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Suggest Treatment For Atrial Fibrillation And Paroxysmal Atrial Tachycardia
Question: A year ago last October I had a 10 second bout of atrial fib as seen on a holter monitor. I saw a cardiologist who did an ultrasound and an ECG. He said he had no concerns, there was no treatment prescribed and I was to see him in a year. I saw him last October and was told to see him in 2 years. My question is how will I know if I am having atrial fib? I have had paroxysmal atrial tachycardia over the years...Metoprolol helped this. I also get PVC's and PAC's. I didn't feel anything when I had the atrial fib...as seen on the Holter. Recently, I have had a couple of episodes of a racing heart for perhaps 3 minutes...returned to a normal rate without problem. I also get some episodes of skipped and extra heartbeats at times...have had this for years and was told they are benign. Now, that I have been told I have had a documented episode of atrial fib, I don't what is what and when to be concerned. Now, I worry every time I feel my heart speed up for no reason or get those darn PVC's and PAC's. When do I head to the hospital? I live alone and it's kind of scary. I have been under lots of stress lately so maybe that is why my heart is acting up a bit. I hope you can make some sense of my note. It's hard to explain it all on paper. I am 72. Thank-you.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your medical history and would explain that there is not a clear clinical difference between short episodes of atrial fibrillation and paroxysmal atrial tachycardia.
Both these disorders are clinically perceived as palpitations, a rapid heart beat, fatigue, shortness of breath, dizziness and fainting feeling.
Besides, episodes of this duration do not need to go to the ER (for possible conversion), because they are not really harmful.
I would recommend you to closely monitor your heart rate and blood pressure. In case of an increased, irregular heart rate, associated to low blood pressure, you should go to the ER.
From the other I would recommend performing a new cardiac check up:
- cardiac ultrasound to examine your cardiac structure and function and exclude possible cardiac failure
- a new ambulatory 24-48 hours ECG monitoring (as it has been a year since the last one and your rhythm may have changed)
- some blood lab tests ( complete blood count, thyroid hormone levels, blood electrolytes) to exclude possible chronic anemia, electrolyte imbalances or thyroid dysfunction, which may trigger cardiac arrhythmia.
I would also recommend discussing with your attending physician on the possibility of increasing the dose of metoprolol, or adding a calcium channel blocker like diltiazem, to control possible cardiac arrhythmia better.
I would also recommend starting aspirin 81mg daily, to prevent possible cardio-embolic events. If there is evidence in the ambulatory 24 hours ECG monitoring of repeated atrial fibrillation, you may need to start oral anticoagulation (warfarin or new oral anticoagulants).
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your medical history and would explain that there is not a clear clinical difference between short episodes of atrial fibrillation and paroxysmal atrial tachycardia.
Both these disorders are clinically perceived as palpitations, a rapid heart beat, fatigue, shortness of breath, dizziness and fainting feeling.
Besides, episodes of this duration do not need to go to the ER (for possible conversion), because they are not really harmful.
I would recommend you to closely monitor your heart rate and blood pressure. In case of an increased, irregular heart rate, associated to low blood pressure, you should go to the ER.
From the other I would recommend performing a new cardiac check up:
- cardiac ultrasound to examine your cardiac structure and function and exclude possible cardiac failure
- a new ambulatory 24-48 hours ECG monitoring (as it has been a year since the last one and your rhythm may have changed)
- some blood lab tests ( complete blood count, thyroid hormone levels, blood electrolytes) to exclude possible chronic anemia, electrolyte imbalances or thyroid dysfunction, which may trigger cardiac arrhythmia.
I would also recommend discussing with your attending physician on the possibility of increasing the dose of metoprolol, or adding a calcium channel blocker like diltiazem, to control possible cardiac arrhythmia better.
I would also recommend starting aspirin 81mg daily, to prevent possible cardio-embolic events. If there is evidence in the ambulatory 24 hours ECG monitoring of repeated atrial fibrillation, you may need to start oral anticoagulation (warfarin or new oral anticoagulants).
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank-you so much for your quick and informative response. I will be seeing my GP on Friday and will discuss your recommendations with him.
Brief Answer:
You are welcome!
Detailed Answer:
Hello again,
I remain at your disposal for further discussions whenever you need.
Feel free to ask me again, in case of any other uncertainties!
Best wishes,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again,
I remain at your disposal for further discussions whenever you need.
Feel free to ask me again, in case of any other uncertainties!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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