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Old 11-18-2004, 10:08 PM   #1
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Irregular Heartbeat

I'm concerned about my father. He's 78yo and was told by his cardiologist that he was going to have an irregular heartbeat for the rest of his life. He's had an irregular heartbeat for years, but in the past few months, although he's been back in the hospital and received electric shock therapy, etc., it hasn't helped. He recently went into CHF for the first time. Now, he's home and doing better, but again the doctor says he's stuck with an irregular heartbeat. I can't believe there's nothing out there that can help him. I'm trying to talk him into getting a second opinion, but he seems resigned. Does anyone have any suggestions or is he truly stuck with this condition?

 
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Old 11-18-2004, 10:51 PM   #2
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Re: Irregular Heartbeat

Listening to the history you've given, it sounds like your father likely has atrial fibrillation. This is a condition where the small chambers of the heart (the atria) do not contract rhythmically...instead, they quiver like jelly. Because the ventricles (the larger chambers) are still able to contract in rhythm, you are able to pump blood to your body. The problem with atrial fibrillation is that, in the long term, it can cause heart problems (as you've seen in your father in terms of CHF) and it can also, more importantly, precipitate blood clots and cause an embolic stroke.

You mentioned they shocked your father, but it doesn't sound like his heart was stopped or anything. Did they have him on any medications before they shocked him? The shocking they did for him is different than the shocking you see on a show like ER. This is a "cardioversion" shock rather than a "defibrillating" shock. It attempts to get the heart out of atrial fibrillation and back in to normal sinus rhythm. Usually, they only do this if they know the person has been in atrial fibrillation for less than 48 hrs. Otherwise, they have to put the patient on coumadin for about 3 weeks before doing the shock or they can cause the stroke.

In terms of the management of atrial fibrillation, it doesn't sound like your doctor explained it very well to you. I'm sorry for that. Anyway, he's right that your father will likely have this irregular rhythm for the rest of his life, but that doesn't mean that it's not treated. The first thing for treatment is to put your father on a blood thinner to reduce his chances of having a stroke. If he's on coumadin, then that has been done.

The second thing is, an irregular heartbeat in terms of atrial fibrilation can be fine as long as the heart isn't beating really fast. If the heart is beating at a regular rate, just coumadin is fine. If however the heart is beating really fast (like more then 120 beats per minute) the doctor should add a beta-blocker to slow the heart down. This is known as rate control. The heart is still in atrial fibrillation, but it is beating at a regular rate.

You can also try to rhythm control with medications like amiodarone, procaineamide, propafenone or ibutilide, but these carry a certain amount of toxicity and can actually make the fibrillation worse.

So....that said...has your father been put on any medications?

 
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Old 11-19-2004, 09:22 AM   #3
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Re: Irregular Heartbeat

Thank you for explaining it a bit better to me. Yes, it was "cardioconversion" that they did on my dad. Since leaving the hospital, he has been on coumadin and lasix. And no, he does not have a rapid heartbeat. And although he's had an irregular heartbeat for years, it has always responded well to medication until the past few months. He is not on any of that type of medication now. Wouldn't a pacemaker help?

 
Old 11-19-2004, 02:59 PM   #4
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Re: Irregular Heartbeat

No, a pacemaker wouldn't help because because his heart is paced just fine. A pacemaker is used if the spontaneous conducting system of the heart begins to fail and does not produce electricity like it should be. Your father's heart is still producing electricity--it's just not very organized. Since he doesn't have a fast heart rate, keeping him on coumadin is the right thing to do. Atrial fibrillation doesn't usually degrade to a rhythm which can lead to death (such as VENTRICULAR fibrillation or ventricular tachycardia).

The other thing....considering your father had heart failure, it might benefit him to be put on medications like an ACE inhibitor or a beta-blocker anyway because these drugs help to reduce mortality in patients with CHF. I'm not sure how bad his CHF was though.

Other drugs which reduce mortality in CHF are: spironolactone (but only in very severe CHF) and also vasodilators such as: hydralazine and nitrates. You should ask your doctor if your dad should be on those. There might be a reason he wasn't put on some of them.

 
Old 11-19-2004, 03:07 PM   #5
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Re: Irregular Heartbeat

Oh...one more thing....a lot of the time, docs will go with the saying "ACEs when wet and Betas when dry" in CHF. If your dad still has a lot of fluid on his lungs, usually only an ACE is started and once that's cleared, the beta-blocker can be started as long as his heart rate already isn't too slow. In this case, the beta-blocker is more being used to treat his CHF rather than his Afib.

 
Old 11-20-2004, 09:00 PM   #6
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Re: Irregular Heartbeat

Thanks for your help on this one. Although I'm not sure I like the answers, at least I know a little bit more than I did before. A few more questions though, my dad's bpm is running between 67 and 75. He's wondering how active he can be. I've been telling him not to rake leaves, pitch horseshoes, etc. but to take it easy since he has been complaining that he's out of breath and his legs are weak. Are those typical symptoms of an irregular heartbeat? Is there any chance that his heart will revert back to a regular rhythm? Do we have to worry about a heart attack? These are questions I've been asking my dad to ask the cardiologist, but he doesn't want his cardiologist to think that he doesn't trust him or he's questioning his ability as a doctor.

 
Old 11-22-2004, 06:29 AM   #7
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Re: Irregular Heartbeat

Quote:
it sounds like your father likely has atrial fibrillation. This is a condition where the small chambers of the heart (the atria) do not contract rhythmically...instead, they quiver like jelly.
for someone diagnosed with PVC's i found this to be intresting. Becasue sometimes when i get heart flutters it feels exaclty like what youve described. I can still feel my pulse through my neck, albeit its a little off. But blood is defaintly still pumping, despite feeling my heart fluttering

I tend to get a PVC,or skipped beat, followed by 4-6 beats of fluttering, before the heart quiets down and returns to normal

can PVC's lead to Afib?? and can AFIB be detected on an event monitor??

or am i just blissfully ignorant as to whats going on ??

 
Old 11-23-2004, 10:50 PM   #8
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Re: Irregular Heartbeat

Quote:
Originally Posted by Schmedsm8
Thanks for your help on this one. Although I'm not sure I like the answers, at least I know a little bit more than I did before. A few more questions though, my dad's bpm is running between 67 and 75. He's wondering how active he can be. I've been telling him not to rake leaves, pitch horseshoes, etc. but to take it easy since he has been complaining that he's out of breath and his legs are weak. Are those typical symptoms of an irregular heartbeat? Is there any chance that his heart will revert back to a regular rhythm? Do we have to worry about a heart attack? These are questions I've been asking my dad to ask the cardiologist, but he doesn't want his cardiologist to think that he doesn't trust him or he's questioning his ability as a doctor.
Good call....there is no problem with your dad trying to do physical things, but obviously he shouldn't overexert himself. He should try to do what he can...if all that he can do is walk a bit, then he should do that.

The shortness of breath is associated with his heart failure--not the afib. The chances of his heart reverting back to regular rhythm are not too good. I mean, it may go back to regular rhythm temporarily, but it will probably stay in afib most o' the time. Yes, a heart attack/cardiac arrest is a concern and that is why the doctors will be working to optimize his medical therapy.

 
Old 11-23-2004, 10:53 PM   #9
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Re: Irregular Heartbeat

Quote:
Originally Posted by stixx
for someone diagnosed with PVC's i found this to be intresting. Becasue sometimes when i get heart flutters it feels exaclty like what youve described. I can still feel my pulse through my neck, albeit its a little off. But blood is defaintly still pumping, despite feeling my heart fluttering

I tend to get a PVC,or skipped beat, followed by 4-6 beats of fluttering, before the heart quiets down and returns to normal

can PVC's lead to Afib?? and can AFIB be detected on an event monitor??

or am i just blissfully ignorant as to whats going on ??
PVCs don't lead to afib...in fact, if they lead to ANYTHING (which is rare unless you have underlying heart disease) it is not an ATRIAL arrythmia they lead to, but rather a ventricular arrythmia like ventricular tachycardia which can degrade to ventricular fibrillation which can lead to death. HOWEVER HOWEVER HOWEVER HOWEVER HOWEVER (I am stressing that like CRAZY so no one misunderstands this post) MANY MANY MANY MANY MANY people get PVCs and they are almost always benign. It's PVCs in the wake of ischemic heart disease (i.e. in a 69 year old person that smokes or has diabetes) when you start worrying about a malignant arrhythmia.

 
Old 11-24-2004, 10:14 AM   #10
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Re: Irregular Heartbeat

Thanks for sharing "butterflytrans". I've shared everything you've said with my Dad and he's relieved, but unhappy at the prospect of having to deal with this for a long time. I'm presently working with my Dad to come up with a list of questions/concerns he has for his cardiologist so we can print them out to give to him. Now all I have to do is talk him into actually giving them to him. He will also be asking his cardiologist to explain to him what each of his medications are and how they're supposed to work.

Again...thanks for your help.

 
Old 11-24-2004, 09:09 PM   #11
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Re: Irregular Heartbeat

You're welcome! I'm glad to be of help!

 
Old 04-25-2005, 03:00 AM   #12
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Re: Irregular Heartbeat

I'm 42 and have been in AF for probably eight to ten years. I was diagnosed (confirmed) in July/August 2004, and I have been on warfarin (Coumadin) since. I underwent cardioversion in February 2005, and after four attempts, the cardiologist has decided that I am best kept on meds for the time being rather than try to cardiovert me again. I am on a beta blocker, because my heart has periods of rapid rates up to 180 bpm. According to the cardiologist, the next step is ablation, but for someone my age that doesn't have any symptoms, and has been in AF for as long as I have, and has unsuccessfully undergone cardioversion, the success rate is only 53%. With that, he said the odds would be better after the second attempt. So all tolled, I am suffering AF, with left ventricular dysfunction, and an enlarged chamber. For the time being, my wife and I have decided to hang fire until at least one symptom should arise.

Question, my family doctor (GP) said that increasing my exercise regime would benefit me. I walk the dogs two to three times weekly, but have since purchased an exercise bicycle to help on those days I don't go out (I work from home) My wife is worried that by increasing my exercise, it would put undue strain on my heart. Oh I am 6'6" and weigh about 250lbs. So far my GP is the only one of the "team" to discuss exercise and heart health. I did ask the cardiologist about losing wieght, but as I don't appear overweight, he said he didn't think it necessary. IYO do you think exercise plays a significant part in AF heart health?

Oh and last thing my Father has AF which has led to CHF, but the doctors have said it's not hereditary, although most of my Dad's siblings, have died from heart trouble at 72-73. He is 69, and his only remainding (out of 10) 72 year old sister (my Aunt) also has AF and isn't very well.

Can you shed some light on the exercise part, and possibly any other advice/questions for my GP, Cardiologist/websites please?

 
Old 04-27-2005, 09:50 AM   #13
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Re: Irregular Heartbeat

bumping my thread to get an answer please!

 
Old 04-27-2005, 05:05 PM   #14
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Re: Irregular Heartbeat

I love explaining to people my situation with my Frequent Pvc's

Had em for years

Have them very very frequently....prolly around every 6-8th beat on average....yes its a lot, but i know lots of people including myself who have that many and the pvc's are still considered begine. Im only 22, had em for 3-4 years.. I am going to the cardio before my vaca and im scared stiff.....like anyone else would be, but never the less, I got them and i seem to be ok!

 
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