Emergency Room Visit: Besremi and Afib?

[Elizka]

It was a stressful week last two weeks as my husband had open heart surgery on November 21 and I'm taking care of him at home now.

Last night around 9pm I noticed shortness of breath, and a racing heart after doing a lot of work around the house. My Apple watch said I was in atrial fibrillation with a heart rate has high as 181.

I took a Xanax and did some breathing exercises, but it wouldn't abate so my daughter took me to ED.

They gave me flecainide and just as the doctor was about to look at doing a cardioversion, I went back into a normal sinus rhythm.

Given everything my husband has gone through since March of this year which started with Afib and cumulated with open heart surgery for many other heart-related issues, I'm very concerned. Afib? WHAT? Me?

I have no history of afib, or anything with my heart. I workout, and have passed stress tests.

Besremi can cause afib according to the warnings.

Has anyone had recent heart issues or Afib while take Besremi?

[Elizka]

My HEMO is advising me to stop Besremi for the short-term until a full heart work up is done. I really don't want to do that but I don't want to afib again.

[EPguy]

I agree stress can bring it on. I've had irregular heart beats for 30+ years, it completely stops sometimes. Drs say no worries, and ekgs are ok. But on IFN with MPN everything gets more interesting I've been seeing a Cardio regularly and finally did a two week Rx type monitor. I'll find out for sure whether it's no worries soon.

Is Hubby doing ok now? Till my Dx I was the healthy one in our couple.

What is your latest Bes dose? I found my limit by low WBCs at ~140.

[Elizka in reply to EPguy]

Yes, I'm the "healthy" parent are my girls say. I just did my Peloton bike ride earlier in the day. No issues at all.

Thanks for asking: My husband had a nine hour surgery. Everything the surgeon threatened to do—he did. My husband had his aorta and aorta root (where the aneurysm was) replaced (too many issues to save them) which required that the whole cavity for it to be rebuilt, his tricuspid value was repaired (they weren’t able to even see it until they opened him up) and the maze procedure was done which will forever (hopefully) prevent Afib...he will need time to recover.

I recently saw my cardiologist for another cardio workup after my husband's whole journey.

I did my research and asked for all the things Peter Attia recommends to starve off heart disease:

A coronary artery calcium score is another biomarker to assess ASCVD risk 

Stress test

Echo

 CTA (a CT angiogram)

and

Apolipoprotein B-100 (ApoB) Test (blood).

Those were already all scheduled for next week.

I just increased by Besremi to around 165 the last 3 doses.

I have been having some caffeine after 15 years, but I've been drinking about a cup a day

for 4-6 months.

[EPguy in reply to Elizka]

That is the whole deal, hope he recovers well.

My mother had aortic aneurysm and had it replaced. I'm at some increased risk as a result. A good Dr can check it by hand quite accurately esp on a skinny person.

I had ASCVD of 14.3, intermediate. I think it was driven up by very high BP at Dr office. I did get coronary artery calcium score, it was zero, so I don't get to take statins, which can be good anti-inflammatory for us. I've not heard of Apolipoprotein B-100, is this related to the other cholesterol values?

[Elizka in reply to EPguy]

Dr Attia: The apoB concentration to me is the most important number you want to understand to predict from a biomarker standpoint your risk, because it captures all of the atherogenic particles Two podcasts worth listening on heart disease prevention and tests (#2 specific to women):

1: peterattiamd.com/understand...

2: peterattiamd.com/erinmichos/

[ALlady in reply to Elizka]

your experience sounds much like mine. My husband went through a several years siege of afib, ablations, conversions and finally mitral valve repair. For a marathon runner at age 71, he was not a happy camper. All recovered now and back on the road.

During his recovery time I began to have irregular heartbeats. They would come in waves lasting from two hours to 48+. I went through all the tests you named and was given metoprolol to control what was determined to be PAC. . It did but I hated the side effects. I was given the go ahead to come off it but to continue restricting caffeine and alcohol. I have done well and since his recovery my stress level is much lower - unless I have caffeine or more than the occasional glass of wine.

I hope you find your triggers and can manage the irregularity and that your husband has an uneventful recovery!

[hunter5582]

Sorry to hear about this turn of events. Unfortunately, it is possible that the Besremi may cause arrhythmias. Expect the full cardiac workup will sort things out. Hopefully it will be nothing more needed than a change in meds. I expect you will wear a heart monitor for a week of two. The newer monitors are much easier to deal with than the old type I used the last time.

Hope you find speedy resolution of the A-Fib and that your husband's recovery goes well.

[EPguy in reply to hunter5582]

This is the one I just used. I was not aware of its presence most the time. Only complaint is nothing happens when it's pressed, no light etc.

irhythmtech.com/providers/z...

Zio

[Elizka in reply to EPguy]

Awesome. Thank you. Right now, I'm using my Apple watch. Lately, my days are spent coordinating cardio care, medication, and rehab for my husband. Today, it was my turn. I spent some time on the phone and scheduled full work up and visit with heart doc scheduled this coming Wed.

The nurse said they might order a monitor at that time. Advised I don't start any other meds right now.

Nurse also said that caffeine can cause afib. Yet, when I read about it online that doesn't seem to be true. I have so enjoyed finally have some caffeine everyday after years of not being able to drink it as they were a major trigger for migraines. All the usual suspects we know (learned a lot during husband's journey) sleep apnea, obesity, smoking and drinking--none of those apply to me.

I was just reviewing my goals for this year. One of the was: Start Besremi and do well with it; I felt that I could check that one off...I hope that is still true. Time will tell.

[Elizka in reply to hunter5582]

I read two books on Afib over the weekend. One of them, The AFIB Cure, was helpful. Turns out medication is one of the most frequent causes of afib (so hoping it is not Besremi!), but so is stress and anxiety which the ER doctor said was not. Also, Pepcid can cause afib! Especially in women over 60. I have been using that lately as I drink carbonated water and that gives me some heart burn.

[hunter5582 in reply to Elizka]

That is odd that the ER doc said stress/anxiety would not cause A-Fib. It is a well known trigger for arrhythmias. It certainly has been a trigger for me. Did not know that Pepcid could be a trigger. Hope you do find the cause is something that can be eliminated or managed in a different way.

[Elizka in reply to hunter5582]

She said afib means you have something structurally wrong with your heart.

It is a sign not the only issue. In my husband's case that was true, but how is it different then tachycardia? I've gotten that many times when I was younger due to trying to be super mom: homeschooling 3 kids while running a business. in fact I had to visit an emergency room with a racing heart just two years ago when my mom died. All stress related.

[hunter5582 in reply to Elizka]

There are various forms of arrhythmias, Sinus tachycardia, Supraventricular, Tachycardia, paroxysmal Atrial Tachycardia (what I had), Atrial Fibrillation, and more. They are all caused by the heart beating out of its normal rhythm. There can be a range of reasons why this occurs as well a a range of different triggers.

This =would be my layman's KISS explanation. Normally, stress might be expected to cause Sinus Tachycardia (normal heart rhythm that is >100 at rest). When stress triggers an abnormal rhythm then something else may be going on. A-Fib means not only is the heart beating too fast but it is also beating in an abnormal rhythm. The question is why is this happening ? There can be different reasons for this to occur. The fact that you have a prior history of occasional tachycardia is suspicious for some underlying issue.

My electrophysiologist warned my that my history of Atrial Tachycardia put me at risk for later developing A-Fib. That is why I have a heart monitor watch and carry a Kardia device so that I can take a 6-lead ECG whenever I have a tachycardia episode. I still get occasional minor episodes. This device is FDA approved to detect A-Fib. It does a decent job providing an ECG i review with my cardiologist. We can see the P-Wave, T-Wave, QT interval etc. While the pattern looks a bit like Atrial Tachycardia, the speed looks more like Sinus Tachycardia.

The bottom line is that while stress may be a trigger, it is triggering something if the patter is A-Fib. The issue is to figure out what the something is. You have plenty of experience with cardiologists at this point. I am sure you will get it sorted out.

All the best.

[Elizka in reply to hunter5582]

ehealthme.com/ds/pepcid-ac/...

[Elizka]

Thank you! I'm determined to start Besremi again. I don't really have another other option. As the ED doctor said: I would have never know you had PV unless you told me. Your CBC looks normal. That's Besremi. And the idea that I'm hopefully stopping progression....

[DiveGoddess]

Elizka, Wishing you and your husband well. I don’t have any experience with Besremi but have had self resolving AFib. I have family history but wonder if platelets exacerbated this.

[Elizka in reply to DiveGoddess]

Thank you. My platelets are controlled with Besremi.

[Wyebird]

every time I over do it I go like that. I’ve gone to a and e a few times but I just need rest. It takes hours for me to recover x

[Elizka in reply to Wyebird]

You have afib? How often? Does it resolve on its own?

[Wyebird in reply to Elizka]

I’ve never been diagnosed. I feel myself getting weaker and weaker.

Usually as soon as I start getting out of breath I take that as a sign my ER wants me to rest and I avoid it. There are times when I’m unable to rest. When committed to looking after children or if my mum was taken ill.

I think I’ve gone to a and e about 5 times 24 to 48 hrs of rest and solitude resolve it.

[Mirror368]

I have paroxysmal AFib. I was given 25 mg Metoprolol Tartrate by primary as a “pill in the pocket” to stop palpitations. It is a low dose, quick acting, and short living. When I start with heart racing I take one, rest, and do deeper breathing. Within two hours it stops.

Ask your doctor if this or something like it could work for you.

Eileen

[Elizka in reply to Mirror368]

Hi there. I'm very familiar with Metoprolol as that is one of the medications my husband takes. Like minds! Unless something else is wrong, I'm going to ask for my own prescription to only take as needed. I compare it to Xanax. I hate to fly so I always carry two of three Xanax pills in my pocket to use as needed.

[Elizka in reply to Mirror368]

How often have you had it? Also, what are your triggers?

[Mirror368 in reply to Elizka]

I have had Paroxysmal AFib for about three years, I have palpitations…heart racing. It only happens two or three times a year.

[Mirror368 in reply to Elizka]

not sure what triggers episodes.

[PhysAssist]

Hi Elizka,

I'm sorry to hear of your A-Fib, glad to hear that you came out of it OK, and that your 'better half' is recovering well!

I specifically wanted to thank you for teaching me something new in medicine today- which doesn't happen all that often these days.

I'm speaking of the "Maze Procedure", of which I had never heard until today, but it sounds like an awesome secondary intervention for A-Fib, and something i'm going to go on the read more about.

Best,

PA

[Elizka]

Hi PhysAssist. Thank you. Nice to hear. I've become very educated (not at your level, of course) about heart failure these past 10 months due to my husband's heart failure.

My husband had two three cardio versions and an ablation but his afib wasn't controlled without medication. Since there were other structural issues with his heart, the Maze procedure made sense as it done during open heart surgery; not many want to go down that path.

[Elizka]

12/9/22 Update. I went into Afib during stress test and had to be admitted to in-patient to get my heart to return to normal sinus rhythm. Official dx with paroxysmal atrial fibrillation. Nothing wrong with heart structure but have AFIB.

On medication now for it and considering an ablation procedure as it has a high success rate for someone like myself with only a few episodes of Afib.

So the question is? Age or PV? I might never know.

[EPguy in reply to Elizka]

Just saw this. Scary. Good to know all is ok for now. As I've noted, cardio has lots of knowledge and answers, we await the same for MPN.