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Meds and exercise
Greetings from the great white north,
I am a 66 year old non smoking, healthy eating, ideal weight etc, with a wicked bicycling and hiking addiction.
I have never had any health issues iother than the usual gammut of broken bones, lacerations etc. Last week, after a normal light supper..pasta/chicken washed down with lots of tap water, I went to bed at my usual time..10...ish. Just before I fell asleep, my heart started racing...then flopping and thumping. I knew then, something was wrong "under the hood"....I thought..odd..no pain or discomfort, but I mentioned it to my wife, and of course the response was immediate..."get dressed, we are going to emerg. 7 hours of monitoring/drug-dripping/pill taking/imaging and talking to heart specialists, my 171/98/168 had subsided to a level that allowed me to return home...after prescribing blood thinners and HR pills..."come back in 3 days for a re-check"...I did, and things were better...BP and HR down to 110/79/81...but, the AFIB was till there..constantly. Not as noticble, not enough to keep me awake..but there.
Soooo, a week later, stable..nice and stable..and yesterday I could not even feel the AFIB...but the home monitor and my apple watch picked it up.
I'm on 2x50mg Metoprolol and 20mg Rivaroxoban for 7 days to see how thing "shake out" ...they also gave me a bunch of 25mg Metoprolol in case the 100 daily was took much...I felt it was...my days were a write off, as I felt too light headed every time I stood up or exerted any effort at all, so I dropped to 25 day and 50 for night, and my eveil plan was owrking fine..until *see dog walking aftermath*
The drugs made me woozy if I stood too quickly etc...and trust me...I always move too quickly..so my wife says ;-)
I was also keen to get back on the bike and go for hikes with my 2 labs, but the last week any attempt to walk at my usual brisk pace brought on a very uncomfortable feeling in my legs..like I'd just finished a 20km hike...after only 500 metres...so I slunk home and pouted and follow doctor and wife instructions (i'm not good with sensible direction) ..."give it a week to let your system adjust" right? But this morning was a new day! Full of promise and vigour. I felt great, the dogs piled in the truck, and off we went to our daily wilderness adventures. It started out full of optimism and the pace picked up. I managed to have enough sense..for a change..to turn around at 2km and head back to the truck..didn't want to bite off too much trail, as this is not your city dog park, it is wilderness trail, and if I keeled, it would take a while before I was found lol. Fast forward...home, feel great, walked in the house...and felt "winded" and very very tired all of a sudden. Afer lunch I thought a wee nap might help to settle things, but the fish were flopping around my chest, so I got up again and pouted. I sat quitely for 30 min...put on the cuff, measured...just fine. Right on the money numbers, but, the AFIB has been flopping around for the rest of the day. NO idea why. I have another appt on Wed morning, but until then...any ideas? Similar experiences?
AHAModerator, March 8, 2021 4:43pm EST
Thank you for sharing your story with the MyAFibExperience community. As you hear from others on the forum leading up to your appointment, I can also share some resources on AFib for you to learn more. Please keep us updated on how you're doing!
The AHA Team
DkinAA, March 9, 2021 7:50am EST
There are several people who do heavy exercise and developed afib on this site - it's not rare. I hope you hear soon from some of them. That's not me - I'm pretty sedentary though I like to walk a lot. But your experience thus far is similar to what most of us went through at the beginning of our afib experience.
There are a lot of videos by experts at stopafib.org - a group organized by Melanie - who often contributes to this forum when she has a chance.
The first thing to know about afib is that it is a very individual condition- we have different "triggers" that set off an afib episode, and feel if differently (some people not at all) and respond to various drugs differently. So you and your docs will have to work out what works best for you. We all recommend that you see a cardiac electrophysiologist, the specialists who deal with heart rhythm problems, and who are usually better informed than regular cardioligists.
I am not a doctor, but from what I've been told and gathered from these resources, a common treatment pattern is first, an anticoagulant to help with the stroke risk, and then a rate control drug (like the metoprolol) that slows down your heart to keep it from going too fast during an episode; as you've seen, you have to work with the dosage. Next level are rhythm control drugs that help maintain a normal rhythm. (Where I'm at). Next level are invasive procedures (like ablation) that stop the out-of-wack heart tissue from triggering heart beats. A lot of people here are enthusiastic about this approach - closest thing to a cure, but often has to be repeated. So you can see that there are a lot of treatment options as you go forward.
Many of us have to work at overcoming the anxiety that goes along with this condition, both during an episode, and worrying about when the next one will happen. For me, using a relaxation/meditation technique helps a lot with that. I've found that my Apple Watch 4 is my friend here - providing an easy way to monitor what's going on - I wear it while I sleep.
Good luck and let us know how it goes!
TR, March 10, 2021 1:15pm EST
I have a similar history to you. I was an extremely active distance runner for 35 years until AFIB hit when I was 68 amost six years ago.Welcome to the zoo, one none of us asked to visit. In one day, I was forced to give up running, coffee, and ****, three of the greatest pleasures in my life. Instead I substitudted endless doctor visits, lab tests, 20 hour AFIB episodes, and a lot of anxiety leading to something I never had before, high blood pressure. Not much of trade, wouldn't you say. It took me 2.5 years and two ablations to get my life back, and that's the good news. You can get through this and get your normal life back, but it will largely depend on how bad you want that to happen. I hated AFIB so bad, I would do ANYTHING to get rid of it. I read every book, every study I could get my hands on, I sent emails to experts in the field(several actually replied and wound up helping me), and the only thing I feared was if I didn't do all that, I'd be stuck with that **** for the rest of my life. The usual way they proceed is to try you on drugs. None of the anti-arythmic drugs worked for me, the rate control Metropolol helped, but certainly was not the answer. I went to a major hospital and had my first ablation, which was unsuccessful. I went out of state, 1600 miles, for my second ablation, to the best expert EP I could find, and I have been AFIB free for the past 3.5 years. I'm in the gym every day and I come out with as deep of a sweat as anyone there. So there's no death sentence here, and you can have it all back if you're detirmened to do it. Here's a few things I learned along the way. The harder you trained as an athlete, the more likely AFIB will appear in the later years. NBA basketball players are at some of the highest risk of all. I kept diligent records of every AFIB episode I had, noting everthing I could think could have caused it. There were three things I learned: 1. AFIB is a totally random disease that can cause episodes for any **** reason it feels like. 2. AFIB episodes can be caused by adreline. This could becaused by overexercising, but so long as you stay hydrated, it is not common. Anxiety producing adrenaline is more common. Vagal AFIB is more common, is when the autonomic nervous system and its cardiac action is to slow the heart. For some patients increased vagal activity is associated with the initiation of atrial fibrillation. This was my problem. When I'd relax in the afternoon, my heartrate would reduce to the low to mid 40's, and that's when my AFIB reared it's head. When your heartbeat is slow, there is a longer gap between the beats and it allows those random AFIB signals an opportunity intercept of the sinal node signals which normally control your heart. 3. Metropolol helped me limit the severity of the episodes, but did nothing to eliminate them, and with the further lowering of the heartrate, in some ways I was even more at risk for an episode. So to sum up, the only clues I could find to the cause were anxiety, mostly due to all the tests and Dr appts which spiked my adrenaline, and low heartrate which provided a greater opportunity for AFIB. An ablation is not a cure, but it's as close as you can come, and if you really want your life back, probably the route to choose. The importance of finding a great EP, even if you have to travel, can't be overstated. Here's a link to an article that might be of interest. Best of luck, and there is a way to get your life back to normal.
TR, March 11, 2021 9:48am EST
Sorry, I was not aware ****, **** was a bad word. In case it get's sensored again, I'm talking about the drink commonly made by Budweiser.
TwoWheels, March 12, 2021 6:43am EST
Thanks for the supportive comments. Ya, the meds were working as advertised,,with the side effects we all love, so, since I need to hike with dogs in the mornings, and the meds made me feel like I was back in the army on a 40km "****" with full gear, I looked for a way to adjust timings. So, I figured since I'm on 100mg a day, I'd take 25 in the morning before the walk, 25 after lunch and 50 at supper, I'd be fine... right? Wrong. Right after supper before the 50 could kick in, my BP shot up to 170 and my hr was 138... almost headed to the ER.
I had seen my GP...waiting on the cardiology appreciate..soon they say...but my GP thinks maybe metoprolol is not the right drug for my particular situation.
He didn't say what else there was, as like he stated, he is a GP but sees lots of AFAIB patients. He said because all the bloodwork, age and history, and I'm otherwise "match fit" other meds may be appropriate...and yes cardioversion ASAP.
An aside,,I think the only reason I didn't end up spending the night on a gurney hooked up to EKG all night at emerg...again..is because my wonderful wife gave me one of her Ativans. At that point my BP had dropped to 140bp HR 97...so Ativan and off to bed early. Slept like a log...as opposed to laying awake all night waiting for the next spike.
This morning, popped 25, going for my hike,,pop the other half right after. Hope that holds until supper.
TR, March 12, 2021 7:26am EST
A couple of things. For some people the meds work, for some they help, and for some they do nothing but create side effects. Metropolol was the only one that I would put in the category of helping me. It didn't to anything to get rid of or stop the episodes, but it did make them more tolerable. My instructions were to take 25Mg once per day, and double(50mg) additional if I had an episode. Second, give some thought to the question of, "When do I go to the ER", and when do I ride it out. Make a decision in advance what your criteria is and it will make the decision much easier. The doctors are all over the place in their instructions. Mine said this. When you have an episode you are going to feel bad, maybe really bad. If you ever feel really, really bad, that's the time to go to the ER. Some docs have said if your HR is over 100 for over an hour go to the ER. If I had followed that advice, the tires on my car would be bald from trips to the ER. Following my docs advice, I never went to the ER except for the initial episode when I found out I had AFIB. It's a good question to ask you EP. Again, if it was me, I wouldn't hesitate for a second to start exploring an ablation. Just got back from two miles with my dog, and I'm headed for the gym. I expect you'll be doing the same in the not to distant future. Stay away from those Budweiser products, I'm learning, I think.
TwoWheels, March 13, 2021 10:33am EST
TR, thanks again...especially love the **** comment...however, as much as I like ****, I tend to avoid too many, and never ever...what is the name of this thing you call "****"? Bud-who?
Anyhoo your words kept me from running to the ER again last night. For some odd reason, late evenings, especially around 10:00-11:00 PM seem to be the "witching hour" for my ticker.
It's fine all the ding-****-day long...when I measure at 11:00 AM every day, it is fine...no idea why. Every night. My diet is what one could loosly call "mediteranian"-ish. I switched to decaf after diagnosis, and don't even dare sip any **** period now. I never did have a bad diet, as my wife is diabetic and is an incredible cook and makes mostly heart-healthy fare. We dont' do fast food.
So, with that said, I was not having a good time on the much-touted Metoprolol...it kept my BP/HR down during the day, but not at night, and made me feel like a 90 year old with COPD issues. My daily hikes with the dogs was sloooooow and laborious, and my legs almost felt like the old lactate-burn coming on from my soccer days, and my eyes ached. Tired and grumpy.
My GP (still waiting on a cardiologist) upon consultation with my pharmacist, switched me to Diltiazam 180mg once a day, and this morning numbers are about the same as the Metoprolol..110/79/102, BUT, I feel MUCH better overall. Had not my usual brisk hike with the knuckleheads this morning but not slow either, with no breathing or muscle issues.
First day on new meds, the witching hour is on the horizon, so we shall see how the new meds do this evening.
*UPDATE* ...Sooooo, don't ask how or why, but it would appear my AFIB is gone...for now..I assume. BP HR fine...no idea what happened there...it has been ging on for over a month and now...just stopped? Is the new meds a coincidence? I'll discuss with my Doc. I'd do a happy dance except I fear it may set it off again lol.
Thumper2, March 14, 2021 9:04am EST
TwoWheels, I'm glad to hear that Diltiazem worked so well. However, most of us here can testify that once you have AFib, it's unlikely to leave permanently on its own. I'll just repeat TR's advice: see an EP, and think "ablation," done, as TR says, by an EP expert who has done hundreds of successful ablations. Don't decide to just "live with" AFib -- my cardiologist (not an expert on AFib) kept me at that level for several years, and my heart was slowly deteriorating, to the place where even ablations did not help. Keep us posted!