Atrial Fibrillation (AFib) Support Group
Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). Heart beats in a normal heart begin after electricity generated in the atria by the sinoatrial node spread through the heart and cause contraction of the heart muscle and pumping of blood.
three weeks ago I contracted pneumonia and this put me into afib. It's been a year since my last episode. (Interestingly, my last years' episode also occurred when I was very sick with an upper respiratory ailment, but I thought it was the psuedophed etc. that I was taking that caused it.) I haven't been on any medications over the last thee or four years, when my afib started, having opted for a pill in the pocket-atenolol.
this last episode was very unsettling, I woke up with afib; the atenolol brought my heart rate down, I went into nasal rythm. Then, coughing while awake brought on afib again, and the atenolol didn't lower my rate. It stayed high for 8 hours, when I took another dose, and it worked. I returned to nasal rythm. Another bout of coughing started the afib again; this time, the atenolol in a higher dose still didn't lower my rate. I ended up being cardioverted. 11 hours later, more coughing, back into afib, but I auto converted in the ER after about four hours.
I've been fine for a week and a half, maybe a little longer. Antibiotics knocked out my pneumonia. I'm taking Atenolol daily. but I've had no follow through with my doctors at Kaiser, except for a brief phone call from a cardiologist that I met once three years ago when I insisted; at that time we had a chat, that was it. this time he offered 'the new rythm drugs' but admitted that they had potential complications; I opted for the atenolol. but remember: we spoke over the phone for four or five minutes, I had pneumonia, and a lot of questions.
anyway, I'm not scheduled for an appointment with my gp or tests or anything; I'm off the map. No follow up.
So I'm going to schedule an appt, with my gp--you can't get to a cardiologist at Kaiser with mere afib. In an email my gp said that cardioversion seems to be working, but crap I can't just keep going in to be shocked; I need a plan. I have a lot of questions that I'll ask my gp about different approaches, but I'm worried that Kaiser has a drug protocol that they apply to everyone equally. My 'cardiologist' was going to prescribe rythm drugs for me over the phone, without seeing me or explaining anything.
So what is a typical/reasonable follow-up for a case like mine? I had an echocardiogram four years ago or so after my first episode and cardioversion, but nothing else.
Help me plan a route that I can lay out for my gp. I don't feel that my doctors are being proactive at all; I haven't seen anyone outside of the ER guys through all of this. At Kaiser it often seems that you have to take charge or nothing will happen.
I also understand that there's no cure and lots of variables; maybe I'm expecting too much.
this last episode was very unsettling, I woke up with afib; the atenolol brought my heart rate down, I went into nasal rythm. Then, coughing while awake brought on afib again, and the atenolol didn't lower my rate. It stayed high for 8 hours, when I took another dose, and it worked. I returned to nasal rythm. Another bout of coughing started the afib again; this time, the atenolol in a higher dose still didn't lower my rate. I ended up being cardioverted. 11 hours later, more coughing, back into afib, but I auto converted in the ER after about four hours.
I've been fine for a week and a half, maybe a little longer. Antibiotics knocked out my pneumonia. I'm taking Atenolol daily. but I've had no follow through with my doctors at Kaiser, except for a brief phone call from a cardiologist that I met once three years ago when I insisted; at that time we had a chat, that was it. this time he offered 'the new rythm drugs' but admitted that they had potential complications; I opted for the atenolol. but remember: we spoke over the phone for four or five minutes, I had pneumonia, and a lot of questions.
anyway, I'm not scheduled for an appointment with my gp or tests or anything; I'm off the map. No follow up.
So I'm going to schedule an appt, with my gp--you can't get to a cardiologist at Kaiser with mere afib. In an email my gp said that cardioversion seems to be working, but crap I can't just keep going in to be shocked; I need a plan. I have a lot of questions that I'll ask my gp about different approaches, but I'm worried that Kaiser has a drug protocol that they apply to everyone equally. My 'cardiologist' was going to prescribe rythm drugs for me over the phone, without seeing me or explaining anything.
So what is a typical/reasonable follow-up for a case like mine? I had an echocardiogram four years ago or so after my first episode and cardioversion, but nothing else.
Help me plan a route that I can lay out for my gp. I don't feel that my doctors are being proactive at all; I haven't seen anyone outside of the ER guys through all of this. At Kaiser it often seems that you have to take charge or nothing will happen.
I also understand that there's no cure and lots of variables; maybe I'm expecting too much.
Gee Paul...you are so aggressive. Yes, sometimes in life you need to kick ass to get what you want. After visits to the ER and a cardioversion, and a diagnosis of AFIB, you should at least be able to see a cardiologist.
...Alot of ppl on here have helped me with some of my decisions...
peace Tony
I know nothing about how Kaiser works. Can you see physicians outside the plan? I know nothing about Kaiser, but my guess is that you need a referral for everything. There must be an appeal process with Kaiser if the referral is denied. Good luck.
sorry that my original post was so long. I guess my questions are:
--is it typical for a follow up after a cardioversion
--is it typical to have a holter monitor or some other device to show if I'm in and out of afib (I don't think so)
--I have no idea what my new protocol is. I'm taking atenolol daily now but that's on my own initiative. I did not do this after the other three cardioversions
--I know nothing about the new rhythm drugs
--after another week I'll want to get back to exercising. what effect does atenolol have on this, if any?
--etc.
I have more questions but I was hoping that people might suggest what a typical clinical response looks like. Maybe Kaiser is doing what is normally done.
I'm about to schedule an appt. with my gp; I want to have a sense of what to ask for in terms of treatment/tests.
I'm not quite sure what an ep does or what ep stands for.
Read :
http://www.amazon.com/Beat-Your-A-Fib-Essential-Fibrillation/dp/0984951407
You have to really push gps at Kaiser to get moved up to a specialist I've found.
I'm Kevin, I have had A-fib for a very long time. It has been my experience that yes, you should expect Halter monitoring or some type of monitoring, unless you are in persistent A-fib and you can give the Dr. a trace on an ECG.
In follow up I would want to talk to a cardiologist at minimum. I have had acute respiratory infections before, and even though I was compromised health wise, I did not notice an increase in A-fib episodes. I think you can safely separate the physical manifestations, but pay attention to triggers like the pseudoephedrine. Also, what dose of Atenolol are you on? My tablets are 100mg and three doses of 100 mg in one day would not be wise in my opinion, possibility of Bradycardia.
The best advice I can give you is to eat healthy and find a Dr. you have respect for, then follow their instructions. If you run into trouble, come here and ask. Most of us have been through something similar at one time or another.
I can't fathom a Dr prescribing a rhythm drug by phone....and not without a full work up. These drugs are not for everyone and can be dangerous for someone with underlying heart problems.
You also need to have a conversation with your cardiologist about anticoagulants (I don't recall if you are already on one).
You are on the right track. I hope you can see an EP...they are not just for having an ablation. Mine manages my antiarrythmic drug...I have not had an ablation. Best wishes
You definitely need a follow up appt.
You definitely need a treatment plan.
Don't agree to a rhythm drug without testing to determine whether you have a heathy heart first ( a stress test or stress-echo I think).
See Primary Care Provider and get a referral to a Cardiologist.
See Cardiologist for consultation to decide what course to take.
Decide on trying meds, or using a holter monitor ( one day)
.
If monitor shows nothing, try an event monitor.(up to a month).(my insurance won't approve an event monitor without trying the one day monitor first. Takes a lot of extra time getting a diagnosis this way, at least for me.)
If event monitor shows the problem, decide on meds or ablation.
I agree...no anti-arrythmic drugs without being watched in hospital.
If you decide on meds, you may have to try a few, or a combination over the course of a year or two to find out if any work.( I have been on atenolol, diltiazem, flecainide, and metropolol....not all at once :)
If you want ablation, you will need to see a dr. who specializes in the electrical system of the heart. (electrophysiologist) He's the one who does the procedure. (I've had it twice)
I was also in the hospital when I had a lot of heart tests done, so don't know how that all works if it's out patient. (angiogram, x-rays, ultrasound of heart, blood tests, etc.)
I have had SVT in the past, and I know I have A-fib now, but it has yet to be seen on a monitor or ECG since it's off and on...so am in the process off all of this. Am waiting for my event monitor.
It can be a long process and very frustrating.
Hang in there. Hope you can work things out with Kaiser. I have a different plan. And be a strong advocate for yourself.......definitely! Keep fighting until you get proper treatment.
Yes, its a long process. Many of us have been at it for years (if not decades). It just needs to become part of your life (kind of like brushing your teeth). Its a difficult thing to accept. Acceptance will take time.
Your plan has promise. Don't forget the anticoagulant. And, you need to be under the regular care of a cardiologist. I used to see mine every 3 months. Now I see my cardiologist and EP each every six months, so I see someone every 3 months. Yes, I have a big stack of EKG's. Keep copies of all the reports of any test you have for reference. I have a folder for blood work, one for heart tests, another for thyroid tests(new), another for my legs (history of DVT's), one for my stroke, and another for misc. When my thyroid started acting up, I was able to pull up ten years of blood work and saw that this was something totally new. Believe me, no doctor is going to do that. You have to be your own advocate.
I have been trying to get a prescription for the right kind of blood thinner. I left my dr. messages Wed.-Fri. Now have to wait till Mon. And on top of that I had another real bad episode last night that woke me up. Strong fibrillation for an hour and another two hrs. for it to calm down enough for me to go back to sleep.
It's great you have copies of everything. Wish I had had the foresight to do that. I am keeping a diary of my symptoms and when they happen though. But no one will really care unless they see proof on the monitor. I have had to ask the hospitals to send all my info. to my present dr. though. So I think it's all in one place now.
So glad all of you are there. It's made a big difference.