this has caused your medic to favour any particular approach to medication, i.e. PIP or block treatment. Were you automatically prescribed an anticoagulant and a beta blocker ( Bisoprolol) or something else.
Just askin' ..... outta curiosity ... thinkin' - did such an announcement influence any special approach to treatment/problem solving.
Hi John. As I understand it asymptomatic simply means that the person with AF doesn't feel any symptoms, even though they have the condition. A symptom is something only the patient feels, strictly speaking, though some confusion with the term. This does not make one any less at risk and anyone with AF should be on anticoagulants. My sister has asymptomatic AF and doesn't notice it. I feel every bump! Hope this helps.
Interesting question John. Rainfern is quite right of course. The problem for people with asymptomatic AF is that they don't know unless it is picked up by routine medical care (case one) or they have THE STROKE!
We read quite often of people in the latter case who were quite unaware of having AF until too late. If lucky enough to be picked up in case one then anticoagulation would depend on CHADSVASC score.
Remember that any and all treatment is only for quality of life (QOL) so once diagnosed then rate control would normally be the way forward to prevent ongoing strain on the heart.
I guess I'm fortunate (or not so, as the case maybe) that my asymptomatic status was detected during my 5 days in the Cardiac Unit of East Surrey Hospital after the A & E Unit had identified paroxysmal AF.
Certainly my Cardiac Consultant in that Hospital was well on the ball as he prescribed the two meds that would as time unfolded return to me that QOL you talk of. Certainly the Bisoprolol has done a great job of taking the strain off the heart with current HR's of 64 to 67 bpm. Nice. Prior to AF it was anywhere from 88 to 95 bpm. With those numbers something had to give 😂😂😂
John I am slightly puzzled in that you have in the past spoken of the occasional AF event so if you are aware of it you are not asymptomatic. The whole point of being asymptomatic is that a person has no symptoms and is quite unaware if they are in AF.
Sure Bob - when I was discharged the Consultant wrote to my GP bringing him up to date ( as at the date of discharge from hospital). In this letter he advised that following my time in hospital it has become clear that at times I will appear asymptomatic and that given the state of my left Atria it would predispose me to future and ongoing AF events .... going forward. That letter was dated early/mid January 2010.
In those days I experienced definate symptoms of AF and the best I could describe them is - a bag of worms wriggling away in an damp earth filled plastic bag. Or, several squadrons of butterflies having dog fights in my chest.
The years moved on and these symptoms disappeared, however, subsequent GP's that I have had in my various house moves since then have adopted the view that although I have no symptoms doesn't mean I have no AF taking place inside me or lurking awaiting a trigger, and that I could well be in AF and not know it. The only thing I can say is that over the years to date I have had a range of AF events each year, but each year such events have diminished and this year none at all. But the view is it doesn't mean I'm not or have not had an event. The only thing I do notice is that I have in my chest and abdomen a feeling of heaviness or lightness. When I'm in lightness I'm normal and feel great. When I'm in heaviness I am unwell but cannot say why nor have I ever recorded anything on any device, i.e. Kardia.
Apologies for the length, its the best I can describe events.
Hi John, after I was diagnosed following a tachycardia episode I was put on Warfarin and Bisoprolol. After my next check up, the cardiologist wrote in my report that I was ‘asymptomatic’ because I had described no further noticeable sensations. Only later, in a subsequent check up when I described mild symptoms, and a couple of short bursts of tachycardia did he mention options ‘for the future, if necessary’. So I think the word ‘asymptomatic’ may be used quite commonly to describe ‘no symptoms relating to their condition experienced by the patient’.
Similar to my experience. I was admitted to A & E after my BP dropped in a few hours from 136/80 to 76/50. A & E determined paroxysmal AF, Cardiac consultant decided to keep me in Cardiac Unit for another 5 days whilst all manner of tests were conducted. It was this "Testing" period in which they came up with the notion of my being asymptomatic. My medication was the same as you, Warfarin ( which now 13 years down the track I self test and self monitor my own INR with my own device) and 5mg Bisoprolol ........ still the same even now.
Mine was diagnosed by chance, but not unexpected as it is familial, I had been prescribed an antibiotic for an infected cut (sustained from an aloe which is supposed to be healing !!!) which did not suit me, caused me to constantly vomit after one dose until I was vomiting flecks of blood. That scared me, I phoned my GP surgery, was told to come straight away, my pulse was 140 and the ECG they did showed Afib, Worried about the blood and a possible dissection, my GP sent me off to a Cardiologist (by the time I got there I was back in NSR - whether it was the anti nausea injection, I don't know). Anyhow he kept me for observation over the weekend, prescribed Biso and an anticoagulant. I saw him six months later for a check up, he told me I was in AF(I didn't know) and would I like a cardioversion? I said Ok . went to the ward and he did it that afternoon. Since then every visit to the Cardio (annually) has shown NSR and I just stay on the same medication despite my dislike of Biso(my GP writes the prescription), but I only take 1.25mg. So for my AF, I take 1,25mg Biso. Eliquis, and 5mg of Atorvastatin (my choice),
Hi AM-ARVC,
Many thanks for that ......... that's an interesting take which had never occurred to me ..... "continue with medication only, and not surgical intervention or devices, while I was asymptomatic".
I divide my medication up into two parts .... part 1, pre AF = Simvastatin, Ramipril and part 2, post AF = Felodopine, Warfarin, Bisoprolol. Sorted.
Right at the beginning in chats with my Cardiac Consultant when we were looking at the way forward I rejected all notion of surgical intervention. No particular logic for my decision other than ......... pure gut feeling I didn't need that approach to problem solving.
I wonder if a patient stays asymptomatic always and for life or whether the heart changes and one feels the symptoms always and forever. ( if you understand my drift).
I have gone the other way . My first afib attacks were very symptomatic - full on fighting frogs in the chest , voiding enormous quantities with trips to the loo every 10 mins. Now they are much milder though I am still aware of when I go into afib and can feel the difference. I think my heart must feel less distressed as the increased weeing has even improved.
Hi John. My now elderly friend was told he was asymptomatic many years ago, and has remained so, taking no medications except warfarin. He's now 89 and doing very well for his age yet still in permanent AF.
After about twenty one years of paroxysmal AF, when I had been taking 300mg of Flecainide daily, and hadn't had an episode of AF for about eighteen months that I had an annual appointment with a consultant. He told me that my paroxysmal AF had become asymptomatic. There was no defining moment when I went from paroxysmal to asymptomatic. I was advised to stop Flecainide . This was confirmed by a 24 hour Holter.I was not convinced that stopping Flecainide was a wise thing to do. I saw one of the GPs in the group who run my local medical centre. He's a GP with specialist knowledge of AF. He used a Kardia to show me that I am in AF all the time. I have no symptoms . He explained why I should stop Flecainide and that nothing untoward would happen and nothing did. My only medication for AF is an anticoagulant, Warfarin being my choice. I self test and send my results by email to an arrhythmia nurse.
When I say I have no symptoms I did get out if breath after walking 100 yards, and needed to rest, but that could have been the result of asthma, as I've been asthmatic for 48 years.
In the last 9 months I have been on a regime to lose weight, with the result that I can walk about 300 yards without resting.
Thanks for posting. You seem to be quite experienced....are you saying you became asymptomatic and your pulse remained like NSR or did you never check your pulse?
I have been on 200mgs Flecainide now in my 10th year, previously been very symptomatic and probably check my pulse weekly, plenty of energy for a 70yo.
Gosh, your comments have blown me away. In a way ....... quite concerning - may I ask how long a period of time the transformation occurred over, weeks, months, years ?
Apixaban (Eliquis) is an anticoagulant so that protects you from "The Stroke", so although you are permanently in AF you take no heart rate control medication at all. So do you have any notion as to what your HR is now you are in asymptomatic Permanent AF.
Gosh ....... how do you feel with this conundrum ? How do your healthcare team feel about it ?
I too am asymptomatic . The plan was to have a 2nd ablation ( the first was 2020) but it was cancelled more than once as my INR was not at the required level for the procedure to go ahead.The consultant decided on a watch and wait approach as my QOL is good generally. I am maintained on digoxin, bisoprolol 5mg twice daily, rampiril and atorvastatin. Also prescribed warfarin since 1998 when I had an aortic valve replacement. My BP and HR are good.
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