AF episode recovery - is this normal?

[LKUK]

I went into AF about 27 months ago and it was completely debilitating. With meds I was a bit improved but still even short walks were very challenging because of breathlessness. Had cardio version a couple of months after onset and it was very successful. It took time but I had built back my fitness to a good level and was feeling well. A month ago after a chest infection followed by an asthma attack I woke up in AF. Took my fleccanide PIP (100mg) and went back into NSR within 50 mins. But since then (nearly 4 weeks) I have been very fatigued and breathless. Early on just loading the dishwasher required me to sit down! I’m slowly improving but I wonder if this is normal? I’ve had a month off work. Should I be pushing myself to do more or resting? How do others feel after an AF episode and is this extreme breathlessness common?

[CDreamer]

Hi - so sorry to hear you are struggling. I think everyone has their own norm. However, I suspect that the important word here is CHEST INFECTION with asthma - infections ALWAYS trigger AF for me. Recovering after such infections takes me weeks/months however your fatigue does sound extreme which begs the question - is there something else going on here. Is it fatigue or muscle weakness or both?

You only mentioned Flec as a drug you had taken - any other drugs?

At this stage I would be pushing my GP (not myself) for chest X-Ray and bloods to rule out any other reason for the extreme fatigue. There are SO many conditions which fatigue is a symptom I think it a little premature to blame it all on the AF, especially if you are still in NSR. Have you got an oximeter to measure your blood saturation? If not, it might be useful to buy one at the chemist. If your blood salts are consistently lower than 92% then you see your GP ASAP.

Hope something in that helps and that you get to the root cause and start improving soon.

Best wishes

[Buffafly in reply to CDreamer]

I think you meant SATS? Predictive text 🙄

[LKUK in reply to CDreamer]

Thanks very much. Having had asthma all my life I pretty sure that this breathlessness is not asthma/chest infection related. GP also agrees as no crackles heard on my chest when listened to. I’m on diltiaiazm (not sure of exact spelling) 120 mg pd, blood thinner and 200 mg of fleccanide daily. Apple Watch says AF less than 2% usually. Am booked for a seven day tape later this month. And for an echocardiogram- but not until March given delays in NHS. Good idea re checking 02.

[Debbiedoo1962]

Hi im same after an attack but mine ladt upto 20 hours.i find it debilitating and afterwards get breathless headache znd exhausted plus anxiety plays huge role as it scares me so much! Im sad you too are going through this. Im on sotalol.increasing to reach a dose to hold attacks off.next step flecanaide .scared to change meds ,more side effects.good luck.keep strong.im trying too. life chanching .horrible condition.

[LKUK in reply to Debbiedoo1962]

Yes very life changing! Best wishes.

[Buffafly]

My thoughts were pretty much the same as CDreamer’s except that when I first began to have episodes of AF I also had breathlessness and I remember wailing to my doctor that I even got breathless going down the stairs never mind up! This was diagnosed as chronic asthma and more aggressively treated - I have since been prescribed a combi inhaler which has improved my health quite magically. But I also discovered later through having a holter monitor that I was having frequent episodes of AF without noticing them and that also caused tiredness.

[LKUK in reply to Buffafly]

Thank you. I’m already on asthma meds as I’ve had asthma all my life, often hospitalised with it. The breathlessness feels completely different and no wheezing. So my feeling is it is heart related. I have a seven day ecg coming up which I hope will help to reveal if I am having AF without noticing.

[mjames1]

Very hard to say what's "normal" with so many competing factors and especially so for all of us here behind a computer with no clinical tests in front of us and no medical training

That said, I would take a look at your daily 100bid Flecainide dose. At least here in the US, ekg's are taken periodically both before being prescribed, one week after and if the dose changes. In my case, a change in dose from 50bid to 100bid pretty much wiped me out and an ekg confirmed a widened QRS and block which prompted the ep to order a stress exercise test as well as lower my dose back to 50mg bid.

If all that has been done and you're still feeling the way your are, further testing might be warranted.

I'll also throw the Covid wrench into the equation as you mentioned a chest infection and the fact that Covid is frequently not picked up with the instant tests. I was short of breath for over six months after my Covid infection. Did all sorts of testing short of a chest CT scan and nothing was found, but time eventually healed. Or, even if not Covid, you still may be recovering from the chest infection.

Good luck finding the cause and hopefully things will resolve soon, You are not alone with these kinds of symptons and you just have to keep investigating while at the same time understand that you may just need time. I would not sit around all day, because deconditioning can happen very quickly and perhaps has. On the other hand, you don't want to push too hard. It can be a fine line, but I found a progressive walking program helpful, not to say you are ready for that yet, because again, we are here and you are there, so we can just speculate.

Jim

[LKUK in reply to mjames1]

Thanks Jim. I’ve been on 100 mg Flec x2 day for two years now and had reached a good level of fitness with no significant breathlessness prior to the chest infection and then AFib. I achieved that by working through, as you suggest, a progression of walking, swimming and a bit of aerobic gym and strength work. That’s why this has been such a disappointment. Since the recent AF episode I’ve started over the last week to see some improvement as I do more each day. I think you’re right about losing fitness quickly. Thanks.

[secondtry]

I have found moderate daily exercise helpful, religiously followed whatever the weather. If memory serves, in my early AF days (10yrs ago) on Flecainide 200mgs/day I felt weird and could only walk very short distances but it gradually got better.

[Ppiman]

When you say "just loading the dishwasher" you made me smile. Bending down, such as when doing that, often sends my heart rate up and causes lots of palpitations. Pumping up the car tyres is another occasion I can associate with the same. I haven't noticed it actually set off AF yet, but I rather suspect it has, briefly. There's something about posture that can set off ectopic beats, perhaps the stomach pushing against the heart (via the diaphragm) and I have read that ectopic beats can, themselves, in prone individuals, spark AF.

Your having to sit down also made me smile, too, as I used to have to do just the same. It dawned on me that a lot of this might have been anxiety related, however, as I wasn't truly out of breath or anything - but I could never be sure and felt unable to separate the physical effects from any anxiety effects. I'm not sure if this is the case with you, of course. Since last March, I have been taking a daily dose of bisoprolol (1.25mg) and that seems to have improved things a lot.

Steve

[dunestar in reply to Ppiman]

I've got a Halfords gizmo for pumping up tyres which works wonderfully. You just plug one end into the cigarette lighter hole and attach the other cable to the tyre valve. Press the button and off it goes.

[Ppiman in reply to dunestar]

They are useful, aren’t they? I bought something similar from Makita that uses my drill battery just last month. But just the bending down will set off my heart on occasion if I stay down a while. It’s an odd thing.

Steve

[Buttondog in reply to Ppiman]

That’s interesting

I’ve PAF and usually feel not too bad

I tried to clear snow pushing it with a yard brush and felt a sudden shock and was exhausted for days-not doing that again

[Ppiman in reply to Buttondog]

That would have likely caused me to phone my GP. Are you fully recovered, now?

Steve

[Buttondog in reply to Ppiman]

Back to normal thanks

wiser man

[LKUK in reply to Ppiman]

I hadn’t thought of the posture thing. But it wasn’t just bending that left me breathless. My cardiologist confirmed that the ectopic beats can cause AF. And I know I have those quite regularly.

[Ppiman in reply to LKUK]

I gather they can, or, at least some, the ones called PACs that arise in the same part of the heart as the AF.

Steve

[dunestar]

i can get very breathless during an Afib episode if my heart rate is very raised. I ended up in A&E once in respiratory failure. But once I revert to NSR everything goes back to normal.

[LKUK]

having set this thread running, by last evening I discovered that I in fact do have another chest infection which is now causing my asthma. So my breathing is now dominated by wheezing and coughing! My sister has just tested positive for Covid so although I am currently testing negative it could be that I have gained that from her. Very disappointing as I was just getting over the AF episode.

But I am certain that for me chest infection/asthma breathlessness is different from heart related shortness of breath. They feel and sound so different.

Back to antibiotics and steroids I go 🤣🤣