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Re: what is Afib, really? [Slowman] [ In reply to ]
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Slowman wrote:
"
so it's the stroke that can kill you or otherwise do a lot of damage."

right. but - speaking as a guy who's spent up to 40 hours out of sinus rhythm - after EKGs, utrasounds, nuclear stress tests, etc., at the end of it all i take a baby aspirin every day. per the doctors orders. as my blood thinner.

others might have to take warfarin, but, have you researched the increased risk of stroke by this with afib? i ask because when i did it seemed to me the increase was pretty small, so much that when i see the TV ads pushing blood thinners for those with afib i really wonder if we've gotten to a kind of ridiculous stage.

so, i'm eager to be taught, but, what do you think the increased risk of stroke is, versus a similar cohort not beset with afib?

Executive summary, my cardiologist reckons stroke risk is roughly double for me, but warfarin introduces other risks that make it much closer to a wash.

When I first presented with permanent AF, I was cardioverted. Didn't last more than a month or so; cardioverted again and put on Tikosyn (dofetilide), a potassium channel blocker. Several months later I was back in AFib. At that point, my cardiologist presented these choices:
  • the various types of ablation procedures
  • the Maze procedure
  • do nothing but take warfarin
  • do nothing

His experience is that the reversion rate of the various ablation procedures is pretty high when you check a few years down the road, and he has done a lot of them. So he no longer recommends ablation. The Maze procedure is open-heart surgery, which has all the risks associated with that. And it is not guaranteed, either. My AF is quite moderate, I never realized I had developed it until an annual physical, and except at high efforts, I don't notice it at all. When doing something hard, like intervals or following some froggy SOB on the group ride, it feels like I don't have the last gear or two I used to have, but I don't notice it at all at moderate steady-state efforts. Given that, he recommended doing nothing, unless things worsened to the point where I couldn't do the activities I wanted to do. Regarding warfarin, his opinion is that a person without other risk factors has approximately a 1% risk of a stroke. Not treating my AF will double that. I have read articles online that have said the increased risk is 5x, but I think he factored into that my overall fitness and activity level. Warfarin in his opinion introduces a similar overall risk increase; stroke risk does not rise as much, but there is the bleeding thing and some other warfarin side effects. He recommended a daily aspirin, but after some months of that I started to feel really crappy, like overtrained. My GP immediately thought GI bleeding, and he was right, I am one of the 20% who will develop an ulcer from a daily aspiring regime. Discussed again with the cardiologist, and decided against warfarin for the reasons above. Knock on wood, but it's been a couple of years now with no treatment and things have not changed for better or worse.


Brian

Brian

Kick over the wall, cause governments to fall, how you refuse it
Let fury have the hour, anger can be power, d'you know that you can use it?
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Re: what is Afib, really? [ergopower] [ In reply to ]
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"Executive summary, my cardiologist reckons stroke risk is roughly double for me"

right. it can be fivefold. but getting a decade older doubles your risk. being white lessens your risk. not having high blood pressure, not smoking, lessens your risk. so i think you've probably got a lesser risk, with afib, than a typical guy in your cohort, your age, who does not have afib.

that's why i say, yes, while you can die from an ischemic stroke where afib is the proximate cause, i just don't think people should get too awfully freaked about afib, unless you're just not in sinus rhythm period. then, don't be freaked, but get it fixed.

we have a 92 year old relative, a 100 pound lady, who lives with us fill time. alzheimers. strong as an ox. has afib. doc finally took her off coumadin for a number of reasons. she's my longevity hero.



Dan Empfield
aka Slowman
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Re: what is Afib, really? [Power13] [ In reply to ]
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"My company manufactures blood pressure monitors for consumers. We have developed a unique and patented technology that can discern the presence of A-Fib while taking your blood pressure. rather than just highlighting an irregular heartbeat (which most BP monitors can do), we can discern the difference between A-Fib and other types of arrhythmia. While we cannot yet sell the technology in the US (thanks, FDA), we do sell it right now in Mexico (and many other countries around the world)"

Ummm... I'm pretty sure it's illegal for an employee of a company to promote a medical device for use in a market it hasn't been approved for. I work for a medical device company and we have very strict rules (mandated by the FDA and other regulatory bodies) on what we can and cannot discuss with our customers based on what products have been approved in the different markets. You might want to check your quality system/ training requirements on what you are allowed to promote.

For Kathy and others interested in Afib symptoms and ablations there has been quite a bit of discussion on this forum over the years by myself and others that have gone through the procedure. My personal experiences are well-documented in other threads - if anyone has any additional questions please feel free to PM me or post here.

-J
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Re: what is Afib, really? [JAM] [ In reply to ]
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I fought a-fib for 9 years and after trying medicine after medicine, I went for the ablation. Totally cured. The ablation is, without a doubt the best decision I ever made. No limits on what I do. The last thing I would wan to do is march through life as a wounded soldier when there is a solution at hand.
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Re: what is Afib, really? [kathy_caribe] [ In reply to ]
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kathy= yeah, the article was concerning, and a nice summary of an area that is emerging, no real population-based epidemiological studies done yet. So, here we are, on the cutting edge of a phenomenon I don't think anyone really wants to be on the cutting edge of. So here's my own N=1 experience to add to the data base:

White male, current age 60. Been doing IM's since 2000, tri's in general since 91'. Professional dancer before that, pretty commonly have 40 hour exercise weeks, x about 15 years. General sports, surfing, swimming, running growing up. So a lifetime history of exercise, and quite a few years of a LOT of exercise. Had my first bout of Afib at mile 20 in IMFL 2009. Everything was great until then; HR steady at 134, then boom! 210. Felt SOB, a bit dizzy, went to a walk, did some relaxation breathing exercises, it went back down to 150, and I managed to walk/slow jog to the finish. Went to the med tent, happened to be a cardiologist there. we talked, I was very dehydrated, and had been using a lot of caffeine. The consensus was that dehydration, some sleep deprivation, excessive caffeine use, caused the tachycardia. after a couple hours, everything was normal. He advised me to get it checked, I told my primary care doc, and that was that. It would occasionally reoccur, and there was a pattern of sleep deprivation, dehydration, caffeine use, and intense extended exercise.

Blew up on me again in 70.3 Miami in 2012, and it seemed to be happening with increasing frequency, but not entirely predictable. Interestingly, it started on the swim in Miami-that's my strongest leg, but it seemed exertion with some breath holding was a trigger. Got it checked out and diagnosed at that point; doc recommended doing nothing, and see what happened over time, as I had no other risk factors, and a stress test provoked nothing. Finally, this year after Afib recurring more frequently, I wore a monitor for a month, induced it a couple times swimming and once riding, and they recommended an ablation. In the meantime, I had done my research, and found an amino acid protocol that seemed like it might help. I tried it, and damn! It really made a very noticeable difference in a short time. 2000mg Taurine, 500 mg L-Arginine, and 1000mg Magnesium. However, not a cure. So I had a cryo ablation 4 weeks ago. Still in the healing process, and the research says you can't quite tell if it took for 1-2 months, but I'm feeling pretty good. So I'm hoping to do IMCOZ in November; we'll see.
My recommendations are to be cautious-become a skilled observer of yourself and see if you can identify a pattern to the events; consider trying the amino protocol; my med providers and pharmacist said no harm from those aminos, and I'm continuing to take them. I'm now able to push harder in swimming than I could for the past two years without feeling I was about to go all tachy, so I'm encouraged.
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Re: what is Afib, really? [Slowman] [ In reply to ]
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Great post.You are speaking from experience-and knowledge from reading up- a combo that more posters should emulate.
The flush toilet analogy is spot on.

Slowman wrote:
blood goes into your atria. atria is the plural of atrium. you have 2 of them, these are 2 of the 4 chambers of your heart. the atrium pumps blood into your ventricles, and it's the ventricles that do the BIG work. atria fill ventricles, ventricles pump blood to your body.

as i remember it, right atrium pumps blood to right ventricle, right ventricle pumps blood to the lungs. blood returns from the lungs oxygenated, goes into the left atrium, is pumped to the left ventricle, then, whoosh, out it goes to the body. so the pa-bumb you hear when you listen to a heart beat is the left atrium (pa), then left ventricle (bump) or, in the case of an athlete, (bump!)

atrial fibrillation is when that "pa" isn't a pa but a pppp brrr ppp. literally mixed signals. it's like your flush toilet. the tank fills the bowl, then the bowl goes "whoosh". right after you flush, if you don't let the talk fill and you try to flush again, you don't get much whoosh. atrial fibrillation is like when you try to flush when the bowl hasn't yet sufficiently filled. you feel tired, you feel like you have sickle cell anemia. your tank (atrium) isn't filling your bowl (ventricle) so you don't get a good flush of blood throughout your body.

atrial fibrillation is not going to kill you, but it's a big annoyance. it's not a life killer, but it is a lifestyle killer. i'm 58, and i had my biggest troubles with a-fib when i was about 50. but i was living like the devil. i was pushing the throttle to the floor in every workout, drinking a man-sized homemade margarita every night, building this property every morning (i had just bought and moved onto the compound a few years earlier).

during WWII, doctors noticed a big spike in a-fib and it was soldiers on leave, drinking, partying, no sleep, 3-day binges. a-fib can be a permanent fixture in one's life, or it might be transitory and if you understand and can identify your triggers then it goes away. i have very few a-fib problems now, because i very rarely drink, i very closely watch my sleep, and i don't ever go really deep in workouts.

for those who have an a-fib problem that won't go away, there are a number of therapies, one of which is ablation, which is an invasive but non-surgical way of "shocking" the heart, trying to kill the offending part of the heart that's causing the arrhythmia. but there are other treatments being tested, such as enervating the pharyngeal nerve in the back of the throat, and if you've read what i wrote about pickle juice (front page) you'll see that this vaso-vagal reflex is really interesting.

but to the point of the velonews article, it's not just a-fib. it's also v-tach, i.e., ventricular tachycardia, and this is what sidelined greg welch. when you have an arrhythmia in your atria, that's annoying. when you have one in your ventricles, this is in the same family as a heart attack.

we will be writing more about this in the future on slowtwitch.
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Re: what is Afib, really? [kathy_caribe] [ In reply to ]
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Hello kathy-caribe and All,

As posted in another thread my wife had an ablation about 4 months ago for a-fib. We educated ourselves as best we could prior to surgery .... and my wife debated having the ablation. It has been partially successful.

An incident occurred when our cousin went into a tachycardia and afib and after 48 hours she could not be cardioverted. She was already on a pacemaker and while not an good candidate for surgery, and ablation was her best option.

She did not have another relative for an advocate close by so we were with her for the bedside consultation just prior to surgery.

We were familiar with the doctor's reputation as best of best so felt good about that. He had done 3 prior ablations that day and was tired and the surgery was going to start at about 2100. He spent time with our cousin and us diagraming the choices ... one of which was to put her on the totally on the pacemaker (which we discouraged) ... but left open as an option if no other solution was available after getting inside.

The operation was successful and while she still had the pacemaker she also had her natural sinus rhythm .... and did not have to worry about a catastrophic pacemaker failure or interruption.

At the time of the operation the doctor described a device that would go into the small triangular chamber of the atrium where a large clot can form during afib and then get released to cause a stroke when normal sinus rhythm resumes. It is currently about 1 year away in 5 year FDA trials. It would sort of fill the space and filter the clot ..... where the clot forms reducing the possibility of stroke and reducing the need for warfarin or other anti-clotting agents.

After the success of our cousins operation my wife decided to give the operation a shot for herself as the frequency of her incidents was increasing.



.

Cheers, Neal

+1 mph Faster
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Re: what is Afib, really? [JAM] [ In reply to ]
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JAM wrote:
"My company manufactures blood pressure monitors for consumers. We have developed a unique and patented technology that can discern the presence of A-Fib while taking your blood pressure. rather than just highlighting an irregular heartbeat (which most BP monitors can do), we can discern the difference between A-Fib and other types of arrhythmia. While we cannot yet sell the technology in the US (thanks, FDA), we do sell it right now in Mexico (and many other countries around the world)"

Ummm... I'm pretty sure it's illegal for an employee of a company to promote a medical device for use in a market it hasn't been approved for. I work for a medical device company and we have very strict rules (mandated by the FDA and other regulatory bodies) on what we can and cannot discuss with our customers based on what products have been approved in the different markets. You might want to check your quality system/ training requirements on what you are allowed to promote.

For Kathy and others interested in Afib symptoms and ablations there has been quite a bit of discussion on this forum over the years by myself and others that have gone through the procedure. My personal experiences are well-documented in other threads - if anyone has any additional questions please feel free to PM me or post here.

-J

Please go back and re-read what I wrote.....Kathy is in Mexico and our BP monitor is available in Mexico. I also specifically note that we do not yet have OTC clearance for the technology in the US (although we do have it for use with a Rx)

Not certain how you read that as me promoting it for use in the U.S. market.

Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams
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Re: what is Afib, really? [Slowman] [ In reply to ]
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I'm not sure I understand your question Dan. I do not specifically remember what the ER doc said about the increased risk of stroke, all I remember is him giving me that stern look (you know the ones doctors do) and saying "we don't like it when someone is in afib for more than 24 or 48 hours" (I can't remember the hours exactly). I guess I read that as 'I don't want to be sitting here at 48 hours continuous acute afib with a wife and 4 year old risking stroking out at 41 y.o.'.

Also, I do remember them putting me on coumadin for either 1 or 3 months after the first episode, again to reduce risk of stroke.

Trust me when I say I'm not for drugs as a first resort. The drugs they wanted to keep me on were awful. On top of the fact that there is now a pill for everything, including things I don't even think are things (restless leg syndrome, really??).

Perhaps there are 'levels' of afib - chronic vs. acute? I don't know I'm just a software guy, not a doctor. For something chronic and low key, perhaps doing nothing is the answer (that is where I'd start). If your chosen doctor thinks you are at higher risk of stroke for some reason, a blood thinner (aspirin or Rx) seems like a reasonable course of action if that works for you (my only side effect was being cold all the time, and I'm NEVER cold). At the end of the day, it's every individuals right/responsibility to weigh the risks and rewards of every procedure/prescription.
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Re: what is Afib, really? [kathy_caribe] [ In reply to ]
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kathy_caribe wrote:
after reading the "slowly killing" thread i started to wonder about real Afib. I always assumed my HRM was funky as VERY ocassionally (honestly like a handful of times in the last year) i'll hit 2teens or 170s for less than, say, i dunno, a minute? and then all goes back to normal (i don't think i've even gone over 160 at extreme effort). i always figured the HRM was funky as I didn't feel weird (i did pay attention to the last one) but it didn't feel terribly different and only mildly SOB so i chalked it up to a funky HRM or something other than the heart.

if you have AFIB you have other symptoms no? SOB or lightheadedness or something? and HRMs are known to do funky stuff like this right? or do i have incredibly infrequent AFIB?

Hi Kathy,

Please, please, get this checked out. There has been a lot of good information about atrial fibrillation in this thread, but that is NOT the only arrhythmia that can cause a heart rate to jump into the 200's. Other possibilities include supraventricular tachycardia, atrioventricular nodal reentry tachycardia (whew!), non-sustained ventricular tachycardia, and ventricular tachycardia (yes, the one that can turn into ventricular fibrillation = sudden cardiac death). A HRM can only show you the rate - it does not show you the EKG tracing that would distinguish between these arrhythmias. Holter monitors, event recorders, loop recorders - these devices can record the actual EKG tracings that occur over time, so a physician can correctly diagnose the arrhythmia, and develop the appropriate treatment.

Good luck,
Sharon

P.S. No, you do not have to have symptoms with atrial fib. Some of my patients can tell exactly when they go into afib, others have been in and out of afib for years without any knowledge.


Festina Lente
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Re: what is Afib, really? [Slowman] [ In reply to ]
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Slowman wrote:
blood goes into your atria. atria is the plural of atrium. you have 2 of them, these are 2 of the 4 chambers of your heart. the atrium pumps blood into your ventricles, and it's the ventricles that do the BIG work. atria fill ventricles, ventricles pump blood to your body.

as i remember it, right atrium pumps blood to right ventricle, right ventricle pumps blood to the lungs. blood returns from the lungs oxygenated, goes into the left atrium, is pumped to the left ventricle, then, whoosh, out it goes to the body. so the pa-bumb you hear when you listen to a heart beat is the left atrium (pa), then left ventricle (bump) or, in the case of an athlete, (bump!)

atrial fibrillation is when that "pa" isn't a pa but a pppp brrr ppp. literally mixed signals. it's like your flush toilet. the tank fills the bowl, then the bowl goes "whoosh". right after you flush, if you don't let the talk fill and you try to flush again, you don't get much whoosh. atrial fibrillation is like when you try to flush when the bowl hasn't yet sufficiently filled. you feel tired, you feel like you have sickle cell anemia. your tank (atrium) isn't filling your bowl (ventricle) so you don't get a good flush of blood throughout your body.

atrial fibrillation is not going to kill you, but it's a big annoyance. it's not a life killer, but it is a lifestyle killer. i'm 58, and i had my biggest troubles with a-fib when i was about 50. but i was living like the devil. i was pushing the throttle to the floor in every workout, drinking a man-sized homemade margarita every night, building this property every morning (i had just bought and moved onto the compound a few years earlier).

during WWII, doctors noticed a big spike in a-fib and it was soldiers on leave, drinking, partying, no sleep, 3-day binges. a-fib can be a permanent fixture in one's life, or it might be transitory and if you understand and can identify your triggers then it goes away. i have very few a-fib problems now, because i very rarely drink, i very closely watch my sleep, and i don't ever go really deep in workouts.

for those who have an a-fib problem that won't go away, there are a number of therapies, one of which is ablation, which is an invasive but non-surgical way of "shocking" the heart, trying to kill the offending part of the heart that's causing the arrhythmia. but there are other treatments being tested, such as enervating the pharyngeal nerve in the back of the throat, and if you've read what i wrote about pickle juice (front page) you'll see that this vaso-vagal reflex is really interesting.

but to the point of the velonews article, it's not just a-fib. it's also v-tach, i.e., ventricular tachycardia, and this is what sidelined greg welch. when you have an arrhythmia in your atria, that's annoying. when you have one in your ventricles, this is in the same family as a heart attack.

we will be writing more about this in the future on slowtwitch.

What an incredibly articulate and intelligent reply. Thank you for putting this into such easily comprehended terms (not withstanding the correction from other poster).

“Bloom wherever you are planted"
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Re: what is Afib, really? [docpeachey] [ In reply to ]
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wow, youse guys are amazing! i was traveling from CO to MN so I'm just starting to go through this thread. My symptoms are so super infrequent i can't imagine they could troubleshoot them but i do have a great cardiologist in my town so i will start wtih that. now to read the thread.

http://harvestmoon6.blogspot.com


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Re: what is Afib, really? [kathy_caribe] [ In reply to ]
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Damn it, now I'm getting WebMD paranoia here (finding matching symptons to a non existent condition).
I was doing a search trying to find info about my irregular HR readings from my last race and stopped on this thread.

So anyway, before I rush to the doctor (I have to go about something legit anyway)...

I noticed my HR was REAL high in my racing yesterday. Normally I expect a few bad readings, and spikes from a bad connection, bit this was persistent and caught my attention. But the persistence and symptoms makes me think it isn't AFib. My HR climbed normal, but just went way higher then what I thought my max was and stayed high. Bare in mind, this was a 4 stage MTB race at 7000' elevation (I live at about 1000') so the hardest event was about 30 minutes, half climbing (XC portion). The HR reacted similar in all four stages, the only spike was the downhill stage where I would expect.

I tested my HR several years ago by doing a warm up, then full sprint up a hill until I felt like I was going to die, then looked at the data. A VO2 treadmill test a year or so ago had a similar number (slightly lower, as I expected) at 185 or so. Yesterday I saw over 200! The data looks accurate. I see 208 twice on the hill climb stage, once for 10 seconds, the fastest I'm moving is 10 MPH and I'm pretty soaked in sweat by then.

Sound like a reason to panic (well, my type of panic, which is sleeping for everyone else)? Or just ignore it and assume my max HR is higher now then a few years ago (I am more fit now)?

Short background, sleep is an issue due to a shit work schedule (nights, over then the weekend, so races are after a full work 'day'), I don't drink, diet is meh. I'm mostly short distance after figuring out that I'm way better at mountain bike XC racing then tri and running (the Oly tri is still a love). 140.6 and 50k finisher in decent times. I don't normally race short distance with an HRM, so no historical data. I did ride 40k on my TT in 1:06 at 90°, 40% humidity, and 12 MPH wind (out and back, so tail wind heading out) and my HR looked normal; 159 average, 182 max.

My other, other, other, other ride has four legs.
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