APNEA vs ATRIAL FIBRILLATION! INTERESTING?

[torontoCPAPguy]

Well, here I am several months down the road and was sleeping like a log for a while. Now I am diagnosed with Atrial Fibrillation and I am wondering if what I have interact and to what extent?

My gut feeling is that having taken care of my sleep apnea with an APAP and infused O2 at night, I have been sleeping pretty good. As of late, I have been finding myself short of breath during the day, am still fatigued and my BP seems to be low'ish all the time (I stand up and the room does a couple of spins). Mentioned it to my GP, he did an ECG just 'off the cuff' to have a quick look and said it seemed okay... but sent it along to my other doctors including my cardiologist, who had me in for an echocardiogram the next day. It was hard to spot but they were thorough and lo ad behold, Atrial Fibrillation, shared by six percent of the population! Now I am on rat poison (Warfarin) and have a terrible craving for cheese. They are going to paddle me in February and try to get me back into sinus rhythm.

So, why do I bring this up? Why do we share all of our most personal of information? Even that we wear a thong underwear? (Just kidding) It is so that newbies coming on here have a chance to read and learn as I did and as most all of us did. We have generally treated our afflictions better than the medical/clinical community has by learning and being tenacious. I would strongly recommend to your perusal the informaton on Atrial Fibrillation you will find on the Mayo Clinic and other sites as YOU may have same mixed in with your APNEA, especially if you are getting older (say, over 45) and it may be very tough to spot at first.

A great reason for having specialists looking after you rather than just the family MD. I have a family MD who 'co-ordinates' and looks after mundane medical tasks, like boiling pricks. Then I have a cardiologist, a pulmonologist, a respirologist, an endocronologist, a dentist, a sleep specialist MD, etc. And all of the attending nurses and technicians who don't have a magic wand but do the legwork, God Bless Them. Had my GP not taken the ECG and fired a copy over to all of the other doctors I never would have discovered this heart issue, which is MAJOR (as in DEAD) but is mitigated with blood thiners and either corrected by paddling (cardioelectroconversion) or drugs (Mary Jane). Oops did I say that?

Symptoms: low blood prssure, fatigue, shortness of breath, low SPO2. The complicated machine we live in semsto get more complicated all the time the older we get.

Just be aware. No conclusions to draw.... just be aware if you are experiencing fatigue even after getting your apnea under good control. That's where I was. And now I know why. But, btw, they are not stopping there and continue to check my cardiopulmonary efficiency, my allergens, and even my upper GI (that's about to happen) with a barium Xray of the upper GI (anyone have oneof thse lately?) to check for hiatus hernia. Eat, lay down before it's all digesed and out your stomache and guess what? Your SpO2 dives as you reach REM sleep, your BP skyrockets, your body wakes you up!

[RDawkinsPhDMPH]

People with untreated obstructive sleep apnea (OSAS) have an 80% higher chance of recurrent atrial fib (AF) in the year after cardioversion (the paddles) than the general population. And since the general population includes people with OSAS that don't know it, people with untreated OSAS have double the chance (100% greater) of recurrent AF than people with OSAS on CPAP. I cover the reason for this in my ebook available at my website.

[HoseCrusher]

While far from perfect, you may want to consider chemical conversion via magnesium bicarbonate.

http://www.afibbers.org/Wallerwater.pdf

The down side to this is that you end up with loose stools. I think this is a small price to pay. Once you get back into sinus rhythm, you can regroup and go from there. If this is going to work, the chemical conversion should happen after the first or second liter of concentrate has been consumed.

It is interesting to note that when I am in afib my SpO2 values don't drop as long as my heart rate stays below 180 beats per minute, and there is only a slight drop when I am at 200 bbm. The oxygen is still getting into the blood but in afib the blood doesn't flow very well.

An pulse oximeter can alert you to when you are in afib, and a portable hand held ECG can take "snap shots" of what your heart is doing to share with your cardiologist.

If you can convert and stay in sinus rhythm, you may be able to save the rat poison for the rats.

[brazospearl]

I'm glad to hear that you're fitting in one more piece of the complicated puzzle of your health. I stand in awe of your ability to keep tracking down all the stuff that's made getting healthy difficult, because I know you've had an extremely difficult time. You are an inspiration!

If your family MD is good at "boiling pricks," I've got an ex-husband and a boss I'd like to send your way for that treatment!

[RDawkinsPhDMPH]

HoseCrusher ... the link between AF and OSAS is through the sympathetic nervous activation which leads to increased "irritability" of the heart muscle... rather than through oxygen levels

[M.D.Hosehead]

Toronto,

I've been through it. Anti-arrhythmics, rat poison, cardioversion, and recently, RF ablation. Dealing with it is certainly no thrill, but it's a better hand than Elizabeth Edwards was dealt.

The best links I found while learning about it--and there's a lot to learn-- are:

http://www.a-fib.com/BostonA-FibSymposium%2710.htm

http://www.stopafib.org/


You don't have to take warfarin. A new anticoagulant, dabigatran, was just released in the US last month. It works better, has no drug or food interactions, and doesn't require blood tests. Obviously, it's more expensive than generic warfarin.

http://en.wikipedia.org/wiki/Dabigatran

[torontoCPAPguy]

Wow. A wealth of information for OSA folk. I'd like to throw in that I have been told that there is something I should be taking inadvance of electro-cardioversion (Paddles) to improve the odds of it working but nobody seemed to know what it was. Information out there is bountiful.

[torontoCPAPguy]

I'm glad to hear that you're fitting in one more piece of the complicated puzzle of your health. I stand in awe of your ability to keep tracking down all the stuff that's made getting healthy difficult, because I know you've had an extremely difficult time. You are an inspiration!

If your family MD is good at "boiling pricks," I've got an ex-husband and a boss I'd like to send your way for that treatment!

Oh. He doesn't do it, he has his nurse take care of it.

[torontoCPAPguy]

While far from perfect, you may want to consider chemical conversion via magnesium bicarbonate.

http://www.afibbers.org/Wallerwater.pdf

The down side to this is that you end up with loose stools. I think this is a small price to pay. Once you get back into sinus rhythm, you can regroup and go from there. If this is going to work, the chemical conversion should happen after the first or second liter of concentrate has been consumed.

It is interesting to note that when I am in afib my SpO2 values don't drop as long as my heart rate stays below 180 beats per minute, and there is only a slight drop when I am at 200 bbm. The oxygen is still getting into the blood but in afib the blood doesn't flow very well.

An pulse oximeter can alert you to when you are in afib, and a portable hand held ECG can take "snap shots" of what your heart is doing to share with your cardiologist.

If you can convert and stay in sinus rhythm, you may be able to save the rat poison for the rats.

Have downloaded that report and am reading it with great interest. 180-200 BPM? Yikes! I am on Rampiril 50MG BID and it keeps my heart rate down in the 60-70 range at rest and 70-95 range with exercise. I am advised by my cardiologist that if my heart rate ramps up over about 110 I am to head straight to Emerg at his hospital (15 min). I was put on Rampiril while comatose on life support with acute pneumonia (to go along with my acute behind). Now we are trying to figure out:

1. Have I had Atrial Fib to some degree for years now or is a recent affliction?
2. Either way, how did it come about? Viral infection involving heart; oral surgery; chemical imbalance during life support (3weeks); etc.

How do we get rid of this or live with it? And thee is where we stand.... the 'how do we get rid of it' part. First step was noticing it and it has progressvely worsened over the past 3 months to be sure. Next was an impromptu ECG that looked 'just about normal' but was sent to my cardiologist for his opinion. Followed by an extensivecardio exam the next day - wants to do a halter monitor for 48 hours and then book me in for paddles. I have this terrible feeling that there is something I am missin here, like a medication that should be taken prior to cardioversion attempts to improve the odds of success.

The thought had crossed my mind that this afflictio was closely associated with my apnea and that is why I even bothered to bring it up. Apnea is a cakewalk compared to the struggle of this one. Truly. So if Ican help even one member of the forum avoidAF by bringing it to the top I wl feel very good.

[LSAT]

I've only had 2 instances of Afib....on the last one my cardiologist gave me 2 Flecainide tablets and my heart rate was back to normal in about 2 hours. He has me carrying these tablets at all times. My Afib is considered Mild. I take one 50 mg Metoprolol tablet daily.

[Guest]

I always read AF posts with great interest!!

My AF was diagnosed BEFORE my SA. After my first attack, my cardiologist ran some routine tests. All were normal, so he sent me for a sleep study (I had little or no symptoms of SA). Sleep study showed severe SA, so he thinks that's why I went into Atrial Fib. The first time, medication (metoprolol) was used to regulate my heart. The second time (5 months later), I had to be cardioverted. Since then (that was in May), I've taken Atenolol and Multaq to keep my heart in regular sinus rhythm. I also take Plavix to prevent blood clotting.

I started APAP in August. So far.....so good.

I'm hoping that now that I'm in therapy for the SA, I can eventually get off the heart medications. We did try to lower the BP med and I went right back in AFib (regulated on it's own that time, though). It's only been 4 months since I began treatment for SA, so I am still hoping the AFib will go away!!

[torontoCPAPguy]

I've only had 2 instances of Afib....on the last one my cardiologist gave me 2 Flecainide tablets and my heart rate was back to normal in about 2 hours. He has me carrying these tablets at all times. My Afib is considered Mild. I take one 50 mg Metoprolol tablet daily.

Interesting. May I ask a couple of questions?
1. How long ago were these two instances of Atrial Fibrillation? (i.e. When)
2. Flecainide rings a bell as a medication of choice in treatment but I thought one was tied to it forever on a daily basis. Is it a racing heartbeat that was your major symptom?

In my case the Metroprolol keeps my heart rate down low even when exercising and even when the AFib made its nastry appearance my heart did not race; it was an erratic pulse that rang the alarms. The upper Atriums of my heart are not filling and squeezing the blood into the Ventricles in rhythm resulting in lowered blood pressure and inneficient heart function, like a fish flopping around out of water. Their main concern asides from shortness of breath is that all the fluttering is going to create a 'clot' that will then make its way out and about and lodge itself somewhere it's not supposed to be, like my brain, a coronary artery, etc., and create a bad result that is going to make me even more unhappy than I am now.

Curiously, I note that you do not mention anything of Cumedin or another blood thinner. Are we talking of the same ailment or does it come in different flavours for different folks?

[LSAT]

I've only had 2 instances of Afib....on the last one my cardiologist gave me 2 Flecainide tablets and my heart rate was back to normal in about 2 hours. He has me carrying these tablets at all times. My Afib is considered Mild. I take one 50 mg Metoprolol tablet daily.

Interesting. May I ask a couple of questions?
1. How long ago were these two instances of Atrial Fibrillation? (i.e. When)
2. Flecainide rings a bell as a medication of choice in treatment but I thought one was tied to it forever on a daily basis. Is it a racing heartbeat that was your major symptom?

In my case the Metroprolol keeps my heart rate down low even when exercising and even when the AFib made its nastry appearance my heart did not race; it was an erratic pulse that rang the alarms. The upper Atriums of my heart are not filling and squeezing the blood into the Ventricles in rhythm resulting in lowered blood pressure and inneficient heart function, like a fish flopping around out of water. Their main concern asides from shortness of breath is that all the fluttering is going to create a 'clot' that will then make its way out and about and lodge itself somewhere it's not supposed to be, like my brain, a coronary artery, etc., and create a bad result that is going to make me even more unhappy than I am now.

Curiously, I note that you do not mention anything of Cumedin or another blood thinner. Are we talking of the same ailment or does it come in different flavours for different folks?

My last episode was in April of this year....my only symptom was my pulse...it was all over the board and the doctor and nurse could not measure it. The EKG was crazy. I was told to only take the Flecanaide when I had an Afib attack and to only take the 2 tablets...no more. The REAL crazy thing was....The day before I had a nuclear stress test that I passed with flying colors.. The next week I had an Echo that was perfectly normal. I do not take any blood thinners.

[RDawkinsPhDMPH]

Two different scenarios .. AF with RVR (rapid ventricular response) and AF without RVR ... the urgency of treatment is different .... also AF at young age and normal atrial volume or AF at an older age and enlarged atrial volume .... very different risk profile ... bottom line, keep your appointments with your cardiologist and trust his/her judgement or get one you do trust ...

The only issue here is ..... untreated OSAS makes you more likely to have it again and treating the OSAS with CPAP fixes that....

[Muse-Inc]

Anyone investigated ubiquinol (active form of Co10) for AFib in addition to magnesium to stabilize rhythm probs? I have a good friend on rat poison and would like to suggest things he can ask his cardio doc about.