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May 29th, 2016
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Hi, I'm male, 23 and reasonably healthy, for about 5 years now I've been suffering with heart palpations. To be more specific my heart will occasionally skip a beat or do some kind of double beat, for years it really bothered me, i made several trips to the doctors, had two ECG's and a blood test, but nothing was found to be wrong. Over the years I've came to live with it and learnt that generally i think it's caused by anxiety, stress and in some cases food/caffeine. Most of the time i try to not let it bother me, but it's always a niggling concern in the back of my mind and i have been given no explanation by a doctor as to what it could be (even if it is just anxiety, that has not been suggested to me). I'm sure anxiety plays a big part but i don't think i can be the sole cause. Anyway, over the past few days I've felt myself feeling quite under the weather. I've been feeling nauseousness, had hot flushes and random sharp short headaches, today it went a step further and actually got a little scary for me. I began the day feeling quite weak and my heart felt very obvious to me in my chest, i was very aware of its beating, but it wasn't beating particularly fast. It skipped a beat and i didn't think much of it and then it did it a few more times, at one point after a skip i would sometimes feel a sudden rush of blood around my chest, my face became very hot and i became instantly nauseous. I tried to calm myself down and it probably only lasted for about 20 minutes on and off and i spent the rest of the day just trying to be relaxed and calm. What i want to know, if this is something to be worried about? Is my doctor right and it's nothing to be worried about, or is there some underlying condition that I'm perhaps making worse by thinking about it. Are there any other tests i could request to have done to help put my mind at ease? Could anyone provide information?
2013-05-01 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

You should do an event monitor to correlate your symptoms with your heart rhythm. This can be arranged by your doctor or he can refer you to a cardiologist for it.

Hello. I am a 40 year old male Caucasian 172cm, 71kg, and normal blood pressure. I exercise a couple of times per week and don't drink or smoke. I had a heart exam 3 years ago following some unexplained chest pains which included a treadmill stress test. My heart structure showed up as normal in the echo and so I was told that I had nothing more than IRBBB. The Duke Treadmill Score was -29. I have unexplained blackouts twice per year and sometimes feel like I have strange heart rhythms before I go to sleep. Recently I have needed to nap more in the daytime and feel excessively tired. My GP wants me to have a sleep test for sleep apnea. I have also had another of my blackouts. I am concerned that my unexplained blackouts could be caused by Brugada syndrome. I am considering going back to my cardiologist but it is expensive here so I want a second opinion to review my ECG results before I make an appointment.
2013-05-01 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

I agree with doing sleep apnea study for your symptoms. You will need a heart monitor to assess for abnormal rhythm and blackout spells. The duration of monitor depends on the frequency of symptoms ( Holter monitor for daily episodes and event monitor for episodes that are less frequent). This can be arranged by your GP. You need to see your cardiologist for the blackout spells and ECG analysis.

Hello Doctor. My partner had 5 heart bypasses and a hole in his heart repaired 3 weeks ago, he did absolutely fantastic and came home on day 6, completely mobile and well. Now he seems to be getting worse by the day, especially at night. They took an artery from his left arm and he has totally bad tingling in his fingers and very sharp stabbing pains all up his arm from his wrist to the top of his shoulder and down his neck. This is really getting him down as the pain is excruciating and pain killers just don't help. He is having tramadol and paracetamol and just this morning I tried him on 500mg ibuprofen. Have you any ideas and is this usual after surgery? He is used to being very active and was only ill for about 2 months before his came on very quickly, and he is only 47 which we are told is quite young for this operation!! His Dad did have surgery at his age but unfortunately died 6 years later, so they have said his heart decease was hereditary rather than lifestyle. Please help
2013-05-01 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

You need to contact the surgeon for the pain.

Im a fit athletic 23 year old male...all natural (no sterioids). I eat well and am the ideal weight. I only go into A-fib occasionally when I choke/vomit, donate blood, or get inebriated (the later happens rarely. It was in early college days when this was discovered). I was diagnosed with hypertention in High School in which me and my family were in denial about. (Why? no family history, Im young and healthy). I saw several doctors at NYU, St. Francis in Roslyn and No. Shore University hosp.) I had a 2 week heart monitor in which the report found nothing except a few normal palpitations and irregular heartbeats. One Dr. said I had a benign condition. Some Drs say it is not worth the risk and some say to go for getting ablated. I really cant be bothered getting cardio-verted in the ER 1 or 2Xs a year. Im am presently on 50mg of tenormin and 75mg of effexor. My BP has been at bay ever since I started these about a year ago. I really dont want to be on these forever meds. Its so early in my life and there will be side effects in my future, no?. My Dr. prescribed these both because he felt I was stressed and under pressure being on a college ball team trying to make it in the majors. Im done now. Can I get weaned off? Will the afib come more often if Im off these meds? One of my past Drs. was reluctant to prescribe a pill in the pocket just in case... he says its too dangerous for me. why?? He gave it to me once but it took several hours before it kicked in for me. I also once went for a vigorous run for a few miles and came out of a-fib. Can I have a heart attack from it? I have also seen endocrinologists to rule out other conditions like pheocromocytoma and cushings disease. All bloods,EKG and Echo normal and checked yearly. What is your opinion? I dont want to have a stroke if I wait a day for it to pass. Please help. Thank you Dr.
2013-04-29 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

You have vagal induced lone atrial fibrillation based on triggers as well as response to exercise. The treatment is based on duration and frequency of symptoms. Your stroke risk is very low given young age and one risk factor i.e. hypertension. A beta-blocker like Tenormin is good to use for blood pressure as it helps control the rate during episodes of atrial fibrillation. You can try pill in the pocket (Beta-blocker + flecainide or propafenone or norpace) as it is better than going to the ER...usually take 1-2 hours to convert. I have my patients come to the office or go to ER the first time they do this to ensure they don\'t have fast atrial flutter with the strategy. The decision to do catheter ablation must be based on increase in duration and frequency of episodes as the main goal of the procedure is symptom relief.

I am a 55 y/o male with paroxysmal Afib. I have htn. and am on atenolol and lisinipril. I have sleep apnea and use CPAP. I have a Chads score of 1. I have seen 2 EP in past with one saying that it was my choice to either use ASA or warfarin. Either is reasonable. The other EP said that I should just use ASA. I just saw a patient education TV show on dicscovery channel concerning Afib and stroke risk with a number of specialists. They all seemed concerned that patients should get appropriate anticoagulation. Hugh Calkins stated that with chads score of 0 , kthe risk is low with no need to anticoagulate and with chads 2 they highly recommend anticoagulation. With a chads score of 1 he said they tend to recommend anticoagulation. What should I do in my case? My understanding is that with a chads 1 the risk of ischemic stroke is equal to the risk of intracranial or GI bleed. Pick your poison, although the use of ASA may decrease ischemic stroke (I\'m not sure how much) it also increases bleeding risk, but not nearly as high as warfarin. Which risk is worse to have? Thank you.
2013-04-08 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

CHA2DS2 VAsc score is a better score to use than CHADS score. The usual practice is to anticoagulate with a score of 2. We tend to use ASA with lower scores but the data on stroke prevention with ASA is not very robust. The newer anticoagulant drugs like dabigatran, rivaroxaban and apixaban have a better safety profile than warfarin. I use them in patients with score of 1 who are worried about risk of stroke.

I am a 55 y/o male, 215 lbs. with paroxysmal afib. The Afib started 6 years ago with a few episodes lasting 1-7 hours each. Testing revealed no cardiac abnormalities. Started on atenolol 25 mg./day. On daily baby ASA for a number of years. Afib stopped as suddenly as it started and was gone for 3.5 years. At that time I had a number of episodes each lating 1-7 hours each over 3- 4 months. Increased atenolol to 25 mg 2x/day. Additional testing unremarkable. Consult with EP. since Chads 1 stay on ASA although increase to 182 mg. Also added lisinipril for better control of mild htn. Tested for sleep apnea was positive and now on CPAP nightly. Lost 10 pounds ( 220 at the time). added a number of natural anti-inflammatories and antioxidants seen in AFIB REPORT. Episodes stopped for 1.5 years until last June. Had 3 episodes. Then 3 more in October and 5 more this Feb./March. Most episodes lasted 2-3 hours with a few lasting 5 hours. EP gave me flecainide to use as PIP. I am symptomatic with the episodes with palpitations, slight lightheaded, and uneasy feeling. I can check my pulse and know every time I have an episode. I have not used the flecainide yet as each episode has spontaneously converted. Is there any harm in waiting to use the flecainide and after how many hours can I waity before using it as PIP. I\'m a little concerned with its proarrythmic potential although I suspect that occurs in ly a small percentage of patients.When do I decide to go on flecainide daily instead of PIP. Is this all a personal choice or are there other paramaters. Is it OK to use PIP method or should I go directly to daily use. Then, at what point do I decide about having an ablation? I have heard that the longer you wait to have an ablation the less successful it is. Is that true? Up until now my Afib burden is relatively low.Is it still a personal choice when to have an ablation (too many episodes to tolerate)? However, this would seem to contradict the previous statement , if true, that the longer you wait (the longer you have afibe epsodes and are remodeling the leart) the less successful the ablation will be? Or is it true that if I go on daily flecainide which works and I stop having episodes or only very infrequent episodes, then my heart is not being remodeled and the delay is OK? Thank you.
2013-04-08 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

Flecainide works well as an antiarrhythmic drug for paroxysmal a fib patients who do not have CAD. You should have a stress test done before taking it. I ask my patients to take the first pill in pocket drug in the ER or the office depending on when they have the episode. It can take 1-1.30 hour for its effect to work and should not be taken for shorter lasting episodes. You should tasking daily flecainide if you have frequent episodes and consider catheter ablation as it is more effective than drugs. I agree with early ablation as more frequent episodes of afib can lead to atrial remodeling and more sustained a fib.

Hello Doctor: I am a 69 y.o. male with occasional afib(every 2 or 3 weeks) over the last 2 years. Episodes last 12-24 hours and consist of stumbling, irregular beats around 70 bpm( normal is low 50\'s). I take 75 mg. of Atenolol and Pradaxa and also have mild sleep apnea. Afib as confirmed by 2 week Cardionet monitoring. Is there any good treatment and do Viagra or Cialis aggravate the condition. Thanks
2013-03-27 Answered By : Dr. Gregory Feld M.D., F.A.C.C. F.H.R.S.

Treatment of AFib can consist of an antiarrhythmic drug such as flecainide or propafenone if you have no serious structural heart disease, or sotalol or dofetilide if you have underlying coronary artery disease, or amiodarone if you have a significant history of heart failure. If medications fail to control the Afib, then catheter or surgical ablation may be effective. This is something you should discuss with your cardiologist or an electrophysiologist. Finally neither Viagra or Cialis are known to aggravate Afib.

Do Viagra and Cialis cause afib?
2013-03-27 Answered By : Dr. Gregory Feld M.D., F.A.C.C. F.H.R.S.

There is no evidence that either drug causes AF to my knowledge, and it has not previously reported as an adverse effect. The use of Viagra or Cialis is of course contraindicated if you are also taking nitrates.

I am in desperate need of finding a physician that can do surgical procedures to stop Afib as close to middle Tennessee as possible, although we will travel out of state for top notch doctor ;). My father was diagnosed as having Afib this past January and was given medication to stop it which didn\'t help, was given a pacemaker and it\'s helped to the point of keeping his heart rate from going below 60 for long (his heart was staying in the 30s at night and dropping in the 40s during the day some), 2 stints and a kissing balloon in his upper left artery and still now having problems to the point of not wanting to live. He is having episodes during the day where he will feel lightheaded, nauseous, shaking, shortness of breath (choking feeling) and heartburn. All of this he has had and all of the procedures he has had done over the past couple months. His quality of life is just not good right now. We need help! I\'m desperate to have my father back to normal. He was always the type of strong man to never miss work and never complain, so I know he is bad off. Also, he is on Plavix and the doctor told us he cannot come off for any procedure. Is there a way to come off for an extremely needed surgery?
2013-03-27 Answered By : Dr. Gregory Feld M.D., F.A.C.C. F.H.R.S.

Catheter ablation or surgical ablation can be done for Afib, but it may be best in some situations to try an antiarrhythmic drug first to control the Afib. Ablation procedures can be done on Plavix if required because of a recent stent. In your area you can check with the following EP doctors regarding treatment of Afib.

I am 67 yr old female. Just had ablation for a-fib a week ago. Episodes every day 15 minutes to 7-8 hrs. Not taking anti-arrhythmia drugs. Had failed propafenone. tolerated dofetilide before although it was ineffective. Dose after ablation showed some interval problems so now just taking Metoprolol. Are such freq episodes common in blanking period? More than I used to have. Also I have sharp pain on right side under ribs when taking deep breath or coughing. Am supposed to fly to Europe in a few days (12 days after ablation) EP dr said ok but now I am getting worried.
2013-03-24 Answered By : Dr. Gregory Feld M.D., F.A.C.C. F.H.R.S.

In a small percentage of cases the frequency of episodes of AF may increase after ablation. These usually settle down after several weeks, but in some cases they do not, and a second ablation is necessary. I am not sure what “interval problems” you had, but usually with dofetilide the QT is prolonged and with propafenone the QRS is prolonged, although the dose can be adjusted to allow continuation of the medication. The sharp chest pain could be due to a condition called pericarditis in which inflammation occurs around the heart after ablation. This is usually treated with ibuprofen 600 mg three times a day, but in some cases requires additional medication to control. If you continue to have frequent AF, especially if the episodes become more prolonged (>24 hours), it may not be safe to travel, unless you are taking an anticoagulant medication such as Coumadin or Xarelto to prevent a stroke, which I assume you are taking after ablation. I would certainly recommend you discuss these issues again with our EP doctor before travelling.

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