Yet Another Cycling Forum

General Category => The Knowledge => Health & Fitness => Topic started by: Peter on August 26, 2019, 11:45:40 am

Title: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 26, 2019, 11:45:40 am
A few weeks ago a had a TIA (mini-stroke) while ordering coffee in the middle of a bike ride.  I recognised the signs, though I have not had one before and rode home (having finished my coffee) and later that day went to hospital to have it confirmed.  After several appoinments and a battery of tests, some of which are yet to be analysed, I have been diagnosed with atrial fibrillation and it has been discovered that I have a severely ineffiecient heart with an ejection fraction of possibly lower than 30%.  I was prescribed statins and edoxoban (anticoagulant) and I am taking these, despite reservations, until all the ends are pulled together and I can have a better consultation with a specialist (I am waiting for the results of a brain scan to decide which type of stroke I had) and from a 5-day heart rate monitor test (R Test).
This has all come as a terrific shock and disappointment after 73 years of almost complete good health.  I have no risk factors (except age):  I am fit, have a healthy diet, don't smoke, hardly drink and all my blood results are satisfactory and I haven't got significantly high cholesterol.
The specialist said (on being asked) that I was fine to continue exercising at the rate I do.  But when  I had an echocardiogram a week later, which discovered the low ejection fraction, thre technician suggested it might be a good idea to "take it easy".  That's what I'm doing, because I don't mind admitting that I am mildly frightened by this turn of events.

I've taken my blood pressure and pulse for years, using a machine such as is used in hospital (OMRON) and have always had low (not dangerously) blood pressure, which was confirmed in hospital.  This BP monitor continues to show my pulse in the 60 -70 range.  But the hospital has me at 90 + variable.  I got a heart-rate monitor, too, now, and that shows my resting heart at about 110 but has me at over 150, if I so much as walk to the shop.  I did a very gentle bike ride and it was in the 180s, when I was hardly going faster than required to keep the bike moving.  In my usual exercise mode I would be technical dead, I imagine.

I feel NO symptoms and never have.  No breathlessness, stiffness, NOTHING.  I understand this is quite common.  I also had a MRI scan on my heart 3 years ago (after a lightheaded episode) and it showed no abnormalities although a treadmill test showed I have ectopics (and I nearly bust the machine!).

It occurred to me that as the heart-rate monitor shows 40bpm above the BP monitor, I guess it is picking up the fibrillation while the BP monitor, which is on the arm only picks up the underlying beat - is that possible?  That makes me wonder whether or not I'm alarming myself unnecessarily about the HRM readings, which if I knock 40 off are not so bad?  What does the team think?

I'll say now that I'm not going to act on the above until I have a chance to talk properly to a specialist.  I'm going to go on taking it easy!

I know how to trawl the net; but I wondered if anyone here has personal experience.


Sorry to go on but after years of loving my exercise, I'm not only frightened about my health but very frustrated!

Thnk you

Peter
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Kim on August 26, 2019, 11:58:04 am
It occurred to me that as the heart-rate monitor shows 40bpm above the BP monitor, I guess it is picking up the fibrillation while the BP monitor, which is on the arm only picks up the underlying beat - is that possible?

Sounds entirely plausible.  The HRM (assuming an electrical chest strap sensor type) will have been designed for a normal rhythm[1], and all bets are off if your heart's doing something electrically weird.  It's not like a diagnostic ECG machine where making sense of abnormal rhythms will have been part of the design spec.


[1] In an "adjust the gain for the strongest part of the waveform and count the pulses" sort of way, rather than knowing anything about hearts.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 26, 2019, 12:04:17 pm
Thank you, Kim!  I'm still going with taking it easy until more diagnosis has been done but I'm allowing myself to be relieved that my heart is probably not going to blow up!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Kim on August 26, 2019, 12:14:49 pm
Disclaimer: IANAD, but I did molish a rudimentary heart rate monitor (operating on the above principle) as a GSCE project many years ago.  It was pretty cool getting the cardiac waveform on the oscilloscope, but mostly it was an education in all the different ways that human beings can introduce noise into your circuit (simply moving around was enough to throw the counter reading off, it barely coped with the presence of mains electricity in the same room, and certainly wouldn't have handled an abnormal rhythm).  I'm constantly impressed by how well the Garmin things work, let alone hospital-grade kit[1].


[1] Yes, I'm the patient who confused recovery room nurses by stopping breathing while trying to work out how the monitor was deriving respiration rate[2].
[2] I looked it up when I got out of hospital: It measures the impedance of your chest cavity through the three-wire ECG pads.  Witchcraft!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Basil on August 26, 2019, 12:18:02 pm
Agree with Kim.  When I first suffered from af, my cheap chest strap monitor was giving bmp of 300 +. Basically it couldn't interpret the samba rythmn of my heartbeat.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 26, 2019, 12:29:28 pm
 ;D  Mine's more Stravinsky than Samba, worse luck!

@ Kim  That's just typical of you: to be doing experiments whilst dying!  I actually don't breathe regularly at all.  I don't have anything wrong - I just don't bother to breathe.  I'm always accused of sighing, when it's just my body forcing me to breathe from time to time.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: chrisbainbridge on August 26, 2019, 01:44:49 pm
What you are describing is the difference between pulse waveform picked up by the peripheral monitor and the electrical function of the heart where you are picking up the atria fibrillating at a significantly higher rate.  Fibrillation simply means spontaneous electrical activity in a muscle fibre not under nerve control.  If the nerves and conduction pathways in your heart are beating at X but the spontaneous rythm of the atria is 2X then your peripheral HRM will say a HR of X but a chest strap eg garmin will say a rate of 2X.  This is the essence of the new apple watch where there is an optical HRM in the base of the watch and if you touch the crown with the other hand it measures electrical.

If you have been like this for some time then you may very well have been functioning with a low ejection volume for quite some time as a result of the AF or you may have underlying ventricular cardiac disease.

This may be overly technical but seems a relevant article https://www.cfrjournal.com/articles/ablation-AF-HF-reduced (https://www.cfrjournal.com/articles/ablation-AF-HF-reduced)

There is a professor in Liverpool/Chester who has a special interest in athletes and heart problems but try your local people first.  I would specifically ask them what treatment they would offer a 40 year old with the same problems, findings, etc and why apart from age are you not eligible.  We still suffer from significant ageism in this country.  You might also take in a list of your last 20 rides or so to confirm what you do and why you want to continue.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: swiss hat on August 26, 2019, 02:37:31 pm
I had an episode of AF at the age of 56 in July 2017 just before I was expecting to ride LEL. I noticed that I was very breathless whilst running at an easy pace and took 30 mins to recover instead of the usual 2-3 mins. After a further run with similar results and using a Polar HR monitor I called 111 and was advised to attend hospital urgently. After diagnosis I was put on anti-coagulant and beta blocker. Like yourself this came as a major shock and I initially found it very difficult to come to terms with after running and cycling for 20+ years. I only walked and took short, easy cycles for 3 months until I had a cardioversion. Fortunately this was successful and I have maintained normal sinus rhythm since then. I stopped the beta blocker on day of cardioversion and anti-coagulant approx 5 months later.

After the cardioversion I steadily built up exercise level/duration and used an HR monitor to keep intensity levels steady, limiting to 150 HR. I did see, and continue to see, the occasional spike up to 180-190 HR but it has always recovered within 5-10 seconds. I sometimes noticed an almost imperceptible flutter during these spikes and at other times was only aware of them on reviewing the HR recording. During 2018 I started to ride audax events again and completed an SR. I had meeting with private Electro-Physiologist in Sept 2018 and presented Polar records of the HR spikes. After a long discussion he encouraged me to keep exercising and be a little less focused on the HR monitor.

This year I have continued to run and cycle regularly. I don't push myself like I used to but can still do a respectable pace. On 400+ km rides I have noticed that on 2nd day my HR is very stable with no unusual spikes. At the beginning of the year my aim was another SR and maybe PBP. I completed both and really enjoyed PBP.

I aim to be caffeine free, have only the occasional beer, eat and sleep well and try to do the "right" things to keep AF at bay. I'm grateful for each day that I can continue to get out and exercise.

Wishing you a return to sinus rhythm and a good recovery. It is certainly possible.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 26, 2019, 02:50:48 pm
In my BP monitor the cuff connection is entirely pneumatic, so it can't possibly pick up A-fib.

Three or four of my cycling chums have started with it in the last few years, and I've a vague, totally uninformed, impression that it could well be due to a lifetime of driving one's heart at high frequencies.  A popular treatment here, too, seems to be catheter oblation: at least it's popular with the cardiologists, but the effect on the recipients seems to be rather hit and miss. In one case the 'beneficiary' can now barely cycle even with an eBike, while another is still doing Audaxes and has noticed no difference in power.  The cases in the middle are now on eBikes.

Re ageism, it's not just the UK.  There seem to be standard cocktails according to age - "he's over 70, give him beta-blockers (the cardiologists' sliding spanner) and anticoagulants". Oh, and if you fall off the bike be careful not to hit the ground.

In my own case I can relate instances of A-fib (well, the occasional strange zzz-zzz-zzz-thump sensations in the chest after hard rides) to caffeine intake and bloody-minded climbing, so next time I'm due at the cardiologist's I'll be off the bike and off the coffee for a week in advance.  Of course, the instances I notice might not be the only ones that occur...  I want my own Holter and a Cardiology 101 course.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 26, 2019, 03:37:42 pm
Thanks, people - lots to consider, there, which I'll look at later.  Just been for a fibrillate in Morrisons, so am taking a break!

Peter
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 26, 2019, 04:21:39 pm
I'd add that years ago I accompanied my FiL to an interview with an anaesthetist before one of his many operations (heart, spine, colon, aneurysm...), and when the anaesthetist asked in passing what kind of sport I did, and I told him, he went on to say with relish "Aha, we'll have you in for a pacemaker one of these days".  I do like people who enjoy their jobs.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: quixoticgeek on August 26, 2019, 04:54:49 pm

If you want an electronic device for monitoring your heart rate without having to pummel your arm with a BP monitor, consider one of the cheap pulse ox devices, you don't need the most expensive just to monitor your pulse. About 20 quid on amazon will get you something that will do the job (https://amzn.to/2ZjJTEX)

Being that it detects based on blood flow, the AF shouldn't mess with it.

J
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: mzjo on August 26, 2019, 05:38:44 pm
In France we have an association called the Amicale des Cyclocardiacs (T42 might have come across them) which is a club for cyclists who have had heart trouble, attacks and the like. (One of my club members is quite active in it). Does the same sort of group exist in UK?
Disclaimer: IANAD, but I did molish a rudimentary heart rate monitor (operating on the above principle) as a GSCE project many years ago.  It was pretty cool getting the cardiac waveform on the oscilloscope, but mostly it was an education in all the different ways that human beings can introduce noise into your circuit (simply moving around was enough to throw the counter reading off, it barely coped with the presence of mains electricity in the same room, and certainly wouldn't have handled an abnormal rhythm).  I'm constantly impressed by how well the Garmin things work, let alone hospital-grade kit[1].


[1] Yes, I'm the patient who confused recovery room nurses by stopping breathing while trying to work out how the monitor was deriving respiration rate[2].
[2] I looked it up when I got out of hospital: It measures the impedance of your chest cavity through the three-wire ECG pads.  Witchcraft!

When I was in recovery they kept yelling at me to breathe when all I wanted to do was doze off the first time. The second time with a lighter dose of anaesthetic I was well awake but the nurses weren't happy until a very kind one looked and said "but the clip is on the wrong finger, I'll fix that. Oh and you're cold, lets get the heated blanket on you" after which things improved rapidly. After that a nurse came in who recognised me, saw the name on the form and said"but it's Laurence's husband:" at which it turned out that at least half the recovery room nurses had either worked with my wife or knew her from work contacts. They got me out quite quickly after that (that was all said in french of course)   
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: mrcharly-YHT on August 27, 2019, 08:35:48 am
I would trust the Omron machine over a Garmin to get an accurate pulse - as you've suggested, it is likely the Garmin is picking up fibrillation (my partner gets this, it is quite frightening to hear/feel her heart going thrrrbbb instead of beating properly).

As for your pulse in hospital; that is just typical 'white coat syndrome'. Many people get raised blood pressure and pulse rates in hospitals.

Peter, I'm surprised to read all of this. Having ridden with you a couple of times, I know you are such a strong quick rider.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: drossall on August 27, 2019, 09:18:59 am
In France we have an association called the Amicale des Cyclocardiacs (T42 might have come across them) which is a club for cyclists who have had heart trouble, attacks and the like. (One of my club members is quite active in it). Does the same sort of group exist in UK?
That's interesting. My situation is different; I had a (very mild indeed) heart attack in early June, leading to bypass surgery a week later. Unfortunately I had some complications (infection etc.) and only finally left hospital at the end of July. I'm currently banned from riding while my rib-cage recovers, but hoping to get back into it soon. In the meantime I'm wearing a Garmin wrist gadget and walking as much as possible - up to 40 miles a week.

Would be good to have a group where experience could be shared.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 27, 2019, 09:32:13 am
In France we have an association called the Amicale des Cyclocardiacs (T42 might have come across them) which is a club for cyclists who have had heart trouble, attacks and the like. (One of my club members is quite active in it). Does the same sort of group exist in UK?

Yes, I know a couple of riders who are in it but never wanted to join because while I don't avoid being aware I don't want to wallow in it. Anyway, my YACF jersey is much prettier than theirs.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: quixoticgeek on August 27, 2019, 11:14:11 am
As for your pulse in hospital; that is just typical 'white coat syndrome'. Many people get raised blood pressure and pulse rates in hospitals.

I have the complete opposite. My home auto BP machine thingy consistently reads high, yet when I went to my GP, both her, and the nurse have checked my BP, and it's fine. I've returned one BP machine, thinking it was faulty, but the replacement unit does exactly the same thing.

J
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Kim on August 27, 2019, 09:56:40 pm
I wonder if there's something about the way the BP machines work that makes them prone to reading high?

I've got a basic analogue dial sphyg at home with the nastiest stethoscope ever made (at least without the benefit of a Fisher Price logo), works fine.  The GP's electronic ones tend to over-read, and if they express concern I get them to do it again with the proper mercury manometer, which tends to be consistent with what I get at home.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 29, 2019, 11:23:41 am
Hello again, Resus. Team!  Let's hope it turns out to be R(h)esus positive!

   Naturally, I've been giving your kind posts and the problem in general a fair amount of thought, in the hope of trying to crystallise what I need to ask the consultant, not that it is likely to be the same one, it rarely is.  Seeing the GP depends on having been walled in when the clinic was built.  But I have a telephone appointment booked, so I look forward to helping him with his problems.

   Thoughts as follow:-

AF is an electrical fault, for which there are two lines of treatment (according to mainstream medicine):-

1.  Invasive methods, such as ablation, cardioversion and pacemakers.  I don't know enough about ablation (although I have read your link, Chris, for which "thanks"!) but cardioversion may not be an option for me because I suspect my AF has not been sudden (would sudden AF cause a clot so quickly?).  I think a pace maker would not initially be used in my case because they are for atrial fibrillation where the base heart-rate (pulse) is too high anyway.  Beta blockers are used to bring the overall rate down and this often leads to the base rate being too low, so it is boosted by a pacemaker.

2. Medication.  I have been prescribed Atorvastatin, though I'm not sure why (my cholesterol is only just over 5 and the proportions are good (less than 2)).  I was told some time ago after a routine MOT that such a level was not considered a problem in someone with my healthy lifestyle.  Incidentally, my parameters have been collated to give CHAD2S2VASC of 3 and HAS-BLED of 1.  I only feature on the CHADS one by virtue of age and the fact that I have now had a TIA.  The HAS-BLED one is age only, I think.  These results posit a 3% chance of a further stroke.

(Chris, thank you for your mention of  heart disease as a cause.  There's certainly at least one poorly functioning  part( LV), for which the numbers don't look good -  and my mother died of heart failure.  I've also read that strenuous exercise can be a factor and it may be instructive that although I've always been fit, I only took up Audax in my mid 60s, after which I did about 150 rides, including a 600 and several very hilly 400s.  A significant factor may be that I did most of my riding on insufficient sleep, even the 200s, but I don't think I was ever "distressed"!  Odd that strenuous exercise doesn't feature in the CHAD2S2VASC list - I thought AF was well known to be a possibility for endurance athletes.)

The other drug I have been prescribed is Edoxaban, which is an anti-coagulant.  I'm a little surprised at this because when I was prescribed it, it was a month ago and I still haven't had the results of the MRI scan which is supposed to indicate whether or not I've had a bleed to the brain, or a clot.  I know the latter is very much more likely, although, mercifully the echocardiogram couldn't find any obvious evidence of a thrombus in the heart.  So I sort of understand the reasoning behind the anticoagulant, even ahead of the MRI results. 

   Both anticoagulants and statins have their downsides but the one I'm more concerned about is one I haven't been prescribed yet but might be when all the results are in.  Of course, I'm talking about beta blockers.  I have a basic heart-rate of about 55.  That has always been the case and was again today when I took the average of four readings, taken at 3 or 4 minute intervals after a three mile walk this evening (no symptoms, as usual).  These were on the BP monitor, by the way.  It seems to me that beta-blockers would just bring my "natural" heart rate down to a level at which I'll need a pace-maker.  I can still see a logic in that if it is actually the only way offered to me to get the AF reduced but I really don't want to go there!

   So, in summary:  it seems to me that in spite of the phraseology used in medical literature, drugs do not treat AF if you have an underlying low heart rate.  What they do is try to ameliorate the possible effects of AF, without actually removing it.  The likeliest way of "removing" AF is surgical intervention of some kind.  Or can it spontaneously disappear?  (Please only answer "yes" if you actually know!)

   I'm aware that AF is unlikely to kill of itself, and that related stroke is a much likelier danger than a heart attack.  But I also know that the heart is not intended to be pounded at AF levels and will probably weaken.  It's a bit of a conundrum!

@ Chris again:-  your suggestion to ask the consultant how they would treat a 40-year-old had already occurred to me.  It was nice to have it emphasised by you!

@ mrcharly:  A, thanks for your compliments!  I'm really surprised by what's happened, too.  I think it's the case that many, if not most, people who are diagnosed with A fib have no symptoms. 

I think the likeliest reason for my condition is exercise-induced AF (and possible heart damage), with a little genetic disposition thrown in.  Maybe Sleep Apnoea, too (I do occasionally wake up as though I've dropped down a lift shaft).  I'm still awaiting the results of my brain MRI and the R-Test .  The trick then will be to get the correct treatment for my case and/or learn to adjust to a different future, which I'm sure I can do - but I only want to do it if I have to!

Thank you all again.  Be happy - don't worry!

I'll keep you p.....aaaaaaagh...................!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: chrisbainbridge on August 29, 2019, 12:15:02 pm
Quote
I have been prescribed Atorvastatin, though I'm not sure why
Statins are used as a drug for everybody with any heart problem as if you treat thousands of people with statins a few will have less heart disease even if cholesterol is normal.  You can perhaps guess my view of statins and most of my colleagues.

Quote
Edoxaban, which is an anti-coagulant
The aim of this is to stop clots forming on the inside wall of the atrium.  In AF as the flow is poor with loss of proper emptying you get stagnant blood clotting on the wall and then breaking off to cause the TIA.  The anticoagulant stops the clotting.

Quote
I have a basic heart-rate of about 55
I am not a cardiologist!!  However the percieved rate may be low because the AF is not filling the ventricle enough and there is not sufficient emptying to register.  The 55 may actually be a false low reading.  Your heart may want to pump faster but cannot.  If you feel your pulse you may find that the pulse is irregular with what seems like missed beats which if filled in would be more like 60-65.  Alternatively you may have some form of electrical conduction abnormality. I am sure helly knows more about this but a low pulse rate is relatively unusual in AF but not unknown

Goos luck

Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 29, 2019, 01:20:02 pm
Good luck from me too.

Without wanting to be alarmist, I'd want to be well-informed of how well pacemaker leads stand up to being flexed at 150 Hz before I consented to having one. There have been a couple of hundred thousand cases of leads having to be explanted following a recall for fracturing.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: quixoticgeek on August 29, 2019, 01:20:39 pm

Does anyone know if AF is hereditary?

J
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Whitedown Man on August 29, 2019, 02:21:14 pm

Does anyone know if AF is hereditary?

J

I was told by my cardiologist that AF is not hereditary but that it does run in families (my mother, one of her two sisters and one of her three brothers all had / have AF as do I, though neither of my two siblings have it). I think I know what he meant, but if one of the YACF medics cares to elaborate that would be great.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 29, 2019, 03:31:49 pm
From what little I have read, I gather that it's not uncommon in folk over 70.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Sergeant Pluck on August 29, 2019, 03:46:39 pm
It is impossible to be sure about the extent to which AF is inherited. There is a group of genes that are associated with an increased risk of AF in families, and it is thought that about 30% of cases of AF that do not have an identifiable cause may be familial.

It is difficult to isolate the genetic component. Many of the risk factors for AF themselves have degrees of heretibility. And many of the risk factors for AF "run in families" in that lifestyle factors are also often common among family members.

The majority of cases of AF are related to age, high blood pressure, and co-existing coronary artery disease. Going down the genetic rabbit hole is unproductive.

I have a basic heart-rate of about 55.  That has always been the case and was again today when I took the average of four readings, taken at 3 or 4 minute intervals after a three mile walk this evening (no symptoms, as usual).  These were on the BP monitor, by the way.

Ditch the monitoring devices and use the MkI finger and a watch. Is your pulse regular or irregular? Get familiar with how it feels so that you can identify change.

If your usual pulse rate (I take it by "basic" you mean at rest) was always 55 ish, and when you were in AF it was 90 - 150 odd depending what you were doing, and now it is steadily around 55 even when not on rate-limiting meds (I assume you are not yet on a beta blocker), one possibility is that you have reverted back to a normal rhythm.

However, even if the AF is intermittent (or paroxysmal), the same concerns, risks, and need for investigation apply, so stay on the edoxaban until you see a cardiologist.

Without wanting to be alarmist...

Pacemaker lead fractures occur at a rate of a few percent of implantations and the vast majority of fractures are due to overly vigorous upper limb movement or chest trauma.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: chrisbainbridge on August 29, 2019, 04:36:50 pm

Does anyone know if AF is hereditary?

J

I was told by my cardiologist that AF is not hereditary but that it does run in families (my mother, one of her two sisters and one of her three brothers all had / have AF as do I, though neither of my two siblings have it). I think I know what he meant, but if one of the YACF medics cares to elaborate that would be great.
hereditary means that it is directly inherited in traditional terms or what is known as mendelian inheritance.  Runs in families means that we think that it may have some sort of genetic basis but it is patchy and unclear but probably occurs more commonly in families than chance alone.

The big thing at the moment is called Genome Wide Assessment studies (GWAS) which is picking up all sorts of interesting things. https://www.biorxiv.org/content/10.1101/242149v1 (https://www.biorxiv.org/content/10.1101/242149v1)
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Whitedown Man on August 29, 2019, 05:03:38 pm
 :thumbsup:
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 29, 2019, 06:00:37 pm
Thank you all, once again.  I am certainly being cautious!  I used the bike to go to the library today, without any problems - but then I never had a problem till I had a problem - and I've never had one since!  So, I'm being careful and trying to stay cheerful.

I am not reading anything into the home BP readings any more, except confusion.  They are now up around the 80 mark, which is closer to readings I got in hospital.  I guess it's very difficult to be sure when the heart is fluctuating as much as mine does!

@Pluck  I haven't got any Mk1 fingers because of arthrirtis, but the Mk3s indicate (as I have always known) a pretty variable rate, with missed beats.  I also don't appear to have the strongest pulse in the world - but it's got me round a few old rides!

Thank you all again - you are very helpful to someone who has been knocked sideways by all this!

Peter
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: drossall on August 29, 2019, 09:49:48 pm
I know I need to discuss this properly with my own doctors, but I'm interested in general terms in the interaction between drugs used to treat these conditions, and cycling. For example, bisoprolols are used to reduce heart rate, but is that what you want when climbing a steep hill? (Or do you have to be more prepared to get off and walk?) I think my racing days are long past, so I won't be pushing it that much...
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: chrisbainbridge on August 30, 2019, 07:30:31 am
No. But if you have heart failure or angina then beta lockers act as a lock on the heart rate and prevent your brain from going high enough to cause problems.

In AF they will increase the cardiac filling by giving more time between each beat for the ventricle to fill and thus improve heart function.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 30, 2019, 08:10:30 am
WRT climbing, I did quite a lot 2008-2011 when I was on bisoprolol. Every so often I had to stop pedalling for a second or two to let the burning pain in my quads die down. I still managed rides with 1500 metres of climbing, though.  I was on 25 mg/day.

In AF they will increase the cardiac filling by giving more time between each beat for the ventricle to fill and thus improve heart function.

A couple of days ago I began to think that something of the sort was what was happening with me, since my performance has actually deteriorated since I came of the BBs, and it now takes me a ridiculously long time to recover from rides I did easily three months ago.  I'm now awaiting the results of a pro-BNP test to see if indeed I'm going down the rabbit-hole.  Should find out this morning.

This feels more and more like wriggling on the hook.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: drossall on August 30, 2019, 09:33:12 am
 :(

Thanks. In my case, as I mentioned above, I'm recovering from a bypass. I'm currently not allowed to cycle until the surgeons confirm that my rib-cage has mended, but otherwise feeling relatively fit and walking (which I am encouraged to do) as much as I can (did manage forty miles in a week at one point).

I'm hoping to return to Audax riding (although I've never gone beyond 200km) in the autumn, and hence the questions.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 30, 2019, 10:28:33 am
Good luck to all of you!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 30, 2019, 10:44:59 am
I'm hoping to return to Audax riding (although I've never gone beyond 200km) in the autumn, and hence the questions.

More power to you.

Good luck to all of you!

Thanks, Peter.

Good news: following my GP visit, my pro-BNP result shows no heart damage or enlargement, but doesn't have any bearing on A-fib/not-A-fib.  So GP says continue with no tea or coffee :o  :'( and just ride. So...
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on August 30, 2019, 11:33:02 am
Take it easy - but take it!  (Woody Guthrie?)  Speaking of which, is there a dose of Dorothy Sayers in you strapline?
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 30, 2019, 04:54:08 pm
Busman's Holiday.  My first bro-in-law used to call that the greatest line in English literature.

And yeah, I'll be out tomorrow, but only a shortie - it gets hot after 11 am.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Giropaul on August 30, 2019, 05:09:45 pm
Just as an observation, I happen to know a number of ex- real big hitter cyclists. A significant number of them Are diagnosed with AF, and others have other cardiac conditions.
As a layman, I wonder if having an ability to really suffer has caused damage, or maybe being mega-fit and perhaps not de-training correctly has had an impact?
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: chrisbainbridge on August 30, 2019, 05:28:29 pm
I think Steve redgrave had to consider this which suggests that cyclists are the same.  As I remember, his heart was so big and strong that he had to continue training after he stopped competing in order to allow his heart muscle to atrophy (shrink) safely.  The risk was that he would end up with less heart muscle but the same size and would therefore have floppy walls and risk clotting in his ventricles.

However this is half remembered and may be wrong
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Whitedown Man on August 30, 2019, 07:25:30 pm
My cardiologist told me that AF was more prevalent amongst endurance athletes precisely because of their enlarged hearts - that the greater volume and surface area of a larger heart provided more and/or larger pathways along / across which the errant signals could travel.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Phil W on August 30, 2019, 07:30:42 pm
I have a copy of this book, which is an interesting read if you want to see what the research is saying. Opinionated but interesting information nevertheless.

https://www.velopress.com/books/the-haywire-heart/
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: drossall on August 30, 2019, 08:32:28 pm
How useful is it for those of us who are definitely not master athletes, and have never been in any danger of over-training (indeed, may never train at all), but do want to do more than the average member of the public? Serious question, since you've read it.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on August 31, 2019, 04:40:42 pm
This looks interesting too:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311486/

Have only skimmed it so far, since I've been out this morning & helping set the house to rights for visitors this afternoon (it's 32°) and I'm banjaxed.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on December 15, 2019, 12:26:24 pm
Hello, again, everyone.

I've cobbled together a rambling update of what is happening to me.  I'm not really asking for help - you've already been very good with that - just wanting to reconnect at what is a rather upsetting time for me.  Sorry it's so long (it was written as therapy by a frustrated currently ex-cyclist).



I have stopped cycling.

Because of another blood-test, à propos very slight (and now non-existent) puffiness in ankles – a sign of heart trouble but also a side-effect of statins! - I was referred as a matter of urgency for another echo-cardiogram because the blood test showed my level of some protein (which indicates heart distress) to be 10 times the acceptable level.  It is also an indication of inflammation in the body, so it occurs to me that it might be distorted by the level of my arthritis, which is very bad in my hands and significant in at least one of my several knees.
At this second echo-test, the technician expressed puzzlement that the results she was seeing did not seem to accord with the suave, light-footed, devil-may-care individual she had powerless on the couch before her.  Where was the breathlessness, the puce skin and hesitant movement?  I imagine that it is only the guidelines that prevented her from referring to me as an Adonis.  Similar guidelines presumably prevent her from directly passing on bad news and she wouldn't tell me anything that I didn't ask directly, such as have I got an enlarged heart?  (Yes.)  This is common amongst champion athletes, so look on the bright side (my thoughts, not her words).
Rachel (for it was she) side-stepped my request to know what the Ejection Volume (EV) fraction was (it had been 30 – 35% in the test in August).  She did mention that the previous reading had been sufficient for that technician to suggest referral to a cardiologist.  For whatever reason, that didn't happen.  Perhaps, as has been mentioned, I have been shunted onto an age-related siding? Rachel would only say that she'd have to calculate the EV fraction and that I would be hearing from my GP.  It looked as if I was in trouble.
Sure enough, my doctor called me in within a couple of days.  My EV fracion is 10%.  That's a drop of two-thirds in an already severe reading – in three months.  Both sides of my heart have “failed”
Even though I've been riding ten miles a day with absolutely no ill effects, I am now off the bike.  What I'm on instead is statins, blood-thinners, ACE inhibitor and a beta-blocker.  And I'm waiting for an urgent (within a fortnight?) referral to a cardiologist, which should have happened months ago.
My doctor is as baffled as I am to understand how this has happened, especially this sudden decline in EV – which has been mirrored by absolutely no change in performance or feeling of well-being.  Less than 3 years ago, an MRI scan showed that my heart had no abnormalities, although I did have occasional ectopic beats.  The GP confirms that my other tests indicate that I haven't got diseased arteries.  My life-style and habits (those that can be openly discussed) have always been healthy.  It's looking (to me) as if stress may be the significant factor: my wife and I are carers and neither of us can remember the last time we had eight hours – or even six of unbroken sleep.  But my wife is fine, while I practically write this posthumously, according to science.

Even though I have been keen on fitness and adventure, and am not a fanatical athlete, I think it also possible that my level of exercise, though modest by the level of obsession displayed by most of the current crop of contributors to the Arrivée magazine, may have set up a chain, which is recognised amongst heart “observers”:-

Strenuous Exercise  >  Arrhythmia  >  L heart failure  >  R heart failure  >  ????????

But what a jolt to go from 35 to 10 in 3 months!  More graphically, I have read of surveys which indicate that 75% of people with an EV of 10% or less die within 3 years.  Whoopee!
Still, that means 25% don't, and I intend to be in that 25%, so have been bloody-mindedly finished planting the tulips in case I'm around to see them.  I've also read research that suggests that a patient's level of exercise is actually a better indicator of mortality than the EV itself, so I might be lucky there.
What a strange business!
I'm still getting out, just on foot.  I see the same beautiful sights, wildlife, sunsets, Christmas lights, but at the moment I have a sort of misty filter and I realise that all these experiences are intensified for me by riding my bike.  It's almost as if I am my bike!  I am Flann O'Brian and you can keep your £5.
Today, I walked back from Rochdale, about three miles along roads and cycle-paths I would normally ride.  I may have done more than I should have, I don't know, since I still haven't had the fabled “urgent” consultation with a cardiologist.  But I did see and joyfully hear a flock of long-tailed tits as they flipped through the hawthorn hedge by one of the ponds near the sports goods exploitarium.
Without the advice from a specialist, I'm not sure how much exercise is enough and how much is too much.  It's peculiar to think that I may actually have arrived at a stage in which, when I have got up, made the bed and walked say to the Co-op and back, I'll have done my exercise for the day.  Actually, it's not just peculiar, it's horrid – one might say unhealthy!

Wish me luck!

ETA  11th December 2019

I have finally received the date for my urgent appointment with a cardiologist.  It turns out to be with a Nurse Practitioner and is in six weeks time.  I am being given the bum's rush here and have almost certainly been shunted onto the senile, waiting to die, don't waste resources on him siding.  It's all very clever, because if I accept it and keep calm I'll possibly drop dead before I'm seen, therefore becoming an easily managed statistic.  If I get agitated about it, I'll drop dead anyway.  I'd rather die trying, so I rang several places to try and find out whether the departments involved actually considered this to be appropriate procedure for someone who has been referred urgently, as a result of a rapid and alarming deterioration in heart function.  Nobody was answering any relevant phones, except to say they were away from their desk and by the way from Monday they'll be on holiday.  I've managed to get a telephone appointment with my GP who is one of the people who think I should be seen urgently.  Let's see what he thinks.  In the meantime...... and breathe....!

Will it never stop raining?  I need sun – and sunsets!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on December 15, 2019, 01:24:38 pm
Let's hear it for bloody-minded, I'm right with you. Thump the table for a real cardiologist - cycling's important for more than physical wellbeing.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on December 15, 2019, 01:37:00 pm
That's the plan!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: hellymedic on December 15, 2019, 01:59:10 pm
[Non-medical suggestion]
If you can afford it, get a e-bike, get out and enjoy being out.
If the Grim Reaper decides to push you off, so be it!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: barakta on December 15, 2019, 03:20:04 pm
[Expert NHS wrangler opinion - not a clinician]

GP appt is right idea, they're taking the piss and you need to not accept "no" for an answer. A failed referral and now a delayed referral is unacceptable. Hopefully your GP can read the riot act at them!

I got myself shifted up the "we have no appts yet available" waiting list after Dept B screwed up and meant I had to defer procedure from Dept A (couldn't have both within 6 weeks, Dept A's was more time critical) by basically saying "I should be seen sooner because the only reason I didn't have procedure in September was cos of Dept-B screwup and hospital maladministration. I told the person I have copied Complaints@ into this email in case you need to seek their permission to do this (cos the admin person wouldn't herself have authority). BANG, appt in 10 days after talking to the medical consultant himself.

Honestly 50% of NHS wrangling is going back and saying "No, the followup was in X weeks, Y is a LOT longer than X, please to be fixing" which usually gets me something like X+2 weeks...

And none of my stuff is as scary as hearts, although some is now age-critical. When I found out delays and age criticality were a thing I basically emailed complaints (who I have an ongoing dialogue with about hospital maladministration issues - cos they think ignoring the issue means I'll go away - fools) to say "My condition from Dept A is now age-critical, I'm taking even less crap than before, I will kick off if there are further delays and insist you resolve them".

Let your GP do the stress of chasing, but don't let them take the piss.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on December 15, 2019, 03:35:59 pm
Barakta, thanks for that.  I thought I'd talk to my doc, who is good and concerned, before going down the complaints route but I'll certainly follow your advice if it seems I need to!

@ Helly

I can ride fine and with no symptoms, it's just that I've been advised not to.  I don't get breathless and can ride up hills ok.  An e-bike wouldn't solve my current dilemma because effort isn't the problem.  Anyway, I think we'll see, in the future, health warnings issued with e-bikes because the very people they are designed to benefit will be having heart attacks just trying to lift them over kerbs or up garden steps!

As for the grim reaper - if I was on my own there would be no problem, really, but I am a carer and need to live for ever.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Giropaul on December 15, 2019, 07:13:54 pm
My cardiologist told me that AF was more prevalent amongst endurance athletes precisely because of their enlarged hearts - that the greater volume and surface area of a larger heart provided more and/or larger pathways along / across which the errant signals could travel.

There are certainly a higher than one might expect number of ex big hitter riders with AF, starting with a certain Mr E Merckx. Quite a few ex pros I personally know have AF as well. The more encouraging news is that they all still ride, albeit at a more monitored pace.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Basil on December 15, 2019, 08:15:37 pm
Best wishes, Peter.  No expert advice to offer, but DON'T PANIC.
My af was diagnosed nearly 20years ago, and although it did knock me back at first, teh drugs n stuff got me back on the bike.
I'm not riding as much as I used to, but that's because not enough of Wales is downhill.

Keep on keeping on,  mate.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Kim on December 15, 2019, 08:39:43 pm
Anyway, I think we'll see, in the future, health warnings issued with e-bikes because the very people they are designed to benefit will be having heart attacks just trying to lift them over kerbs or up garden steps!

This isn't far from what the SCIENCE coming out of the Netherlands suggests.  E-bikes aren't dangerous because they go fast, they're dangerous because they're used by vulnerable and/or inexperienced cyclists, and the main risk is through falls at low speed and when mounting/dismounting.

(I'm also impressed that my lifting-impaired friend's 700c e-bike can push itself up a standard-height kerb in a controlled manner using the thumb control 'walk mode'.  Makes a big difference.)


Anyway, what Basil (and barakta) said.  I'm used to lungs being rubbish, but hearts are scary!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: mrcharly-YHT on December 16, 2019, 08:12:03 am
That is a right bugger of a thing to happen, Peter.

I wouldn't think too lowly of a nurse practitioner, actually. In my experience, they are absolute specialists, highly focused on the patient and interested in the subject area. More observant of patient behaviour, wellbeing and feelings than some specialists.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on December 16, 2019, 11:26:34 am
Thanks, everyone, for the advice and encouragement.

Charley, I too have been impressed with the nurse practitioners I've seen (only a couple), so I do respect their expertise and concern.  However, I'm not sure that in this case an appointment with a NP six weeks down the line, is quite what my doctor and the echocardiologists had in mind when they were visibly shocked by my "figures".  Maybe it'll all be fine but I think I should push a little first.

@ Basil  Ha!

Peter
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Redjeep! on December 30, 2019, 11:04:33 pm
Hi Peter,

Firstly I have to admit that I've not read every thread in this chain, so apologies if I'm repeating everything.

I was diagnosed with Ab Fib about 5 years ago when I was at my peak physical fitness, running 3 or 4 marathons a year, loads of Halves, and dozens of cycling events.

I had cardioversion which lasted about 2 weeks and shortly after this failed had the ablation op. Since then I still get the odd event which can last up to a few days. They typically come on when I have the perfect storm of too much caffeine, booze and stress. Each of which I try to manage but sometimes can be hard. My last event was after a week that involved a wedding (booze) , job interview (stress) and doing a 43 hour week in 3 days (stress and caffeine)  to accommodate the first two.

I was on blood thinners for about a year and rhythm drugs for a bit longer after the op. I'm now pretty much drug free except for one tablet to reduce my blood pressure.


There's a lot of risk factors for Ab Fib, I was told mine was a lone event, in that it didn't indicate any underlying heart problems, but that it was brought on by too much endurance sport ( hence the comments above) . Apparently it's very common in anybody over 70, men are more susceptible, possibly due to body mass. Bigger men (I don't really mean fat) are much more likely to have it than small women. Excessive fitness is a contributing factor as it can cause the heart to grow larger and fibrous which can create problems with the electrical wiring.

There's some evidence that taking Magnesium can help reduce the symptoms. It seems to work for me.

If you want to learn everything about it, there's a great book called The Haywire Heart' by Chris Case that's well worth reading, but settle in to read it, it's not an easy reader.

I'm back running and cycling, but not as much as I was. I've been told never to do another marathon but haven't been imposed any restrictions on cycling as the consultant seemed to think it was far more sedentary than running and who was I to correct him 😙.

Good luck. It's not the end of the world and a lot of people can get back to almost the same activity levels that they were at beforehand. There's a lot of stuff on the web about it and numerous groups on Facebook where you can chat with people with similar conditions.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Karla on December 30, 2019, 11:24:16 pm
Peter, this had all passed me by until now but I'm sorry to hear it, you sound like you've got far too much on your plate.  I'll be thinking of you and hoping you find a treatment with the minimum of stress.  All the best.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Redjeep! on December 30, 2019, 11:40:45 pm
I meant to mention that you can get home use EKG monitors reasonably cheap. Here's a link.

I have one but am not sure that want to post a specific link to it as I don't think that I'd totally recommend it. It's ability to read heart traces seems ok, but it's quite tweaky to use.

https://www.amazon.co.uk/s?k=Ekg&ref=nb_sb_noss
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on December 31, 2019, 04:43:22 pm
Redjeep and Karla, thank you for the posts, info., and good wishes, they are very much appreciated.

I have actually had a consultation with a cardiologist now, and he was fairly sanguine.  When I asked him if I was likely to drop dead, he said, "We all have to die sometime!", which I think I take as "It's possible".  He thinks my heart is in a bad way and one that would probably have killed me, had it NOT been for my otherwise healthy lifestyle.  Really, the only two factors that are likely to be involved (apart from genetics) are stress (which is a big one, I'm afraid) and cholesterol, for which I have pretty good figures.  On this latter, the consultant wants me to have an angiogram to check the state of my arteries, so that will be the next "intervention".  He has also doubled my beta-blocker dose and introduced essence of foxglove.  He also said I don't look my age - which is actually a medical condition, apparently.
I check my heart-rate regularly and it does seem to be coming down gradually.  So, though I'm fed-up with the overall situation, I'm trying to remain optimistic (the consultant remembered at the last minute about being encouraging and said it was quite possible I'd be back on the bike before long because the drugs are much better than what was available 20 years ago).

I'm also taking encouragement from all the advice from fellow-sufferers and other friends on here.  Thank you again!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Redjeep! on December 31, 2019, 06:59:58 pm
Peter, no problem.  Good luck with all this.

There are a few good groups on Facebook such as 'Parkrun for people with heart conditions' which you may find helpful and supportive. Sometimes it's just good to know that you're not alone. There used  to be a very good thread on the Runner's World forum with numerous people who'd been through it and returned, mostly, to running. I can't find it now but if I do I'll post it here. 

If I can be of any help please feel free to PM me.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Phil W on December 31, 2019, 08:47:52 pm
I think Steve redgrave had to consider this which suggests that cyclists are the same.  As I remember, his heart was so big and strong that he had to continue training after he stopped competing in order to allow his heart muscle to atrophy (shrink) safely.  The risk was that he would end up with less heart muscle but the same size and would therefore have floppy walls and risk clotting in his ventricles.

However this is half remembered and may be wrong

That’s what I have heard as well.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Wowbagger on June 30, 2020, 11:24:43 pm
I saw this thread when Peter first started it and have been doing some catching up now.

How is it going now, Peter? Wishing you well.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: MikeFromLFE on July 01, 2020, 11:07:25 am
I thought I'd chip in here with Mrs M's AF experience.
(As we both have significant healthcare expereince, I don't tend to wade in on this type of thread, but thought her story might be interesting, and maybe useful)

She has known that she's got a PDA (hole in the heart) since she was a late teenager, it's something she was born with and has never knowingly caused any issues.
About 5 years she had a TIA (stroke) and underwent extensive investigations, which over the course of maybe three years, revealed she'd unknowingly had an MI (heart attack) at some point - possibly during childbirth some >30 years ago! and had frequent AF (Atrial Fibrilation) which explained a lot of her 'funny turns'.

She was shunted off to a multitude of Cardiology sub-specialities none of whom seem to talk to each other, including the congenital heart clinic (for her PDA). She was put on a full pharmacy shed load of drugs and she had a heart rate monitor implanted in her chest (aka 'loop recorder') with a receiver that 'phones home' every night to report any AF events back to the cardiology clinic - in theory.
The implanted monitor connects to the base unit (next to the bed) about 3am every night, and the deal was that she'd get contacted if there were any 'significant events' - yeah right, that happened!

She had a telephone consultation with one of the cardiology clinics last week, and mentioned about the implanted device which the doctor on the phone knew nothing of, and appeared disinterested - he said as she was having no symptoms, he was going to discharge her, and contact the recorder people to get it removed.
Cue the copy of the GP letter where - reading between the lines - he'd contacted the recorder people who'd said (something like) "but.... but... but" - the letter detailed multiple significant TIA events in the last three months, and he advised the GP to urgently change her anticoagulation therapy. No mention of removal of the device, or discharge.

She's trying to get hold of the consultant's secretary (as suggested by our very helpful GP) to find out WTF is going on.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on July 01, 2020, 03:51:31 pm
Sounds like WTF aptly summarises it.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on July 18, 2020, 11:54:19 am
I'm sorry, I hadn't noticed there were recent posts on this thread!

Wow, I was sorry to read that you have AF, too, now.  Mike, the confusions you and your wife have experienced in her treatment sound very worrying and I hope you get satisfaction quickly.

Everybody has been very generous with their time and suggestions (you lot, I mean) for which a repeated "Thank You"!  I've just re-read the thread and realised that there are a couple of links I haven't followed up, which I'll get on to immediately (Phil W, that publication you cited will be one).

As it is exactly a year since my TIA (mini-stroke) leading to a finding of an Ejection Fraction of 8 - 10%, I thought I'd sing "Hearty Birthday" and give a resume of to where I am up.

I'm still alive, having had a third of the allotted span for 75% of people with an EF/EV of <10%.  However, I'm not too anxious about that prediction because exercise is a better predictor of life-span than EV and I'm sure it's very likely that as I already live in the recommended fashion I am almost certain to be in the 25%.  Look on the bright side, Peter, it's better for the stress levels!

I never did get to see a NHS cardiologist.  In fact, I have been discharged by letter because of the need for the NHS to concentrate on Covid.  Yes, it actually says that in the letter.  I don't feel the need to dispute this at the moment, because I feel fine just as often as I did before the TIA.  But I've kept all the paperwork, just in case.  Apparently my affliction should continue to be managed "medically", which I think means keep taking the tablets.

Every now and then, I take the wheelbarrow down to the chemist's.  I am on statins, blood thinners, digoxin, beta blockers and an Ace Inhibitor, Ramipril.  This seems to be a full house and I am a little confused as to why I need so much.  Admittedly, the Beta Blocker level is quite low (5mg).  I have a regular appointment with the Nurse Practitioner (always cancelled into a phone appointment) at which she up-titrates the Ramipril, as my kidney function has thus far remained unaffected by the administration.  The next rise will get me to the intended 10mg.

What I want to insist on having is another echocardiogram, because I want to know if my EV has improved (it can) or deteriorated (it can).  This will help me decide about how to manage exercise and life in general.

I feel fine.  I very occasionally feel a little leaden-legged after a ride (I re-started in the New Year after more advice and ride most days, usually about 10 - 15 miles, occasionally more but so far not over 30, all at an easy pace) which I put down to the beta-blockers.  I do feel a bit weary from time to time and I occasionally get a light-headed episode, usually on standing up quickly, and very short-lived.  All these effects could be due to heart deterioration but are also known effects of the drugs.  It's a bit of a conundrum, as I didn't have any effects until I started on the medication -  but I also know I've got heart trouble!

(Apparently, Cardioversion and Ablation are not considered suitable in my case.)

I've had an angiogram, which confirmed my and my doctor's feelings that I haven't got any significant coronary artery disease.  That was a big boost but leaves me with the question of why I've got the condition (AF and low EV).  I think Chris suggested that AF can lead to EV, which seems very plausible.  And the exercise over the years has led to an enlarged heart and possibly stiffening of the Left Ventricle, which the Ace inhibitor is intended to ameliorate.

So, I'm really determined to get another echocardiogram to see how the LV is shaping.  I take my BP and pulse several times a week.  The BP is where it always was (acceptably low) but the heart-rate, while it usually averages between 65 and 80 (I take an average of five readings) can vary enormously in one series of readings from 65 to 90.  So I guess (know) I'm still fibrillating. 

 I'd like to know if I need to resign myself to my current bimbling lifestyle (I can do that and it's a lot more than many people are able to do) or whether I can eventually get back into the hills I love!

But I will be sensible (I hope).  There is a lot more at stake than whether or not I can ride my bike.

Thanks for your interest and comments.  Please keep in touch and let me know how you (and your loved ones) are doing.

Peter
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on July 19, 2020, 03:15:07 pm
OOPS!  Just read this, browsing through the heart prOn:-

From NCBI, US National library of Medicine:-

EF of <15% is end stage/transplant candidates...….

At almost 75 I don't think I'd be considered for a transplant, so I've got to hope my treatment and life-style improve (as in at least double) the EF.

In the meantime, I may have 2 years to get my affairs in order.  And I may not......

"Smile, though your heart is aching....."   (Charlie Chaplin)
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Mothy on October 22, 2020, 11:00:52 pm
Your Charlie Chaplin quote is better than Chris Farlow’s Eskdalemuir song!!
Keep smiling too.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on October 23, 2020, 08:18:29 am
Keep 'er lit, Peter.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on October 25, 2020, 01:39:07 pm
Thanks, both!
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on November 05, 2020, 05:05:54 pm
Am now the [proud*] possessor of a Withings Scanwatch and have set it to monitor for afib. So far, so good.

* we'll see.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: MikeFromLFE on November 05, 2020, 06:01:25 pm
Mrs M bought a Withings watch following my recitation of the comments here.
She has an implanted monitor for AF and thought the watch might offer additional insights. She also has some sort of weird inversion due to a PDA.
It certainly shows the inversion, but the AF detection seems a bit hit & miss. She suspects - after looking at the traces - that it's 'seeing' the AF, but the algorithm doesn't recognise it as such.
Overall, she's more happy with the watch than she is with me.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on November 14, 2020, 10:44:44 am
Mrs M bought a Withings watch following my recitation of the comments here.
She has an implanted monitor for AF and thought the watch might offer additional insights. She also has some sort of weird inversion due to a PDA.
It certainly shows the inversion, but the AF detection seems a bit hit & miss. She suspects - after looking at the traces - that it's 'seeing' the AF, but the algorithm doesn't recognise it as such.
Overall, she's more happy with the watch than she is with me.

That's a bit of a blow.  I've had zero detections since I got the watch, and a few snaggle-toothed ECGs.  But since lockdown started here and I've been doing 1-hour rides where I maybe push too hard out of a sense of urgency I've had lots of extra-systolic beats and I've been telling myself it's that. It's years since I had extra-systolics after a ride.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on November 25, 2020, 03:28:38 pm
Further observations: BPM measurement.  The thing monitors it intermittently through out the day, and night as well if you keep it on.  Last night it would appear that my heart was running at over 140 BPM for over an hour - oh dear, I thought, here we go.  However, this morning I got a reading of >140 by starting the on-demand BPM monitor with my hand resting against an eye-level cupboard, and I counted my pulse over a minute at the same time: 63 BPM.

The detector is just a green-LED type, and they aren't renowned for accuracy.  140+ seems to be its "ooer, what's up?" default.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on January 26, 2021, 12:52:34 pm
I thought I’d give an update on my heart trouble and its treatment.  I seem to be actually winning the battle, although I don’t take anything for granted.

A brief resumé:-

In July 2019, I had a Transient Ischaemic Attack (barely noticeable minor stroke).  Subsequent investigations showed I had an Ejection Fraction (measure of the heart’s pumping ability) of 8 – 10%, where 55% is regarded as normal.  My level is predicted to be fatal within 3 years for 75% of such sufferers.  However, an angiogram showed I don’t have significant arterial damage.  I was also found to have Atrial Fibrillation and both sides of my heart had “failed”.  All this yet no significant symptoms, except occasional light-headedness, which I put down to supporting Newcastle United. 

The treatment:-

I have had no surgical intervention.  I have been on statins, a blood thinner, low-dose beta-blocker and digoxin and a gradually increasing dose of an ACE inhibitor.  Unfortunately, several of these drugs, perversely, can cause side-effects of heart-failure, such as ankle swelling, light-headedness and fatigue but when this has happened it’s been very fleeting.  It’s sobering because I know that heart failure also causes heart failure…….

The result, so far:-

An echocardiogram just before Christmas showed my EF had recovered to 38%!  This is still bad but the heart nurse is confident that we can get it even higher.  My “Right Heart” seems to have recovered to normal again, and the valve readings are within normal ranges.

When the technician told me his estimate as I came away I nearly died of heart failure.

So, I appear to have made real progress, whilst still being able to cycle, apart from a short break after the 8% echo (never over 30 miles, admittedly – but that was a deliberate policy and not dictated by how I felt, or medication).

I’m not about to go round The Old 240, or LEL or, indeed, do anything very different, because I still have a bad heart.  But I’m really encouraged.  The specialist who said that the drugs are much better these days seems to have been right!

Once again, thanks to all of you for your messages over the last 18 months.  You have been very informative and encouraging and I have been very grateful.

I’ll keep you posted!

Peter
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: T42 on January 26, 2021, 02:54:26 pm
 :thumbsup:
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: rafletcher on January 26, 2021, 03:03:16 pm
Excellent news.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: sojournermike on January 27, 2021, 06:41:35 pm
Great news. It’s good to hear something positive.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Basil on January 27, 2021, 06:49:57 pm
Thanks for the update Peter. Good to hear this.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Polar Bear on January 27, 2021, 07:56:09 pm
Just caught up with this.

Long may your improvement continue Peter.   :thumbsup:
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: mrcharly-YHT on January 27, 2021, 08:06:11 pm
Amazing - very glad to hear it.
Title: Re: Atrial Fibrillation and Heart Rate Monitoring Help?
Post by: Peter on January 27, 2021, 09:53:34 pm
Thanks all - it's just as well the pubs are shut!