Re: Father had a stroke, Looking for Insight?

[Guest guest]

In a message dated 6/27/2003 8:41:10 AM Pacific Daylight Time,

dharpr_2000@... writes:

<< What is more likely, he had the irregular heartbeat before the

stroke, or after the stroke.

What would have been some signs that he can look for?

Befor his stroke, he was getting very light-winded, shortness of

breath, and this went on for awhile. Could this have been him having

an irregular heartbeat?? >>

Hi, Dennis,

I'm sorry for you and your father. As a twenty year afibber with an older

brother who has been in permanent afib for about thirty years, I understand very

well the fear and frustration you are feeling. Although afib can cause all

of the symptoms you describe (dizziness and shortness of breath), stroke is by

far the most serious possible outcome of afib. It is the reason that I

continue to take Coumadin even though my afib episodes are practically

nonexistent.

It only takes one to cause a stroke. It is most likely that your father had

afib before he had the stroke, even if he was in sinus at the time of the

stroke. When the heart is in afib, it beats at 33 percent less efficiency,

causing blood to pool and possibly clot. My cardiologist told me that there is

a

chance of having a stroke up to six weeks after returning to sinus rhythm

because a clot formed while in afib could be kicked out at any time. Therefore,

the

Coumadin is essential for your father to keep his blood from clotting and

thereby to prevent another stroke.

As to how long your father has been in afib, it's difficult to tell by

symptoms alone because my experience is that symptoms can change over time.

Most

people experience a sensation of jumping or flopping in their chest in the

beginning of afib but not necessarily dizziness and shortness of breath. This

was

true of my brother and me. However, as time progressed, we both began to

experience severe dizziness and fatigue. That's when medication to control the

heart rate became necessary. My brother takes Lanoxin and Atenolol, and I take

Atenolol and Verapamil. These drugs control the heart rate and allow us to

function normally while in afib. It's usually the extremely fast heart rate or

sometimes delayed or premature beats that cause the sensations of dizziness and

imminent fainting. The fatigue is cause by the fact that the heart simply

does not supply enough blood since it's beating efficiency is decreased.

Regarding your question about triggers, I would say if your father is in

permanent afib, triggers are not a concern for him. My older brother in

permanent

afib eats and drinks anything he chooses, except alcohol, and notices no

difference in his afib. I, on the other hand, have paroxysmal (intermittent)

afib, which means that my afib can be triggered by substances like dairy

products,

grease, acid, caffeine, excessive fiber, food with additives, and the list

goes on. Triggers vary from one person to another, but these are my personal

triggers. As I said, if your father is in afib all the time, this concept does

not apply because the only way one discovers triggers is by paying attention

to what one was eating or drinking before an afib episode starts.

You have several options here, including drugs and procedures. Your father

is taking a rhythm control drug (Amiodarone) and a rate control drug

(Lopressor). The purpose of rhythm control drug is to keep the heart in sinus

rhythm.

If it doesn't accomplish that, I would look at other drug options because

Amiodarone is well-known to cause many serious side effects. My cardiologist

told

me he would use it only as a last resort after all other meds failed.

Starting with Amiodarone seems questionable to me. Many other drugs are

available,

and it seems to me that some of those others might be tried, especially if

Amiodarone isn't working and your father is still in afib. If rhythm control

doesn't work, rate control with beta and calcium channel blockers can be very

successful in suppressing afib's symptoms and allowing one to live a normal

life.

This is the case with my brother and me. If the drugs are not satisfactory,

a procedure called ablation can be very successful for some and can eliminate

the need for any drugs if it works. A final and more complex option is the

Maze surgical procedure, which may not be advisable for your dad at his age,

although I don't think there is any age limit on the Maze procedure.

The most important consideration here, I think, is to avoid future strokes.

That means your father must continue to take Coumadin faithfully and have his

INR (anticoagulation measurement) monitored regularly by Protime tests. Then

the next step is to find a medication that successfully controls either the

rate or rhythm so that your father doesn't suffer so many symptoms. If afib is

properly controlled, one can live a normal, active life in afib with few

restrictions as my brother and I have done for a long time. Good luck to you

and

your father.

in sinus in Seattle

[Guest guest]

Dear Dennis,

I'm sorry to hear your father's having such a difficult time. The drug

Metaprolol I believe is a beta blocker which can make some people feel terrible.

I was given Toprol and progressively got worse and worse because I have vagal

afib and didn't need to have my heartrate reduced that much. If he

has afib all the time, perhaps vagal and adrenergic don't matter, but finding

the right drugs can make

a huge difference.

Father had a stroke, Looking for Insight?

snip The doctor now has him on these medicines.

Cordarone(amiodarone@200 mg

Prinivil(lisinopril@10 mg

Coumadin(warfarin@5 mag

Lopressor(metoprolol@50 mg

Dennis H

[Guest guest]

Hi Dennis,

It is so awful to read of all the problems that a-fib can cause,

including your father's stroke. I do hope he has recovered fully from

the stroke.

Starfish () gave you some very good info, but I wanted to add

some advice.

It certainly does sound like your dad has a-fib if he went through a

cardioversion. (mine only lasted 1 day, so at least he had 2 weeks of

relief!). But, I would recommend asking the Dr to define 'irregular

heartbeat'. Sometimes the irregular heartbeat can be caused by

ventricular problems or a combo or artial and ventricular problems.

Next, the response we always give to new members is to seek out an

electrophysiologist (EP) at a hospital nearby. Electrical problems of

the heart are their expertise, and they will know better how to treat

your dad's condition and which meds are the best for him. Be sure to

have copies of all test reports and records and a letter from his Dr

sent to the EP before his first appointment.

The different beta blockers affect each of us differently. I switched

from toprol to atenolol and would become short of breath in less than

30 min after taking it. So, I had to go back to toprol, which makes

me very sleepy and provides some fatigue along with some other minor

things.

I and several others in the group are on tikosyn (dofetilide) for

rhythm control. After a-fib for 2 months that was debilitating as far

as hardly being able to walk to the mailbox when using rate control

meds (cardizem and toprol), the tikosyn (must be loaded as inpatient

in the hospital) was what I called my miracle drug! I converted 3

hours after the first dose. Had some issues of small bouts of afib

for the first month, but after that, I've been virtually fib free

unless something major changes in my body chemistry (antibiotics

cause diarrhea that causes electrolyte imbalance that causes afib) or

I eat something with MSG or get extremely stressed, then I might have

a short bout of afib.

Hope all the info from Starfish and my info will help. Best advice is

seek out an EP.

Keep us posted on your dad.

Cheryl

> My father had a stroke In December. The doctor told him he has an

> irregular heartbeat(which I think Is the same thing as A-Fib?)

SNIP

> I " M CONFUSED with all of this.

SNIP

> Dennis H

[Guest guest]

Dennis: I'm not a cardiologist, but my guess would be that your

father had atrial fibrillation which caused his stroke. If he was

cardioverted one time and went right back in it, and especially

considering his age, I would think he may have underlying heart

disease and that this is not a case of LAF (lone atrial fib). He may

in fact have had the rhythm for some time without knowing it, if it

is at a rate of < 100BPM. If he has chronic atrial fib secondary to

heart disease (may have had a silent MI in the past), then they would

usually let him stay in atrial fib and just attempt to control the

rate. Atrial Fib, in and of itself never killed anyone. In that

case they would just keep him on a Beta Blocker or Calcium Chanel

Blocker. In chronic atrial fib, the risk of stroke is less than

Paroxysmal Afib because it's the going in and out of afib that causes

clots to form. Perhaps they will order nuclear studies on him, given

his age, to see if he has any heart damage which may be causing him

atrial fib. I'll be watching for your posts. Good luck to Pop's

Pam in polis

[Guest guest]

Dennis: One more thing: You said that you were worried because your

father had short windedness and weakness? This could be underlying

heart disease and/or atrial fib. Atrial fib causes a 25% drop in

Left Ventricular ejection fraction. In other words regardless of

etiology or rate, your heart is pumping out 25% less blood, which

would always make you have a feeling of weakness and, particularly if

it is at a rapid rate, shortness of breath.

Pam in polis

[Guest guest]

> ...If he was

> cardioverted one time and went right back in it, and especially

> considering his age, I would think he may have underlying heart

> disease and that this is not a case of LAF (lone atrial fib.

I don't think this is the case. Cardioversions are notorious for not

lasting for anyone unless the right medication has been found to keep

the person in normal rhythm. If Dennis' Dad has underlying heart

disease, I would have thought that the doctor would have said so.

[Guest guest]

> There is a big difference between atrial and ventricular

fibrillation, for

> example; and I think it's in the patient's best interest to know

which is his

> problem.

That's easy - if it's vfib and they don't intervene immediately,

you're dead. That's a good clue :-)

[Guest guest]

> > ...If he was

> > cardioverted one time and went right back in it, and especially

> > considering his age, I would think he may have underlying heart

> > disease and that this is not a case of LAF (lone atrial fib.

>

> I don't think this is the case. Cardioversions are notorious for

not

> lasting for anyone unless the right medication has been found to

keep

> the person in normal rhythm. If Dennis' Dad has underlying heart

> disease, I would have thought that the doctor would have said so.

Trudy: Dennis' dads' doctor wouldn't know without medical records to

indicate cardiomyopathy. The patient would need nuclear studies to

know if, and to what extent heart disease was present. Still seems

to me that given his age (81) with no history of arrhythmias that

this is unlikely to be LAF. People with heart disease very often

have chronic atrial fib., in which case they will never stay out of

it for long. Thus, generally these people would be allowed to keep

their Afib. at controlled rates alleviating the need for a harsh

drugs based in rat pioson. It will be interesting for Dennis to let

us know what they find out. If you read this Dennis, I hope Pops'

well.

Pam in polis

[Guest guest]

> In a message dated 6/27/2003 7:24:56 PM Pacific Daylight Time,

> trudyjh@a... writes:

>

> << That's easy - if it's vfib and they don't intervene immediately,

> you're dead. That's a good clue :-)

> >>

> Hi, Trudy,

> I don't think that ventricular fib causes immediate death in all

cases

> although it certainly is usually deadly. In fact, I know of one

person who

> survived. Her heart actually stopped for a short time, and she

would have died if her

> husband had not called 911. However, she had about a 15-20 minute

period

> before help arrived. She feels that she did suffer some brain

damage because her

> skills are not what they were before. She had to quit working but

is now

> living a fairly normal life with a pacemaker and meds.

Unfortunately, our old

> friend afib has also taken up residence with her. She actually had

been taking

> Atenolol and other meds since childhood for this ventricular

problem which had

> been with her most of her life. Another example, I think, is Vice

President

> Cheney, who also has a ventricular problem for which he now has a

pacemaker.

> However, I think he survived some episodes before he received the

pacemaker.

> Yet another example is my own mother, whose EKG showed both afib

and

> ventricular fib while she was in the hospital for surgery. Often

the vfib occurred

> during the night, and no special measures were taken to help her,

but she

> survived. Complicating the scenario of arrhythmia is the fact that

there are as

> many variations or settings for ventricular problems as for afib.

Of the two, I

> definitely prefer afib.

> in sinus in Seattle

: The only people who ever survive V Fib and those who code in

hospital and immediate response and defibrillation might work, with

the addition of epinephrine. You're probably thinking of V Tach.

When a person has V Tach, it would require immediate conversion lest

it deteriorate into Vfib (lethal). Some people have runs of V Tach

which requires immediate intervention and is usually treated with a

device called AICD - Automatic Implanted Cardiac Defibrillator,

which, like a pacemaker can sense, but also can deliver a small shock

when it senses Ventricular Tachycardia. I also prefer Afib.\

Pam in polic

[Guest guest]

> In a message dated 6/28/2003 8:57:27 AM Pacific Daylight Time,

> pammie416@h... writes:

>

> << Thus, generally these people would be allowed to keep

> their Afib. at controlled rates alleviating the need for a harsh

> drugs based in rat pioson. >>

> The " harsh drugs based in rat poison, " otherwise known as Coumadin

or

> Warfarin, do nothing to control rate. They simply provide some

measure of insurance

> against stroke caused by blood that pools in the heart during afib,

regardless

> of the rate. Afib can cause a stroke whether the pulse rate is 70

or 140

> because the blood is not adequately pumped and allows pooling and

clotting. As

> long as even the potential for afib is there, the possibility of

stroke is

> there. My E.P. told me that I could have an afib-caused stroke for

up to six

> weeks after I return to sinus because a clot that formed during

afib could be

> kicked out during sinus rhythm. This is why I continue to take

Coumadin although

> I have had only two short afib episodes in the past eleven months.

If I do

> have an afib episode, my rate will be controlled by Atenolol and

Verapamil, not

> by Coumadin. My E.P. directed me to continue all of those drugs

because of my

> potential for afib, and I take Coumadin willingly and gratefully

for the

> peace of mind it offers.

>

> After four years of taking Coumadin, I fail to recognize " harsh "

qualities in

> it. As far as I know, I have absolutely no side effects from

Coumadin.

> Similarly, my older brother in permanent afib just started Coumadin

about a month

> ago, and he has experienced absolutely no side effects from it. He

says he

> can't notice any difference in his body since beginning Coumadin.

He agrees

> with me that the main drawback to taking Coumadin is the nuisance

of Protime

> tests which he now has every week. (He hasn't found out his INR

yet because he

> hasn't asked, much to my chagrin. I think I have nearly convinced

him that he

> needs to be a bit more proactive in monitoring his health care.)

His INR must

> be acceptable because he continues on the same dose after each

Protime.

>

> After my experience and that of my brother with Coumadin, I believe

that the

> constant labeling of Coumadin as " rat poison " is not productive or

completely

> accurate. After all, Coumadin is not that different from the many

other

> substances which we use daily that could also be lethal if used in

excessive

> amounts. Also, there is a bit of a difference between humans and

other animals.

> Rats may also succumb fatally to the effects of chocolate, a known

toxic for

> dogs, yet humans eat chocolate by the pound with impunity. My

other brother,

> who is a doctor, tells me that ordinary table salt could be

dangerous if taken

> in immense quantities. Another drug, Digoxin or Lanoxin, is

notoriously based

> in a toxic chemical from the foxglove plant. Yet Digoxin,

carefully monitored

> and taken in the correct quantity, has helped many heart patients,

including

> my brother, to live normal, active lives by controlling heart

rate.

> Constantly dwelling upon the origin of Coumadin in " rat poison "

serves no useful

> purpose that I can see and may dissuade some persons who really

need Coumadin from

> using it. I just took my Coumadin dose with gratitude and complete

absence of

> fear.

> in sinus in Seattle

: Let me see if I can explain where my information came from.

First of all when I said harsh drugs I was not referring to Warfarin

(or Coumadin). I was referring to antiarrhythmics like Flecanide.

Incanide (SP) Those ending in anide are based in cyanide. I don't

believe I ever said that Coumadin controlled rate. , I would

never say something I didn't know, and if I did I would qualify it by

saying it would seem, or possibly, or I wonder if. I am an RN with

20 years background in cardiac intensive care, worked for a time for

an electrophysiologist and for a time ran an arrhythmia clinic where

I telephonically monitored pacemakers, event recorders and read

holters. I do know the mechanism of clot formation during Afib and I

don't believe I said that it was rate dependant. I also never

suggested that coumadin controlled heart rates. If you find such

statements I would love for you to snip them and send them back to

me. Make sure they are " in context " . I don't know where you got all

this that you think that I blamed on Coumadin. Please send it back

so I can see. I am the one who advocates the use of Coumadin. I am

the one who said, with regard to the stroke post that I would rather

err on the side of safety. I also have never had a side effect form

coumadin. Whatever, I know I never said Coumadin was rat poison and

I think since you misread or I misspoke that your answer was harsh to

say the least, and I wouldn't know anything about rats and

chocolate! Also, I never said anything about digoxin (which I

certainly know the history of). I take Coumadin, Digoxin and

Atenalol and am happy to do so. I never blasted those drugs. Read

again.

Pam in polis

[Guest guest]

> Dennis' dads' doctor wouldn't know without medical records to

> indicate cardiomyopathy. The patient would need nuclear studies to

> know if, and to what extent heart disease was present. Still seems

> to me that given his age (81) with no history of arrhythmias that

> this is unlikely to be LAF. People with heart disease very often

> have chronic atrial fib., in which case they will never stay out of

> it for long. Thus, generally these people would be allowed to keep

> their Afib. at controlled rates alleviating the need for a harsh

> drugs based in rat pioson.

I'm assuming that any doctor treating someone for afib has either

tested for underlying heart disease or has obtained any records

relating to heart problems. My cardiologist told me that stress

echos could diagnose heart wall problems, etc. My mother was

diagnosed with cardiomyopathy without nuclear studies.

I think also that people in permanent afib are generally on coumadin

(aka rat poison.)