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.
I'm a 48 yr old female who has had heart palpatations off and on for about 7 years (nothing dr were concerned about) and have been treated with metoprolol ER (25mg)for high BP. Five years ago i ended up in the hospital for several days because of a rapid heart rate over 140bpm (I have a very low normal resting heart rate of around 62). They did just about every non invasive test possible (ekg, echo, ct, stress and probably a few I don't recall) in the end I was never diagnosed with anything cardiac related, I was told I have generalized anxiety disorder. So I left happy thinking yeah, think God I'm only crazy & followed up with my primary care dr. He agreed nothing to worry about. So every year at my physical I make a point to mention these palpitations. The last few months they have become more prevelant and rather annoying. My normal heart rate is still low & I can't say that I have had a significant spell of rapid heart rate since the incident 5 years ago however if I do a couple of deep sharp breaths usually corrects it pretty quickly. In general my palpitations have gone from a couple of short episodes a month to nearly every day. Multiple times a day. And on occasion I will have it happen about every 5 minutes for several days, when this happens there is always a little hitch (takes my breath away) in my breath. I finally said hey doc, at what point do I need to be concerned about these or am I still just crazy? Lol
Well he put me on a 30 day event monitor (as I never seem to have them in his office) to get a bigger picture and doubled my metoprolol. Well he called with my results and said I have A Fib, but didn't think I needed any additional treatment at is point. He does want me to come back in 2 weeks from now for a BP check to maybe increase metoprolol again.
Does this sound like standard protocol? Should I ask for a referral to a cardiologist instead of being treated by my primary? What other questions do you recommend a newby ask?
Well he put me on a 30 day event monitor (as I never seem to have them in his office) to get a bigger picture and doubled my metoprolol. Well he called with my results and said I have A Fib, but didn't think I needed any additional treatment at is point. He does want me to come back in 2 weeks from now for a BP check to maybe increase metoprolol again.
Does this sound like standard protocol? Should I ask for a referral to a cardiologist instead of being treated by my primary? What other questions do you recommend a newby ask?
Metoprolol is one of the first-line drugs they give to people with afib.
One thing you need to ask about is anticoagulation. The biggest risk inherent with afib is stroke. When your heart doesn't beat efficiently, blood can pool in the heart and eventually form a clot, which can travel to the lungs or the brain and cause a much bigger problem. Anticoagulant drugs like warfarin (coumadin), Pradaxa, and Eliquis mitigate that risk. It's the one thing that most of us here on the board share - we've all taken them.
As long as you're anticoagulated, there really isn't any other treatment required for afib. It all depends on how symptomatic you are. Since you mentioned the shortness of breath, I'm going to guess that you indeed are symptomatic. So it just becomes a question of how much it interferes with your day to day life. There are treatment options beyond what you're doing now - both in terms of surgery and medication as well as other changes you can make like diet, exercise, supplements, and treating other things that are known to cause afib (like sleep apnea and thyroid issues).
Test blood for Thyroid issues
Check for Sleep Apnea
Do an echocardiogram to rule out any heart problems (which looks like you already had)
Give you a CHADS score that will indicate your stroke risk and if you need an anti-coagulant.
Put you on a beta blocker which you are already on.
My chads score is a 1 for treated HBP. I was only put on Eliquis after I had been in afib for 48 hours (in preparation for a cardioversion which didn't happen because I went back in rhythm on my own.) I was taken off after that.
Over the course of 12 months I went from Afib episodes a few times a month to 4 or 5 times a week and then to a 13 day episode. At that point they tried a rhythm control medicine that failed a few times, and then I had an ablation.
So in my opinion the standard protocal (at least as determined by my insurance company company) is :
Rate control (you're on this now but maybe they will bump it up)
Rhythm control
Ablation
Everyone is different so don't assume you will end up having an ablation. My wife has afib about once a year and all she is on is metoprolol. It's never progressed like mine did. (We are also both in our upper 40's like you.)
So definitely ask why they aren't referring you to a cardiologist.