Frustrated, need guidance: Mom's in constant A-fib post-op

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indigo

I just took my mother to the ER for the 3rd time this month. She's spent most of March as an inpatient. Please bear with me, long, you all helped me here once, I hope you can give me some guidance again.

My mother (75) had open heart at Nwestern in Chicago in August, 05. She had both valves repaired and MAZE (valve replacement was initially on order but they felt confident in doing a repair). We live in the 'burbs, so have a local cardio but are also in touch with Chicago.

She was recovering OK, save for med side effects and severe anemia from Coumadin aggravating pre-existing pernicious anemia.

In January 06 she had an incident of atrial fib. Her heart spiked to 147, she was vomiting, I took her to ER. Stress test results stated "Probably LVH with ST-T abnormalities, Q's, V1, V2, possibly due to LVH and/or ASMI". They did cardioversion and released her a week later. Doing OK, I took her back to Chicago in Feb for a recheck and because of the a-fib incident. NW cardiologist said they didn't know what caused it, it could happen again. On the positive side, her heart muscle is "strong, better than ever" (EF is low 50's, think it was 52.)

All seemed well till this month. She had two bouts of a-fib early in the month. Took her to local ER, cardizem IV, admitted for 7-10 days, cardioverted, monitored, released, and like a revolving door, back in again in a couple days. This past week she was home, but in a-fib nearly the whole time. Since she was asymptomatic and hr never strayed much above 110 home nurse kept watch on her and showed me how. (Since she can't feel her own heart racing, I use a home BP machine to monitor her her pulse, & her home cardiac nurse gave me a stethoscope to listen for signs of a-fib since it can happen with a low heart rate as well.) I was told take her to ER if she's above 110/120 bpm and/or if she's symptomatic (sob, dizzy, vomiting.) It's been like waiting for the other shoe to drop on a daily basis. Sure enough, yesterday morning she woke up sick and heart spiked at 157 bpm.

I am at my wits end for her. My sister is just plain ticked and my brother says get another opinion now, this is too much. She lives with me, so it's falling on my shoulders and I can't get solid answers from MDs. Local cardio mentioned ablation last admit, then back tracked, says if she goes into a-fib they'll just zap again, but then turns around in same sentence and says heart can only take so many zaps. (That kind of info leaves us spinning.) Another problem is if I schedule an appt for 2nd opinion, odds are she's in hospital and we can't get her there. So while an inpatient, we're stuck with only local/on-staff second opinions. Updated her surgeons office at Northwestern, but waiting for a call back from MD.

She almost pleads with me not to take her back to the hospital. She hates being in there, and each time she gets cardioverted, she's very weak and tired for almost two weeks, then rebounds. I'm noticing she's not rebounding so much now, she doesn't get around well and has had a couple falls in my home from stumbling in recent days.

Home cardiac nurse encouraged me to push MD for answers as to why ablation is not being done. But that's usually followed up with "her heart is aging". Cripes, I don't know which it is. A "strong heart, better than ever" or "it's getting old" or both.

She just called me. Her primary (general) care MD was in her room and said she's in sinus rhythm again now but that a specialist will be in to discuss ablation.

I'm trying to get all the info I can. Grateful for any advice, experiences, or guidance.

I'm going to list her meds, in off chance one of those might be triggering this. (We took it upon ourselves to stop her inhaler for a few days, because a pharmacist told me that could cause a-fib on rare occasions, but it still happened.)

She's severely arthritic and diabetic, COPD as well.
Her meds are:
Home oxygen 24/7
Amiodarone 200mg 2 x day (was 100mg till mid-March)
Lisinopril 10 mg 1 x day
Aspirin 81mcg 1 x day
Lopressor 25 mg 2 x day
Coumadin 1 mg 1 x day
Lasix 25 mg 2 x day
Glucophage 500mg 1 x day
Zoloft 50 mg 1 x day
Advair Discus 250/50 2 puffs 2 x day
Prevacid 30 mg 1 x day
Niferex Forte 150 mg 1 x day
K-Dur 200 meq 1 x day
Azulfidine 500 mg 2 x day
Neuronton 300 mg 2 x day
Fosamax 70 mg 1 weekly
 
i'm sorrry your mom and family are going thru this. i would get a second opinion also. When I got 2ned (and 3rd and 4th lol) opinions for Justin, I called the doctors first and we just had to send all his records to the doctors. Maybe you could look into getting a second opinion that way. good luck and keep us posted, lyn
 
Her list of medications look like my husband's, long and complicated. He actually has had pharmacy doctors helping his cardiologist keep all things going in the right direction. That has been a BIG help.

Joe has been in afib, aflutter and normal sinus rhythm for many, many years. His converts on its own most of the time, but there are also incidents of afib or flutter happening.

I DO know that with so many meds, unusual things can happen.

Has anyone suggested the services of an electrophysiologist/cardiologist? I would mention that and also mention getting a pharmacy doctor involved with her meds. Perhaps he/she can tweak the dosages and or times of day taken to help minimize side affects.

Another thing that has happened to Joe after long stays or numerous stays in the hospital, is deconditioning. That is a really big issue and one he is battling at the moment.

Being in the hospital and then coming home and not feeling like doing much have contributed to his losing muscle mass, more than I would have ever believed possible. This is a man who was a superb athlete. But he has been in and out of the hospital for most of this year.

I can actually see the deterioration of his arm and leg muscles. He is starting now on a rebuilding program, very slowly.

What happens to him, is that he has difficulty breathing and his heart races when he starts the slightest movement. It's a hump he has to get over and it is uncomfortable and not easy.

Perhaps your mom could benefit from a cardiac rehab program, where she would be monitored.
 
Thanks for the replies so far.

Lynlw: I plan to get my mother's records today, I'll be at the hospital anyway. Don't need them if a second opinion is local/on staff, but will need to get them for out of area. Northwestern in Chicago can get them via fax faster than I can, but they still have not returned my call from earlier this week, asking for their input and or for them to see her (puzzling to me, since her open heart surgery was done there).

Nancy: yes, I've noticed the same issues in my mother. She's down to 102 lbs and looks like a starving child from a 3rd world country. It's pathetic, try as I might, can't seem to get the weight back on her. (Blood thinners decrease her appetite, other meds=nausea, etc.) I watch her like a hawk, make sure she eats well. (Tricky, low salt for heart and diabetic also). We also use Glucerna as a supplement. She was supposed to go into Cardiac Rehab last November. Severe anemia put that on hold. Finally she got a transfusion with the cardioversion in late Jan., got her released for cardiac rehab, and as soon as she was set to start the a-fib incidents began again.

I've seen references here and there online from actual patients that ablation may not be the right/good choice. She is set to have an electrophysiologist see her today. So I am rapidly searching, but can't find why the ablation might be a poor choice. It looks minimally invasive, lower risk and has good success. But if others have had problems with it, I'd really like to hear about it.
 
my brother had cardioversion and it held for a short time. They afterward treated it w/meds when he'd go to ER. He's always in a-flutter and sometimes a-fib. I believe it was increase in digoxin that they gave him, because I refused to let them give him amiodarone and if they did, they'd be in great trouble - It's in his records that he's not to have amiodarone ever.

With all those meds, no wonder your mom has no strength. I am so sorry she has to take so much to keep her going. I hate it when they keep giving us oldies more and more meds. I hate it that we need them. My prayers for her and you all.
 
More information;

More information;

what valves were repaired?
Who was the surgeon?
 
don't know if this helps or not, but....

don't know if this helps or not, but....

I don't want to scare you or anything, but I was wondering why she's on the amiodarone in the first place --- was it prescribed for the a-fibs?? I have a-fibs myself -- but luckily they are not too problematic. (eg. tonight at work - I wait tables - my heart started racing -- I squatted down, laid my head on my knees and started to take slow deep breaths until it stopped. Several people came over to ask me if I was ok -- to which my reply was - It's only my heart -- I do this every now and then and I just need a minute to make it stop. If it doesn't - I'll just go to the er when I get off.) But I digress, back to the amiodarone - my son is on it for svt's, but check out the post about amiodarone in heart talk -- talks about people taking it for a-fibs and that it wasn't really made for that. We've been very lucky and my son's not having any problems being on it -- he's been on it since he was bout 3 weeks old and still takes it now -- he's now 2 1/2. Plus I was curious as to why she was on the amiodarone and lopressor -- they treated my a-fibs when I was pregnant with lopressor. -- Like I said before I don't know if this helps or not, just raising questions I gues, I just wish you the best -- you and your mother will be in our prayers.
 
It sounds like your plate is overflowing.

My husband is in chronic a-fib. For the most part, it is controlled with beta blockers. Yes, he is VERY fatigued most of the time, but he does manage to have a reasonable quality of life. He is 59 years old, and has been in chronic a-fib for about 5 years now.

They also attempted to cardiovert him. Four days later...back in a-fib. Since his condition is caused by rheumatic fever, and he has enlarged atria, they felt that until he had the valve replacement surgery, concersion again would have the same result. Surgery 4 months later. He was back in sinus rythm for about 3-4 days, then back into a-fib, where he remains todya.

Yes, they have spoken about ablation. However, for him, that comes with its own set of problems. He has severe tricuspid regurgitation, and if a pacemaker is necessary (which it would be), then the placement of the leads could lead to a worsening of this condition. (become acute???) Also, ahving a pacemaker also comes with its own problems. For example, infections are not uncommon, and the last thing a valve patient needs is an infection.

Frankly I think he would FEEL better, and he has in fact been advised to get a pacemaker bu a number of doctors, but his cardio truly feels that a wait and see attitude is best, considering the complexities, and the fact that he is able to tolerate his condition.

I am not at all sure if this helped, but I hope it might be at last marginally informative.

I am so sorry you are going through this difficult time.

Marybeth
 
Thanks to all for replies.

Nightmare of a day yesterday dealing with red tape, but there is forward momentum now.

She has been on amiodarone to control the heart rate. Told flat out it 'has terrible side effects but has been a necessity'.

knightfan and RCB: valves repaired were tricuspid and mitral. Surgeon was McCarthy (among the best, we're told).

Last night an electrophysiologist saw my mother at local hospital, he called me on the phone to discuss. He told me her EF was 36 on Jan 18. I was surprised, I told him just a few weeks later (in Feb) at NWestern it was 52. This morning they did another echo and per technician, it's "slow, in 30's". Don't understand the differences, have not been able to discuss with an MD yet, just got that news. He said infortunately she's among the 10% where MAZE is not successful, and if MAZE fails, there are not many more procedures that can be done. He said AV Node ablation is an option, with pacemaker if EF is above 50, defibrillator if EF is in 30's. Nice man, he encouraged the consult at NW.

She's worried and scared, I'm trying to research the ablation.

Northwestern is arranging for an electrophysiologist consult, they'd like to see her next week.
 
You and your mom sound discouraged, however, there are some options available which could give her some relief. So please stay positive. Things can seem so overwhelming at times, but if options are available, then that is the thing to focus on. Tell her to just hang in there until all the testing has been done and a treatment plan is developed.

Remember, NEVER GIVE IN AND NEVER GIVE UP! The body has amazing healing properties if the right treatment plan is found.
 
Gosh, your mom is on a lot of meds and has so many issues it is difficult to know how to analyze.

I am not sure I can understand so I will ask - is your mom having symptoms during the a-fib?

I have been in constant a-fib for 2 years now. I usually cannot feel it although it does limit my activity levels. Since I am on coumadin for a mechanical mitral valve, my cardio and I have simply decided to "ignore" it. I do not want to take any more meds or go through any more procedures. I am even hesitant about an ocular angiogram I am supposed to have next week.:rolleyes: :rolleyes:

Since your mom is on coumadin, if she does not "feel" the a-fib, maybe it would be best to just leave it alone, cut out the amiodarone (of course with the cardio's approval) and go on from there.

Thank you for taking such good care of your mom. I think you are really great to take such an active role in her medical issues.
 
Thanks Nancy and geebee for the encouragement and kind words ;)

geebee: The only time my mother has symptoms with a-fib is when her heart rate goes above 130. Oddly enough, she cannot feel her heart pounding. But her symptoms are classic: at a higher heart rate, she is sick to her stomach, dizzy, short of breath. Those episodes are what have prompted the 3 trips to the ER this month and subsequent admissions and cardioversion. She has been in pretty much constant a-fib this past week at home, and we went about living (just didn't over exert). But it seems like it's inevitable that she'll hit a spike and I have to take her to ER. She pleaded with me last time not to take her, give her her meds, see if that helped. Against my better judgement, I gave her only the Amiodarone. It worked quickly, dropping her rate from 157 to 120 in about 20 minutes, but I kept close watch, and all it took was the activity level of walking a few feet to the bathroom and brushing her teeth to cause her rate to jump back up to 150, so I had to take her in. When she's in a-fib but a lower heart rate (90's to 120) she doesn't exhibit any dramatic symptoms, other than occasional fatigue.
 
Maybe you should talk to the cardio about using the little tricks to get out of a-flutter (fast heartrate connected to a-fib). I used to have a lot of problems with a-flutter and used a similar method to tantekay's as well as a couple more. If I had jeans on (thus a fairly tight waistband), I would squat and hold my breath. Often this would cause natural conversion. The other 2 "tricks" were holding my breath while "bearing down" similar to the actions during labor or (and this is trickier) pushing on the neck artery until conversion (but you have to learn when to stop). All of these should be discussed with the cardio - PLEASE DO NOT TRY THESE WITHOUT.

I am a real advocate of remedies not requiring medication if they exist. One of the above routines always worked for me except once and that required an ER visit and verapamil worked at that time.

Good luck.
 
geebee,
I will definately ask about your techniques (but not ask local cardio, he's getting to be a royal pain in the behind with his massive ego and do-as-I-say-don't-question-me-or-I'll-yell-at-you attitude. I experienced that first hand myself yesterday when I posed a question to him. I've heard rumblings recently from nurses on his floor about it as well.)

Anywho, a cardiac nurse that comes to the house by coincidence just told me last week that massaging the carotid artery area can often convert a-fib, but she said you MUST know what you're doing, and she did not want to teach me without getting MD approval first. I'll definately follow up on those tips, thank you!
 
indigo said:
knightfan and RCB: valves repaired were tricuspid and mitral. Surgeon was McCarthy (among the best, we're told).

Last night an electrophysiologist saw my mother at local hospital, he called me on the phone to discuss. He told me her EF was 36 on Jan 18. I was surprised, I told him just a few weeks later (in Feb) at NWestern it was 52. This morning they did another echo and per technician, it's "slow, in 30's". Don't understand the differences, have not been able to discuss with an MD yet, just got that news. He said infortunately she's among the 10% where MAZE is not successful, and if MAZE fails, there are not many more procedures that can be done. He said AV Node ablation is an option, with pacemaker if EF is above 50, defibrillator if EF is in 30's. Nice man, he encouraged the consult at NW.

She's worried and scared, I'm trying to research the ablation.

Northwestern is arranging for an electrophysiologist consult, they'd like to see her next week.
Click to expand...

Indigo,
There is no better than McCarthy! When he does a Maze, he always removes the LAA, so the danger of stroke is rare. At this point you may just try to control the heart rate and wait for the heart to heal more. Node ablation is an option at her age, if it is the only way left. The EP at NW is your best bet. Unfortunately, more valvers as they age will have these
problems, it is only a question of time. Too bad, because EPs don't really
a lot of answers after a Maze fails- just rate control.
Good luck- you are doing all you can for your mother.
 
Hi RCB,
Yes, we were rather naive going in to NW. Blessed to get in quickly on referral, when all was said and done, a local MD said 'next to God, they don't get any better than McCarthy'. So that was an answered prayer, because we got my mother in within a week and the man is booked for months. So I will feel much, much better when we get her back to NW so they can take a look at this. That entire cardiac group is not only outstanding, they are among the most humble and down to earth physicians we've ever run across.
 
Couldn't agree with you........

Couldn't agree with you........

indigo said:
Hi RCB,
Yes, we were rather naive going in to NW. Blessed to get in quickly on referral, when all was said and done, a local MD said 'next to God, they don't get any better than McCarthy'. So that was an answered prayer, because we got my mother in within a week and the man is booked for months. So I will feel much, much better when we get her back to NW so they can take a look at this. That entire cardiac group is not only outstanding, they are among the most humble and down to earth physicians we've ever run across.
Click to expand...


....and the local MD more. I had search and read many databases since 1996
when I realized that I was going to need more surgery. My 3rd one was tough and I had to get more done the 4th time- so I was high risk. There are
many great surgeons and I was willing to go anywhere as I felt my life depended on it as it did in my first three. I decided on McCarthy in '99.
When a bad echo report came back in Jan. of 2004, there was no doubt who
was going to do it. I got an appointment at CCF in March and one week before I was to see a cardiologist there, I read an announcement on the internet that he was leaving CCF. I was in shock! We discussed it on this board. McCarthy finished his surgical schedule and left for NW. I needed
surgery right away and didn't want to be on any surgeon's "shakedown cruise" getting use to a new hospital and new staff. I went with CCF, because of the overall reputation. If I had to have surgery tomorrow, I'd
be having Dr. McCarhy do it. He is excellent and he surrounds himself with excellent people.

I just want you to know that you are doing the best for your mother and that you are in the best of hands. The rest, as the local MD implied, is up
to God.:)
 
Is her SURGEON aware of all that has been happening?

The surgeon I consulted about MVR and MAZE procedure gave me his standard information sheet which clearly states that HE wants to PERSONALLY follow ALL MAZE patients for several MONTHS following surgery.

You mother's case sounds a little like "too many cooks..." BUT, getting an electrophysiologist involved is a good move. Who is Coordinating ALL of those Doctors / Medications? Does she have a Good INTERNIST?

'AL Capshaw'
 
2 questions

2 questions

Is she on Digoxin?That is the drug used to control A FIB. Does she use a rescue inhaler, like Albuterol. I noticed the Advair. Albuterol is great at opening the airway but causes tachycardia.
I am sorry she is having such a hard time. She sould be enjoying her spruced up heart but hers is acting up too much.
Hope they get her straightened out soon.
 
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