Time to rant...

[Bryan B]

For those who have read about my current situation with a-fib / a-flutter, I have been and am currently going to one of the "best" cardiology groups in the area from Duke University Medical Center. They specialize in ACHD patients such as myself. I also have a "portal" on their website where I can review all test reports as they are posted on the site.

Let me back up for a second. I had a PT INR blood draw Monday (yesterday) after being on Coumadin (first dose 5mg and subsequent doses at 7.5mg) for 6 days (the 6th dose being Sunday night) and also on Lovenox 80mg injections every 12 hours until I got into range. The lead cardiologist suggested that my a-fib/flutter was caused by "holiday heart". That is when you are a hard or binge drinker. According to the AMA I drink to excess...and I admitted when I was admitted to the hospital that I drink on average 6 beers a day. I'm not proud of that but I have been drinking at that level for over a year...pretty much since my cardiologist recommended strongly that I do not work until I have surgery for my dilated aortic root and dilated ascending aorta as well as aortic insufficiency. I'm not trying to make excuses for my drinking, but I personally don't think I would suddenly go into a-fib/flutter drinking that amount (which is very consistent). Well I got my INR result today and it was at 4.0, so apparently my alcohol consumption is not affecting my liver function enough to inhibit the Coumadin and/or Lovenox from doing it's job. The good news is that I can stop the Lovenox injections for now. I talked to the group's NP who seems to have more common sense than anyone, and she suggested that I hold my dose tonight, then cut back to 5mg daily and get tested again on Monday.

OK...if you're still with me I've been reading some of my test results and wonder if anyone can help me with what they mean, other than a couple of them are way out of range. First, all of the ECG reports come back reading "LVH BY VOLTAGE" and "ANTERIOR ST ELEVATION, PROBABLY DUE TO LVH". Am I correct in assuming that "LVH" means Left Ventricular Hypertrophy"? If so then I believe that at least part of my problem is due my worsening insufficiency (caused by my worsening aortic root dilation).

What I really need help with is 2 of my blood tests that came back way out of range (these are the only two not in range out of dozens of different readings. I'll list them just as they are listed on the report.

THYROID STIMULATING HORMONE *8.26 uIU/mL: Reference [0.34-5.66]

PRO BRAIN NATRIURETIC PEPTIDE *469 pg/mL: Reference [<125]

I'm guessing that something is out of wack with my thyroid or something is causing my thyroid to be out of wack, but I have no idea what the second result means other than it's a lot higher than the reference range. I apologize for the rant but it took me 6 hours today just to find out what my INR result was so I would know whether or not to keep jabbing myself in the stomach with Lovenox or not. It's a good thing I was persistent or my INR might have been really high in another day or two. They are the ones that told me to get tested yesterday (Monday) and call to find out if I was in range (2-3) and stop or continue the Lovenex shots. I'm pissed that the lead cardiologist would tell me the morning of my discharge that I had "holiday heart" in front of his entire staff without looking at all of the information and test results. I'm pissed because I asked him for the numbers from the Cardiac MRI they performed and all he said is that there was "no significant change but that's on the back burner until we get you out of a-fib/flutter". I wanted to say "duh, but I asked you for my numbers from my MRI, not which issue is more important right now". BTW by numbers I mean my LV dimensions, aortic root size, ascending aorta size, and my level of aortic insufficiency. I know the EXACT numbers from my Cardiac MRI from a year ago, so if he would have just rattled off the latest numbers I would have automatically known if they had progressed and by how much. It also may have given me a clue of why I was in a-fib/flutter if the numbers had gotten worse.

Excessive drinking is one possible cause for a-fib/flutter. Hyperactive thyroid is another. Valvular degeneration is another. Left ventricular hypertrophy is another. Just going by pure mathematical odds it would seem that there is more going on than "holiday heart". But then again it could be that I'm just being defensive because I do drink more than I should. But he didn't even ask the details about my drinking habits, like the fact that I play a lot of golf and I generally drink 6 beers a day over about a 10 hour period...it's not like I'm banging them down and getting hammered.

OK...enough already...rant off.

 

[Bill B]

Hi Bryan:

An elevated TSH indicates possible HYPOthyroidism (low thyroid function), not hyperactive thyroid. Your pituitary gland is producing excess TSH in an attempt to get your thyroid gland to produce more thyroid hormone. The relationship between TSH and thyroid hormone is a classic negative feedback loop. If you had a hyperactive thyroid, it would lead to a reduced TSH, not elevated. BTW, alcohol can be involved in hypothyroidism.

The second test measures a hormone produce by your heart that is elevated in heart failure. As the left ventricle enlarges, it produces more of this hormone, which stimulates the kidneys to produce more urine in an attempt to reduce the blood volume and reduce the ventricular enlargement. You need to talk with your doctors about the implications of both results for you. BTW, alcohol can be involved in heart failure.

The effects of alcohol on warfarin are variable. Yes, it can reduce the effects of warfarin, but chronic alcohol use can accentuate warfarin and reduce the ability of the liver to produce clotting factors. Also, it sounds like you just started warfarin and have already reached an INR of 4. That's too high.

OK, pardon me while I rant too...
You seem to think 6 beers a day it is not having any effect on you because you don't get "hammered". Spacing the beers over 10 hours is keeping you from getting hammered but that doesn't make it harmless. You probably have heard all the lectures about alcohol and don't want another but I would be doing you a serious disservice if I just let this go. I have a degree and long experienced in pharmacology (study of drugs) and worked on the wards a large university hospital for 10 years as well as being trained at a VA hospital, where I saw and studied the effects of alcohol. I have no problem with alcohol in moderation at some intervals. However, 6 beers a day, every day for a year or longer is going to do you harm. You may not feel it, but you will. Alcohol is a direct cell toxin. Even a single bender causes measurable inflammation of the liver (hepatitis). The liver has tremendous capacity to regenerate and repair itself and can recover from repeated insults over years. But at some point it loses the battle and develops a chronic form of hepatitis. Over time the architecture of the liver changes, fibrous deposits form, the liver shrinks, blood flow through the liver is impaired, and it starts to lose basic functions. This is called cirrhosis and is irreversible. Because of the fibrosis and altered blood flow, pressure in the vessels that supply the liver, called the portal circulation, rises dramatically. When that pressure rises, fluid begins to move out of the vessels and into the surrounding abdominal cavity. This is called ascites, but is more commonly called a "beer belly". A beer belly might just appear to be an overweight condition, but when it's from cirrhosis it's really more like a water balloon. When people with cirrhosis and ascites lie down and you tap their belly you can hear a "splash". I'm not saying this is you or that you will ever get there, but that is what alcohol can do.

Anyway, I could go on with my rant, but I'll just summarize that alcohol, even at the level of only 6 beers a day is probably hurting your liver, heart and possibly your thyroid gland. This is all well documented. I didn't make it up to give you a hard time.

My understanding is that studies show that risk of atrial fibrillation is increased in men consuming more than 5 drinks a day. It may just be unfortunate that your doctors called it "holiday heart" making you think it is related to binge drinking. I would talk to your doctors more about that.

Also, alcohol consumption at your level is regarded as a risk factor for bleeding in patients with a fib taking warfarin.
http://www.stopafib.org/newsitem.cfm/NEWSID/252/

Bill

 

[Ross]

None of us would hold a dose for an INR of 4. Simply hold half a dose and lower your overall by 5 or 10% for the week.

Bill pretty much summed it all up. Nothing for me to say there, but in my opinion, I wouldn't consider 6 beers over 10 hours as heavy drinking. 6 beers in 1 hour, yes.

 

[kfay]

Bryan, I think Bill hit everything pretty much on the head here. The BNP test shows the degree of heart failure you may be in. Here is a link to CC's page on it. According to this, you would be considered to be in mild heart failure (http://my.clevelandclinic.org/heart/services/tests/labtests/bnp.aspx).

The only other thing I would add to Bill's info on alcohol is this, I know you are trying to get surgery to repair your heart and I think your body could have a very hard time going through this surgery with that level of daily consumption of alcohol. Look, I had a father who was an alcoholic, so I know first hand how difficult it can be for some to quit. But, I think you have an extra incentive, and I think it would really do you a lot of good to start decreasing that amount of alcohol. I really wish you the very best and am sorry you are having all these problems.

 

[Maryka]

Yow! I don't know much about all of those numbers of yours, but, I am also concerned about your self-medicating with beer. I am also concerned about how you were on Lovenox and coumadin together. I was warned against that combo by people in the "Anticoagulation" forum and, after 24 hours of that combo I started bleeding through my clothing, so dropped the Lovenox. I guess you were in the hospital for this combo treatment, but I would wonder how you can tolerate that combo?

Please find another relaxant other than alcohol! I would miss you greatly if you did yourself in!

 

[kfay]

Bryan, I want to add that a good percentage of people who are heavy drinkers can be malnourished. You may be out of wack with your magnesium and other minerals your body and, more specifically, your heart needs to function properly.


Kim

 

[Jeanie]

Edited to remove a sentence. I would be asking for a surgical consult right now, if I were in your shoes, to see if your aortic structures are deteriorating to the point that you need surgery sooner rather than later.

The BNP test is fairly new, I think, and as another poster said, is now being used to determine if someone has CHF. On the beer, you're a grownup, but if I were in your shoes I would switch to a red or at least rose' wine, supposed to be better for the heart due to resveratrol content from the grapes. I think you need a consult with an endocrinologist on the TSH, as both hypothyroid and hyperthyroid conditions can cause arrythmias. Did you ever take Amiodarone? If so, that is a drug that sometimes causes thyroid abnormalities which is why Docs are supposed to monitor thyroid function while someone is on it. Good luck and keep us posted!
Edited to add, I double ditto what Bill said, and agree that it is highly likely your electrolytes (such as sodium, potassium, magnesium etc) may be out of proper ratio. Did the docs check those recently? I've been told that even small decreases out of optimal blood level ranges of potassium or magnesium can be factors in arrhythmias. So, if you must self-medicate with alcohol, cut the consumption drastically (drink Gatorade after golfing instead!) and/or switch to a red or pink wine, following the example of the heart-healthy Mediterranean diet across the pond.

 

[AgilityDog]

And when you DO get surgery, you'll want to cut way down on the alcohol consumption in order to heal properly. I had an acquaintance who was an alcoholic. She broke her humerus (upper arm bone) and for over 3 years it did not heal, because she drank constantly, resulting in malnourishment. It was still broken when she died.

You don't want to prolong the healing of your sternum!

 

[Bryan B]

Like I said in my opening post I realize that drinking on average 6 beers a day is excessive. My question is whether or not you truely believe that drinking 6 beers a day when you've been consistently drinking that amount for the length of time I've been drinking at that pace would suddenly cause me to go into a-fib or a-flutter (i.e. "holiday heart"). I don't binge drink. The 6 beers a day does not consist of drinking none on one day and 12 the next. I can't remember the last time I got "drunk" because I never drink fast enough to reach that point. If I play golf I usually drink 3 beers during a 4 hour round, and I was usually walking (~5mi) during that time (until the a-fib/flutter made it impossible to walk while playing). Then I would come home, eat dinner, take a shower, and probably drink 3 more beers while surfing the net and/or watching a movie. Again about a 10 hour window. On a day when I didn't play golf I might only drink 4 beers over a six to eight hour period. Since I have been living with my parents during this time (and my mom is an excellent cook) I am eating well balanced meals and I am FAR from malnourished (the scales do not lie ) . Although this test result doesn't show my magnesium levels here are some of the results in that area and all but one is normal (UREA NITROGEN is barely out of range whatever that is):

COMPREHENSIVE METABOLIC PANEL

SODIUM 140 mmol/L Reference [135-145]
POTASSIUM 4.5 mmol/L Reference [3.5-5.0]
CHLORIDE 104 mmol/L Reference [98-108]
CARBON DIOXIDE 26 mmol/L Reference [21-30]
UREA NITROGEN *6 mg/dL Reference [7-20]
CREATININE 1.0 mg/dL Reference [0.6-1.3]
CALCIUM 9.7 mg/dL Reference [8.7-10.2]
PROTEIN TOTAL 6.7 g/dL Reference [5.8-7.8]
ALBUMIN 3.7 g/dL Refernce [3.5-4.8]
BILIRUBIN,TOTAL 0.6 mg/dL Reference [0.4-1.5]
ALKALINE PHOSPHATASE 65 Reference U/L [24-110]
ASPARTATE AMINOTRANSFERASE Reference 29 U/L [15-41]
ALANINE AMINOTRANSFERASE 35 U/L [17-63]
GLUCOSE 101 mg/dL [70-140]

I honestly wasn't looking for lectures although I appreciate the concern. I know I should probably drink less and I have cut back to about 4 beers a day since I was discharged (obviously I didn't drink at all while in the hospital with no physical discomfort or withdrawal symptoms).

As far as being on Coumadin and Lovenox together I honestly don't know enough about it to make an educated response other than when they took me to do the cardioversion they found a clot in my heart and wanted to make sure I was anticoagulated until my Coumadin level was in or close to the range they wanted. Since I have never been on Coumadin before I went into the hospital I had no protection at all. I had always thought that Lovenox bridging was to protect you until your INR level reached a safe level, maybe I don't understand how Lovenox is used to bridge patients as they ramp back on to Coumadin. I do understand why they use it to bridge as you're stopping Coumadin for an invasive procedure that requires that you are not anticoagulated. I thought they did the same bridging procedure afterwards until you were back in range. I do agree that they were aggressive with their approach, but when you have a blood clot in your heart that could break free at any time they probably felt that they needed to be aggressive in getting me anticoagulated ASAP.

OK...close to 10% of the population in the US meet the diagnostic criteria for alcohol abuse or alcoholism. So in theory 1 out of 10 people on this forum fall into this criteria. When I was working full-time I drank less than I do now, although I still probably drank on average 3-4 beers a day. What can I say...I'm of German ancestry and I love beer. I don't drink wine and I don't drink liquor...never have and never will. But I love beer. Did I mention I love beer? As a matter of fact I'm drinking one right now and it's very refreshing.

If I had recently increased my alcohol consumption I could possibly see that the change could throw my heart out of rhythm but I haven't. But I can see that I've reached the point where I have LVH (not mentioned last year) and my insufficiency has gotten worse. Trust me when I say I know a lot about my heart condition (I've been living with it since birth), and IMO this was not caused by my drinking. Again...that doesn't mean I don't realize I need to cut back on my drinking...not so much because I think the amount I drink is causing problems in my personal life but because it may complicate my heart problems. But then again I'm broke, I'm restricted from working, I've run into a brick wall with trying to get financial aid for surgery, and I can't stand not living my life the way I want to.

Again I appreciate everyone's input and I will take everyone's comments into consideration. There's an old saying not to judge someone until you have walked a mile in their shoes. That way you will be a mile away and you will have their shoes.

Thanks for all the responses. I truly appreciate them and don't take any criticism personally! I started this thread to get feedback on whether or not members here thought my a-fib/flutter was caused by alcohol or by complications from my current heart issues and I respect your opinions. But my gut tells me something more is going on here than "holiday heart", and my gut is usually right. I agree that my alcohol consumption is most likely not helping, I just don't think it was what triggered the problem. I've been "burned" before by accepting what doctors told me when my gut told me something else was going on and I have that same feeling now.

 

[AgilityDog]

It sounds like the doctors are not going to look for another cause for your flutter unless you stop drinking. So, the only way to know if the alcohol is causing your a-flutter, is to stop drinking and find out. If it is something else, the flutter will continue (unless the flutter is caused by damage from the alcohol or other reasons, in which case it will continue).

If you are not willing to stop the alcohol, you're not likely to find the cause.

 

[kfay]

Bryan, I'm not sure how your heart issues are progressing, but I know for what I have, new arrhythmias are not only a possibility but a probability as I age. That's one of the reasons my surgeon did a maze on me...I didn't have a-fib/flutter at the time of my surgery, but it is so common in my condition that they do it to try and prevent it from happening. So, it could very well be that you going into a-fib was your hearts way of saying that it is starting to not be happy with what's going on and have absolutely nothing to do with the amount of alcohol you are consuming.


Kim

 

[Ross]

The short answer for me to you is, I don't buy that the beer is the cause, though it may well contribute to it.

 

[Bill B]

There is no way to give you a definitive answer as to whether the acohol CAUSED the a fib. It definitely contributes. ON AVERAGE, consumption at your level raised the risk of a fib about 40% in the one most often quoted study. But that is a statistic. That means that over all the rate was not increased so dramatically that everyone who drank like that got a fib, but it was raised. In either drinkers or non-drinkers, a fib is rare. BUT some additional people developed a fib in the group that drank more than 5 drinks a day, like you, and that this was real. For the people who drank and developed a fib, it was very real. Still that doesn't mean it CAUSED it. These kinds of studies can never establish that. BUT when they controlled for other factors that could cause a fib, alcohol stood out a separate factor. So, it might not be directly casual but it's close enough. If you need to know for certain, I think you will never get that answered. Actually, it's the same for binge drinking. The association is based mostly on casual observations of incidents of a fib soon after drinking binges. So, I decided to give you the "lecture" on some of the other things alcohol defintely does, even at your sort of modest consumption. Over the long haul it could get real nasty.

Anyway, I do understand why you think your doctors may have jumped the gun blaming alcohol, and seem to be indicating they think you are a binge drinker and that you resent them not really investigating that with you before announcing that you did it by drinking. I really do get that. I see that you just want an answer and your not trying to deny it necessarily. Doctors are not always appropriate or right. Far from it. They certainly may be wrong and misguided in your case. That's why I encourage you to try to talk to them some more about this and get it as clear as possible. Right now, you have a fib, which can be debilitating, and they are blaming the alcohol.

Oh, and your other labs sure look good for the most part. However, albumin is on the low end of normal and so is urea nitrogen. Albumin is sort of a nutrional marker. Low UN can reflect low protein intake as well. Make sure you keep up on your nutrition so the empty calories in the beer don't replace good food.

 

[Ross]

Anyway, I do understand why you think your doctors may have jumped the gun blaming alcohol, and seem to be indicating they think you are a binge drinker and that you resent them not really investigating that with you before announcing that you did it by drinking. I really do get that. I see that you just want an answer and your not trying to deny it necessarily. Doctors are not always appropriate or right. Far from it. They certainly may be wrong and misguided in your case. That's why I encourage you to try to talk to them some more about this and get it as clear as possible. Right now, you have a fib, which can be debilitating, and they are blaming the alcohol.

I agree. Problem is, they aren't likely to take you seriously until you stop drinking. I for one, think doctors should stop playing God, telling people what they can and cannot do before treating them. That is not their job.

 

[RonP]

I for one, think doctors should stop playing God, telling people what they can and cannot do before treating them. That is not their job.

Sorry, I disagree. You're going to a doctor to address a health problem and/or to stay healthy. If the doctor feels that something you're doing is contributing to that health problem, he/she has full right to tell you to change your lifestyle. If you beat your head with a hammer every day and then go to the doctor each time asking him to stitch you up, that doctor has full right to ask you to stop beating yourself - before fixing you up.

A relative of mine had a massive haeart attack at 48. We was a heavy drinker and smoker. He was given a 1% chance to live - and he did. They worked on him for hours, bringing him back several times. A few weeks after his attack he saw the emergency room doctor in a social setting. The doc told him straight out - "You need to quit drinking and smoking or I won't work on you so hard next time. I did my part, now you do yours." He hasn't had a drink or smoked since.

Ron

 

[Jeanie]

Just curious, on the 'But then again I'm broke, I'm restricted from working' - how are you affording to buy so much beer? That stuff is not cheap. IMO, if you are capable of playing golf, you are capable of desk work. What kind of work have you been looking for? Edited to add, on the other hand, the economy is so tanked that many people are having trouble finding jobs. I hope things improve for you soon. I just saw a very interesting thing that may be helpful to read and think about, http://www.msnbc.msn.com/id/37230565/ns/health-aging/?ns=health-aging

 

[Jeanie]

It sounds like the doctors are not going to look for another cause for your flutter unless you stop drinking. So, the only way to know if the alcohol is causing your a-flutter, is to stop drinking and find out. If it is something else, the flutter will continue (unless the flutter is caused by damage from the alcohol or other reasons, in which case it will continue).

If you are not willing to stop the alcohol, you're not likely to find the cause.

This, definitely, is good advice, Try it!

 

[youngmom]

Sorry but this sounds more like condemnation and not consideration. Let's keep in mind here, we are a support group. No one knows exactly what goes on in a persons life so we should give good and caring advice.

 

[Jeanie]

Sorry but this sounds more like condemnation and not consideration. Let's keep in mind here, we are a support group. No one knows exactly what goes on in a persons life so we should give good and caring advice.

I am so sorry you are missing the point. If you were referring to what I said, it was not condemnation, but as with many of the other posters, it is something called REALITY CHECK, which is capitalized to make it easier to read for comprehension. Especially if someone does have an alcohol problem, one very well known feature of the problem is rationalizing/not admitting that there is 'a problem'. Just as his Doctors surely hope, we all would be very happy to see our 'ranting' online friend find a solution to his health problems. Providing a reality check in the realm of 'there are factors under your own control you could change' is actually a very caring level of response that those of us who have volunteered it have taken the time and trouble to try to provide. I really hope that helps.

 

[Cris N]

Bryan, while I somewhat agree with Ross' viewpoint about doctors shouldn't be judgmental - just treat the patient, I can also understand why a physician might be reluctant to pursue the cause and recurrence of your a-fib. I personally think that 6 beers a day is a few too many - partly because of the liver thing but also because of the risk of diabetes. I googled beer and a-fib and found that there is quite a bit of anecdotal evidence that the beer may be aggravating the situation. I wonder if you've thought about cutting down your consumption of beer (maybe in half) for a few months to see if that has any effect - and look at the other things you consume that may be triggers as well.

There are a lot of websites out there dealing with a-fib and I'm sure that some of our members come up with some of the better ones, but I was curious and googled a-fib triggers. While this is not a medical site, I found it rather interesting: http://atrial-fibdiscussion.tripod.com/id2.html

I do hope you get some resolution to your health issues in the near future