Doctor Says I have Atrial Fibrillation...What's Next?

[harleygirl528]

Hello Everyone,

Well, I thought I was going to go on record as having the quickest, easiest recovery ever but it was not to be so. I went to the cardio yesterday because of continued pain in my left lung and an annoying, pinching pain that almost felt like a broken rib. Also was experiencing intermittent pain in my back when deep breathing, which is causing me to do a lot of shallow breathing, thus prolonging the lung problems. Anyway, they did another chest x-ray and she called me and said that it looked "better" (whatever than means) but I still have some adolacteses (sp?) and my left lower lung is partially collapsed? She said to just keep doing the deep breathing (easy for her to say...it hurts!), walking, taking Motrin and she felt it would resolve on its own.
Let me point out that my cardiologist's office really never sees patients post-operatively since people usually have surgery locally and see their surgeon's office for post-op follow ups. My husband feels we should go get copies of the films of my last 2 chest x-rays since being home and forward them to my surgeon in Ca for review. Afterall, the first ER visit resulted in an inaccurate diagnosis of pneumonia.
Okay, then to add a few more complications to all of this....last night I noticed that my heart felt like it was going to pound out of my chest, literally. It felt really fast to me so I took my pulse, and it was 101! I kept monitoring it and even at rest it was in the high 90's, when it has been running in the 60s and 70s. So, this morning, it still hadn't resolved and we called Dr. Raissi on his cell phone. He said that I most likely was experiencing atrial fibrillation! Yikes, I thought this primarily happened right after surgery not 3 1/2 weeks later! He instructed me to take an extra dose of Atenolol and to just take it easy, skip my walking for today, and call him back. I went on the internet and looked up atrial fibrillation and it sounded very serious to me. Has anyone experienced this so long after surgery and what are the long term ramifications? Will it just resolve itself (seems to be coming down a bit already, in the 80s now)? I am concerned and am wondering if this is something I am always going to have to deal with or maybe just an one time episode.
I am getting a little nervous about my post-op medical care and wondering if it is sufficient. My plan is to fly back to California the end of February to have Dr. Raissi check everything out, see how the graft is doing, etc.
Thanks for any and all input on the lung issues and the a-fib. You guys are great!

 

[lieb2101]

Lorie,

Hang in there!
I can't even imagine. I'm so paranoid right now about every little thing going on...
Do you have any alternatives in your area for post op care? Anyone else your doc can recommend? Even just a little piece of mind can go a long way...

Best wishes.

-Brian

 

[Phyllis]

Lorie, I agree with your husband. I would run this all by Dr. Raissi's office. Does he have an email that you can contact him by? Dick's doctors did and we did not hesitate to email them with any questions and the replies were almost immediate.

 

[Susan BAV]

It needs treated quickly.

It needs treated quickly.

I'll try to briefly explain my post-op A-fib/A-flutter experience. It began a week post-op. My family doctor caught it on an EKG and it was 198 beats per minute. He wanted to hospitalize me immediately but we strongly dislike the local hospital so he tried digoxen but it didn't fix it. We puttered around with it for a week before we were finally convinced we should just go back up to our first hospital and let my cardio treat it.

Anyway, the cardio began me on Sotalol in the hospital and just kept me there for about three or four days and they also gave me magnesium IVs while I was in the hospital. Sotalol kicked it immediately and I was only on that med for about three months and I was also on Coumadin for about three months.

I hope it resolves as easily for you. Take care and keep us posted, Lorie. Best wishes.

 

[marie]

My a fib kicked in while I was in the hospital. I am on 40mg twice a day of sotalol and that has kept it in check. My surgeon said he sees this in 30 to 50% of his patients and that it resolves itself with time. I think your husband gave you some good advice about getting in touch with your surgeon. You're in my thoughts and prayers.
Earline

 

[Granbonny]

Lorie

Lorie

Sorry you are having post-op problems..I remember..5 days post-op in hospital ..sitting with my daughter in room watching T.V. and the nurse came flying in.. She said, I was in A-fib and I was scaring her to death.. .this was before I had found VR.com and had no idea what she was talking about?I felt fine..but she gave me something.....and I was suppose to go home the next day..but they kelp me an extra day... .to make sure it had gone away?(normal?)A-fib?..never had it again...From my readins on VR.com for 6 years..I think most do have it shortly after VR surgery..claiming the heart doesn't want to be messed with?.......I just took my meds I was sent home with for 3 weeks before I saw my surgeon..(assistant) and then the next week when I saw my Cardio..he took me off all my post-op meds.. ..Like I have posted many times..when I came home..I was a whimp..just walking in house the first week/walking a LITTLE outside/ect..the 2nd week...JUST letting my body heal....until I felt like going for a ride/ect. the 3rd week and NOT doing anything for 6 weeks..........Was lucky to have a Hubby that did everything for me.. ..After 6 weeks..I finally felt like I was getting back to my old self..............VR surgery is a major surgery..not to be taken lightly.....Need time to heal.. ......I am sure that Dr. Raissi will give you the best advise.what to do..Bonnie

 

[BackDoc]

I developed this on the morning I was going to be released from the hospital. Up to then things were cruising just like you--only two days post-op and I was going home...NOT. The surgeon told me this can happen in up to 70% of patients such as us. In simple terms, our heart is not happy from being cut open.

I had to spend another 48 hours until they were sure I stayed in normal rhythm.

Two days after being home I developed it again--lasted about 10 hours. A few days later the same thing.

I was prescribed low dose Amiodarone, low dose beta blocker, and cumadin for three months. I hope to be off of all three within the next two-three weeks.

I also avoid anything with caffeine and nutrasweet.

Remember; this too shall pass.

I am really surprised that your cardiologist doesn't do more post op. I had my surgery 90 miles from home, and was released to my cardiologist. He told me once the surgeon is through with you, the post op care is the domain of the cardiologist. The surgeon told me the same thing.

 

[WayneGM]

Sorry to hear about your in the recovery road. Unfortunately I can't add to what's been said as I didn't experience this. I hope this is resolved soon and my best wishes for a smooth recovery continue.....

 

[ALCapshaw2]

"Take Two Deep Breaths and call me in the morning"

Well Lorie, it sounds like you are getting the Full Length Feature. Sorry about that.

And YES, many of us had bouts of A-Fib up to several weeks post-op. My first eposide was in the hospital before being discharged. The floor nurse went through the entire Digoxin protocol for about 3 hours, then sent me back to ICU. By the time I arrived in the ICU, I had converted back to Normal Sinus Rhythm (NSR).

Second time it happened was about 5 weeks post-op and I went to the Local ER where they put me on a monitor and watched. I converted after 3 hours and they sent me home.

Third time it happened was about 6 weeks post-op, at night. I 'bargained' with my PCP's On-Call Doc, telling him that it seemed to convert in 3 hours regardless of what was done. He agreed to let me 'ride it out' at home on the condition that if I had not converted by morning to go to the ER. Sure enough, 3 hours later it converted.

Heart Rates of 100 to 120 are NOT uncommon following surgery. The Doc's don't seem to get to concerned until the HR gets over 120, then they take more drastic measures. Some Doc's just go ahead and Rx Amiodarone, the SLEDGE HAMMER of anti-arrhythmics. Personally, I told my Doc's that I want to exhaust ALL the other options before submitting to that Powerfull Drug that takes forever to leave your body and has a laundry list of adverse side effects (to the eyes and lungs) if taken in too high doses for too long.

SOTALOL (generic for BetaPace) works well on A-Fib but takes a few days to fully kick in and you need to be monitored for more dangerous arrhythmias until your body adjusts to it. Several of us have had good results with this medication, sometimes even in small doses.

TRIGGERS for A-Fib include Caffeine (coffee, cokes, CHOCOLATE, etc.), Stress, Nicoteine and a host of others I have forgotten. Avoid them as best you can.

IF your A-Fib is constant and does not go away after a day (or so?), I would recommend discussing anti-Coagulation (
Coumadin) with your Cardiologist as a protective measure. (Continuous A-Fib can cause Clots to form after a while - I'm not sure how long 'awhile' is).

Just remember, "This too shall pass".

Cursing is allowed.

Hoping(sp?) for the Best,

'AL Capshaw'

 

[tobagotwo]

Just to echo some of the previous posters...

Atrial Fibrillation is not uncommon in the first couple of months following open heart surgery, most especially in the first few weeks. I had it on the second night after the surgery, and was still out on day three. It's often transitory, and it will hopefully go away for you on its own.

If it doesn't go away fairly quickly, drugs such as Sotalol are given to calm the heart down, and they usually work. For an unfortunate few, AFib becomes a longtime companion. In those cases, Coumadin or Plavix are usually prescribed to lower the possibility of a stroke from clots that can sometimes be created by constant or long-lasting bouts of AFib.

Here's hoping this is just a passing fancy for your ticker.

Best wishes,

 

[Bina]

A few days post-op in the middle of the night I had a sudden HR of 170, I was given Sotalol and potassium, and the next day started Metoprolol. It was diagnosed as SVT. During the next few weeks it happened a few more times and I would go to the local ER to get checked out. Now it's better.
Lorie, make sure you rest alot, don't rush the exercise.

 

[MaryC]

Lorie,
I got a-flutter around 3 weeks after my surgery and it was a scary time for me. My cardiologist of 13 yrs put me on flecanide and coumadin and referred me to a specialist in his group who dealt with heart rhythm issues. The specialist upped the dosage on the flecanide and sent me on my way. When I went to cardiac rehab the next day they noticed my heart rate at rest was 126 bpm. I ended up having issues with the flecanide, almost passing out twice. My trust level by this time was at the lowest level with my cardiologist and the specialist. I got back with my surgeon and found another cardiologist. When I saw the new cardiologist I was back in normal sinus rhythm and have been ever since.

I hope you get your a-fib resolved quickly.

 

[harleygirl528]

Update after Speaking with Surgeon

Update after Speaking with Surgeon

hello everyone,

As always, thanks for your prompt and informative replies. I spoke with Dr. Raissi be telephone twice today with my vitals etc. and he says if I don't feel better to go to the ER tomorrow. He now feels I may have something call postpericardotomy syndrome characterized by malaize, low-grade fever, joint aches and pains, pleural effusions, pericardial effusions, lack of appetite, etc. I seem to have all these symptoms.
It is usually treated with NSAIDS like Ibuprofen and pain pills and bed rest (no more 2 mile walks) but sometimes can develop into full blown pericardial tamponade. Anyone familiar with this term (postpericardotomy syndrome)? It does seem to make sense. I am not letting the doctors at the ER make any big decisions about my care but if I am not better Dr. Raissi said to call him in the morning on his cell and he will give me a list of all the test to have including a bunch of blood work,ECHO, EKG to see if I am in sinus rhythm and another chest x-ray. My problem is that I live so far away from my surgeon, over 1000 miles. On a positive note, Dr. Raissi is always available via cell phone (evenings or weekends included) unless he is in surgery or consult so that has been really helpful. I have to say, I feel like s#%t....probably comparable to my first couple days post-op....just like I have been run over by a truck and feverish with wicked joint pain. Apparently this postpericardotomy syndrome does occur in a good percentage of OHS patients post-operatively. Thanks again for all your replies! I'll keep you updated...sounds like I may have another visit to the ER....I just can't wait to feel better! Trying to stay positive but it's really hard when you feel this bad Thanks again, everyone, and keep the comments coming!

 

[harleygirl528]

Forgot to Mention

Forgot to Mention

Forgot to mention, another issue has been extremely low bp. I had one that was 73/47, 78/47, 81/49. It seems that every time my pulse goes down the blood pressure gets extremely low. I do have a great hint for those that suffer from these episodes of low bp~drink 2 tall glasses of water. It really does work. I am wondering if I am truly in a-fib since the highest my pulse went was 101. Sounds like a-fib is characterized by much high pulse rate than that. Looking foward to your thoughts.......

 

[ALCapshaw2]

I'm sorry you are suffering so Lorie.

The Silver Lining to this story is how concerned, supportive, and available Dr. Raissi has made himself to you. In all the years I've been reading recovery stories on VR.com, I don't think I've ever seen such post-surgery support from a Surgeon. You picked a Real Gem there Lorie. I can only hope that more surgeons will follow his exemplary example.

I'm confident that with his guidance you will get through these 'bumps in the road to recovery'.

Keep Repeating Nancy's Mantra:
"Never Give In and Never Give Up!"

You WILL get through this!

'AL Capshaw'

 

[ALCapshaw2]

<SNIP>
I am wondering if I am truly in a-fib since the highest my pulse went was 101. Sounds like a-fib is characterized by much high pulse rate than that. Looking foward to your thoughts.......

I have also been told I was in A-Fib when my HR seemed 'normal or near normal'. Perhaps the key is the irregularity.

Here is what I found in my Merriam-Webster's Medical Dictionary
(which seems to add more confusion than clarity IMO):

Atrial Fibrilation :

"very rapid uncoordinated contractions of the atria of the heart resulting in a lack of synchronism between heartbeat and pulse beat"

Atrial Flutter :

"an irregularity of the heartbeat in which the contractions of the atrium exceed in number those of the ventricle"
--------------

A clear definition of "heartbeat" and "pulse beat" would be helpful!

I *assume* that the "pulse beat" is the beat that is "felt" in the arteries, i.e. the beat (rate) of contractions of the Left Ventricle which pumps blood to the body.

The above definitions would *seem* to imply that the major difference between A-Fib and A-Flutter is "heart rate" which itself is ambiguous if the (L) antrium and (L) vertricle are beating at different rates.

Good Questions for the Doctors!

Let us know what you find out.

(Anyone else have any better / clearer definitions?)

'AL Capshaw'

 

[harleygirl528]

Okay, I mispelled the term the surgeon used. It is Postpericardiotomy syndrome. Interestingly enough I did a search on the forum for this term and did not find a match...seems interesting since it appears upon some research that it is a fairly common phenomenon after OHS. Here's some info I found on the internet:

Postpericardiotomy syndrome is diagnosed after excluding other conditions such as endocarditis and pneumonia.
Postpericardiotomy syndrome is a frequent complication of cardiac surgery and is characterized by fever, chest pain, and a pericardial friction rub.
Although the postpericardiotomy syndrome is a common complication of cardiac operations, the most effective drug regimen for the treatment of this condition has not been established.
Postpericardiotomy syndrome is a multi-faceted inflammatory illness that occurs .
Postpericardiotomy syndrome is a multi-faceted inflammatory illness that occurs after the pericardium has been opened, typically after major cardiac surgery.
Retrieved from "http://www.steadyhealth.com/encyclopedia/Postpericardiotomy_syndrome"
Here's another description of the syndrome:
Postpericardiotomy syndrome
CE McClendon, RD Leff, and EB Clark


Postpericardiotomy syndrome, a frequent complication of open-heart surgery, is characterized by fever, chest pain, and pericardial and pleural effusions. These signs may develop 1 to 12 weeks after intracardiac surgery in approximately 30 percent of patients. Although the etiology of the syndrome is unknown, evidence points to a viral and/or autoimmune cause. Postpericardiotomy syndrome is diagnosed after excluding other conditions such as endocarditis and pneumonia. In many cases, the syndrome is self-limiting and occurs only once, but in other cases the symptoms have recurred as many as eight times. When the symptoms recur, management is more difficult because optimal pharmacologic treatment is not known. Antiinflammatory agents, such as salicylates and steroids, represent the drugs most commonly used. Although analgesics with codeine or oxycodone are important for the patients' symptomatic relief, early recognition of the syndrome is the key to limiting the discomfort and possible complications associated with this condition.

I am really surprised I didn't find this term when doing a search since it appears as if it is fairly common (30%) of the time. Anyone have any info on this?

Thanks and I'll keep you updated!

 

[kfay]

Lorie, I had this same syndrome when I had OHS in 1980. I got it before I left the hospital but you have to remember that those were the days when they actually let you stay in the hospital for a while. I remember having a fever for several days and feeling like my heart was "rubbing" inside my chest. I didn't actually know that that was what I had until just recently I received a copy of my surgical notes from Duke because the Mayo clinic had requested them. It says in there that they put me on Prednisone for it as well as an antibiotic (I don't know if the antibiotic was just standard or if it was specifically for the postpericardiotomy syndrome). Sorry, I don't really have too much more info for you other than to say I recovered from it just fine and I'm sure you will as well. Good luck on your trip to the ER today and I know you'll soon be back on a good path.

Kim

 

[Freddie]

From Wikipedia
Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium (the sac in which the heart is enclosed). The blood significantly elevates the pressure on the heart, preventing the heart's ventricles from filling properly. This in turn leads to a low stroke volume. The end result is ineffective pumping of blood.

Hope you get some answers soon, take it easy and be good to yourself

 

[JudithD23]

As a result of reading all this, and sometimes I don't know if ignorance is bliss, I'm going to be so vigilant regarding every ache and pain Tom has. It also makes me wish Stanford, if that's where we finally end up going, was closer.

Lori, you've been having a bumpy road here now for a week, you're getting it all over with and I'm hoping all goes well from here on out. Looking forward to how this all resolves.

Judith