Thank you for your question. When our hearts become weaker, in particular, when the function declines more than 50%, we are at risk for many different types of abnormal heart rhythms. The most common rhythm is in the upper chambers of the heart, the atrium. When our hearts get weak, the pressure inside the heart goes up. This causes the upper chambers to become larger and stretch out. When the upper chambers stretch out they are more likely to experience a very fast chaotic heart rhythm called atrial fibrillation. If your father is experiencing atrial fibrillation there are medications and procedures (such as catheter ablation) that can be used to treat the atrial fibrillation and minimize the occurrences. More importantly, your father needs medications to prevent stroke if he is experiencing atrial fibrillation that he should use long-term. Also, when our heart gets weaker (>50% decline) then we are at risk from abnormal heart rhythms from the bottom chambers, the ventricles. These abnormal rhythms can cause sudden death. The best way to prevent sudden death if these rhythms have occurred is for your father to receive an implantable cardioverter defibrillator (ICD). This is a device similar to a cardiac pacemaker, but also has the ability to deliver a shock to the heart and stop these fast heart rhythms from the ventricles. The best approach is to have your father see a cardiologist who has additional training in the management of decreased cardiac function and the associated abnormal heart rhythms in the upper and lower heart chambers. Medications can be used to help strengthen the heart function or stabilize it, treat the abnormal heart rhythms, and as mentioned if atrial fibrillation is present to minimize risk of stroke.
Thank you for your question. The best option is to contact your doctor and request a heart monitor. These monitors are designed to wear in the day and night and record abnormal heart rhythms both when you activate the monitor and automatically. Understanding what type of heart rhythm your husband is experiencing is very important. The most frequent heart rhythm we see if called atrial fibrillation. This heart rhythm can increase risk of stroke and often occurs at night. When is occurs at night your husband will also need to be screened for sleep apnea. Sleep apnea often occurs in people that snore at night, snore and hold their breath at night, and have fatigue and difficulties with high blood pressure in the daytime.
Thank you for your question. When you feel racing in your heart the best approach is to first understand what is happening with your heart. Sometimes a fast heart rate can be your normal pacemaker cells working in an exaggerated fashion (inappropriate sinus tachycardia) and other times there can be an abnormal heart rhythm. Sometimes what your are feeling is a normal heart rhythm but a forceful contraction. Sometimes everything that you are feeling is associated with a normal heart beat. Then we have to look at other causes for your symptoms. The best approach at this time is to gather more information. We do this by using heart monitors that you can wear over a period of days and push a button when you experience your symptoms. We all feel our heart differently. People often feel there pulse in their throat because the throat is just above the big artery that leaves the heart (aorta). Also, there are small arteries in the throat. When these arteries pulse they can be felt be the nerves around them.
Thank you for your question. Often when you are young and get into a warm shower or bath that causes you arteries to open up and dilate. This can drop your blood pressure slightly. When your blood pressure drops even a small amount your heart will start beat more forcefully or faster or both. Pruning of your hands and feet typically is from saturation of the skin with water. This later finding is usually more related to the time your hands and feet are exposed to water rather than a manifestation of the heart or a potential heart problem. You could try lowering the heat temperature of the shower and/or the time spent in the shower to minimize these symptoms. If your experience heart pounding forcefully, rapid, or pausing the next step is to consider wearing a heart monitor to truly understand the heart response to various conditions. You canít wear these monitors in a shower, but they can be used immediately before and after. Another option to try is making sure to stay very hydrated, minimize periods of fasting, and use more salt in your diet. These measures will bring up your blood pressure and allow you to tolerate stress likely being exposed to hot water and having your arteries dilate. Finally, if your chest pain get worse, you should see your doctor. Chest pain even in somebody that is young like you can be significant and your doctor may need to evaluate it further with some routine tests.
Thank you for your question. When you feel racing and pauses in your heart the best approach is to first understand what is happening with your heart. Sometimes a fast heart rate can be your normal pacemaker cells working in an exaggerated fashion (inappropriate sinus tachycardia) and other times there can be an abnormal heart rhythm. Sometimes what your are feeling is a normal heart rhythm but a forceful contraction. When you feel your heart pausing it can be extra beats. If these extra beats come very early it will feel like your pulse or heart just stopped or missed that beat. If you have are experiencing an abnormal heart rhythm, when this stops, it takes a period of time for your normal pacemaker cells in your heart to stop beating. In this case there is literally a pause in your heart. This pause can become longer over time as our normal pacemaker cells take longer to start beating. Sometimes everything that you are feeling is associated with a normal heart beat. Then we have to look at other causes for your symptoms. The best approach at this time is to gather more information. We do this by using heart monitors that you can wear over a period of days and push a button when you experience your symptoms. This will tell your doctor exactly what is causing your symptoms. Without this information, any physician regardless of how they treat a problem (medicine, natural therapies, catheters, etc), would largely have to guess of how to treat you best. Since a lot of the therapies have risks and side effects, I would recommend getting to the bottom of understanding your symptoms by using an ambulatory heart monitor.
Thank you for your question. I am glad that you are interested in carefully managing your diet while taking Coumadin. When I start Coumadin in my patients, I tell them they need to carefully plan their diets each day, similar to a diabetic patient. You may want to meet with a dietician not only to understand quantify of vitamin K in a food source, but also learn meal planning strategies that will allow you to have a diverse diet. Sources of vitamin K on the web are: 1. http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=1 (United States Department of Agriculture) 2. http://nutritiondata.self.com/ (A comprehensive nutrition and supplement resource) 3. http://www.ars.usda.gov/main/site_main.htm?modecode=12-35-45-00 (nutrient data laboratory for specific quantify information) 4. http://ods.od.nih.gov/ (Office of dietary supplements)
Thank you for question. There are a number of potential medications for atrial fibrillation. If you heart size and function are normal and you have no evidence of coronary artery disease then we can use all of them. If you have coronary artery disease then we can use Ė dronedarone, dofetilide, sotalol, or amiodarone. If you have heart failure, then we typically need to use amiodarone or dofetilide. The newest medication available is dronedarone. It is like amiodarone (an analog). It is not nearly as strong as amiodarone, but it also does not have the same risk of injury to the lungs and liver. It also does not interact with the thyroid gland like amiodarone. Dronedarone is only safe if you have not had any recent episodes of heart failure and your atrial fibrillation is such that it comes and goes. If you have heart failure or are in atrial fibrillation all the time you should avoid it.
I believe we only have part of your question. It appears that your atrial fibrillation is progressing in severity to a more persistent subtype that requires cardioversion. This pattern is not surprising since you have valvular heart disease with both ventricular and atrial remodeling. Although amiodarone is a relatively cardiac safe medication in the setting of valvular heart disease, your age and pulmonary disease to me would be reasons to consider other options. These options include a washout of amiodarone followed by use of a less toxic medication versus catheter or surgical ablation. With you valvular heart disease and moderate-severe left atrial enlargement, if you are interested in a catheter ablation it should be performed by an operator that is experienced not only in pulmonary vein isolation, but also in mapping both micro- and macroreentrant tachycardias that are often seen in those with a surgically modified heart. The operator should take every possible precaution to minimize your exposure to fluoroscopy during the procedure and rely heavily on a 3D mapping system to avoid placing you at risk for various radiation-relative malignancies over your anticipated long life span. I would consider a percutaneous catheter-based approach before surgery since your prior procedure would preclude a minimally invasive approach.
I completely agree with you. Iím not a fan of drugs but when they work, why not using them. We have to keep in mind that the aim is to reduce the impact of AF on quality of life. If rate control doesnít fulfil that goal, AA drugs have to be tried. You can even continue Propafenone at the same dosage. There is no dugs able to cure AF. What we look for is to reduce the number of episodes and their impact on your quality of life. I therefore donít consider the 2 episodes you had as a failure. You can certainly increase the dosage up to 900 mg per day if your kidney function is normal and shift to Flecainide when Propafenone will be inactive. It may or may not work. Ablation is to be considered if at least one drug has failed. In other words, if you consider the present situation not acceptable with Propafenone, you could go for an ablation. I would suggest to wait a little longer with an increased dosage of Propafenone. Donít wait too long as once the AF is permanent, ablation is more difficult and less successful.
Yes, this is frequently observed and is probably due changes in the autonomic nervous system by ablation. The interruption of AA drugs may also explain it partly. But keep exercising and training and it will improve.