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What do you think?

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Old 11-13-2004, 05:34 PM   #1
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sam061 HB User
Question What do you think?

I have a-fib and have had it for about 25 years. I have been on Rythmol and digoxin for the last seven years.

One and a half years ago I had a chemical stress test and was told I had an EF of 40. I also received in the mail a study for LV dysfunction from this cardiologist. He did a cath and told me that I had 50% blockage in one artery with two clear and minimal in the rest.

About two weeks later I was feeling very bad and I went to see my EP. He stuck me in the hospital and put a new pacemaker in me. He told me the battery was about to go out.

This year I saw a new cardiologist (nice doctor). He ran a stress test and I was told my EF was 70. He started me walking on my treadmill at 2mph for twenty minutes, then after the chemical stress test he told me to go to 2.5mph/ twenty minutes. And as of last check up he told me to go to 3mph/ 15 minutes. I am leaving out the warm up and cooling down time on the treadmill. He told me I had no LVD. He told me I was given a lot of misinformation.

I seem to bring up a lot of phlegm at night. My PC say's it is drainage. The cardiologist told me it had nothing to do with my heart. My EP said he didn't know. Can my EF go from So, what do you think? I still get weak off and on, but this may be due to the Afib. I had an AV ablation in 98.- Thanks Sam061

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Old 11-13-2004, 09:13 PM   #2
Join Date: Aug 2004
Posts: 434
Jack51 HB User
Re: What do you think?

Hi Sam,

Do you have any chest pain or angina?

Have you ever sit down with your cardiologist and discussed why you are taking these medicines? Rythmol is a somewhat toxic antiarrhythmic drug, usually used in a have to situation only, I have read. Digoxin is for patients with heart failure. These medicines have to work closely with each other and your pacemaker. It appears to be a delicate balancing act between the 3 medical treatments.

Did the AV ablation in 98 help?

You said that your EF of 40 was determined during a chemical stress test 1.5 years ago. This test was followed by a cath. During this cath, an EF was calculated that would probably be more accurate, but you didn't mention it. It would be in your records if you would like to find the value that was recorded.

This year you saw a new cardiologist that performed a stress test and told you your EF was 70 and that you had been given a lot of misinformation. The very best of young athletes do not have an EF of 70, so I doubt that yours is that high. This doctor that performed the cardiac cath, and told you that you had a blockage of 50% in one artery, has had a great look at your heart beating, and the coronary arteries supplying it. This last doctor you saw, had a very poor means of diagnosing the condition of your heart. Stress test are not that reliable much of the time. I don't see how any doctor could be so confident in his findings, after reviewing your stress test results.

If I were you I would talk to my cardiologist about coming off the Rythmol. It could be a very risky endeavor, and he doesn't want to try it?? Maybe you can't, but it can damage the heart, I have read. I would also want an echocardiogram to check the dimentions of and functional appearance of my heart muscle and valves. It will also calculate an EF.

Do you ever feel any arrythmias? Is your phlegm ever frothy? Froth is a sign of pulmonary edema.

I hope that your Saturday night has been better than mine. I have had a bout with angina, and have been hitting the nitro and it helped. Don't take what I have said too seriously. I have just read a lot about antiarrhythmic drugs being not so nice to the heart. Be well

Old 11-14-2004, 07:49 AM   #3
Join Date: May 2004
Posts: 70
test5629 HB User
Re: What do you think?

If you have questions, write them down, specifically and see your doctor again and address them. I have read alot of Jack 51's posts. He is ceratinly adept at getting information (? web, books). However, his information, while often factually correct in a literal sense, does not make sense in the context of any individual's problems.

I do not have the time, energy or inclination to correct every mistake that I read. Just do yourself a favor and take the informations with a grain of salt and leave the diagnosing and recommendations to someone with the training to combine the book information with your specific issues.

I am sure Jack51 means well, he certainly does alot of research on people's behalf. But as a practicing and board certified MD in Internal med, Cardiology and Cardiac Electrophysiology, there are MANY incorrect statements being made.

If people want to take the information, I certainly cannot stop them. But consider yourself warned.

Old 11-14-2004, 08:06 AM   #4
Join Date: May 2004
Posts: 70
test5629 HB User
Re: What do you think?

I'll preemt Jack 51, here because he has flamed me in the past for being critical of him. I'll reiterate my position. I read these boards to get an idea of how and where my patient's may be getting their information. I have no vested interest in giving anyone here information. From a liability standpoint, I think it is wrong. If I were the moderator of these boards and I saw the amount of diagnosing and recommendations being given, I'd be scared and make sure that my isurance policy was up to date.

But when I hear misinformation, potentially life threatening and wrong, I can't just let it happen. The most I feel comfortable doing here is pointing it out and letting the original poster know that they need to be careful with the information they read. Textbooks and websites have a tremendous amount of information. From a factual basis, they are very good. But it takes skill to put the information in the context of an individual patient. The lack of taking a full hsitory, exam and diagnostic studies on a board like this makes an accurate diagnosis or treatment plan, nearly impossible.

AS I stated before, Jack51 has a tremendous amount of accurate factual information. It is his synthesis of the information and diagnosis and treatment recomendations that i have reservations about.

Old 11-14-2004, 12:36 PM   #5
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Join Date: Nov 2002
Posts: 263
sam061 HB User
Re: What do you think?

Thanks to both of you. Test5669, after I read Jacks article I was about to call 911. ha! Son-of-a -gun that scared me. There are a couple of things I have questioned. The phlegm is frothy, but I seem to produce a great deal of saliva and swallow also. Most the phlelgm which is sometimes frothy seems to occur when I sit at my computer for any length of time or after eating supper. A few times I have had it happen at night. I also wondered about the EF being 70. But I am able to walk that twenty minutes at now 2.6mph without any effort at all and feel I could go more than the second doctor has directed. He wants me to progress to 3mph/15min with warmup.
I have aniexty disorder from my military days. The first doctor told me I had had a large heart attack and after the cath said I didn't. It was an aberation from my pacemaker he thought.

The second doctor also told me I had not had a heart attack. My second doctor told me Rythmol would not have been his choice of medications. He uses ameoiderone (sp). But my new EP and the EP that origianally implanted the first pacemaker told me they would not use it because of dangerous side effects including death. My new EP said he thinks I need a pulmonary ablation. My new cardiologist was totally against that. He said it was in its infancy.

I wear out off and on throughout the day, but then a-fib can make cause that. I only feel the Afib sometimes near early morning in my chest. If it occurs during the daytime I don't notice it unless I feel it in my carotid or in my stomach. If I take my pulse I can feel it, but mostly when I feel it in my chest is at night. I had been told with an Av ablation I would not be able to feel it. I did notice that after my second chemical test I could feel a-fib quivering very rapidly in my chest (early morning) for about two weeks. I haven't told many people about what happened to me in the military. When seeing the new cardiologist he ask me if I had ever seen a psychiatrist. Then I told what happen to me but could hardly get it out. He made the statement we should always work with the mental as well as the physical aspects. When I took the stress test, it was uncomfortable, but I was able to carry on a very strong conversation with the doctor. When it was over they told me to hop up and go into the other room and sit down. The only thing they insisted on was I drink coffee or something with caffine. I declined, but again they insisted. Anyway, I most certainly appreciate your information. I do know one thing, I feel much better than I did, but not like I did before seeing that first doctor. But again it could be to the afib. I have not talked to my PC who is almost like a friend to me. I had a full blown Panic attack in his office the first time I saw him. We just bonded and I have not left him since the 2nd stress test. I have not seen him since this last stress test. When I need help he is always there unless he is on vacation.

After reading this if you have the time please make a comment. If you don't have the time I will understand. I don't know how doctors can even handle the stress they are under day in and out. You can't tell it from my spelling, but I was a inner city middle school teacher within an industrial city for twenty years. That to was stressful. The Afib began during this period and it forced me into retirement. Thanks again for your imput. I can tell you are a dedicated doctor. And Jack I also thank you for your input. But I do understand that we laymen that are not trained as a physician can often takes things out of context. I certainly know I have many times. - Sam061

Last edited by sam061; 11-14-2004 at 01:30 PM.

Old 11-14-2004, 07:33 PM   #6
Join Date: May 2004
Posts: 70
test5629 HB User
Re: What do you think?

Your situation is complex. You may need to stay on anantiarrhythmic agent to maintain sinus rhythm, since you feel the afib itself. Most people only feel the rapid rate, whicy is eliminated with the AV nodal ablation.

A pulmonary vein ablation is also an option. If it is done by someone who has done alot of them, it is a good option. But too many EP's are just starting out with this.

Your situation would take me >30 minutes to discuss, if you were in front of me. Having to type it out is too difficult. Sorry I don't have more detail.

Since you trust your PCa lot, make sure that teh physician's they send you to are people he trusts and then follow their advice.

Old 11-15-2004, 12:59 PM   #7
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sam061 HB User
Re: What do you think?

Test 5629,
I know you are busy, but I just want to say that I did have a AV ablation and at night sometimes I still feel the fast quivering AF in my chest, but when I take my pulse it is normal. I have had two of the monitors one wears for a week. All the doctors have told me is I am pacing.

My doctor never did recommend a cardiologist to me. I found them on my own and because I am so nervous they don't want to keep me as a patient. Besides my military experience and teaching in an inner city middle school they seem to think it is funny to be blunt with me. My EP office is a forty minute drive from here. He really is a great EP, but the distance takes 45 minutes to get to see him. I was hoping to find someone closer. So I was in the hospital and another doctor saw me. I went to his office twice when I got out of the hospital. He had a tech to check my pacemaker. Within thirty minutes I began feeling the Afib again. I called the doctors office and he told me I was suppose to feel Afib. I told him I had not felt it since the av ablation in 98 (except sometimes at night). He began lauging at me. So I went back to my EP downtown. He wanted to know who the doctor was and the technician was that I had seen. I could tell by his actions that something had been changed. He acted pretty upset.

The next time I went in the hosptial near where I live another cardiologitst came and asked me if I wanted a cardiologist out closer. I said yes. I told him about my father dying of a heart attack in front of me when I was nineteen. The last words said to him were "Kent you have had a large heart attack. I still see the look on his face when it looked as if he sucked all of the air out of the bedroom. This was when the doctors came to the house.

I gave my father mouth to mouth and the other doctor cut him open to preform open heart massage. It left a deep impression on me.

So I took the chemical stress test after I had told me about my father and it wasn't bad at all. I came for a follow up and he looks up at me and says, "You've had a large heart attack!" My wife almost turned purple. Then he said there was a 1% chance that it could be a shadow of my pacemaker. As it turned out that is what it was. I was feeling so bad 2-3 weeks later and I called him. He began yelling at me, "What do you want me to do!" If you don't feel good go to the ER. I finally did and my pacemaker was going out. Later I went downtown and the doctor put me in the hospital and put in a new pacemaker. Two weeks later I almost fainted. I have a bpressure monitor and it showed my pulse at forty. My EP had set it at 60-150. I called 911 and by the time I was put in the ambulance I was told it was 150. My EP said he set the high end to high.

I have always had to find my own cardiologist. But this new one is compassionate and caring. I have been on this Rythmol for 6-7 years.
He did put me on Rythmol SR last week. I didn't think anything of it. It is the same medication, but that night I woke up twice not being able to get my breath until I stood up. I didn't take it again. To much of a chicken.

You know I really admire you. I really do. To be as busy as you are and to take time to read these posting to check up on what people post. I would have to say you are an incredible doctor. I hope you take time away from the stress of your job and try to relax. We need more people like you.

This insurance thing is a mess. I have always wondered why doctors don't have patients sign an agreement if they make a mistaek they will not be sued unless it is something very drastic. Like amputating the left leg when it was to be the right. I really wish you the best. I have no idea of how old you are, but I just hope you never change your values. Please have a long and healthy life. - sam061

Last edited by sam061; 11-15-2004 at 01:03 PM.

Old 11-16-2004, 06:22 AM   #8
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babag HB User
Re: What do you think?

"ef" What Does This Stand For?

Old 11-16-2004, 08:47 AM   #9
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Join Date: Nov 2002
Posts: 263
sam061 HB User
Re: What do you think?

EF = ejection fraction or the squeeze of the heart when it pumps. -sam

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