Question: Hello,

I am a 51 year old male.

I had to go to the ER on Wednesday December 3rd with a racing heart. I was admitted to the hospital with possible Atrial Fibrillation/Atrial Flutter. My BPM was about 170. They tried different drugs and finally did a cardioconversion the next day (Thursday) which put my heart back into normal rhythm. Was discharged Friday the 5th with a diagnosis of Atrial Flutter.

(Background: In October as part of a physical the clinic did a chest CT scan and abdominal ultrasound. Ultrasound was perfect. The CT Scan showed mild emphysema and bronchitis. But, it also showed calcium in my heart. All labs were OK as well as my cholesterol. So, they did a Heart CT scan with contrast and the results were "Coronary Atheromatosis in left anterior descending artery and the circumflex artery, with areas of less than 40% stenosis." (This is translated from Spanish. I am in XXXXXXX Chile.))

The doctor prescribed me:

20mg Rivaroxaban 1x AM
50mg Atenolol 2x AM/PM
100 mg Aspirin 1x AM
40mg Atorvastatin 1x PM

(The aspirin and Lipitor are for the CAD shown in the CT Scan.)

He also told me to cut down on alcohol as I was a heavy daily drinker. I actually quit drinking because I had planned on doing that anyway for 6 months. Probably not the smartest thing to go cold turkey but it has been 11 days and I did not have any withdrawal symptoms except for anxiety.

Also, he told me to cut down on coffee. (I was drinking 4-5 cups a day.) He said to keep it at 1-2 cups a day.

And to quit smoking. I was also a heavy smoker. I have gone from 30-40 smokes a day to 10-15. Plan on quitting for good ASAP.

I have 2 major questions:

1.) Slowly over the week I have kept my coffee at 2 cups. Suddenly out of nowhere I had major coffee overdoes symptoms. No heart involvement at all. But it seemed like I had drank 50 cups of coffee. The last time I felt anything like this was when my liver was injured with Levaquin. I had extreme coffee intolerance out of the blue in that experience too. I almost went to the ER with only 2 cups of coffee.

I have asked people with Afib/AFlutter and no one gets this overdose feeling. They just get Afib symptoms.

The only thing I could come up with was that the Lipitor is cleared by the liver just like coffee? (98% of coffee is cleared by the P450 pathways, etc.)

Could the Lipitor be affecting my liver that much? And my liver is also adjusting to the sudden withdrawal of alcohol?

(So, I quit the Lipitor for now. I want my liver to heal from the quitting of alcohol a while before I put another know stressor on it. )

2.) The doctor want to do an Atrial Flutter Ablation ASAP. Thoughts?

Thank you!

Hello Dr. Shehu,

Thank you for responding. Here is some more info.

I have had:
- ECG in the ER/Hospital
- Echocardiogram in the ER/Hospital. They did the ultrasound esophagus insert thing before the cardioconversion at the same time to check for clots.
- Angiography was in late October of this year.

ECG showed the Flutter. (They also did labs for heart attack and those were not present.) Echo was OK.

The Aniography (the Heart CT with Contrast?) was run in late October because a regular CT Chest showed some calcification. Here are the results translated from Spanish. (I am in Chile.)

The trunk of left coronary artery presents normal gauge and adjust contour.
Plates predominantly calcified in the proximal segment of the anterior descending artery, with less than 30% size decrease. Distally shown permeable, with trayecto middle and distal intramyocardial segments, at this last level with intraventricular component right.
The circumflex artery is normal caliber, with mixed plaque stenosis lumen in approximately 30-40%.
Right dominance according to coronary circulation pattern.
The right coronary artery is usual diameter, its walls are regular, without evidence of atheroma plaques.
Heart and great vessels of normal configuration.
Thickness and myocardial contractility preserved.
Intracavity thrombus are not identified.
There is no effusion or pericardial thickening.
Tricuspid aortic valve.
Summary:
Coronary Atheromatosis in left anterior descending artery and the circumflex artery, with areas of less than 40% stenosis.

My labs from last week were:
Cholesterol: 186
HDL: 40
LDL: 121.4
VLDL: 24.6
Triglycerides: 123

Those have been consistent all of my life. Actually the LDL and HDL are usually better.

Blood pressure has always been normal/below normal.

Does that information help with any suggestions?

Thanks again!

Hello Dr. XXXXXXX

Thank you. Now I understand what you are saying with the angiography with catheterisation.

So, the Atrial Flutter can be caused with a constricted artery? If that is the case will it come back? Is it the beginning of more Atrial Flutters which can lead to Afib? (Atrial Fibrillation).

IF the artery is treated could that cure the Atrial Flutter?

Thank you!