Thanks for your thoughts Alan. One thing my doctor told me, and I try not to do more research outside of him, is that caffeine in normal amounts is not a trigger at all, as in zero. But he advised giving up alcohol almost entirely. Most of what else he advised has been said on this thread. At least a week off after IM races, and one day off a week.
No disrespect intended (*but one thing that drives me batshit crazy is misinformation) but that statement is simply untrue
. Although caffeine has not been shown to actually provoke arrhythmia in large studies, it is incorrect to say it is never a trigger. It actually can be a trigger in some patients
who are sensitive to it. And in my practice (*clinical cardiology over 30 years), there are more than a few patients who have increased palpitations from caffeine. It can cause ectopic beats as well as psvt and paf. I am just one practitioner and I have not one or two, but dozens of patients with documented monitors showing cause and effect of various triggers-including caffeine.
The large studies did show that most people don't seem to have an issue, but that is not all
people. So to say it is never a trigger, as in zero, is just wrong. Every patient must find their own individual triggers and avoid them. Some people have to give up alcohol and some don't.
From Up to Date:
Arrhythmias â€” Despite the theoretical relationship between caffeine and arrhythmogenesis, the available clinical evidence suggests that caffeine in doses typically consumed (ie, up to about 400 mg per day, which is roughly equivalent to up to five cups of coffee) (table 1) does not provoke arrhythmias [19-25]. Nevertheless, there are patients who may be more sensitive to caffeine and note a relationship of palpitations to caffeine intake.
In addition, there are case reports of arrhythmia in patients with underlying cardiac disease who have ingested excessive amounts of caffeine [26-30]. Thus, patients susceptible to cardiac arrhythmias should avoid consuming large quantities of caffeine, although modest amounts appear to be safe.
Based on data from large cohort and case-control studies, regular caffeine consumption does not appear to correlate with an increased arrhythmia risk [22,24,25,31,32]. In a meta-analysis of seven observational studies with >100,000 individuals, caffeine exposure was not associated with an increased risk of atrial fibrillation (odds ratio [OR] 0.92; 95% CI 0.82-1.04) . In an observational study of 130,054 patients enrolled in the Kaiser Permanente Medical Care Program, those who reported modest coffee intake (ie, one to three cups per day) did not have an increased likelihood of hospitalization for arrhythmia compared with coffee abstainers (hazard ratio
0.93; 95% CI 0.84-1.02), and those who reported heavier coffee intake (ie, â‰¥4 cups per day) had a lower risk of hospitalization for arrhythmia compared with coffee abstainers (HR 0.82; 95% CI 0.73-0.93) .
In the prospective Cardiovascular Health Study, 1416 participants aged â‰¥65 years completed a dietary assessment (including frequency of consumption of caffeinated products) and underwent 24-hour ambulatory electrocardiography (Holter) monitoring . There were no differences in the number of supraventricular or ventricular premature beats across different levels of caffeine intake. After adjustment for potential confounders, more frequent consumption of caffeinated products was not associated with ectopy
And you could have A-Fib and still have a pretty regular rate too. I myself have always had sinus arrhythmia (heart rate increases and decrease significantly with each breath) that is very distinct and prominent. But anyway, given that I am pretty geeky, I picked up an AliveCor Kardi
so I can see the electrical interruption of my heart. I use it to assess my heart rate in the morning with something I can absolutely trust because I can read what it is reading electrically. The devices are made for a-fib but it is the perfect tool for the geek to get a solid electrical interpretation of their heart. Highly recommend for the typical older ST crowd who want to stay in tune with their bodies and be better able to communicate and understand with doctors down the road.
Super boring read, but Rapid Interpretation of EKG
is a great book for understanding all of rhythms the heart can have. Definitely overkill but I thought someone out there might like it.
OMG! I won't let the medical students rounding with me have this book in my sight. Too simplistic for them but probably reasonable for the general population. Overkill and Dubin will never been in the same sentence out of my mouth-HA!
But...I also love the Kardi device! More cost effective than an iphone 10.
when you are feeling an 'irregularity' to your pulse, you may or may not be having a-fib--
when there are lots of ectopic beats (pac's or pvc's-early extra beats from the top or bottom heart chambers), that can feel very similar to AF but it is NOT the same in terms of risk
Agree. I hope you would also agree with me that both would warrant a check up.
and people may or may not be symptomatic-which is why rhythm control may not be needed or desired, but AC (anticoagulation), when indicated, will certainly lower the stroke risk-and an aspirin, although not a 'blood thinner' since it works on the platelets and makes the blood 'slippery', does work to somewhat lower the risk
Also agree but I did say "rate" control. I guess I was being more generic in my answer of controlling the rate of AF if it is too rapid...the setting in which I see it the most. Apologies to all if I've added to any confusion.
The point of my post was twofold.
1. To thank AC for a well thought out summary on AF (I forgot to thank him for emphasising reducing the risks for those prone to AF)
2. To get people to check their own pulses. It is not diagnostic as you and Thomas point out but it helps! At the very least it will confirm or deny your HRM and it will help your doc when you see him or her because by then the AF may be gone and your pulse is back to normal.
("First, check your own pulse", Samuel Shem "House of God"!).
Love the House of God reference! The complete quote: "At a cardiac arrest, the
first procedure is to take your own pulse
". Ah, the 'laws'. Very cool reminder. I must pick that book up again.
Yes, Dr. Mark, I agree with all you've written.