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questor
Jun 15, 2006, 9:32 AM
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This is my first post. :) Okay, so I've had two acute episodes of atrial fibrillation (AF) exactly a year apart.
For those that don't know, AF is when the regular electrical signal of the heart is disrupted and the atria contract randomly and at high speed - up to several hundred bpm - resulting in a high risk of developing dangerous blood clots. These episodes are unusual in people younger than 60, except where there is a history of drug use, which doesn't apply in my case. The episodes may pass almost unnoticed, or in some cases, as mine, are unpleasant and somewhat alarming.
cardiac catheter shows that I have no ischaemia, and 7 day holter shows nothing remarkable except sinus bradycardia at 41 bpm early in the morning. I have an septal hypertophy, but no one is worried abou it.
I am 43, cycle 14 miles a day, train for rock climbing twice during the week and hit the rock at the weekend.
Second time round, the cardiologists treated the acute symptoms, decided I didn't need warfarin (coumarin) in the long term, and stuck me on a
beta-blocker that maintains normal sinus rhythm. I am waiting to see an elecrtophysiologist.
My question is, for any MD's out there, how much does a beta blocker reduce cardiac output during severe exercise, and secondly, how dangerous is it to have an attack of AF during a long, committing climb such as a difficult, aerobically demanding winter climb in a remote place? Would one be able to complete a route at one's limit, unpleasant as that might be?
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j_ung
Jun 15, 2006, 1:34 PM
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I'll let an actual expert handle the particulars and correct me if I'm wrong, but I'm under the impression that one cannot continue to live indefinitely in a state of AF. It's just too much strain on the heart.
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anykineclimb
Jun 15, 2006, 1:54 PM
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Keep in mind that warfarin (coumadin) reduces your ability to clot and you could bleed to death with a 'minor' injury. good thing you're not on it.
In reply to: My question is, for any MD's out there, how much does a beta blocker reduce cardiac output during severe exercise, and secondly, how dangerous is it to have an attack of AF during a long, committing climb such as a difficult, aerobically demanding winter climb in a remote place? Would one be able to complete a route at one's limit, unpleasant as that might be?
What Beta Blocker are you on? Do you have hypertension?
I say if you start feeling symptoms while on a climb, at the very least rest. I'd be more advisable to just head down. But thats just from the book of DUH
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questor
Jun 15, 2006, 2:12 PM
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[What Beta Blocker are you on? Do you have hypertension? ]
Sotalol, also called BETAPACE, I think. No, I have no trace of hypertension.
The drug is also used for cardioversion (returning to normal sinus rhythm) and for maintaining the right interval between parts of the cardiac electrical waveform.
There's no effect on my climbing performance, but aerobic activity, like cycling, seems much harder. This is of course because the maximum pulse is reduced and so, accordingly is cardiac output. All of which means that you're operating anaerobically when you try to go very fast, instead of aerobically.
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anykineclimb
Jun 15, 2006, 2:20 PM
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Ooooh, I was thinking of selective Beta Blockers (atenelol, metoprolol)
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reno
Jun 15, 2006, 2:25 PM
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Get thee to a doctor, and talk to him about switching from your beta blocker to a calcium channel blocker.
Better rate and rhythm control with Ca++ blockers than B- Blockers.
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questor
Jun 15, 2006, 2:36 PM
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Thanks - are you a Doctor, by the way? Or is this based on personal experience?
Do you know if calcium channel blockers also reduce cardiac output, as sotalol does, annoyingly?
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anykineclimb
Jun 15, 2006, 2:41 PM
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Umm, no.
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sircamalot
Jun 15, 2006, 2:46 PM
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Actually,
many people walk around every day in A-fib and do just fine. The major complication is from blood clots that form in the atria due to the erratic nature of the fibrillation. Your doc may want to put you on warafin to thin your blood and reduce the risk of clots.
The major downside to warafin is that you can bleed like a stuck pig and not stop. Bad stuff if you're in the backcountry and get injured.
Other than that....it shouldn't slow you down other than some minor fatigue. But you shoud be seeing a cardiologist if you're not already.
j
paramedic
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robbovius
Jun 15, 2006, 2:54 PM
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questor, what were your symptoms?
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questor
Jun 15, 2006, 3:07 PM
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In reply to: many people walk around every day in A-fib and do just fine. The major complication is from blood clots that form in the atria due to the erratic nature of the fibrillation. . The major downside to warafin is that you can bleed like a stuck pig and not stop. Bad stuff if you're in the backcountry and get injured.
Thanks, but I made these two points earlier :wink:
I've read about people walking around with AF every day, and find it hard to believe that they could do so with the same strong physical sensations that I experience - we're talking tachycardia close to 200 bpm and big, bounding extra pulses in the chest and abdomen. It's not something you can really ignore. Perhaps there are mild versions that can pass unnoticed.
Also, I'm not on warfarin/coumarin, as I posted earlier. :wink:
But you're quite right, I should see a cardiologist and am in fact waiting to see an electrophysiologist.
Thanks for replying
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pinktricam
Jun 15, 2006, 3:10 PM
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:oops: ...uh, okay, you're right. I got my V-fib mixed up with my A-fib. Dammit, good thing I didn't do that during my ACLS exam.
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questor
Jun 15, 2006, 3:14 PM
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In reply to: questor, what were your symptoms?
Each time, I woke up from my sleep with the symptoms. First time 0430, second time 0130. First time, I thought, uh, what's happening? I could feel the chaotic pulse racing away, slowing down and then speeding up again. It kept me awake. Once in a while, there's be a big pulse that seemed to fill my chest and abdominal cavity. I didn't feel ill, just not right. Perhaps I was anxious that first time.
Second time round, I woke up at 0130, on a night sleeper train back from a
winter climbing weekend where I'd been doing perhaps 9 hours of activity at a high level for three days. I immediately recognised the symptoms as AF this time, presented myself to casualty on my return to the city and was admitted to the acute medical unit for cardioversion. However, the problem resolved with medication after 24 hours.
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devils_advocate
Jun 15, 2006, 4:00 PM
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Have you looked into catherter ablation? I'm sure if this is an option your doctor has discussed it with you. I see it as it's the most permant and minimally invasive option out there... but I'm not a doctor, nor am I the one going "under the knife"...
I've known several people who have successfully undergone catherter ablation for A-fib or tachycardia. Just something to consider, good luck.
Edited: Just noticed that you seemed to say that you have not had cardioversion yet? I would start there, some people have a lot of sucess with that. They'll numb you up so you can't even feel the horse kick you in the chest (d-frib).
a-fib=d-fib :lol: I love the internet.
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chezdillon
Jun 15, 2006, 5:06 PM
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In reply to: how dangerous is it to have an attack of AF during a long, committing climb such as a difficult, aerobically demanding winter climb in a remote place? Would one be able to complete a route at one's limit, unpleasant as that might be?
I have been climbing with A-fib. I have had episodes of both A-fib and V-fib while climbing. I now have a D-fib. I can tell you the obvious - it is difficult to hike out of a climbing area while experiencing A-fib in the 200-400 range. I have done it twice. I would not recommend it. I was in relatively easily accessible crags and it was a pain to get back out. I would think it would be much more difficult if there were much of an approach to the climbing.
I have experienced A-fib while leading close to my limit. It is disconcerting. Again, I would not recommend it. On the few occasions when I climb in a back-country setting, I try to keep well within my limits and choose routes that offer the possibility of escape/retreat.
In reply to: Sotalol, also called BETAPACE, I think.
I have been on sotolol, as well as many other heart medications. Some do affect your ability to climb more than others.
In reply to: Have you looked into catherter ablation?
As for the ablation advice - I would suggest using caution. It does not always make things better. I have been through it twice with disastrous consequences.
Good luck.
- Jeff
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questor
Jun 15, 2006, 6:09 PM
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In reply to: . I've known several people who have successfully undergone catherter ablation for A-fib or tachycardia. Just something to consider, good luck. Edited: Just noticed that you seemed to say that you have not had cardioversion yet? I would start there, some people have a lot of sucess with that. They'll numb you up so you can't even feel the horse kick you in the chest (d-frib). a-fib=d-fib :lol: I love the internet.
thanks - all good information. actually, it's a little premature for me to be looking for solutions. in the uk, private healthcare is for the very few, and most of us wait for treatment on the national health service. it's exactly the same quality and expertise, but you wait a lot longer getting there.
my original post was really asking what sort of risks you're facing with a new, sudden onset of AF under aerobically taxing conditions, such as leading a multipitch winter route in severe weather conditions at a remote location.
:shock:
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devils_advocate
Jun 15, 2006, 6:24 PM
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In reply to: I have been climbing with A-fib. I have had episodes of both A-fib and V-fib while climbing. I now have a D-fib. As for the ablation advice - I would suggest using caution. It does not always make things better. I have been through it twice with disastrous consequences.
Do you have a pacer or ICD? or combo? I would have assumed a pacer was more standard of care, but I'm certainly no expert in the area and you seem like you've been around the proverbial block.
Thanks for the info on ablation, I will watch before running my mouth on the subject in the future. I have known several people that have had tremendous success with the procedure... but obviously, if this was always the case, doctors would not be relying so heavily on meds and a-fib would be going the way of the dodo. I'm always sorry to hear of medical procedures and devices that didn't work as intended. It's a sad fact of technology and it's evolution. It takes time and practice, and perfection is never achieved. Glad to hear you've learned to adapt and are still out there climbing.
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jabtocrag
Jun 15, 2006, 6:25 PM
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Questor...How old are you?
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devils_advocate
Jun 15, 2006, 6:30 PM
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In reply to: my original post was really asking what sort of risks you're facing with a new, sudden onset of AF under aerobically taxing conditions, such as leading a multipitch winter route in severe weather conditions at a remote location.
Sorry Questor... a little drift on threads is inevitable. Actually, the fact that we're still talking about things even related to the original post is pretty good for us.
Seems like there are a couple of posters here with direct experience. I'll bow out for their expert testimonials
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reno
Jun 15, 2006, 7:06 PM
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In reply to: in the uk, private healthcare is for the very few, and most of us wait for treatment on the national health service. it's exactly the same quality and expertise, but you wait a lot longer getting there.
Heh.
In reply to: my original post was really asking what sort of risks you're facing with a new, sudden onset of AF under aerobically taxing conditions, such as leading a multipitch winter route in severe weather conditions at a remote location.
Well, the conservative answer is this: Don't do it until you have a good grasp on your condition, how it responds to various forms of treatment, and gain a good insight into how your body deals with the a-fib.
Much like migraines, chest pain, or various other syndromes, Atrial Fib can be precipitated by various factors: Electrolyte imbalances, fatigue, drug use, medication use, diet, dehydration, etc. You'll probably need to spend some time figuring out what triggers your episodes. You'll also then need to keep track of what works to fix the problem: Some people convert with a single dose of diltiazem, while others need repeat doses for a few hours. Still others won't respond to diltiazem at all and may require, say, amiodarone, procainamide, esmolol, or another antiarrhythmic.
This, of course, is all predicated on the concept that you actually have symptoms with your a-fib. As has been mentioned, some people do fine in daily life with an underlying cardiac rhythm of AF. What you describe, however, is a variant of AF, known as A Fib with RVR (Rapid Ventricular Response.) This is more significant than 'slow' AF, and (typically) needs more care.
Unless your heart rate is very slow (say, less than 50) you do not need a pacer. Nor would you need an ICD or AED (Internal Cardiac Defibrillator or Automatic External Defibrillator.) Rare is the case of Atrial Fibrillation that needs immediate electrical cardioversion. Far too rare to justify the cost.
As for risks taken by hiking into remote areas with this condition: Well, let's be blunt straight away... you could die. It's possible that you'd have an episode, your cardiac output (a function of heart rate and stroke volume... if the heart rate is too fast, the heart can not fill with blood, and thus the amount of blood pumped out is insufficient,) would drop dangerously low, and you'd lapse into unconsciousness. I probably don't need to tell you how dangerous it can be to become unconscious in the backcountry.
Other risks: Unless your blood coagulation factors are dialed in, you could risk hemmorhage (or, as you Brits say, haemmorhage) from a minor injury. The opposite of that is a clot... such as in a stroke or pulmonary embolus. None of these would be very welcome in the best of settings, let alone the backcountry.
Short verison: Get to a doctor as soon as possible, get your condition figured out, and learn to pay VERY close attention to your body. Until such time, best to stick to day hikes with a partner.
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questor
Jun 15, 2006, 7:23 PM
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In reply to: Questor...How old are you?
43 in October.
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questor
Jun 15, 2006, 7:25 PM
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thanks, Reno, for that useful answer.
is it based on personal experience of the condition or/and are you a medic?
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chezdillon
Jun 15, 2006, 7:35 PM
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In reply to: Do you have a pacer or ICD? or combo? I would have assumed a pacer was more standard of care, but I'm certainly no expert in the area and you seem like you've been around the proverbial block.
I have a shiny new combo device. This is my sixth pacer, first ICD. Its been a long proverbial block. As for the ICD, it hasn't gone off yet and the suspense is killing me!
- Jeff
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chezdillon
Jun 15, 2006, 7:53 PM
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In reply to: ...Atrial Fib can be precipitated by various factors: Electrolyte imbalances, fatigue, drug use, medication use, diet, dehydration, etc... ... learn to pay VERY close attention to your body...
I would stress this point. It has taken me some time to learn what triggers the episodes and I take great care to ensure epic-free back-country trips to the best of my ability. I drink 3-4 liters/day, I don't climb more than two days in a row, I don't walk very far if I can help it, I go to bed ridiculously early, and I try not to stress out even if things aren't going so well. It is still possible for me to do fun stuff, but it takes more planning and care than it used to.
- Jeff
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