Bad test news - questions to ask doctor

[Donti]

I knew my husband had AF following an EKG prior to surgery in 2012. He was a college athlete and only health issues have been hip and knee replacements. They tried to shock him out of AF but it was unsuccessful. He was put on Xarelto 20 mg. He has always been asymptomatic and I was naive since he was so active and healthy.

Forward to 2023. Husband is now 68 years old. Plays golf daily and works in our yard. He fainted one night going to the bathroom. Ambulance ride to a level 4 hospital (in US you must go to a level 4 hospital with AF, fainting and hitting head). No heart attack or brain bleeding and husband was released from hospital. His follow up with cardiologist included an order for a Zio monitor to be worn for two weeks. Preliminary findings:

"48 Ventricular Tachycardia runs occurred with fastest interval lasting 14 bpm with a max rate of 279 bpm (avg 244 bpm); the run with the fastest interval was the longest. AF occurred continuously (100% burden), ranging from 42-252 bpm (avg of 91 bpm). Isolated VE were rare (<1.0%, 1752), VE Couplets were rare (<1.0%, 372) and VE Triplets were rare (<1.0%, 89). MD notification criteria for Rapid Atrial Fibrillation met - doctor notified. " Husband admits to noticing the 279 bpm episode (corresponds with monitor time) while pulling overgrown bushes and roots from our son's yard on a hot afternoon. He sat down for a bit, didn't tell anyone, and got back to work. This is what I'm dealing with 💔 he's a tough farmer's son.

Cardiologist followed with a cardio MRI which was a "Technically challenging study due to respiratory motion artifact." The Report includes:

Normal left ventricular size LV EF = 52% and normal right ventricular size RV EF = 50%

Atria: Severe left and right atrial enlargement. Intact atrial septum.

Valves: No significant valvular stenosis or regurgitation.

Pericardium: Normal thickness, no effusion, no late gadolinium enhancement.

Vessels: Normal ascending aorta. Normal caliber descending aorta w/o coarctation. Conventional aortic arch anatomy. Normal caliber main pulmonary artery. Conventional pulmonary venous anatomy.

The follow-up appointment after the MRI is this Friday, April 4th. I'M GOING. I've done prolonged internet searches (to reputable sites) in an attempt to grasp this and ask the cardio appropriate questions... if that's possible. Nothing I've read begins to approach my husbands 279 bpm or severe bilateral atrial enlargement. Frankly, I get so upset I have to stop.

I realize ablations are not an option and meds (metoprolol) dropped his BP so low he had to stop. If you've read this far you're likely hesitant to reply because things don't look good. BUT the discussion I read this morning regarding Vagus Nerve AF made me hopeful that maybe someone can provide some insight and questions for the cardiologist, if that's even relevant at this point... Thanks for reading anyway. In any event this should make you feel better about your AF.

He just got home from golf. Looks great.

[mjames1]

"He just got home from golf. Looks great."

------------------------------

Often, how someone functions and looks is even more important than the numbers

No one here has your husband's complete history, nor are we qualified to comment on that report, but I will say that all these reports frequently sound a lot worse than they are and my totally non professional eye doesn't see anything that alarming.

For example, no stenosis and a normal ejection fraction is great. And not surprising his atrium is severely enlarged, but that can often be reversed with appropriate treatment. And yes, the heart can beat very fast when in various tachycardia's -- that's why they are called that!

My suggestion is to stop looking and "googling" about that report and wait until you hear what the cardiologist says and puts things in perspective. I also strongly suggest you set up an additional appointment with an electrophysiologist (ep) who are cardiologists who specialize in fixing different kinds of arrhythmias.

We have lots of options these days and hopefully one will be a good fit for your husband.

Jim

[Donti in reply to mjames1]

A sincere thank you for your kind response. My husband was initially set up with an electrophysiologist before we got the results of the monitor. I know the cardiologist conferred with other doctors and an echo was cancelled and a MRI ordered instead. The cardio is affiliated with the major heart hospital in Kansas City. We will see what the appointment brings. No more googling. No one tells you how to interpret a cardiac MRI on the internet anyway. It's been two weeks since the MRI and the report was posted on the portal very quickly. That coupled with the monitor results have made it a very long two weeks. Thanks again Jim. You are a kind person.

Mary Ann

[Rainfern]

Afib is an absolute darn thing whichever way you look at it, and it takes some adjustment for all concerned. It sounds like your husband is getting on with it best he can and hope he appreciates all your research! I did my own research but in the end got all my best advice by listening to everyone else’s experiences here on the forum- oh and of course my EP and cardio team! I have found planning holidays with my husband great medicine!

[Stentrunner]

I think it’s a really really good idea for you to be there. My wife remembers things said in consultations that I have no memory of. And do try to listen rather than line up your own questions - the consultant may have a completely different agenda. I know this because it’s exactly what I do (and my wife tells me off for it!). My AFalso has short runs way faster than my calculated max.

Go together, listen, take notes. Bless you both!

J

[Donti in reply to Stentrunner]

Thank you for this. You are absolutely right about listening rather than adhering strictly to my questions list. At this point I don’t understand afib and his specific test results enough to know what to ask.

[wilsond]

Agree with above. That heart rate looks impressive but with tachycardia ( just mens fast heart). It is not that unusual. My God daughter had Supra Ventricular Tachycardia attacks from age 3 and it would go that high .She had an ablation this past year and its stopped 100%.

Good that you are going along. Also good that husband is going about his normal life!

Electrophysiologists are the best people for arrhythmia of all kinds but cardiologist will be useful too.

Kind regards and do let us know how you get on. Xx

[Donti in reply to wilsond]

Will do. Thanks.

[BevCynfelyn]

Everybody is different with AF.Having few symptoms, able to walk around a golf course sounds marvellous to those of us who struggle to walk from their front door to their car.

A recent bout of pneumonia saw me with a resting heartbeat of 288 for quite a while until the I V antibiotics began to have an effect. The other patients in the 6 bedded ward were very glad because it meant the warning beeps from the heart monitor gradually reduced too, so they could get some sleep!

[Donti in reply to BevCynfelyn]

You are the first I have heard of bpm as fast as my husband’s! All I could find was max heart rate for 65-70 year olds was around 155, which in this case sounds very scary. I needed to know that he isn’t the only person to have had it and is still breathing. Thanks for sticking through the long post!

[BevCynfelyn in reply to Donti]

You're welcome Donti! I recently had to show a student nurse how to use a stethoscope to take my pulse as she couldn't get a sensible reading from the oxymeter on my finger, alternative way is to put it on my earlobe....

[Donti in reply to BevCynfelyn]

I neglected to express that I’m sorry about your illness and that you had to go through it. And I’m glad you are over it and are able to share your experience. I know that everyone on this site is here because they have suffered and/or are suffering too.

[Buffafly]

Most of that sounds great, I was waiting for the aneurysm, valve damage, low ejection fraction, cardiomyopathy - nothing! As others have said he probably needs some treatment to prevent the episodes of tachycardia but otherwise he seems to be a fit and lucky man 😀

[Donti in reply to Buffafly]

You and several other responses have been very helpful in identifying some positive aspects of his tests - I thank you all for that. To be honest, I would fall asleep at night not knowing what I would wake up to. And yes, tears. I know my reactions are an argument for only doctors to reveal test results. But I disagree, I think it’s better to go into an appointment with an idea of the gravity of the situation and having had a chance to digest it beforehand. However, a two week wait to discuss gave me time to panic. I’m ready to listen now and (hopefully) will fully hear what doc says and what, if any, treatments are available. And thanks for sticking with me.

[JOY2THEWORLD49]

Hi

Metoprolol even 23.75 gave me pauses in the night. So banned also because it made me breathless, fatigued and no energy.

Even at 176mpm avge Day I was sweating profusely. Lots of cold showers.

Sounds like hubby needs to down his energy to moderate exertion.

We await more information.

Metoprolol did nothing for my Heart Rate. CCB Diltiazem was introduced. On 180mg dropped 105bpm in 2 hours!

Now Diltiazem 120mg AM and Bisoprolol 2.5mg PM.

124/69. 60s (a year later from 88-96 H/R Day) H/R Day

cheri jOY. 74. (NZ)