well crap. Afib maybe...

[OlJarhead]

Hi Guys,

As some of you know, I canceled my live that I was going to do last night, the reason is (and this is the first I'm sharing) I had an incident that involved a ride in the ambo Friday in which my heart was acting funny and my heart rate would drop very low and then come up and go high (not super high, just around 110 from a low of 42 on my home cuff and o2 sensor).  Paramedics said I was describing afib and saw my heart rate going up and down.

By the time I got to the emerg it was fine.  Lots of tests and EKG's and all was fine and they sent me home with instruction to see a doc and cardio doc asap.

I was totally fine on Saturday and thinking this may have been a more isolated incident however yesterday my heart was clearly not beating properly (it was like it was skipping a beat every 3 or 4 and then every 12 or 12 beats) so I decided it was time to relax rather than get on camera ;)

I'm going to take the day off and try to see the doc (I use the VA so....) and hopefully they can get me into a cardio doc so I can get this sorted.

My mom has afib and has lived with it for 2 decades now so I know a little about what the future holds and I know exercise is supposed to be good for this condition so I'll be retiring again as soon as I can and working to live a little healthier.

Nothing like a heart scare to make you think about age and priorities!

[Magicman]

My Prayers are with you My Friend.

[Old Greenhorn]

Eric, sorry to read this. That is a very scary thing when it happens to YOU. Maybe one of the Docs will come by and explain some of the pathophysiology involved as well as some of the treatments used. I won't take a stab because I am very rusty on my cardiac stuff these days. But I did have many patients in my ambo over the years and got to see it close up quite a bit. One of those was my Dad who had a heart murmur since he had rheumatic fever as a child. Later in life that turned into a-fib when he was about 90 or so. The Navy wouldn't take him because of that, so he enlisted in the Coast Guard and then got attached to the Navy running a subchaser. But I digress.
 Anyway, you probably know this, but if you have a pulse Oximeter you are using, for a-fib conditions they are wildly inaccurate because they can't settle in on a regular pulse. You will see crazy numbers and that just adds to your stress. SO always do a manual pulse for comparison. It is quite difficult to count a pulse rate of 130 or so, but you get a ball park idea, is it racing (tachycardia) or is is slowing (bradycardia)? Don't trust the pulse ox and let it freak you out. With a-fib manual pules can be tough too, best way is with a monitor. You can now get monitors for your phone that will give you a trace lie but I have no experience of how they work with a-fib, if at all.
 There are several causes for this ranging from genetic to damaged or 'not normal' valves, and changes in the way the electrical impulses travel in the heart. Treatments can range from zero to medication, pacemakers, or abrasion techniques to restore proper electrical pathways. Hopefully if I have mis-spoke on anything here a Doc will correct me, but I think I got it all pretty close.

 It's a scary thing, as I said and it's very important to get it checked out ASAP to find out what's going on. Early detection and treatment if needed are the keys to success. Best of luck and keep us in the loop.

[OlJarhead]

Thanks guys.

GH -- yup, learned from the ER doc that the o2 thingy won't really work due to the skipped beats and the wrist cuff is better but not necessarily too accurate in this state either.  However, the Paramedics agreed with my wrist cuff so I can at least assume it's close and on it last night my pulse was showing 79-89 at rest.  However, manually I could feel it skipping.  Was pretty weird and that's when I decided to cancel the live and just relax.

Unfortunately I've learned I have a lot of the precursors (if you will) and that doesn't help at all, specially the weight gain around the old mid-section the last couple years as I dealt with immense work stress (that I quite past spring) and stenosis (which made it difficult to do my usual walking).

I'm working to get into the VA clinic (oh joy) this morning (so far their online stuff is crap so I'll call them at opening (no point before then) and see if I can get an app today or if I can just walk in as I will need a referral to a cardio doc since I'm on Community Care (which is good but can take time for them to authorize).

I guess I'll find out how this impacts things but ultimately I know mom has lived with this for more than 20 years and continues to be active at 83.  

However, I will NOT be working past the 20th of July regardless of whether they want to extend or not as I will officially tell them I'm done.

[doctorb]

First...we really don't have a confirmed diagnosis yet.  So a work up is definitely in your future.  At least, you are going to wear a monitor for a period of days or weeks to keep track of your ticker.

Second, many people live with their afib.  You can flip into and out of this arrhythmia or you can be constantly in a state of afib.  Some don't even know it's happening.  In other patients, the chest sensations can be disquieting and thus they seek treatment.  Some just don't feel well when it's occurring.

Third, I might suggest you look into a smartwatch, cell phone, or Fitbit type of device that can record your ECG.  If there's a sudden change in your heart rhythm, you can document it, and contact your doc.

Fourth, the issue with afib is an electrical short circuit in the heart.  Everything is normally timed for optimum efficiency with the atrium contracting just before the ventricle does.  This maximizesthe volume of blood that your heart pumps out with each beat.  In afib, this coordinated contraction is electrically disconnected, and that maximized blood volume is decreased.  While the amount of blood expelled from the heart with each beat may still be quite sufficient for your bodily functions, the irregularity of the beats can make your heart race.  As the volume of each contraction can vary wildly depending on the rapidity and irregularity of ventricular contractions, your palpable pulse can be quite irregular.  Some beats, after a prolonged pause, can be pounding and patients really feel them in their chest.  Others may not have enough volume so that you can barely feel the pulse.

Finally, this random blood flow through the heart can lead to some slowing of the normal blood progression.  This can lead to the Formation of clots within the heart, which can then be expelled into the blood stream.  This leads to strokes, heart attacks, and peripheral arterial blockages.  The number one problem with afib may not be the altered irregular rhythm and how your heart arrhythmia makes you feel, it's the potential for blood clots.  Patients who have afib are routinely anticoagulated for this reason.  You've all seen the ads on TV for the different meds to treat afib.

Treatment of the afib arrhythmia can involve other meds (besides anticoagulants) to treat the hyperactive electrical system of the heart.  Other treatments also exist, including zapping (cardiac ablation) the electrical pathways of the heart, filling a part of the atrium with a prosthesis to prevent clots, cardio-conversion (shocking the heart back into normal sinus rhythm),and pacing the heart electrically.  This is a common problem which needs understanding and attention.  Keep us posted.

[OlJarhead]

Thanks for that, I appreciate it.

I should be going in today to see my PCP in order to get a referral to cardio but again, it's the VA ;)  They've told me they put a note in the system for a 'same day' appointment and I should get a call at 8am.

With luck they will get me in right away and I'll get the referral (and approval which can take weeks) to cardio.

Never been a fan of smart watches ;) but I guess I might have to consider one.  I wear a watch so that isn't the issue but just never been interested in (and I worked in telecom for nearly 30 years so I have a better understanding than most of what they do) but I may have to consider one to help out the docs which is of course, important to me ;)

Like to keep on milling for decades to come!  After all, I have a lot of work to catch up to MM on the mobile milling Mbft amounts :P

[doc henderson]

I agree with all that is said.   You might just take and aspirin a day for now ( unless they started you on a blood thinner).  They will do an EKG and check that you are still in that rhythm.  You may end up with an stress test to r/o ischemia, and an echo to look at valve function and muscle strength.  Ideally they will try to get you back to a normal sinus rhythm and keep you in it.  then you need a medicine like amiodarone.  They may be able to get you back in rhythm and then no blood thinners are needed.  The new pacemakers keep a computer recording of your rhythm.  some are defibrillators' and can give a little internal shock if needed for bad arrhythmias.  

I will not go into great detail, but fibrillation means the atrial muscle just quivers and does not real contract.  there are corners of the atrium that is normally  cleared with a contraction.  the atrium i a booster to fill the ventricle fuller to augment the amount of blood per beat.  if the ventricles are beating, they fill through the atriums weather they are beating or not.  If not, the blood travels though them and the blood in the "corners" just sits there and can clot.  so they may do a echo to look at the atriums before the try to get you back into NSR.  (normal sinus rhythm).  If they start beating, they can eject the clot.  

I assume you can go to any ED you want, and in ours, we often admit to get the workup done.  If it has been going on a while, we start blood thinners and they see the heart doc in a few weeks.  If you keep having problems go back to the ED, and if they have cardiologists, you can ask to be admitted for evaluation and treatment.  most are evaluated and treated as an outpatient.  

[OlJarhead]

Thanks Doc.

They did recommend aspirin daily and we didn't have any baby aspirin so I've been taking 325mg's and hopefully will see the VA doc today.  My issue has continued pretty much non stop (maybe a few times it stopped but I can't tell for sure) so of course, it's a bit worrisome. 

[OlJarhead]

The sad part about dealing with the VA is that they can decide you didn't need to go to emergency, in which case you get the bill.

Of course, they will pay the initial visit (and I got that authorized -- which you have to do within 72hrs or you get the bill) but they could decide I didn't need to go in again until I saw my PCP and may deny my visit.

Of course, I can call them first, wait on hold, and when they answer get authorization if I feel I might need to go in, or just take my chances and go in anyway.  It's a crap shoot.

So far though, everything they said and everything I've read and am hearing suggests I should be fine, if uncomfortable, and a little wait isn't going to be a problem....it's just a matter of how long to wait I guess.

And then also, what to do or not do while waiting -- I'd like to get working in the shop a bit, or at least try, but wonder if I should just hold off...same with driving the 45m to work.  I could go to work while waiting I guess, but then I'll be 45 minutes from town and may not concentrate as well.

This did, at least, make my decision to quit working really easy.  I'll work for another month, maybe 3 or 4 but plan to retire to the sawmill and cabin stuff as soon as then.

[firefighter ontheside]

I'm sorry you're going through this.  Hopefully it will be sorted out sooner than later.  My dad had eye surgery middle of last year and he went into Afib during the surgeryand his heart rate went to 200.  They were not able to do everything they had planned on and he had to be admitted.  Fast forward to several weeks ago and he had a cancer treatment and again went into afib and was admitted overnight.  He does great several days after, but its with the anesthesia that he goes into afib.  Guess what...he has more cancer treatment this week.  You can bet he will have afib and be admitted.  I don't know which one, but he is on blood thinner now because of it.  He thinks he has always had afib looking back.  He has noticed heart racing even back to when he was in his twenties.  Otherwise, he has been one of the healthiest guys(despite cancer).  He will be 80 next month.

[doc henderson]

In his 20s may have been wine, women, and song.  (sex, drugs, and rock and roll in todays terms).  It is treatable.  In the old days, was a cause of embolic stroke.

[firefighter ontheside]

Lol.  Definitely wasn't wine.  I've never known my dad to drink alcohol and I'm pretty sure he never did.  Alcoholis was a problem in his family growing up and I think it made an impression on him.  Of course I drink some now, but he made an impression on me that caused me not to drink alcohol until I was about 30.

[OlJarhead]

Well VA called me back and said go back to emergency so am back in emergency and hoping maybe will get answer.

[OlJarhead]

not afib but something called pvp's

[doc henderson]

PVCs maybe,?  premature ventricular contractions, up to 6  per minute is normal.  PACs are atrial contractions and not a big deal.  Atrial fibrillation is no P wave, just the fibrillating atrium.  hope they consult a cardiologist.  If they are not concerned, than prob. ok to wait.

[doctorb]

I have PVC's.  I discovered them after a spine surgery several years ago and the irregular beat in my chest was strong enough for me to seek treatment.  After several weeks of monitoring, they determined that the number of PVC's I was experiencing was considered "benign", and required no further treatment.  However, I did not like the feeling, as it made me focus on those sensations.  I am treated with a very low dose of a medication that slows my heartbeat and prevents the vast # of PVC's.  Haven't had an issue since and I see a cardiologist annually.  Most adults have PVC's.  It's a question of how often you have them.  I have no restrictions on my activity, either from my docs or from the way I feel.

[OlJarhead]

Thanks guys,  there was an RN Practitioner there and she said she could see them even when I couldn't feel them.  It was strange to suddenly have this but I'm happy to know it's not a big deal!  Was a weird weekend but I'm happy to know a lot more now and can move forward without that worry hanging over my head so glad, in the end, the VA made me go back in :D

[Magicman]

I have knowingly had PVC's for over 10 years.  I was alarmed at first but a Cardiologist explained to me.  I still have a yearly appointment with him, I guess because I need to help him pay for his new boat.   ;D 

[RetiredTech]

  Glad to hear it's not too serious. I'm having a little problem myself and your right. It's pretty scary when you don't know what's going on. Good luck catching up to Magic. That's a lofty goal for a young man.

[OlJarhead]

ha!  Catching up to MM?  Hmmm....maybe half way?

And I hope your issue gets sorted out soon!  It's the not knowing that is the worst.

[GAB]

OJ:
Reading the title: the first thing that came to mind was that you were going to confess to having told us a tall tale.
I guess that is what I get for jumping to conclusion.
Any way I wish you the bestest and a speedy recovery.
GAB

[OlJarhead]

lol nah... but I am well and good to go!

Thanks!

[doc henderson]

Now if it were @WV Sawmiller It would be "a fib for sure"!!!