Re: When to go to ER while in Afib

[Guest guest]

In a message dated 2/9/2004 7:28:23 PM Pacific Standard Time,

JPindorski@... writes:

<< They all cautioned that the patient

has to be darn sure of when the afib started so that they be

convinced that a CV can be performed safely. Could it be that the

criteria is changing in the medical community? >>

,

My understanding from my cardiologist is that a cardioversion cannot be

safely performed without stroke risk until the patient has been on Coumadin for

at

least three weeks. Once when he was planning to cardiovert me after eight

days of afib, he insisted that I should start Coumadin, but I converted on my

own

before a cardioversion could happen. In my 20 years of afib, I have never

been to an emergency room for afib and have never been cardioverted even though

I have had episodes as long as ten days. Even before I started Coumadin, I

always stayed home and waited it out, always converting on my own. I am not

recommending this course for others but simply recounting my experience. We are

all different, and I think age enters into the decision, also, because I was

quite young when I started afib. For an older patient, a doctor might

recommend getting to the emergency room immediately at least for chemical

conversion

even if the patient is not on Coumadin.

in sinus in Seattle

[Guest guest]

In a message dated 2/9/2004 8:27:23 PM Pacific Standard Time,

bobbyr@... writes:

<< Also, if your heart starts acting up and you

*think* its afib, and wait around the house because of something you

read on the Internet, but it was really something new (maybe a dangerous

tachycardia or a heart attack) you could do yourself great harm.

>>

Bobby,

That is a very good point. I didn't think of that when I posted my response

to this question. It's better to be safe than sorry or worse.

in sinus in Seattle

[Guest guest]

I was told by 3 different EP's and several cardiologists and several

ER doctors that the window of opportunity for a cardioversion is 48

hours from the onset of afib. They all cautioned that the patient

has to be darn sure of when the afib started so that they be

convinced that a CV can be performed safely. Could it be that the

criteria is changing in the medical community?

P <Michigan>

'''''''''''''''''''''''''

> When you have an episode of atrial fibrillation, you can wait for

up

> to 6 hours to see if it stops on its own. If it does not, get

medical

> attention. Make sure the doctors get you back into a normal rhythm

> within 12 to 24 hours (don't let them take the " wait and see "

gambit

> too far), because blood clots begin to form in the atria after this

> much time has passed. If you do not convert to a normal rhythm on

> your own, insist that they cardiovert you before 24 hours has

passed.

>

> http://heartdisease.about.com/cs/arrhythmias/a/AFIB_4.htm

[Guest guest]

There are too many variables here.

A great deal of us are on Coumadin and that would change the whole

picture. If you are properly anti coagulated, you are not racing time

unless I am mistaken. Also, if your heart starts acting up and you

*think* its afib, and wait around the house because of something you

read on the Internet, but it was really something new (maybe a dangerous

tachycardia or a heart attack) you could do yourself great harm.

That is a great link with a lot of information (from that one doctor),

but we must take it for what its worth. A new group member reading the

original post may misinterpret it as medical advice, and that's not what

we're here for.

Bobby

Atlanta

Debbi wrote:

>When you have an episode of atrial fibrillation, you can wait for up

>to 6 hours to see if it stops on its own. If it does not, get medical

>attention. Make sure the doctors get you back into a normal rhythm

>within 12 to 24 hours (don't let them take the " wait and see " gambit

>too far), because blood clots begin to form in the atria after this

>much time has passed. If you do not convert to a normal rhythm on

>your own, insist that they cardiovert you before 24 hours has passed.

>

>http://heartdisease.about.com/cs/arrhythmias/a/AFIB_4.htm

>

>

[Guest guest]

Bobby,

I've never been cardioverted, but have been to ER several times where

I was chemically converted. I have yet to figure out when I'm in

afib or tachy.

Thanks for you post.......

Debbi, OU Alum, in OKC

Also, if your heart starts acting up and you

> *think* its afib, and wait around the house because of something

you

> read on the Internet, but it was really something new (maybe a

dangerous

> tachycardia or a heart attack) you could do yourself great harm.

>

[Guest guest]

In a message dated 2/10/04 6:35:56 AM Pacific Standard Time,

Pagequeen1@... writes:

<< When they have to use the paddles to shock your heart back into

rhythm. >>

I thought using the medicine to convert the heart was also called

cardioversion. Is this right? Thanks.

Toni

[Guest guest]

What is Cardiovert?

michele ny 52

When to go to ER while in Afib

When you have an episode of atrial fibrillation, you can wait for up

to 6 hours to see if it stops on its own. If it does not, get medical

attention. Make sure the doctors get you back into a normal rhythm

within 12 to 24 hours (don't let them take the " wait and see " gambit

too far), because blood clots begin to form in the atria after this

much time has passed. If you do not convert to a normal rhythm on

your own, insist that they cardiovert you before 24 hours has passed.

http://heartdisease.about.com/cs/arrhythmias/a/AFIB_4.htm

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acted upon without consultation with one's physician.

[Guest guest]

It has always been my understanding that cardioversion must be performed within

24 hours of afib onset, and if the afib episode goes over 48 hours, then

coumadin must be taken, and the cardioversion cannot then take place until the

coumadin has done it's thing and the blood is stable. Apparently prior to 24

hours the likelihood of clots is low, and after 48 hours much much higher.

Prior to my current episode (now going on a month) I have always converted by

myself, so my doctor was not at all anxious to cardiovert me, but now that I've

been in afib for a month, and my coumadin levels have started to settle in, they

are talking about doing it next week.

The risks from cardioversion are not to be ignored either.. although rarely,

they can include stroke, heart attack, permanent arrythmia and even death. I

think the doctors would almost always prefer that the body convert naturally,

even with the help of medications, vs. converting with shock.

Stef

Starfi6314@... wrote:

In a message dated 2/9/2004 7:28:23 PM Pacific Standard Time,

JPindorski@... writes:

<< They all cautioned that the patient

has to be darn sure of when the afib started so that they be

convinced that a CV can be performed safely. Could it be that the

criteria is changing in the medical community? >>

,

My understanding from my cardiologist is that a cardioversion cannot be

safely performed without stroke risk until the patient has been on Coumadin for

at

least three weeks. Once when he was planning to cardiovert me after eight

days of afib, he insisted that I should start Coumadin, but I converted on my

own

before a cardioversion could happen. In my 20 years of afib, I have never

been to an emergency room for afib and have never been cardioverted even though

I have had episodes as long as ten days. Even before I started Coumadin, I

always stayed home and waited it out, always converting on my own. I am not

recommending this course for others but simply recounting my experience. We are

all different, and I think age enters into the decision, also, because I was

quite young when I started afib. For an older patient, a doctor might

recommend getting to the emergency room immediately at least for chemical

conversion

even if the patient is not on Coumadin.

in sinus in Seattle

[Guest guest]

,

When they have to use the paddles to shock your heart back into

rhythm.

Debbi, OU Alum in OKC

> What is Cardiovert?

>

> michele ny 52

[Guest guest]

> When you have an episode of atrial fibrillation, you can wait for

up

> to 6 hours to see if it stops on its own. If it does not, get

medical

> attention. Make sure the doctors get you back into a normal rhythm

> within 12 to 24 hours (don't let them take the " wait and see "

gambit

> too far), because blood clots begin to form in the atria after

this

> much time has passed. If you do not convert to a normal rhythm on

> your own, insist that they cardiovert you before 24 hours has

passed.

>

> http://heartdisease.about.com/cs/arrhythmias/a/AFIB_4.htm

This seems contradictory to what I've been told by several cardio's

and gp's: that with anything that lasts over 24-48 hours you may

want to go to an ER. As for blood clots forming, I have been told

that it takes about 2 weeks for that to happen. Of course, when afib

first strikes it can be a really frightening experience and I think

a call to your doctor and a trip to the ER is not uncalled for.

After my first afib episode (and a trip to the ER) I was evaluated

for any underlying issues. None were found and I haven't been to the

ER since. I was averaging 4 serious afib episodes per year. (Now I'm

in chronic afib and taking coumadin.)

I suppose it's possible that the guidelines for this are changing.

[Guest guest]

Right, at least as I understand it. There are 3 kinds of cardioversion --

electrocardioversion (zapping, bbq) in which the paddles are used, chemical

cardioversion using drugs either in or out of a hospital environment and self

cardioversion where it just goes away.

Bill Manson

Guelph, Ontario

[Guest guest]

> I thought using the medicine to convert the heart was also called

> cardioversion. Is this right? Thanks.

Right. As I understand it, there are 3 kinds of cardioversion:

electrocardioversion (zapping, bbq) where the paddles are applied

(This is the one that we usually refer to as cardioversion on this

board), chemical cardioversion which uses medications either in or

out of a hospital setting, and natural cardioversion where the heart

kicks back into sinus rhythm 'on its 'own.'

[Guest guest]

Oh my god!!! That is sooooo scary. Would the situation have to be life

threatening for them to have to do that? Isn't there a less scary way?

Michele

********************************

Re: When to go to ER while in Afib

,

When they have to use the paddles to shock your heart back into

rhythm.

Debbi, OU Alum in OKC

> What is Cardiovert?

>

> michele ny 52

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acted upon without consultation with one's physician.

[Guest guest]

Actually, the process is a breeze. You're anesthtized. You wake up and you're

in rhythm or not. It's one of those things that it's better not to think about

;-)

That sounds cavalier, but it _is_ something that you pretty much get used to as

an occasional occurance. (I feel better about it than about some of the meds

that I take.)

Bill Manson

Guelph, Ontario

[Guest guest]

I have been in and out of Afib for the last year. I never went to

the emergency room, and I was put on warfarin. Since Novenber, I have

had worse episodes that last longer. Sometimes my heart is thumping

so bad my whole chest shakes. I never could take my own pulse, but I

think it would have scared me!

Yesterday I got a radio shack calorie/pulse monitor for 9.95- product

number 63-1122. I recorded pulses as high as 167 while just sitting

there, and watched a gradual slow down over the course of the day. I

can see by the way the little heart on the monitor pulses, that the

rhythm is not regular, but when my pulse is 90 or under, I feel fine.

I now have an objective measure for when my heart seems to be racing

especially at the beginning of an afib episode! My question is what

do I do with this information?

How fast is a dangerously fast pulse? How long should someone allow

their pulse to race at a dangerously fast pace before seeking

intervention?

[Guest guest]

- if you're in and out of afib, and on warfarin already, you should ask

your cardiologist about going on a " rate control " drug such as diltiazim

(Tiazac, Cardizem). I have been on Tiazac for a year now, and I don't notice

any side effects (no tiredness or lethargy) but when I go into an afib episode

it does work to control the rate of the afib.

A rate of 167 or above is high and can be pretty uncomfortable... tight chest,

hard to breath.. hard to sleep... plus it sort of takes over your brain, since

you're usually so aware of it... and it shouldn't be sustained for any length of

time... a day, maybe, but not days...

as my doctor says.. it's not the afib that's going to kill you (if left

uncontrolled).. it's the fact that your heart is beating itself to death! A

sustained heart rate can lead to heart enlargment (just like working an arm or

leg muscle too much) which over time can be a bad thing.

Stef

katie_in_az wrote:

I have been in and out of Afib for the last year. I never went to

the emergency room, and I was put on warfarin. Since Novenber, I have

had worse episodes that last longer. Sometimes my heart is thumping

so bad my whole chest shakes. I never could take my own pulse, but I

think it would have scared me!

Yesterday I got a radio shack calorie/pulse monitor for 9.95- product

number 63-1122. I recorded pulses as high as 167 while just sitting

there, and watched a gradual slow down over the course of the day. I

can see by the way the little heart on the monitor pulses, that the

rhythm is not regular, but when my pulse is 90 or under, I feel fine.

I now have an objective measure for when my heart seems to be racing

especially at the beginning of an afib episode! My question is what

do I do with this information?

How fast is a dangerously fast pulse? How long should someone allow

their pulse to race at a dangerously fast pace before seeking

intervention?

Backup web page - http://afibsupport.proboards23.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

---------------------------------

[Guest guest]

I too am on Warfarin and Cardizem LA. I was on Amiodarone. I am glad to be off

of that. It is a deadly drug. Since being on the warfarin and ardizem, I

notice that when the afib starts, it is not as long and

and not as hard as it was. I hope this works for a while. My mind, at times,

is so opessed with this.

Michele ny 52

Re: Re: When to go to ER while in Afib

- if you're in and out of afib, and on warfarin already, you should ask

your cardiologist about going on a " rate control " drug such as diltiazim

(Tiazac, Cardizem). I have been on Tiazac for a year now, and I don't notice

any side effects (no tiredness or lethargy) but when I go into an afib episode

it does work to control the rate of the afib.

A rate of 167 or above is high and can be pretty uncomfortable... tight chest,

hard to breath.. hard to sleep... plus it sort of takes over your brain, since

you're usually so aware of it... and it shouldn't be sustained for any length of

time... a day, maybe, but not days...

as my doctor says.. it's not the afib that's going to kill you (if left

uncontrolled).. it's the fact that your heart is beating itself to death! A

sustained heart rate can lead to heart enlargment (just like working an arm or

leg muscle too much) which over time can be a bad thing.

Stef

katie_in_az wrote:

I have been in and out of Afib for the last year. I never went to

the emergency room, and I was put on warfarin. Since Novenber, I have

had worse episodes that last longer. Sometimes my heart is thumping

so bad my whole chest shakes. I never could take my own pulse, but I

think it would have scared me!

Yesterday I got a radio shack calorie/pulse monitor for 9.95- product

number 63-1122. I recorded pulses as high as 167 while just sitting

there, and watched a gradual slow down over the course of the day. I

can see by the way the little heart on the monitor pulses, that the

rhythm is not regular, but when my pulse is 90 or under, I feel fine.

I now have an objective measure for when my heart seems to be racing

especially at the beginning of an afib episode! My question is what

do I do with this information?

How fast is a dangerously fast pulse? How long should someone allow

their pulse to race at a dangerously fast pace before seeking

intervention?

Backup web page - http://afibsupport.proboards23.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

---------------------------------

[Guest guest]

Michele:

I'm sure you will get plenty of replies like mine & I want to assure you A-fib

is not life threatening under almost any circumstance. The danger with A Fib is

the development of a clot in the atrium that could be pushed out & cause a

stroke. That's why most of us take blood thinners (coumadin and/or aspirin) so

to lessen the chance of a clot forming. I will concede the EC procedure seems

scary, but in reality it isn't. It a very simple, quick, and VERY SAFE procedure

to put the heart back in NSR. It is done in ER's when those Fibbers who are

paroxysmal (occasional A Fib) have an episode & the Dr. aren't concerned about a

clot forming (apparently they would take about 24 hrs. to form) so they can

convert to NSR. I'm in chronic A Fib (24/7) so I had to wait a few weeks before

I was EC'ed. (needed to get blood thinned & stable for 3 weeks prior to the

procedure) From when the Dr. comes in to do the procedure (you are put " under "

with a light sedative) till you are awake again is about 10 minutes, so it's

real quick.

For many A Fibbers the EC is a cure - it may have to be repeated from time to

time to stay in NSR, but it a would be a good choice to try. In my case

(unfortunately) I was converted to NSR, but it only lasted 6 days. If it would

have worked for say 6 or 12 months, I wouldn't have hesitated to have it done

again. If it works, it's better choice than rhythm drugs, in my opinion (totally

non medical opinion !)

Thor 24/7 AF

Re: When to go to ER while in Afib

,

When they have to use the paddles to shock your heart back into

rhythm.

Debbi, OU Alum in OKC

> What is Cardiovert?

>

> michele ny 52

Backup web page - http://afibsupport.proboards23.com

List owner: AFIBsupport-owner

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send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

<<I too am on Warfarin and Cardizem LA. I was on Amiodarone. I am

glad to be off of that. It is a deadly drug.>>

..........................................................

I was on Amiodorone/Corderone for 16 glorious months and afib free.

Then Afib truck. After a cardioversion I was afib free for one year

and then afib free for ten months after that. I was taken off the

Amiodorone because my thyroid became hyperactive. They put on

Sotalol for six months which made me feel terrible and wouldn't keep

me in rhythm. My thyroid numbers normalized and I'm now back on the

Amiodorone and happy to be back on it. I don't think it's anywhere

close to being a " deadly drug " like the claim you're making. Does it

have side effects? Yes, But that's why you need to be monitored

while on these drugs. And which one of these anti-arrhythmic drugs

don't have side effects?

Will I have the success with the Amiodorone like the last time I was

on it? Hopefully.

All I know is it's working for now and I don't mind in the least

about getting my thyroid levels checked along with an occasional

chest xray. If they find the start of some problems with the tests

then I'll go off of it.

[Guest guest]

,

My ER won't let you go home from ER or cardio won't let me go from

hospital until h/r is under 100. I would be very concerned if it

was much over that. Keep a little journal entry of your h/r. Times

you took it during the day and show to your cadio.

Debbi, 5 days in Afib, in OKC

>

> How fast is a dangerously fast pulse? How long should someone allow

> their pulse to race at a dangerously fast pace before seeking

> intervention?

[Guest guest]

I agree. Aside from my concern about moving clots, a DC cardioversion

does not " phase " me much at all. I have had three, and each one has been

a breeze.

What really gets me is that the anesthesia they use(on me) kicks in so

fast, and wears off so fast. From the time I open my eyes to the time I

walk out the door is around 15 minutes. I feel totally refreshed - like

I have had a full 8 hours of sleep. That plus the suddenly returned

pumping efficiency makes me feel like jogging to the car. Bizarre, but

no exaggeration.

To top it off, the apparatus they used on me can also pace the heart if

there is any problem. I feel very safe with that. As long as you are

anti coagulated properly, have the TEE, or have it done before you are

in afib for whatever period your doc says (mine says 18 hours!), you're OK.

By the way, if you go into afib and there is any possibility that you

may be going in for a cardioversion - think twice about eating, because

it you may delay the process due to concerns about anesthesia on a full

stomach!

Bobby

Atlanta

bookman00@... wrote:

> Actually, the process is a breeze. You're anesthtized. You wake up and

you're in rhythm or not. It's one of those things that it's better not to think

about ;-)

>

> That sounds cavalier, but it _is_ something that you pretty much get used to

as an occasional occurance. (I feel better about it than about some of the meds

that I take.)

>

> Bill Manson

> Guelph, Ontario

>

>

>

[Guest guest]

The deadly side effect is Pulmonary Fibrosis. Once you get it, there is no

turning back. My girlfriend just had a double lung transplant because of it.

My primary doctor sent me for a PFT to keep watch on my lungs. I am thrilled to

be off of it. It wasn't helping me anyway. I was getting more episodes on it

then being off it. COumadin and Cardizem LA are giving me less frequent

episodes and shorter. I just started these new meds and they are keeping track

of me. I didn't mean to sound like a know it all, but my new cardiologist also

said that being on Cordarone the rest of my life is not a good thing. He took

me off right away. Thank god I was only on it for 7 months. You can read any

information of Cordarone and you can see all the side effects. My thyroid was

fine until I started Cordarone. Now I am on Synthroid. The doctor told me that

when the Cordarone washes out of my system, then my thyroid should go back to

normal.

Michele NY 52

********************************************************************

Re: When to go to ER while in Afib

<<I too am on Warfarin and Cardizem LA. I was on Amiodarone. I am

glad to be off of that. It is a deadly drug.>>

.........................................................

I was on Amiodorone/Corderone for 16 glorious months and afib free.

Then Afib truck. After a cardioversion I was afib free for one year

and then afib free for ten months after that. I was taken off the

Amiodorone because my thyroid became hyperactive. They put on

Sotalol for six months which made me feel terrible and wouldn't keep

me in rhythm. My thyroid numbers normalized and I'm now back on the

Amiodorone and happy to be back on it. I don't think it's anywhere

close to being a " deadly drug " like the claim you're making. Does it

have side effects? Yes, But that's why you need to be monitored

while on these drugs. And which one of these anti-arrhythmic drugs

don't have side effects?

Will I have the success with the Amiodorone like the last time I was

on it? Hopefully.

All I know is it's working for now and I don't mind in the least

about getting my thyroid levels checked along with an occasional

chest xray. If they find the start of some problems with the tests

then I'll go off of it.

Backup web page - http://afibsupport.proboards23.com

List owner: AFIBsupport-owner

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send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

------------------------------------------------------------------------------

[Guest guest]

Stef

We are working on rate control with beta blockers. Right now, I'd say

they aren't doing too well, but I am still upping the dose I take

Toprol xl 50 mg 2x a day. I saw another afibber on this site who is

doing alright on 100mg toprol xl 2x a day, so i want to try that

before I switch.

The heart has been nice and slow all day. Maybe the new pulse monitor

is having a bio-feedback effect!

[Guest guest]

never underestimate the power of the mind! When I go into an attack, I do try

to visualize my heart beating more slowly.. doesn't work, but I think sometimes

I can slow it down just by concentrating on doing so, so hopefully maybe the

monitor is working that way for you.

I was only on 120 mg of diltiazim, but when i went into my latest episode, which

I'm still in (for a month now) they upped me to 240 mg, but that didn't slow my

heart below 140mg, so they added .25 mcg digoxin, which slowed it down almost

immediately. Took my first dose on a Friday and by Saturday morning I was

almost up to my own self energy wise. I'm still waiting to be electoverted (I

have always converted on my own prior to this time) which will likely happen

next week. I was looking forward to having it done today, but I had the most

violent stomach flu this weekend, and the doctor said he didn't want to risk

putting me under if I was puking ever few minutes.. don't really blame him and

truthfully I think the whole thing would have been too much.. I could hardly get

off the couch, let alone go to the hospital for a procedure!

So, next week, hopefully!

I don't know anything about toprol, but I do know there are lots of different

types of heart rate drugs.. maybe if that doesn't work, you might suggest the

digoxin.. it really worked wonders to slow down my heart!

Stef

katie_in_az wrote:

Stef

We are working on rate control with beta blockers. Right now, I'd say

they aren't doing too well, but I am still upping the dose I take

Toprol xl 50 mg 2x a day. I saw another afibber on this site who is

doing alright on 100mg toprol xl 2x a day, so i want to try that

before I switch.

The heart has been nice and slow all day. Maybe the new pulse monitor

is having a bio-feedback effect!

Backup web page - http://afibsupport.proboards23.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

---------------------------------

[Guest guest]

In a message dated 2/10/04 6:15:08 PM Eastern Standard Time,

katie_in_az@... writes:

We are working on rate control with beta blockers. Right now, I'd say

they aren't doing too well, but I am still upping the dose I take

Toprol xl 50 mg 2x a day. I saw another afibber on this site who is

doing alright on 100mg toprol xl 2x a day, so i want to try that

before I switch.

***************************************

Hi , Im taking Toprol XL 100 x 2 a day. I was on 50 and had a failure

when I was exercising I went right into afib but they said don't consider it a

failure yet because I was only on it three weeks so they upped it to 75 x 2

and I had a break through again so they said as long as my heart rate and bp

could tolerate upping the dose they will stick with the Toprol. I seem to be

converting very fast on the Toprol and the afib is less intense. I had one minor

breakthrough with the 100 x 2 dose for 45 minutes and I converted so this is

the dose for now. I have been on this dose a month and a half and IM not really

that tired. I do like to lay down for a half hour of so if I can daily and

If I don't I go to bed early. Good luck,

a in Massachusetts 49 NSR 20 days Toprol XL 100 x 2 Adult Aspirin