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AF (Read 2974 times)
pitterpat
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AF
Apr 16th, 2010, 4:55am
 
Hi all
I am a 49yr old woman and have experienced occasional palpitations since I was 20. These were mainly 'missed beats' or feeling my heart 'flop' in my chest. These were investigated and no underlying cause was found and I managed to ignore them mostly.
Last year I experienced an episode of fast AF with rates of 190 bpm. This was very frightening for me. I was treated in A&E with IV Flecanide and my heart returned to normal sinus rhythm. I found myself reacting very badly to this episode and became very fearful and hyper vigilant of my heart rate and rhythm. I had an Echocardiogram and no abnormalities were found. This episode occurred following a bout of acid indigestion and while I was resting.
I experienced another episode of fast AF 2 weeks ago and was again back in A&E and treated with iv Flecanide which resolved the AF.
I am otherwise fit and healthy although obese, I have a normal BP and no other underlying conditions. During the episodes of AF I could feel my heart racing and see it bouncing in my chest. I did not feel dizzy or breathless and had no chest pain. The paramedics did see some ischemic changes on ECG during the AF, but this resolved with cardioversion. The onset of the AF was again while I was at rest in the evening although there were no gastric symptoms.
Due to my extreme anxiety following this event my GP has prescribed Propanolol 80mg slow release and Citalopram 20mgs daily.
My main concerns now are how to manage further episodes of AF; do I wait at home for spontaneous resolution or do I continue to summon paramedics and attend A&E?
The ischemic changes on ECG during the AF; does it cause any permanent damage?
What is the prophylactic effect of Propanolol on the AF? Do I keep taking it now that my anxiety has subsided a little?
Thanks Sad
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RLR
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Re: AF
Reply #1 - Apr 25th, 2010, 5:43am
 
Well, it's a normal to experience apprehenision and vigilence following an event such as described and atrial fibrillation in normal healthy adults is far more common than one might imagine. To primarily address your question of whether to wait for spontaneous resolution, although the AF is not considered to be life-threatening in of itself in these particular instances, persons who have historically required intervention to restore normal sinus rhythm will find it ultimately necessary in most subsequent events. I will state, however, that several maneuvers in otherwise healthy persons can be performed to determine whether spontaneous recovery can be induced.

The valsalva maneuver is performed by tensing the stomach muscles and forcefully pushing air against a closed glottis, similar to the natural action induced when straining during a bowel movement. The activity should be initiated and maintained for a period of about 10 seconds or so, followed by release and normal breathing. If recovery doesn't ensue, it can be repeated about three times.

The dive reflex is a natural occurrence in all mammals when submerging underwater, where water temperature and pressure cause changes in blood pressure and blood returning to the heart. It can be invoked artificially by immersing the face in very cold water for 10 seconds or so, followed by pressing gently on the eyes for about 30 seconds. Realize that one need not keep their face in cold water while pressing upon the eyes. This is somewhat more complicated to perform than the valsalva maneuver, but can produce spontaneous recovery from uncomplicated AF in some instances.

If these actions fail to initiate recovery to normal sinus rhythm, then medical attention should be sought but you should in all instances try to make certain that someone is aware of your circumstances prior to trying these maneuvers and that medical attention may possibly be necessary to ultimately resolve the issue.

Best regards and Good Health
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Best Regards and Good Health
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Re: AF
Reply #2 - Apr 25th, 2010, 6:27am
 
Hi
Thanx so much for taking the time to reply. I am working on my anxiety so that I can better cope with future episodes.
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