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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Should I Fear Another Heat Attack Due To Low Pulse Rate After Having Had An Angioplasty And Atrial Fibrillation?

I am a 79 yr. old female. I had my first atrial fibrillation in 1983 when I was 48 yrs old and was in intensive care for two weeks. I was given medication and reconverted (without using defibrillator); I was prescribed digoxin which was my sole medication until Jan. 2002, when I avoided a heart attack by undergoing angioplasty. Since then I have been taking amlodipine besylate, losartan, isosorbide mononitrate, and digoxin. I didn't have any fibrillation again until June 2005 and was pharmaceuticaly converted (in the hospital for three days, no difibrillator used). It recurred again in Feb. 2006, (in hospital for 3 days), and again exactly one month later, in March 2006 (in hospital for 5 days), again reconverted by medication with no defibrillator used; prescribed amiodarone 200 mg daily; I have been been taking this amiodarone since then for 7 years; I do not have a valvular problem; I am concerned about low pulse of 46; Thank you; appreaciate any advice you can offer me.
Fri, 13 Dec 2013
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Cardiologist, Interventional 's  Response
I appreciate your concern and attitude towards your disease. You are having recurrent paroxysmal atrial fibrillation. Your low heart rate is due to combination of digoxin and amiodarone. adjustment of dose of amidarone to 100mg/day, withdrawing digoxin(as you underwent angioplasty), including a lowdose B-blocker like Metoprolol Succinate 25mg/day will be abetter combination for you and may also relieve your problem. You also need to take aspirin 75- 150mg/day for your angioplasty(probably at that time bare metal stent was used). If your atrial fibrillation recurs, you also need to take warfarin/ Dabigatran after consulting your doctor and monitoring your blood coagulation parameters. Hope this will answer your problem. I think your heart rate will improve with the above combination. A holter monitoring will also help to detect, whether you are having sick sinus syndrome. Treatment will be different in that case(pacing along with antiarrhythmic medications).
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Should I Fear Another Heat Attack Due To Low Pulse Rate After Having Had An Angioplasty And Atrial Fibrillation?

I appreciate your concern and attitude towards your disease. You are having recurrent paroxysmal atrial fibrillation. Your low heart rate is due to combination of digoxin and amiodarone. adjustment of dose of amidarone to 100mg/day, withdrawing digoxin(as you underwent angioplasty), including a lowdose B-blocker like Metoprolol Succinate 25mg/day will be abetter combination for you and may also relieve your problem. You also need to take aspirin 75- 150mg/day for your angioplasty(probably at that time bare metal stent was used). If your atrial fibrillation recurs, you also need to take warfarin/ Dabigatran after consulting your doctor and monitoring your blood coagulation parameters. Hope this will answer your problem. I think your heart rate will improve with the above combination. A holter monitoring will also help to detect, whether you are having sick sinus syndrome. Treatment will be different in that case(pacing along with antiarrhythmic medications).