Category Archives: Fibrillation

Atrial Fibrillation

Heart Is Pumping Just Fine

I just received news from the cardiologist’s office that the pumping function of my heart is fine according to the echocardiogram.  Well within their parameters. Also, the Nuclear Stress Test indicates that there are no blockages in the veins and arteries.

As I told you in Cardiac Stress Tests, they were concerned with my heart’s pumping function after the Nuclear Stress Test. Last Thursday I had the echocardiogram test.

To all my family in friends, I apologize for all these false alarms.  I do not want to be the boy who cried wolf!

I am very pleased with Kaiser Permanente doctors and their constant pursuit of potential problems in me.  Occasionally, I feel that I get stampeded with the concern.

All in all, I am very lucky that carcinoid cancer has not made me any sicker and that the treatments seem to be holding it steady for now.  I am lucky also because this atrial fibrillation (afib) is treatable.  Even though I complain about having to miss fishing trips and not riding my bike, the larger picture is that I am still moving on.

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Cardiac Stress Tests

Last Monday July 9th, as I was told in “Walk Don’t Bike” I had a cardiac stress test. That consists of being hooked up to an electrocardiogram (ECG) and walking faster and faster up a steeper and steeper incline while the medicos monitor the ECG. It’s a common test and I know other members of our family have had them. The doctors are looking for possible blockages that would cause symptoms of pain or pressure over my heart.

The results were inconclusive.  I was told that my atrial fibrillation (afib) was so strong that it masked anything else on the ECG.  I was also told that my heart rate had jumped from 85 to 180 bpm very quickly.  Five years ago when I trained in spinning classes, it took 20 minutes of very strenuous work to get to that rate and of course I made no attempt to stay that high.  Also, after sitting and talking about the test results, I stood up and got dizzy.  The nurses immediately took my blood pressure and pulse rate.   My blood pressure fell like it is supposed to when you stand up.  The heart rate also fell!  Definitely not supposed to.  Again, my body works a little differently.

Since there were no good results, I was scheduled for a “nuclear stress test” last Friday the13th.  For this test, I was injected with a radioactive substance designed to hang around the heart area.  Then I was scanned by a machine which makes pictures of the heart and all the blood vessels around the heart. This was the before picture.  Because of the afib problem with actual exercise, I was injected with a drug which expands the blood vessels and stimulates the heart and only walked very slowly on the treadmill.  After that, I was scanned by the machine again so that the doctors could see any differences.

I just got the results today.  Again, not very conclusive.  But the cardiologist thinks there are signals of reduced pumping ability in my heart.  So on Thursday the 19th, I will have an echocardiogram like I had a couple of months ago but they will be looking for pumping problems.

Yesterday Laurie and I went with some friends to their condo in Frisco in the Colorado mountains.   I had intended to stay 3 days and fish.  That first night I was up most of the night with shortness of breath, difficulty getting enough air.  I also developed a splitting headache and my carcinoid diarrhea started up.  We came home this morning and I was feeling much better within a couple of hours.  My cardiologist simply says make sure to perform no strenuous exercise.

Once again, I fit the phrase my team surgeon used: “You have the misfortune of being an interesting case!”  This seems to me to be equivalent to “May you live in interesting times.” which is reputed to be an ancient Chinese curse.

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No Pacemaker For Now!

We met with the cardiac specialist today.  He is actually a specialist in Cardiac Electrophysiology.  In essence, there are a number of options for my treatment.  A pacemaker is actually about last on the list. This is not what the original cardiologist led me to believe: “Walk Don’t Bike”

The list includes several other possibilities but the upshot is that Laurie and I have chosen to go with a procedure called Cardioversion.  Essentially it is a mild electric shock to coax the heart back to a regular rhythm.  It works about 75% of the time and is not permanent but can be repeated.  If it works, it could last as much as 5 years before it would need to be repeated.  It is an outpatient procedure.

If it works even temporarily, it can give us an idea of whether the symptoms I have are directly related to atrial fibrillation (AFIB) or maybe another problem.

If it does not work, then we will proceed down the list of cardioversion and drugs, other drugs, something called ablation (which seems dangerous!), ablation and drugs, and finally pacemaker.

The cardioversion is currently scheduled for August 6, 2012 because I have to start taking warfarin and adjust to that first.

A shout out and thanks to all my family and friends for the their love, support, and patience.

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Walk Don’t Bike

Well, I’ve been ordered not to bicycle any significant distance. So now I simply walk 45 minutes to an hour every day.  More boring, but it gets me outside.

As I reported in “Atrial Fibrillation” I have been told to wear a heart monitor (holter monitor) 24/7 for two weeks. I have one day left. It’s amazing technology. Whenever I have a “symptom” (ordinarily dizziness, woozyness, difficulty breathing), I press the SYMPTOM button on the device and it records a few seconds of history of my heart. It also monitors my heart and records any time that it thinks things are not right. Whenever I have recorded symptoms or if none, whenever it tells me to, I dial a number and transmit the recorded information to the business which specializes in this. There is always a specialist on the phone who could help me if I were having real cardio problems.

My cardiologist logs on every day and monitors my symptoms.  Last week, after 4 days of monitoring, the cardio nurse called and told me not to do any very strenuous activity including long bike rides.  She also had me make an appointment with a pacemaker specialist.  I have that Monday.

The monitor has shown that I definitely have afib and that it is pretty constant.  It also has shown that I have episodes of racing heart (tachycardia) and slow heart rate (bradycardia).  This means that they cannot just give me drugs to slow down the tachycardia.  The drugs could make my heart go far too slow.  Maybe the solution would be a pacemaker to keep my heart from going too slow and drugs to keep it from going too fast.  This is not decided or recommended yet.

This week I also had a few symptoms of light pain or heaviness in the chest.  The monitor did not show anything going on.  This made the cardiologist concerned that I might be having little heart attacks but they later decided that it was probably a form of heart burn.  None-the-less, I am now scheduled for a cardio stress test on the 9th. Lucky me.  The carcinoid cancer symptom of acid stomach has been recurring more lately than at any time since I had the chemoembolization last August.  This worries me a little.  The blood tests that I have every two months do not show an upward trend in gastrin in my blood, but with carcinoid, we can get symptoms without the blood tests reflecting more activity.  It’s actually pretty common.  No one has been able to explain that to me in a way that I could understand.

On the link between carcinoid tumor and atrial fibrillation, my oncologist still thinks it’s possible but my cardiologist does not think so.  It’s likely the treatments would be the same either way.

All of this troubles Laurie and me a great deal of course.  Pema Chodron, a famous America Buddhist nun and prolific writer, advises us to embrace our feelings, not avoid them.  I work daily on meditation to help maintain a sense of serenity.  Not being a Buddha myself, it does not always work but it helps.  Laurie is also a rock in these times.  I know this is very difficult for her but she keeps moving forward and being her practical self.

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Atrial Fibrillation

I wrote about being diagnosed with atrial fibrillation (afib) in My Carcinoid Heart about a month ago. I saw my primary care physician a few days after that. He referred me to a cardiologist and also felt that my blood pressure may be “over-medicated”, so he took me off my high blood pressure medicine. Two days ago, I had an echocardiogram. Today I met with the cardiologist.

The cardiologist and I discussed my symptoms of lightheadedness and shortness of breath.  He believes the shortness of breath and the lightheadedness are symptoms of the afib, not the carcinoid tumor and not my being out of shape.  The lightheadedness is also a side effect of four of the medications that I take, so he thinks it was a good idea to take me off the high blood pressure medicine.  My blood pressure was only mildly elevated when we met.  I have had only a couple of minor episodes of lightheadedness since stopping the medicine.

Currently, I am to continue to take one baby aspirin a day and to work at staying well hydrated with electrolytes like gatorade or other sports drinks.  I can continue my exercise although in the future we may have to limit strenuous bike rides, not yet though.  When Laurie and I return from Hawaii in early June (Woo Hoo!!!), I will have to wear a continuous heart monitor for a couple of weeks to measure my heart rate and arrhythmia anytime that I get lightheaded.

If the heart monitor shows more problems than he suspects, we may have to talk about blood thinners or a pacemaker. Ironically, other drugs for afib are used when your heart beats too fast. Mine beats slower than most people’s and sometimes too slow, so, in worst case it would be the pacemaker.

On the plus side, he saw no sign of the heart valve deformity that can be caused by carcinoid.  About 25% of carcinoids die of heart failure and a number of carcinoids must have their heart valves replaced with artificial valves. I am thankful that we are not looking at that, at least for now.

He told me something that I would never have guessed.  Endurance athletes like distance runners and bicyclists (me?) have afib more often than the ordinary population.  Who would have guessed that training to be healthy and athletic can have such a dangerous side effect?

The net of all this is that I have atrial fibrillation.  Current treatment is baby aspirin and careful hydration.  Final treatment decision to be determined.

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