Irregular Heartbeat

Schmedsm8 · 11-19-2004, 01:08 AM

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?

butterflytrans · 11-19-2004, 01:51 AM

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?

Schmedsm8 · 11-19-2004, 12:22 PM

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?

butterflytrans · 11-19-2004, 05:59 PM

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.

butterflytrans · 11-19-2004, 06:07 PM

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.