Vagal-mediated AF, sleep clinic, sympathomimetic agents

[Guest guest]

This is my monthly visit to this site and to all you wonderful folk.

(As usual, since I lost weight and got into shape, I continue to go into AF

at night about once every four to six weeks and I get out of it by taking

Norpace - 200 mg every four hours - for about 30 hours, when it pops back

into NSR.)

I continue to try to figure my weird AF out. I went to a sleep clinic

last week, and will report the results of that venture after I see the doctor

on Monday. Since I had gone into AF about two weeks before, nothing that I

did could even get my heartrate to budge from a very very regular bump, bump,

bump, as if it never did anything else. (I didn't take my magnesium - I slept

on my back and on my left side - I didn't take my vitamins - I got real tired

by working out and taking a long walk - all the things I thought would bring

it on) So, I think the sleep study will be a wash. I had really wanted them

to hear it when the vagus nerve is acting up! That would have been something

different for these pneumologists, don't you think.

Sympathomimetic agents - what a name! The two week episode before the

sleep study occurred on a little island in Florida called " little Gasparelli "

where I was staying with my husband and friends. One of the friends is a

psychiatrist who is very learned about the pharmachological aspects of all

sorts of things - I've heard her lecture on them (she does this

internationally) and she is very good. She was with me when I went into AF,

and listened to my heartbeat. (It was interesting because she could tell the

difference between the chaotic atrial beats and the underlying ventricular

beat - I still have trouble doing that.) I dutifully took my Norpace while

venturing that, since I was in a strange place, it was good that I had my own

doctor along in case the heart didn't go back into NSR in the thirty hours

alloted. She opined that she probably could get me a little more attention

than I could without her.

The word " cholinergic " (from and Noble " Concise Medical

Dictionary " ) is applied to nerves which liberate acetylcholine at their

termination. This is one of the chemical messengers. There are at least two

types of chemical messengers - the excitory ones (getting excited) -

" adrenergic " or adrenaline ones.

The other kind is inhibitory, like the vagus nerve, which liberates

acetycholine at its terminaton. The acetycholine cause you to become very

sleepy, the heart to slow down, and is at least part of the reason why my

heart goes into atrial fibrillation when I say my prayers and lay down and go

to sleep. This is why the nurse identifies me as one of Dr. Marody's

patients who has " vagally-mediated AF " (her words).

There is another chemical - atropine - a principal alkaloid of

belladonna - which is given to reverse the effects of acetycholine, which it

does quite well. It is an antichoinergic drug, that is, it is inhibitory to

the action of a cholinergic nerve by interfering with the action of

acetycholine, a chemical by which such a nerve transmits its impulses at

neural or myorneural junctions. (For those of you still reading, you might

recognize atropine - It is given before anesthetics to decrease secretion in

bronchial and salivary systems to prevent cardiac depression, and it is also

used for asthma, bronchospasm, and for gastric spasms -the gastric system

being mediated by the vagus nerve).

Norpace has effects like atropine, that is, it inhibits the secretions

of the vagus nerve, which why it is such a good medication for me. However,

since I have to take it about every 4-6 weeks, it is awful because I feel

like I have been through surgery every time I take it. The amounts I take

are about 200 percent of the normal dose of Norpace so it is a huge amount.

So, my psychiatrist friends recommended that I consider taking a

medication to undue the effects of the Norpace. (My gut doesn't come

mobilized for about a week after every episode.) She recommended a new drug

called Provigil. It is a wakefulness-promoting agent which is used for the

treatment of narcolepsy, which is probably related to the vagus nerve. (We

come around full circle).

They do not understand the precise mechanism through which Provigil -

generic name is Modafinil promotes watefulness, since it does not interfere

with ordinary sleep. Anyway, Provigil acts on the CNS (Central nervous

system). I checked with Dr. Marody and he has no objection to my using it,

since it apparently would not be expected to affect the heart. I now have a

short prescription for it, and am taking 100 mg of it. I have taken it in

the morning for two days. So far, my heart is beating exceptionally well. I

will tell you more as I get more information Monday from the pneumologist on

the results of my sleep test, as well as having a further discussion with

him. Dorean Koenig

[Guest guest]

> This is my monthly visit to this site and to all you wonderful

folk.

> (As usual, since I lost weight and got into shape, I continue to go

into AF

> at night about once every four to six weeks and I get out of it by

taking

> Norpace - 200 mg every four hours - for about 30 hours, when it pops

back

> into NSR.)

> I continue to try to figure my weird AF out. I went to a

sleep clinic

> last week, and will report the results of that venture after I see

the doctor

> on Monday. Since I had gone into AF about two weeks before, nothing

that I

> did could even get my heartrate to budge from a very very regular

bump, bump,

> bump, as if it never did anything else. (I didn't take my magnesium

- I slept

> on my back and on my left side - I didn't take my vitamins - I got

real tired

> by working out and taking a long walk - all the things I thought

would bring

> it on) So, I think the sleep study will be a wash. I had really

wanted them

> to hear it when the vagus nerve is acting up! That would have been

something

> different for these pneumologists, don't you think.

> Sympathomimetic agents - what a name! The two week episode

before the

> sleep study occurred on a little island in Florida called " little

Gasparelli "

> where I was staying with my husband and friends. One of the friends

is a

> psychiatrist who is very learned about the pharmachological aspects

of all

> sorts of things - I've heard her lecture on them (she does this

> internationally) and she is very good. She was with me when I went

into AF,

> and listened to my heartbeat. (It was interesting because she could

tell the

> difference between the chaotic atrial beats and the underlying

ventricular

> beat - I still have trouble doing that.) I dutifully took my

Norpace while

> venturing that, since I was in a strange place, it was good that I

had my own

> doctor along in case the heart didn't go back into NSR in the thirty

hours

> alloted. She opined that she probably could get me a little more

attention

> than I could without her.

> The word " cholinergic " (from and Noble " Concise Medical

> Dictionary " ) is applied to nerves which liberate acetylcholine at

their

> termination. This is one of the chemical messengers. There are at

least two

> types of chemical messengers - the excitory ones (getting excited) -

> " adrenergic " or adrenaline ones.

> The other kind is inhibitory, like the vagus nerve, which

liberates

> acetycholine at its terminaton. The acetycholine cause you to

become very

> sleepy, the heart to slow down, and is at least part of the reason

why my

> heart goes into atrial fibrillation when I say my prayers and lay

down and go

> to sleep. This is why the nurse identifies me as one of Dr.

Marody's

> patients who has " vagally-mediated AF " (her words).

> There is another chemical - atropine - a principal alkaloid of

> belladonna - which is given to reverse the effects of acetycholine,

which it

> does quite well. It is an antichoinergic drug, that is, it is

inhibitory to

> the action of a cholinergic nerve by interfering with the action of

> acetycholine, a chemical by which such a nerve transmits its

impulses at

> neural or myorneural junctions. (For those of you still reading, you

might

> recognize atropine - It is given before anesthetics to decrease

secretion in

> bronchial and salivary systems to prevent cardiac depression, and it

is also

> used for asthma, bronchospasm, and for gastric spasms -the gastric

system

> being mediated by the vagus nerve).

> Norpace has effects like atropine, that is, it inhibits the

secretions

> of the vagus nerve, which why it is such a good medication for me.

However,

> since I have to take it about every 4-6 weeks, it is awful because I

feel

> like I have been through surgery every time I take it. The amounts

I take

> are about 200 percent of the normal dose of Norpace so it is a huge

amount.

> So, my psychiatrist friends recommended that I consider taking a

> medication to undue the effects of the Norpace. (My gut doesn't

come

> mobilized for about a week after every episode.) She recommended a

new drug

> called Provigil. It is a wakefulness-promoting agent which is used

for the

> treatment of narcolepsy, which is probably related to the vagus

nerve. (We

> come around full circle).

> They do not understand the precise mechanism through which

Provigil -

> generic name is Modafinil promotes watefulness, since it does not

interfere

> with ordinary sleep. Anyway, Provigil acts on the CNS (Central

nervous

> system). I checked with Dr. Marody and he has no objection to my

using it,

> since it apparently would not be expected to affect the heart. I

now have a

> short prescription for it, and am taking 100 mg of it. I have taken

it in

> the morning for two days. So far, my heart is beating exceptionally

well. I

> will tell you more as I get more information Monday from the

pneumologist on

> the results of my sleep test, as well as having a further discussion

with

> him. Dorean Koenig

What an informative, educated post! Thank you so much for helping us

all learn. Every tidbit will be helpful to someone along the line. In

some cases, we have to depend upon info beyond what our caregivers can

provide.

Thanks, Dorean.

Lawrence