Anyone else notice this? Laying down makes irregular beats worse?

[ARGreenMN]

I was doing great the first 2 weeks post-op, just an occasional irregular beat here and there (much like before surgery). Then last weekend I started having significant irregular beats, and took myself back to the ER. Even went into A-fib that next morning. And the irregular beats have continued and maybe even gotten worse (went back in a 3rd time even because of it). They keep telling me it's all due to the surgery, healing, swelling, etc. and it'll eventually go away. Which leads me to believe others in here may have had this too. So, my question - I've noticed a distinct difference when standing/sitting up straight vs. reclining or laying down. When standing/sitting up, the beats are almost always quite normal (75 beats per min). As soon as I start reclining or laying down, it doesn't take long before the irregular, and slowwwwww beats start setting in. It drives me crazy because it's going down into the 40's when I lay down, and the pressure this causes is uncomfortable. With the new ticking sound I have, it's very easy to tell when it misses a beat, has an extra beat, etc. I've gotten to where I can pretty accurately tell what my pulse is without taking it (can certainly tell difference between 40's and 75). Has anyone else noticed anything like this? And if so, what the heck is going on???

 

[ALCapshaw2]

Post Surgery arrhythmias are pretty common and they can come and go for several weeks.
Caffeine ( in coffee, tea, chocolate, etc.) is a common 'trigger'. Also stress and/or 'over-doing-it.

I recommend that you contact your Cardiologist (or his Nurse) ASAP, preferably TODAY if possible.
A Slow Heartbeat may warrant a pacemaker if it gets 'too slow' (typically under 40).

There are medications that can help control A-Fib (Sotalol, or the Sledge Hammer of anti-arrhythmics, Amiodarone, or it's new alternative ...the name escapes me at the moment, a.k.a. "Amiodarone Lite"). Less powerful Beta Blockers (there are several) work well controlling PAC's and PVC's.

Clot formation is a risk with A-Fib but since you have a mechanical valve, you should already be covered by your anticoagulation, assuming your INR is maintained above 2.0

'AL Capshaw'

 

[Ross]

Multaq is what your thinking of.

 

[ARGreenMN]

Thanks guys. I've been on Amiodarone since the a-fib incindent the other morning. Don't think I've dipped below 40, but gotten close (43 was lowest sustained rate I saw on the monitor). They talked about the next step if Amiodarone didn't work was probably gonna be putting me under and using the paddles. I was cheering for Amiodarone big-time! They were gonna give me all day to get out of it with the amiodarone and some chill-out drug (can't remember name - not valium, but kinda like that) but I got out of afib on my own in about 4 hrs. One doc said it probably wasn't the amio that caused me to get out, since it takes several days for that to really "work". Anyway, due to the recurring episodes of slooooowwwww beats when I lay or recline, they took me off Metropolol figuring that might be mulitiplying the effect of Amio. Had a hell of a time getting to sleep last night, but maybe I'm finally just getting convinced I'm gonna be ok, even with a beat in the 40s when laying down (it's closer to 50 now than 40). Oh, and yea, my INR has been 2.5, 2.5, 2.2 and 2.1 since surgery - going in few min. for my 5th test - will be curious to see if Amio has affected it. They lowered my Warfarin dose from 5 mg to 4mg the other day in anticipation amio will increase my INR. Alright, blabbed enough for now, gotta go shave (with a razor) drink some caffeine wanna-be soda (diet 7-up) and get to the doc for my INR test. At least I don't have to do a mani or pedi. Later guys.

 

[RunMartin]

I was doing great the first 2 weeks post-op, just an occasional irregular beat here and there (much like before surgery). Then last weekend I started having significant irregular beats, and took myself back to the ER. Even went into A-fib that next morning. And the irregular beats have continued and maybe even gotten worse (went back in a 3rd time even because of it). They keep telling me it's all due to the surgery, healing, swelling, etc. and it'll eventually go away. Which leads me to believe others in here may have had this too. So, my question - I've noticed a distinct difference when standing/sitting up straight vs. reclining or laying down. When standing/sitting up, the beats are almost always quite normal (75 beats per min). As soon as I start reclining or laying down, it doesn't take long before the irregular, and slowwwwww beats start setting in. It drives me crazy because it's going down into the 40's when I lay down, and the pressure this causes is uncomfortable. With the new ticking sound I have, it's very easy to tell when it misses a beat, has an extra beat, etc. I've gotten to where I can pretty accurately tell what my pulse is without taking it (can certainly tell difference between 40's and 75). Has anyone else noticed anything like this? And if so, what the heck is going on???

Sounds very similar to me except my heart rate drops when I sit down and is usually higher when I get out of bed. The irregular beats seem to go (or are not as noticable) when the heat rate increases.

 

[ALCapshaw2]

I'll bet they were thinking of using VERSED to 'semi-sedate' you.

It can take you anywhere from "You're gonna do what? Can I watch?"
to "I don't want to know or remember ANYTHING of this!"
just by varying the dose in your IV. It is often used during Heart Caths and Upper or Lower Endoscopies.

'AL C'

 

[Lynlw]

I'll bet they were thinking of using VERSED to 'semi-sedate' you.

It can take you anywhere from "You're gonna do what? Can I watch?"
to "I don't want to know or remember ANYTHING of this!"
just by varying the dose in your IV. It is often used during Heart Caths and Upper or Lower Endoscopies.

'AL C'

I think he was talking about a med to relax him along with the amiodarone during the day while they were waiting to see if the AFib would stop, not for the procedure, where they probably would use versed.

Andy, Hopefully now that you are off the Metropolol, your HR won't drop as low And as your heart heals things will be much better rythm wise.
If it helps you at all to feel better, Justin always has a low HR. He had a pacemaker for a while for for complete heart block that he goes into some times after caths or surgeries.
When he was in complete heart block he was 100% paced. As he recoverred his heart would start beating right, sometimes it was a couple of weeks others a month or so. When he wasn't in heart block he didn't need it much, but it was set to go off if his HR went below 40. His usually would drop when he was laying down too. But usually didn't go below 40 except when he was asleep a couple times.

 

[Bina]

Andy, I really hope you don't end up like me. After 4.5 years I still can't lay half-reclined or totally reclined without HR problems.
Sometimes the PVC/PACs kick in and I have to cough or roll over.
It is totally annoying. My HR will dip into the 50s during the night, but during the day it stays at or just above 60 while resting.
(taking metoprolol). My doc doesn't want to put me on Sotalol right now.

 

[ARGreenMN]

Yikes, that's a little scary.... Sounds like your symptoms are exactly what I'm having too... But I suppose you just have to learn to live with it. I am already adjusting. Still very annoying, even alarming, but getting better at just ignoring it... Depressing to know it might stick around - but thanks for telling me so I know it's possible.

 

[ALCapshaw2]

Andy,

Is your Cardiologist aware of the Heartbeat issues you described in your post?
If not, be sure to make an appointment with him to discuss these issues.
As the ER people advised, post-op arrhythmias are not uncommon and typically DO subside in time.
Bina's experience is rare so hopefully yours will improve as your heart heals.

Do you have a stethoscope? If not I highly recommend getting one to facilitate listening to your heartbeat.
A simple, low cost stethoscope is adequate for this task and can be found at most pharmacies.
After a while, I was able to differentiate between PAC's / PVC's and A-Fib just by listening.
It's also an easy way to take count your heart rate.

'AL C'

 

[ARGreenMN]

Lol, stethoscope? Who needs a stethoscope? I can hear every tick very, very clearly - that mechanical valve is not shy about letting me know when each beat happens, or when I'm in some weird irregular pattern (like the normal tick... tick... tick vs. tick-tick-tick... tick... tick-tick-tick). And I've confirmed a few times that my counts based on counting ticks for 15 seconds and multiplying by 4 are pretty darn accurate compared to what they get on the machines and by taking my pulse the old fashioned way. And there's a very different feeling in my chest when it's in the 40's vs. the 70's, so even without counting beats, I know when I'm in that damn 40's pattern. But a stethoscope still might not be a bad idea - they say sometimes you may not hear a tick and think it skipped - not sure I buy that, but supposed it COULD be true. And would be interesting to hear it through a stethoscope anyway, so think I'll get one!

Yea, my cardiologist was very much in the loop during all this. The ER called him at 2:30 in the morning that first night, and he was there the next morning, as well as several other times during my stay. And when he couldn't make it, one of his partners did - which was nice to get 2nd and 3rd opinions on everything. He was also there when they released me the last time, to help put my fears to rest (as much as possible). And I've got a followup with him in 2 wks. I've gotten to kinda like the guy (finally). He was always kinda "cold" and not very good at giving me info in the years leading up to surgery (plus has a thick Eastern Eurpean accent so is hard to understand). But we kinda bonded during this last hospital stay - guess it just takes time to get to know some guys

I think the irregular beats are getting better now finally - maybe the anti-anxiety things are just helping me ignore it better. Nah, I think it really is getting better - so I'm doing much better now.

 

[tobagotwo]

The irregular beats are more noticeable when you are lying down, as the other internal organs are lying against the heart. Specifically, you will likely feel them most when lying on your left side, as the heart is somewhat to the left and you have the liver and lungs draped over it.

Well, everything's not quite as loose in there as it sounds above, but your innards are movable enough to place a harmless amount of weight on your heart when you lie down, enough to amplify the good heartbeats as well as any off-beats.

Best wishes,

 

[ARGreenMN]

Agreed - easier to detect irregular beats when laying down. But... This thing I've been having is not just irregular beats, it's a drastically reduced heart rate, triggered by reclining/laying down. It was confirmed several times while on the heart monitors at the hospital that it really is slowing down. That first night for example, as I was having that familiar feeling (which I described as the damn thing is missing every other beat - like a four-cylinder engine that's only firing on 2 cylinders) it was right around 43 bpm. There were times when I could watch the monitor and became very confident that every every irregular beat or slow-down I'd feel (and hear) was showing up on the machine exactly as I was feeling/hearing them. And I also confirmed it a few other times, like when I'd be laying there thinking - I'm getting about 48 beats per min. when I count - I wonder if it really is that slow - yep - it was 49 on the monitor when I'd ask the nurse to check. So I'm pretty sure it really is doing some weird things - but you're right it is amplified when laying down. I am gonna get a stethescope tho - I like that idea - anyone with a bad ticker should probably have one of those suckers lying around!

 

[Penny]

Andy, I seem to be heading the same way. I woke up this morning and everything seemed like every other day. I made some breakfast and when I sat down to eat it I noticed my heart was pounding. It was slow pounding beats that were very noticable. I took my pulse which usualy is around 72 and it was down to 58. It lasted about 5 minutes then it went back in normal range. Freaking scary thats for sure. I am off to see the doctor today so lets hope he will have a solution so that I won't have to keep going through that.. if so I guess it means a trip to the emerg room