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Thread: svc and a-fib irregular heart beats

  1. #1
    JodyC Guest

    Default svc and a-fib irregular heart beats

    I wasn?t going to post but then I thought it might help someone else. I went in to the ER once on Thursday and by the second time Friday I was there the ER called for an ambulance to come and take me to St.Vincents hospital cardiac unit. I came in once in A-fib and then I had irregular heartbeats which a nurse said was svt (super ventricular tachycardia). My heart rate kept going to 180-190bpm. It was a horrible feeling. I am small and my shirt moves with my heartbeats as it is but nothing like that. The nurses on the first visit Friday got it under control with injections of toporol but the second time it was a different shift and they didn't want to try anything. I was really upset. When the ambulance guys got there they were mad that I had laid there for 3 hours with a heart rate of 180+ without any drugs to help slow it down. They loaded me in the ambulance and started meds to try to lower my rate and to "reset" my heart back to a normal rhythm. Anything they gave me only worked short term and I went right back but they kept the toporol going so at least my rate was better. I spent 4 days in the hospital and just got home yesterday. I am on two new drugs to keep my rhythm regulated plus I am still taking toporol. The new drugs are working but they make me feel really lousy. I hope after I am on them for a while the side effects will ease off a bit. My INR was 7.1 when I got to the hospital so I had an injection of vitamin K. My cardiologist is now going to get my INR stabilized and only have my regular doctor test my blood but not adjust me. My reg. doc seems to only want to try 2.5 or 5. I am not going to let this frustrate me. I have the very best cardiologist and I trust him very much. Now that he is handling things I know I will be ok.

  2. #2
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    WOW! I had SVT and that is very unpleasant and makes you feel awful! You feel like you had just run a marathon. I was lucky. Every time I had SVT they gave me the injections and I was done. They said many people go right back into SVT. I never did. I can not imagine sitting there w/a 180-190 bpm and them not doing anything. If that were me, no one would have had to call anyone....they would have heard me loud and clear. That is incompetent. I realize they were waiting for an ambulance, but a pluse of 180-190 is nothing to play with.
    I have a tissue valve so I did not have that complication. (INR) Did they call your cardiologist the second time or who made the decision to make you stay in SVT before the transfer?? Anyway, I am so sorry that happened to you and I hope it never happens again. I hope the new meds help. I hope the side effects go away w/SVT. Good luck!

    Deb

  3. #3
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    OH BOY, what an ordeal.....svt can be scary!
    I'm taking Metoprolol to calm my heart, and I would be interested to know about the other 2 meds you are taking. Thanks.
    BAV-Aortic Stenosis...AVR Oct 11, 2005 / St.Jude Regent mechanical 21mm
    INR Home testing since 2007 with Coaguchek XS...Self-Dosing

    "Caution: I may have been in contact with Nuts"

  4. #4
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    Sorry to hear about your post-op trials and tribulations Jody.

    Out of curiosity, what new drugs did they put you on for your rapid / irregular heartbeat?

    The Down Side of getting Vitamin K to lower your INR is that it can take a couple of weeks to 'wear off'.

    Have you had your INR checked since the Vitamin K shot?
    If not, I would DEMAND that it be checked.

    Is your INR Below 2.0 now?

    If so, I would DEMAND an Rx for Lovenox Bridging to protect you from possible clot formation. Is your Cardiologist managing your anticoagulation? Hopefully he knows how to prescribe and manage Lovenox and/or Heparin "Bridging" until your INR gets back into Theraputic Range.

    'AL Capshaw'

  5. #5
    JodyC Guest

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    The two new drugs I am on are digoxin and flecainide. One will regulate the top of my heart and the other controls the bottom. I had to stay in the hospital for observation to make sure they worked and I didn't have a bad reaction. My INR went down to 1.5. I am supposed to take 5mg for three days and then 2.5 for 3 days and keep doing that to see if that will work for me. I had my INR done yesterday which was the 1.5 and I will have in done again on friday. My cardiologist thinks I will do best on 3mg but another doc in his group wants me to do the 5/2.5 until I see my cardio on the 23rd of this month. I didn't know the vitamin k hung around in my system. Kinda scary. Should I get checked sooner?

  6. #6
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    if your INR was 1.5 yesterday, they would have been wise to send you home with a few Lovenox needles. That's what I had.
    BAV-Aortic Stenosis...AVR Oct 11, 2005 / St.Jude Regent mechanical 21mm
    INR Home testing since 2007 with Coaguchek XS...Self-Dosing

    "Caution: I may have been in contact with Nuts"

  7. #7
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    Well, it sounds like you've seen an "old school" Doc and a "new school" Doc relative to giving a Loading Dose or Not. Current thinking is that Loading Doses don't work and may set you up for an INR Roller Coaster Ride until you finally stabilize.

    I am SHOCKED and Disappointed that they did NOT prescribe a Lovenox (Low Molecular Weight Heparin) Bridge to protect you from a possible STROKE that may result from clot formation with an INR of 1.5 Fortunately you have an On-X Valve which has a low propensity for clot formation (and maybe that's why they didn't order the Lovenox).

    I would call your Cardiologist TONIGHT (or whoever is on-call for him) and ask for a Lovenox prescription. They will probably want someone to educate you on how to Self Administer the injections so you may not get anything until tomorrow, unless you go to the ER to have a shot.

    'AL Capshaw'

  8. #8
    JodyC Guest

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    Yikes! Ok, I called the office and I am leaving here in a little bit to get my INR checked. The cardio that released me with an INR of 1.5 wasn't my regular cardio he was just in the same group. I will post back when I get the results which should be late afternoon. Thanks AL.

  9. #9
    JodyC Guest

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    Well my INR is now 1.1. My cardio's nurse wants me to take 5mg for the next 2 days and then switch to 2.5 on sunday and get my INR rechecked on Monday. I will see my cardio on wednesday. She said not to worry and that with the way my levels shoot up that this was the best way to go. Any opinions??

  10. #10
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    I hope you are taking Lovenox shots....an INR of 1.1 means you are not anticoagulated.
    BAV-Aortic Stenosis...AVR Oct 11, 2005 / St.Jude Regent mechanical 21mm
    INR Home testing since 2007 with Coaguchek XS...Self-Dosing

    "Caution: I may have been in contact with Nuts"

  11. #11
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    It's FRIDAY evening, all offices are closed, your INR has plummeted to 1.1 (i.e. NO anticoagulation in your blood) and your Doctor's NURSE wants you to Double Dose your Coumadin until you can test again on MONDAY.

    If I were in that situation, I would be on the telephone to my Cardio's office (i.e. get passed to whoever is fielding after-hours calls) and INSIST that I speak with a Doctor about getting a Prescription for Lovenox Shots (and instruction in how to self administer those shots). If I couldn't get in contact with a Cardiologist within an hour or so, I would call my Primary Care Physician's office number and ask whoever is on-call for his group for the same Prescription (and instruction). Option 3 is to go to the ER.

    Situations like this are exactly why patients need to learn to Stand Up to POOR ADVICE when they KNOW they are being placed at RISK for an adverse reaction or event.

    I guess you are going to get an "opportunity" to participate in the NO Anti-Coagulation Trials for On-X Valves whether you want to or not :-)

    'AL Capshaw'

  12. #12
    JodyC Guest

    Default Al

    It was my cardio office and I told her that I was really concerned to be so low. She said sometimes they have to bring people off their meds temporarily and it was nothing to worry about. If I don't come up by monday I will have to go on something else. I thought about the on-x trials same as you! Our ER is totally worthless and I would risk my life again to go back. My regular doc agreed with the cardio. What to do? Cross my fingers I guess. If I die at least my family will have a good lawsuit??

  13. #13
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    Quote Originally Posted by JodyC View Post
    It was my cardio office and I told her that I was really concerned to be so low. She said sometimes they have to bring people off their meds temporarily and it was nothing to worry about. If I don't come up by monday I will have to go on something else. I thought about the on-x trials same as you! Our ER is totally worthless and I would risk my life again to go back. My regular doc agreed with the cardio. What to do? Cross my fingers I guess. If I die at least my family will have a good lawsuit??
    I would call the Cardio's office again, tell whoever answers that you INSIST on speaking with a Doctor. Same with your PCP. Be sure to tell them your INR is now 1.1 and you do NOT want to remain unprotected from a STOKE RISK for 4 days in a row. Are you still in A-Fib?

    Document EVERYTHING and be sure your family knows where to find it.

    BTW, who manages your Coumadin?

  14. #14
    JodyC Guest

    Default Al

    My regular doc was monitoring my INR and my dosing but he kept going from 2.5 (too low) to 5 (too high) with no in between. My cardio was upset because when I was taken by ambulance to St. Vincents my INR was 7.1 thanks to being on 5mg for 4 days. Now he wants to dose me and have my blood drawn at the lab. I am in regular heart rhythm now because of my new meds. Do you know how long the vitamin k stays in your system? I had one shot of it monday.

  15. #15
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    Quote Originally Posted by JodyC View Post
    My regular doc was monitoring my INR and my dosing but he kept going from 2.5 (too low) to 5 (too high) with no in between. My cardio was upset because when I was taken by ambulance to St. Vincents my INR was 7.1 thanks to being on 5mg for 4 days. Now he wants to dose me and have my blood drawn at the lab. I am in regular heart rhythm now because of my new meds. Do you know how long the vitamin k stays in your system? I had one shot of it monday.
    I'm not sure how long the effect of Vitamin K lasts, but I have seen reports of it taking 'some time' for INR to come back up after a shot of Vitamin K (I'm thinking over a week).

    It sounds like you REALLY need to talk with *your* Cardiologist directly (not his nurse) ASAP. He probably will not give you an Rx for Lovenox unless / until you can be instructed in it's proper use and how to self inject.

    You may have no alternative but to go to an ER, preferably with your Cardio calling in exactly what he wants done, i.e. a *weight-appropriate* dose of Lovenox injection (for a 220 lb person the dose is 100 mg). You will need an injection TWICE per Day, i.e. every 12 hours.

    If you cannot get through to your Cardio and your ER won't help you out, you may need to go to another hospital in another town where you can get appropriate care. I am concerned about you going 4 days with an INR below 1.5 (now 1.1). As it stands now, the ONLY protection you have is the fact that you have an On-X Valve which produces the least turbulence of the mechanical valves.

    Jody, PLEASE Call your Cardio and INSIST that he contact you TONIGHT. I get the impression he understands your situation, he just doesn't know your current INR status. Once he is made aware, I expect he will see that something is done to protect you.

    'AL Capshaw'

  16. #16
    Susan BAV Guest

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    I'm not sure if a Vitamin K shot is measureable, in regard to the degree a person may be anticoagulated (or rather, anti-anticoagulated), but I don't think it is. Does anyone else know, for a fact?

    From what I've read, aortic valves tend to throw less clots than mitral valves.

    But, I think it would be important that you are able to communicate directly with your cardio about this situation, as has been mentioned.

    I hope you will be okay.

  17. #17
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    This is excerpted from AL Lodwick's site www.warfarinfo.com/vitamin-K.htm

    Note that Jody C was administered a Vitamin K injection due to having an INR of 7.1. She was released from the hospital with an INR of 1.5. I has now plumetted to 1.1

    =======

    The Journal American Family Physician published a case study where the author conceded that there was an overly aggressive response to a bloody nose. The patient was a man with mechanical heart valve who had a bloody nose of two hours duration. His INR was found to be 4.7, The bleeding was controlled by packing the nose and including bacitracin, oxymetazolone and cocaine. (Not that the bleeding was controlled at this point.) Then they injected him with vitamin K 2.5 mg subcutaneously, administered 2 units of fresh frozen plasma and held his warfarin for 5 days. Ten days later his INR was only 1.7. He was put at high risk for a thrombus by using vitamin K, fresh frozen plasma and holding warfarin all after the bleeding was controlled. Holding the warfarin for one day should have been sufficient in this case after the bleeding was controlled.

    When there is no bleeding, just an elevated INR, I use the approach advocated by Witt et al. They state that at INRs of 4.5 to 10.0, the risk of major bleeding is not high enough to warrant rapid INR reversal with vitamin K. I do not have prescribing authority, so I must request that a physician order vitamin K therapy. I seldom request this if a patient is not bleeding. The only exceptions I can think of are when patients live many miles from health care. Then I have asked for a prescription to be used only if the patient begins to experience bleeding. For patients who are healthy enough to come into an outpatient clinic and live near the hospital, the chances of a life-threatening bleed are very small. As Witt et al state, "We believe that the INR overcorrection frequently seen after vitamin K administration is worrisome in non-bleeding patients with INRs between 4.5 and 10.0, especially when the underlying thromboembolic risk is high."

    Patel et al conducted a randomized, double-blind, placebo-controlled study of using vitamin K 2.5 mg orally. They studied patients who had INRs between 6 an 10 and gave them either a single dose of vitamin K 2.5 mg or a placebo. Warfarin was stopped until the INR fell back to below 4.0. The people who took the vitamin K had their INRs come down faster, but they also came down farther and dropped too low more often than the others. Neither group had significant warfarin resistance when they restarted warfarin.

    How long should you hold warfarin? I think that it depends upon the dose of warfarin. The average dose of warfarin seems to be about 4 or 5 mg per day. This is the average dose because these people are about average in their metabolism of warfarin. With this dose, the INR should decline to about half of its previous level in about 48 hours. So if someone taking 3 to 6 mg of warfarin per day has an INR of less than 8, their INR should be back below 4 in two days. (A statistical analysis of about 2,500 visits to my clinic found no additional risk of bleeding with an INR less than 5.0.) Therefore, I feel confident in having these people rechecked in two days. When someone who takes less than 3 mg of warfarin daily (a slow metabolizer), they will usually not have their INR decrease by half in 48 hours. I will check this person again in 48 hours to be sure that they have not developed bleeding. However, if they had a INR of near 8, their INR will usually still be above 4 after 48 hours. They often need to be checked again in another 48 hours. When someone takes more than 6 mg of warfarin daily (a rapid metabolizer), I am reluctant to hold warfarin for more than one day. They will usually have their reduced by more than half in 48 hours.

    How much vitamin K do you give when it is needed? I have seen an INR of 9 reduced to less than 2 within 24 hours of giving 2 mg of vitamin K IV. I have also seen a patient with moderate bloody diarrhea and an INR of 7.4 have the diarrhea resolve within 24 hours after an oral dose of 11.25 mg of vitamin K. (He had used all of his sick days and declined to come back to the clinic after the diarrhea resolved, so I do not know what the after-treatment INR was.) I probably would not use this large dose today, but it was advocated a few years ago. I think now that 2.5 to 5 mg of oral vitamin K would have been sufficient.

  18. #18
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    Jody you need to speak to your cardiologist immediately. Call after hours and get his answering service if you must and insist on speaking to no one but him. You are in danger if your below 2.0. The entire treatment of your case sounds like it was done by monkeys, not medical professionals. You've got to find someone that knows what their doing, apparently those folks don't.

  19. #19
    Bridgette Guest

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    I agree with Ross.

    My cardio said that for me (range is 2.5-3.5) any test below 2.0 warrants going to the ED (ER) and getting them to give me an injection of heparin or whatever it is they use.
    He said he would be much more concerned about a low INR than one that's a bit high.

    Good luck, I hope you get some help with this very soon.

  20. #20
    JodyC Guest

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    I called my cardio and spoke to him directly. He wants me to take 10mg today instead of 5 and 7.5 tomorrow and get my INR checked first thing monday morning. I told him my concerns and he says I am fine. I will never ok a shot of vitamin K again unless I am over 10 on my INR. This is crazy and very scary. It is a tough position to be in when I have someone so knowledgable as AL telling me one thing and my cardio whom I adore tell me another. I have to make it through the rest of today and tomorrow and I will know where I stand with my INR. I am going to get a home tester after all this and then I will have the comfort of knowing what is going on right away. I really appreciate everyones help and knowledge and hope no one here is upset with me for waiting until monday. If my INR is the same then I will not take no for an answer on getting shots.

  21. #21
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    This is exactly what the doctor who gave you the shot of vitamin K should have expected. I consider it right at the edge of malpractice to give somebody an injection of vitamin K for an INR of 7.1 when they are not bleeding. You can expect to need a high dose of warfarin for up to 2 weeks depending upon how much vitamin K you were given. Then the nurse who told you to cut back on your warfarin on Sunday probably compounded the problem. You are getting just about the worst possible treatment. You docs probably haven't looked at any info about warfarin since they were in medical school. My mother always said, "Somebody finishes last in every class."
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  22. #22
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    Jody,

    You just heard from our Resident Expert on Coumadin Management. Reading his website, www.warfarinfo.com will teach you more than any of your Care Providers ever learned about managing anticoagulation.

    I highly recommend buying his Dosing Guide for your reference. It will be the Best $5 you ever spent on health care!

    You may also want to browse through the Anti-Coagulation Forum, especially the "sticky posts" at the top of the Forum Listing.

    You have stumbled upon the Achilles Heel of Anti-Coagulation Management in the USA, namely that many Care Providers are seriously out of date* or undereducated in the latest techniques and protocols.

    *Note that anticoagulation management became MUCH better and more consistent after the development of the INR technique in the early 1990's.

    Is there an Anti-Coagulation Clinic in your area? Such Clinics usually have better results than individual care providers, including many Doctors, who should know better.

    Home Testing and Dosing after proper education and training results in the BEST results for anticoagulated patients.

    You may want to take copies of the relevant sections of AL Lodwick's website with you on Monday. I'm guessing your Doc won't know what to do when your INR comes back too low (again). And YES, that would be a good time to insist on an Rx for Lovenox Injections and training in self injection.

    Good Luck! We await your results with baited breath :-)

    'AL Capshaw'

  23. #23
    JodyC Guest

    Default INR results

    I had my blood drawn at the lab for my INR this morning. My cardio's office called me at 2:00 and said my INR was in range at 2.7 and I am to have it tested again thursday. WHEW!!! What a load off of my mind. Now I just need to keep it in range. My cardio suggested 3mg each day and the nurse that ordered my bloodwork wants me at 2.5 every day except tuesday and thursday and I take 5mg on those two days. Taking 5mg alone is way too much and 2.5 is a little too low so I will see what my cardio says on wednesday. I will tell him that if I go that low again I want shots to keep me safe until my INR goes back in range. I am normally not a person to be quiet about anything. I speak my mind and get into heated arguments all the time with my regular doctor(we disagree on dosing for my thyroid meds). Somehow I become meek with my cardio and I guess I just don't want him to think I don't respect him. I know I need to speak up and I will on wednesday. If he just wasn't so kind hearted. He needs to be an egotistical jerk so its easier to tell them my "opinions". Well, I will post how my discussion with him goes and feel free to give me opinions on dosing. Thanks!

  24. #24
    Karlynn Guest

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    Glad you are back in-range. I'm so sorry you had to learn the Vit. K Shot issue the hard way. A few years ago, I had an INR over 7 (and I knew why). I was back in range in a little over 2 days by skipping a dose and taking half a dose. I remember thinking that if I had to go to the ER for some reason I'd probably spend most of my time getting the doctors and nurses not to freak out over the INR and do something stupid.

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