When I was first diagnosed in the hospital emerg with atrial flutter/fibrillation my heart that day had instantly started being around 140 bpm (brought down with IV medication). I was referred to a cardiologist. I’m 67 years old and after months of heart tests and blood tests everything was normal, plus I don’t drink, smoke, do not have sleep apnea and I’m average weight.
Going forward 5 months with tests completed I saw the cardiologist. The first question he asked was “what were you doing right before your heart first started beating fast?” I told him I wasn’t doing anything unusual. I was relaxed and happy that day.
Did any of you have this question asked and could you connect your beginning first AF episode? Either right away or when you thought it over?
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FraserB
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Hunting the root cause of AF has become a kind of sport, all of us here, in the forum, enjoy. Of course, the MDs enjoy it too, lol. All of us have been wondering, how is it possible that, despite all the search techniques in medicine nowadays, such a "simple" thing, as root cause of AF, can remain undiscovered for so long...
In MHO, it is because the cause is absolutely not before our eyes, it is "invisible" and not a single person, patient or MD, comes to the idea that it could even exist, not to talk about causing health problems.
An example, only to illustrate it, might be "energy meridians". We all have an not fully defined idea that there could be something of the kind, but they are not detectable, even with all diagnostic devices we possess nowadays. We know that our ancestors have known something about it, but the modern medicine ignores them and never mentions them. If there is something that nobody ever takes into account, how can it be positively identified as the cause...?
For now, it is certain that the genetics play a significant role - AF runs in the families, numerous people here have stated it.
As for the process of ageing, numerous young ones with AF eliminate it as the cause. It can be contributing factor, but it is not necessary to get old as to be rewarded with AF.
Here the puzzle that is in my head for years, without the sensible explanation - when a heart of a person without AF history gets transplanted to a person without prior AF history, the patients develop AF in 40% of cases... Brain breaking information, isn't it!?
The heart has many thousands of neurons - it's own mini brain, like we have a gut brain. It sends message upstream to the main brain. Seems entirely plausible that if the 'heart brain' is transplanted along with the main organ that it would carry neurological patterns with it.
From 90 billion living cells, which our body contains (who had the patience to count ? , lol), about 20 billion are said to belong to the brain only. Us, humans, will not come to the point to understand how it works in the next 1000 years (if we do not mess up with nukes, lol, than no use counting). I remember seeing for the first time flat cables with numerous wires, in computer (believe about 60 wires pro cable) and being very, very impressed. Can you imagine the Vagus nerve, with the diameter of several mm, containing millions of isolated conductors (neurons). No, we definitely will not understand how it works for tens of thousands of years.
So, I think sometimes, do we expect from cardiologists and EPs too much, too early... And, on the other side, do we have to know the thing in detail, in the course to help and cure AF...? Maybe not. A lot of knowledge is hidden in ancient times, some of it written, some of it not. Almost all of us here are elderly and have no time for it (not enough left, lol), but the young ones might try to benefit from what people have known centuries ago.
All the best!
Peter
• in reply to
Hi nesko. I think you’re severely underestimating the power of artificial intelligence and its future capabilities. I for one am hoping it will decipher the mystery’s of the heart and brain and give us all some well deserved relief. I’m sure it will come with many pitfalls but on the whole I think it will be massively net positive.
• in reply to
Hi, RogueRhythm !
Please, do not get angry with me, but I believe that AI is only one more means of manipulation with the people. For the first time, we have an absolute authority, the ideas and conclusions of which can not be questioned by us, the people. It is AI, hey! But how clever it is!? Only as much as the program, written by the people, has made it possible. Will it work like Dominion machines at the elections, lol? According to the needs...
My opinion is that us, the people, underestimate our own capabilities. We can do it! Even more, people have done it until now, but, unfortunately, it is not for "everyday use", lol. It is for the "elites". How do I know!? I have seen how successfully they have manipulated the immunity in the COV era, so it means that somebody knows!
• in reply to
I wouldn’t get angry at you for stating an opinion. That would be childish. I don’t necessarily agree with you though but that’s fine. I especially don’t agree that ai is only for the elites. With a little bit of technical knowledge it can already be used by the general public in incredible ways. Far beyond what many people believe capable and that’s right now. Wait until things really get going. I don’t think the general populous quite understand what a ridiculous leap forward this is and will continue to be. Even the scientists who are deeply involved in the research and development of AI don’t fully understand what is being implemented. Large language models are just the start.
• in reply to
I would be more than happy if AI brings positive things for everyone on this planet! But knowing what their agenda is, I dare not to hope...
I had a Physician appointment one morning 30 years ago coincidentally the same morning I jogged on the beach and jumped in the ocean to clear a hangover. He asked what I was doing so I explained too much alcohol till about 2am then exercise. He told me that it was most likely the trigger. He also added that other contributors are caffeine and stress. I know genetics can play a part as well. Think about what you were doing in the day or two beforehand. My 8 or 9 episodes over the last 30 years can be correlated to the activities I was doing. I could run up stairs after a couple of coffees no problems but if I was in a stressful situation at the time and drinking coffee then the AF would kick in.
With me the trigger was stress caused by bullying unruly neighbours which continues to this day after seven years of abuse. I live on my own the police here in Spain do nothing. Their aggressive dogs bark day and night and have bitten passers by their house and continue to get-away with their behaviour.
My AF started less than 48 hours after steroid injections in both knees. I still had facial flushing at the time, which is a recognised side effect of these injections, so I wondered if the steroids could have also caused the AF, and started researching on the internet.
I found Dutch research which looked at the records of people who had received a diagnosis of AF during a 10 year period. It found that the risk of new AF was significantly higher for people who received a high dose corticosteroid prescription within 1 month before the AF started than for those who hadn't been given steroids.
After a cardioversion 9 months later, I had more than 3 1/2 years free of AF, till persistent AF returned late this September - this time my first thought was that dehydration may have triggered it - and later I remembered I'd had my 2nd Pfizer Covid booster 6 days earlier. Research has also found that there is an uncommon increased risk of AF after these boosters - and within a week of the second Pfizer booster is more common than after the 1st. So that's another possibility for why it returned.
Now I need to find out if the locum GP I saw has referred me back to my cardiologist to discuss another cardioversion - as there's no note of it in my online GP record.
I hope things go well for you in managing your AF.
Thank you for the Dr John Day link Belle11. Most of the triggers I'd already discovered but it was great to have them confirmed by someone who knew what they were talking about. I would just add two other things that I think are triggers:
Wearing tight clothing around the body (bra, waistband even pants).
Becoming so engrossed in something like t.v. that we forget to breathe deeply enough.
That's interesting. Another one for me is probably sulphites - they seem to be a trigger for ectopics for me, so I've avoided them in case they would also trigger AF. Or it might be aged foods - the tyramine in aged cheeses, parma ham etc can be a trigger, and there are a few case studies about it.
That's interesting re the steroids. Although I've talked below about a 3 week period of high anxiety I've often wondered if the whole thing was triggered by a hefty cortisol injection I was given to reduce swelling in my throat due to a bout of quinsey. I recall getting out of bed the next day and almost passing out. I never felt right after that and towards the end of the year, that's when I finally got diagnosed.
Never been asked that question by a doctor but I asked it of myself. In my case sailing a yacht through some tricky island waters so only napping for short periods.
My first really bad episode I was somewhere in the middle of the Atalantic on a small yacht, about 200 miles away from the nearest doctor, let alone emergency room. I just went below and rested for a while and it went away in about 5-6 hours. (There were 2 other people on board so I wasn’t solo). I think it was another 6 years before I went to a doctor about it, by that time I was having frequent episodes which completely disabled me with very high HR of 180+, syncope and very low BP which no-one ever explained to me why so I had to research it for myself.
Thankfully in 2013 I found this forum and lots of support and knowledge and learned more from Patient Day in one day than in all the previous years of asking doctors. AF is better understood these days by most doctors but even 20 years ago AF was dismissed as ‘just palpitations’.
When I first came onto this forum BobD told me that I would drive myself mad chasing triggers - and I did anyway - until I realised he was quite right - and then I stopped because living my life and enjoying it is more fun and it turns out - actually much better for our health.
Having said that Infection, Angst and Stress which all cause inflammation I found is THE biggest antagonist so I accept I am going to have occasional episodes, even after all the drug treatments, 2 ablations and a pacemaker - which have all helped to lessen the intensity and frequency but at the end of the day - I have AF and have had for at least 20years but only diagnosed in 2007. My father was the same.
Hi Fraser. At any one time in our lives there are many activities, events and experiences that manifest at the same time. As human beings we like to find correlations and look for cause and effect where often none exist. So here’s my magic thinking correlations! ….
I felt the start of my AF like a jolt a year ago. Previously I had been super healthy at 69, walked a lot, run upstairs, a healthy weight, Mediterranean style diet etc. Diagnosed initially with PAF this changed within a couple of months to persistent. The 2 things I associate with that jolt are 1. A strong emotional event that put my body in “heartbreak” and stress and 2. Receiving the covid booster and flu jab at the same time just a few days previously. I would like to add that I continue to accept a booster jab to no noticeable effect, but decided to put some time between that, the flu jab and recent ablation.
The problem with our amateur attempts to seek the cause is that it inevitably creates a lot of false correlations and sometimes these get backed up by showmen scientists and poorly set up research.
Difficult one to answer ,because with hindsight I'm sure I had AF for quite some time prior to actually being diagnosed by coincidence. That was when my husband called and ambulance as I had an awful bout of norovirus, was all over the place, fainted in bathroom etc.
When the paramedics came they took vitals and said ' have you ever had a diagnosis of AF?'
I said ' no but my mum had it'
' Well so have you!'
I had had a really stressful extended period of time,and hadn't got time to analyse or query why my heart was racing and weird at times!
I was taken in for fluids and monitoring, nothing happened regarding AF but a referral was made.
Subsequently, neither my EP or Cardio has ever enquired as to how IT may have got going.
That’s a very interesting question, Fraser. I had my first and very dramatic episode of AF 15 years ago and, like you, I always said I was relaxed and happy beforehand, looking forward to a nice day out walking with a friend. However, I now realise that over the preceding years I had gone through an almost unimaginable series of personal traumas, or ‘heartbreaks’, one piling on top of another. I now believe that one more dreadful heartbreak that year was the straw that broke the camel’s back and ended up with me at the Sunday emergency GP clinic (remember those?!) with a heartbeat of 300bpm. I know this line of thought will likely seem fanciful to some other members, but it’s my sincere conclusion after a great deal of reflection, so I wanted to put the thought out there and I hope it won’t cause offence. Like everyone else on here, the issue for me now is how to go forward from here and be as well as possible.
My AF started immediately after open heart surgery for an aortic valve replacement back in 2009 and I’ve had it on and off ever since. In the last few years it became almost every few days and ended with a Pacemaker implanted in June this year. So far, so good. 🙏
I definitely know. Undiagnosed Papillary Thyroid Cancer.
Stroke with AF was diagnosed, the thyroid papillary thyroid discovered 4 days but in hospital having a carotid arteries scan. I can remember the las saying "I always check your thyroid ...oops your thyroid has a shadow on it." I'll get the boss to check.
I was so lucky and a biopsy was taken later and there was arguing about when the operation could take place. Now against at least 6 mths from the Stroke Ward Endocrinology.
Surgeon and Anaethestist said a.s.a.p and they won. 4 mths later thyroid out with 12 lymphs. 2 were affected. They caught it in time. I declined RAI and Suppression.
My first diagnosed episode of AF came on during a period of extreme stress when I was recovering from a virus which had caused pericardial effusion (fluid around the heart)and ear inflammation. I had also been putting a display up in a classroom and then eaten some fish (which I now know I’m intolerant to) - oh, and several family members had AF! So, perfect storm and who knows what was the final straw?
Each time I have been in A & E with Afib my Potassium/Magnesium levels have been low but again I have other underlying problems, I have had a kidney transplant resulting in taking immunosuppresssants and other medication, so its quite hard for me to know where to start.
With respect to low potassium levels - last year I was diagnosed with AF and separately with my annual blood tests I was found to have low potassium. I was taken off a diuretic which I took for high BP and changed to losartan - my potassium levels have now gone up to normal. I am therefore thinking low potassium levels are my "trigger" but time will tell.
Thank you for your reply. I have also recently been taken off diuretics and I'm on a course of potassium & magnesium meds so like yourself time will tell.
Hi, I was diagnosed in A&E after noticing in warming at the gym my heart rate was 180. But I think I'd probabaly had undiagnosed episodes before that, eg when out running. My feeling is that by the time lots of us are diagnosed we've already got AFib without realising, so identifying a cause or trigger can be difficult. Few years later diagnosed with sleep apnea, but again think I have probably had that for much longer and if so may have contributed to AF.
I too had a routine day. After my evening meal, I noticed that my heart was racing. At 11 pm my heartbeat had not settled and I went to A&E. This was the beginning of my AF journey.
My first bout of tachycardia, presumably caused by undiagnosed atrial flutter, but which I put down to my hiatus hernia or some kind of anxiety attack, happened when I was carrying some boxes, bulky but not heavy, up some stairs to our loft room. The second time, and when it was diagnosed, I was with my son walking up some stairs at an exhibition in Oxford’s Boddleian library after eating a heavy lunch of fish and chips. That time it never did go away until an ablation came my way a couple of months later.
I have given up on trying to find “triggers” for arrhythmias. I started having it three months after a heart attack eleven years ago. Since then, I’ve been on the entire pharmacopoeia, five ablations, multiple cardioversions, and currently on sotalol hoping that controls it for a good while. Turning 70 in a couple months and hope my last 15-20 years are Afib free.
the only thing i had different was covid a couple of weeks before it happened. Have under active thyroid but been checked and on medication for 20 years! So I don’t think that was connected.
I was walking to my annual dr appointment in a wintry cold day and all of a sudden I felt shortness of breath. When I explained to my Dr the situation he immediately took my ECG and confirmed that it was an AFib episode.
During a very stressful time for me, I bent over to tie my shoe lace, straightened up to an apparently 180 heart rate. Thought my end was nigh! A.F confirmed in A and E. The good thing was I got a quick diagnosis as no previous indication of it.
A few years ago we were holidaying in Valencia to witness the madness of the Las Fallas festival. The streets were crazy all night and our hotel was right in the city centre, so it was almost impossible to sleep. During the week I developed a really nasty cough / cold, lost my voice and felt like death. On the last morning we had to be up very early and catch the train to the airport. I was feeling quite odd, and when we got on the train, my heart started beating fast with palpitations. It was all a bit scary, and when we got to the airport I decided this needed some medical intervention before boarding a flight. Managed to find the airport doctor who did some basic tests and advised me to get home and have an ecg straightaway. By the time of the flight things had settled a bit and the return home passed uncomfortably but without incident. Got home, saw GP, had ecg, nothing conclusive, no further action. However, I'm now certain this was the start of my AF journey, which was diagnosed a year or so later when I walked into A+E with funny tightening of throat and racing heart.
Mine seems to have started after an episode of shingles ( along with chronic fatigue) when the pain came before the rash and I couldn’t get an appointment at my surgery ( precovid!) I was previously fit and healthy and diagnosed only after a trip to Bath Spa to celebrate my daughter’s birthday which I wouldn’t have done had I known I had a heart condition!
I was "diagnosed" in an ambulance Code 3 to a hospital to have surgery for Brachial artery clots so I wouldn't lose my arm. I do feel I had had episodes over the years which were always brushed off as hormonal.
Nobody has ever asked me that question, but I can tell you when my first episode happened. In early Jan 2020 I was out with friends at a restaurant. I’d literally just had a couple of sips of red wine, then all hell broke loose! HR went up to around 135 and I felt pretty awful.
I’d treated myself to a FitBit for Christmas to count my steps, but it went bonkers congratulating me on what’s good workout I was doing! A friend there is a practice nurse and I showed her my Fitbit and she advised I speak to my GP asap.
A few things;
1. I truly suspect I contracted COVID between Christmas and New Year 2019.
2. I’d struggled for years single-handedly trying to cope with my mother’s progressive Alzheimer’s. Stress!!!
3. Confirmed COVID in March 2022 exacerbated it, but it was still fairly sporadic and mild.
4. I started back in the swimming pool in October 2022 and that’s when it went really bad - 2-3 times a week, lasting 2 days, HR up around 160-180. Was it vagus nerve irritation or did I catch COVID again?
Something damned well triggered it off in the first place.
NB I’m 65, female, sporadic smoker (not now of course), moderate drinker, keen hiker, moderate weight - and a healthy heart!!
Interesting. For me, looking back, it was 3 weeks of being on high alert during the floods of 2019. Our sewage pump failed because it was so overworked pumping out groundwater that was seeping into the tank because of the high water table. I was waking up several times a night, listening to air bubbles being released as the tank overfilled with a popping noise through the showers and basins. Horrible! In the days after that I kept feeling odd - tired, lethargic and with short vasovagals. I had an appointment booked at my GPs buy on the Sunday before I just knew something was wrong. We called 111 and went through various levels of triage. It was when my husband (a musician) was asked to take my pulse and told then there it was completely arrhythmic that they kicked into action. 10 minutes later an ambulance arrived. I was lucky not to get a stroke.
I’m unable to remember my very first episode. In fact I’m fairly sure I wasn’t even aware of it and it progressively got worse over time. But I do remember the first time it put me in A&E. After what felt like an eternity I was finally diagnosed with what I’d been trying to explain to my doctors for months. I was sleeping at the time and was awoken with my heart jumping out my chest. Sleep and/or lack of is 100% a trigger for me.
I now do know how mine started! 2017- I was woken at 2.30am with a pulse of 155, rang 111 and was told to go to A&E, so off we went. When I was seen, I had bloods taken, and my potassium was found to be very low. So a shot into my tummy of potassium and shortly after I reverted to a 'normal' heart rate. As this continued I was discharged at around 6.30 am and given a number to call to make an appointment with the NOAC clinic. There I was given Edoxaban and sent on my way! Research since then has taught me the fine balance between various minerals, called electrolytes- potassium, sodium, chloride and magnesium in particular which are needed for the sinus rhythm to fire in the right order in the right quantities. When there is an imbalance is when it all goes pear shaped!
"Electrolytes, such as sodium, potassium magnesium, chloride and calcium, are molecules that carry an electric charge and are essential for various physiological processes in your body. Electrolytes are dissolved in bodily fluids, such as blood and cellular fluids, and play a crucial role in maintaining proper cell function, nerve impulses, muscle contractions and fluid balance".
One day, a 'live' check will be able to be made to diagnose- at the point of 'firing'- exactly which electrolyte is being used and how much in which order. Until then, it's all guesswork as although it is known what the sequences are, until it can be observed in life, there is no way the specialists, doctors etc, are able to rebalance an individual's mineral levels. This is what my cardio told me when I asked about the firing sequence which makes the heartbeat. So I make sure I have optimum levels of these electrolytes each day, and so far, apart from the odd extra beat- I haven't had a recurrance.
Cancer treatment can also interfere With the electrolyte balance, so it's important that levels are at their optimum.
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Commenced Bisoprolol
Should one asymptomatic and isolated AF episode be medicated?
First 'fast AF' episode - at the beach
af episode following ablation
Flecanide and Bisoprolol
