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cardio appt.... (Read 8101 times)
seffie
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cardio appt....
Feb 24th, 2008, 12:59am
 
Hi Everyone,
well, went to cardio follow up appt on Friday & thankfully saw a different cardiologist!
I told hm that the ectopics had improved a lot since October & that although I still had them sometimes they were nowhere near the rate & frequency that I was having when I wore the holter moniter. I said that I thought that this was because my anxiety is much better.
Also told him that I had stopped taking the betablockers after 2 weeks as hadn't got on with them, & he was fine about that!

Told him that I do still get flutters & rapid beats etc but that these don't last more than 10 seconds, I said that the other cardio thought that I was having atrial fibrillation. He said that he didn't think it was atrial fibrillation but he thought it was more likely that I was having bouts of atrial flutter & explained the extra circuit in the right atrium that causes this.

Although he said that the problem here can be the risk of a blood clot forming he said that because they only last a short time & my heart is structurally normal that this atrial flutter is more of a nuisance than anything & that most people take medication for it just for symptom relief.
I asked if I should be taking aspirin daily for it as I wasn't keen to & he said it was probably OK not to but obviously if they lasted longer or became more frequent then I would have to review it. He said that if it became a problem they could always burn the extra pathway away (ablation?) & that this was quite a simple procedure-is it ?!

He said that this wasn't caused by anxiety & that I had probably always had this extra pathway.
He didn't seem very concerned by my symptoms & said that they'd see me again in 5 years when I'm 50!

So, overall I was relieved & felt better about having a diagnosis of atrial flutter rather than atrial fibrillation but now I'm worrying a little about it as it seems to be something that I'll always have & I guess has the potential to get worse, not like anxiety-induced palps that can go away & I think I'll have to think seriously about taking the aspirin just as a precaution, just worry about the effects of aspirin on your stomach etc.

RLR-I'd really appreciate your views & opinions on this diagnosis & anything else you can tell me about it as I did google it when I got home but that was a bad idea (I know, I know) as some of the info was a little more worrying!!

Hope everyone is doing OK! Not many posts this week so that must be a good sign!!
Thanks for your support before my appt!
love Seffie xx
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angiebaby
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Re: cardio appt....
Reply #1 - Feb 24th, 2008, 5:53am
 
Hi Seffie, i am so glad that your appointment went well as you were so worried about going and what he would say to you.  I am sure that RLR will be along soon to put your mind at rest.  But seeing as he doesn't want to see you for the next 5 years then that must be a good sign.  Keep us updated and glad that you are feeling a little better. x
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It take a minute to get anxiety and a lifetime to get rid of it!!
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RLR
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Re: cardio appt....
Reply #2 - Feb 24th, 2008, 6:19am
 
Well, it's as I said before; If you're persistent enough, someone will offer a physiological cause for your symptoms. Based upon your inquiry to me, however, I see it's done little in the way of bringing any sense of relief or comfort now that you have a physical diagnosis.

Although I'm certainly not here on the forum to challenge medical decisions by your own doctor, my personal opinion here is I don't agree with the evaluation that you have atrial flutter. Atrial flutter is associated with very rapid and often irregular contractions of the atria due to a re-entrant node (the extra pathway) that becomes excited and causes a rather cyclic electrical signal to perpetuate through the atria. It typically causes breathlessness, dizziness and nausea in most patients, with some patients describing the sensation as feeling as though a little motor is running inside their chest. Because the atria aren't able to properly contract during AF, blood can pool and given the right hemotological circumstances, a clot can form. In the absence of other pathology, such as history of heart disease or stroke, it is typically harmless.

Ablation is used to destroy the re-entrant pathway to stop the cyle that precedes and ultimately causes AF to take place. While it is not considered very invasive, ablation where re-entrant irregularities are not present does nothing to relieve the symptoms due to other causes.  

Correct me if I'm wrong, but I just don't recall you describing your symptoms as any sudden onset of tachycardia with associated irregular rhythm and I'm not speaking here about either of those events separately, but as a firm sequential and characteristic event.

AF is the consequence of a physiological abnormality and it's there to stay and produce symptoms until a decision is made where ablation techniques are warranted. You don't just experience a few palpitations here or there in the absence of other qualifying and necessary criteria. I certainly do not have the advantage of evaluating you directly or seeing the ECG for myself and I'm not in the position here to challenge the diagnosis. I'm merely stating that based upon the history of the complaint as you described it to me, I just don't see this being AF at all.  

Patients with health anxiety and somatic symptoms are often caught in a world of pure torment. They are compelled by uncertainty and fear to associate their symptoms with an underlying physical cause and when one if finally given, they subsequently employ the very same uncertainty and fear that originally brought them to the doctor's doorstep appealing for them to find a cause.

The only constant in this scenario is the uncertainty and fear based upon unwavering perspectives that are flawed in nature. You do realize that you can't live in purgatory. You must decide whether you're well or sick, but not both. If the palpitations are the consequence of stress-induced anxiety disorder, then you must proceed to treat it from that standpoint and move forward with your life knowing that you don't have any underlying disease.

By contrast, if you remain convinced that there is an underlying physical cause for your palpitation events, then you've already received the official diagnosis of AF and you must prepare to live out the remainder of your life within the restrictions of care and prevention associated with such a disorder.

As much as there is a pathway to choose from a healthcare standpoint, there is likewise a decision to be made regarding the identity of what compels you to continually place yourself in the position of uncertainty and subsequent fear. You can choose to ignore this characteristic, but it always manifest itself in one aspect or another until you do.

Best regards and Good Health

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Best Regards and Good Health
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seffie
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Re: cardio appt....
Reply #3 - Feb 24th, 2008, 8:42am
 
Hi Angie & RLR,
Angie thanks for your lovely post-much appreciated! Yes, I'm just relieved that this cardio was easier to talk to & explained things more simply.

RLR-thankyou for your response. Actually I do feel better after seeing this cardiologist, it just might not have come across in my post.
First of all I want to say that I very much appreciate the fact that you give up your time to advise & support us on here, you have always responded to my posts with great insight & advice.
However, this time I feel that you're basically saying to me that I went looking for a cause & I got it!

Originally I went to see the doctor because I had a very severe episode of racing, pounding palpitations last summer (which I did post about) & she thought it could have been a bout of SVT & so she referred me to the cardiologist.
I had the first appt in August & the appt this week was a 6 month follow up, I didn't ask for this appt, they asked me to go back.

I have tried to describe my symptoms on this forum as clearly as possible but to be honest it's very difficult to explain exactly what's going on, I have experienced a range of different sensations including  ectopics, flutters, quivering & short runs of irregular beats, all of which I've posted about. I guess the only way to be sure is getting them caught on an ECG which is what I've done. I don't expect you to be able to diagnose what's going on from my (probably) inadequate descriptions but I am always interested in, & grateful for, your views & opinions.

Obviously, if they think this is what I have then I have to be guided by their diagnosis & act accordingly. I still believe that most of the palpitations that I've had over the past 3 years have been linked to anxiety & hormonal fluctuations but maybe this atrial flutter has also contributed.

I understand that anxiety needs to be dealt with otherwise it will constantly manifest itself in different ways, I've had it most of my life in one form or another & at last I feel that I have found a treatment that has really made a difference. I do feel however, that health anxiety irritates many in the health professions because there are so many people who are really ill & it can be such a frustrating condition to treat. Many people around me are irritated by it so I tend to keep it to myself.

I fully appreciate that there are so many people with painful & debilitating conditions & I can see why people lose patience with health anxiety sufferers but I find the lack of understanding & intolerance from people around me to be extremely hurtful.

RLR-I appreciate you taking the time to reply to my post. I have taken your views on board.
Thanks again,
Seffie xx
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Re: cardio appt....
Reply #4 - Feb 25th, 2008, 1:59am
 
Hi Seffie
Bead here. You are lucky that you were able to see a more helfpul cardiologist and lucky that he offered to see you again (in five years - so that can't be bad).

I want to tell you that your symptoms sound exactly like mine from all your descriptions and I have been sent away. Despite being told that I have a faulty pathway in my heart (AV node re-entrant tachycardia). I was told that this may require ablation (to me a terrifying thought), but it has not happened in a while to my knowledge. Lot of other weird bumps and thumps and episodes that last up to half an hour of irregular fast heartbeat. I have been consoling myself with the idea that it is ectopics that sets all this stuff off. Has the faulty pathway been there all my life (I have no way of knowing - I doubt it as I have never had any heart palpitations all my life until these last two and a half years since which my heart reacts weirdly every day as you know!) Perhaps it is the ectopics that sets off the other irregularities and if we could get the ectopics under control everything else would abate too.
I certainly haven't had many of these AVNRT episodes (and they do feel very different to ectopics - just like rlr said a motor in your chest. Sort of buzzy like a fast machine gun. They do frighten me a lot because I know they are seriously considered. So while an abnormal pathway may not be caused by anxiety - having anxiety may be more likely to trigger it off - let's face it when your heart is going out of synch with ectopics I think that probably makes this a very likely scenario.
Try not to worry about what might happen - concentrate on here and now (I am trying too - I know it is hard!). Apparently statistics show that 95% of what we worry about never happens. Take care and we're here for your support.
bead xxx
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seffie
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Re: cardio appt....
Reply #5 - Feb 26th, 2008, 7:50am
 
Hi Bead,
thankyou for your post. I feel a bit better about it all now to be honest, I will go & discuss it with my GP when she gets the report from the cardio & decide with her whether to take aspirin or not.
I agree with what you have written, that the palpitations are probably a combination of things & anxiety will always make them worse.

To be honest since October the ectopics have been 90% better than they were & I can only think that this is because I have reduced my anxiety & tried really hard not to be scared by them. To be honest, this is the only thing that I have changed, I even have small amounts of chocolate sometimes & it doesn't seem to trigger them!!

Really sorry that you are still suffering so much with them but I think you're doing brilliantly with your exercise programme! Keep it up! I have just started a walking programme as my fitness & stamina are very low for my age after 18 months with fatigue symptoms.

Thanks very much for your support Bead, it is very much appreciated!
love Seffie xx
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RLR
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Re: cardio appt....
Reply #6 - Feb 26th, 2008, 3:39pm
 
This is the point I was alluding to earlier. The physiological presence of a re-entrant circuit in the heart tissue is not affected in the least by any reduction in anxiety or changes in stressors. It is a physical defect and responds to circumstances within the tissues and is not related to stress or anxiety but rather cellular and electrical conductivity variations within the heart.

My earlier post was intended to reflect the point that people need an answer for their symptoms. It is a common and unrelenting perspective is that if it's a physical symptom, then there is a corresponding physical cause.  

I'm truly glad that you feel better subsequent to your doctor's visit and it represents a suitable stopping point for me where the matter is concerned. Regardless of the underlying cause, I'll wish you the very best in hoping your symptoms are abated permanently and things return to an acceptable degree of normalcy for you.  Smiley

Best regards and Good Health
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seffie
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Re: cardio appt....
Reply #7 - Feb 27th, 2008, 6:03am
 
Hi RLR,
thank you for your comments, I do understand the point you are making. I think sometimes though, people with health anxiety aren't just looking for a physical cause for their symptoms, I think often we're looking for the reassurance that there isn't one-or at least that the cause is a benign one!!
That is how I see it anyway!
Thank you for your support & advice.
Seffie xx
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