Answer:

Many thanks for your email. Your family history is certainly concerning, and so while your symptoms could represent many things I recommend you see a Cardiologist and a Neurologist for these symptoms. The chest pain and shortness of breath may need to be evaluated using a stress test by your cardiologist, while your right face/arm numbness may warrant screening of the arteries that supply your neck and also a quick screen for an irregular heart rhythm called atrial fibrillation. To avoid unnecessary delays, I would try to get these referrals soon. Please remember that we physicians always say that if you have chest pain at rest - particularly if it does not go away - please go to the ER. Similarly, if you have numbness again, please go to the ER.

Answer:

Thanks for the interesting question. In general, your father\'s physicians are doing the right thing to bridge him with heparin and lovenox. These things are a fine line, but since he cannot have full blood thinners while they place the new line, this is a very reasonable plan and would be followed by many physicians since it minimizes the time that he is without a blood thinner.

Answer:

Thanks for the interesting questions. Yes, it is possible to diagnose an accessory pathway from the ECG without doing an EP study - if it is a clear pattern and under the right circumstances. Based on what you are experiencing, I would go with your Cardiologist\'s advice based on the results of your Holter. If you have ever had a blackout or near blackout, you should tell you cardiologist straight away. Decisions about coumadin depend on many factors, and should be made by you with your doctor after a proper discussion. Thanks.

Answer:

Many thanks for this interesting and enlightening observation. If you search the internet, you can find several reports that raw ginger (or drinking ginger tea) has helped others to reduce their AF. However, there are very few, if any, scientific studies on this subject yet. Thus, it is now clear how ginger may work. However, if it works for you please continue (in moderation!). Watch the literature for further developments, and thanks again for your email.

Answer:

This is a very important question. In general, most practitioners anticoagulate based on the CHA2DS2VASc score, and not based on AF burden per se. Thus, since your CHA2DS2VASc score is zero, most practitioners would agree with using no agent or aspirin - even though you are in AF 30% of the time. The opposite argument is also true - in a patient with a high CHA2DS2VASc score (2 or more), most practitioners would recommend anticoagulation with warfarin or a newer agent regardless of the precise amount of AF. In summary, based on this information your cardiologist\'s opinion seems sound.

Answer:

This is a very important question, and Yes, there are several studies on this topic. In general, most practitioners anticoagulate based on the CHA2DS2VASc score, and not based on AF burden per se. Thus, if your CHA2DS2VASc score were high you would be anticoagulated with warfarin or a newer agent regardless of the precise amount of AF you have. Accordingly, since your CHA2DS2VASc score is zero, many would consider placing you on no agent or potentially aspirin even though your AF is 30% of the time. Thus, your cardiologist\'s opinion seems very sound.

Answer:

Many thanks for this question. The short answer is that you may never be fully accurate in determining if your skipped beats come from the atria or ventricles. There are some \"classical\", \"old school\" tips, but these are not fully reliable. For instance, if the beats go away when you are exercising, they were previously felt to be ventricular. However, this is not always true, and one could have atrial and ventricular beats. It is odd that the event monitor has not picked these up. It is worth going through the tracings and your diary log (of symptom times) with your Doctor. Please make sure that the time on the event monitor is the same as the time on your watch. If, after checking all of this, your \"skipped beats\" do not correlate to any rhythm irregularity, then your symptoms are likely from something else.

Answer:

Thanks for the question and the interest in FIRM. Actually, several FIRM studies are underway, with the major ones at the moment led by Dr. John Miller, Chief of Arrhythmia Medicine at Indiana University. Several more are expected in the near future. FIRM is being used by several groups with PVI, but also as standalone FIRM-only. Both appear very successful. Since new data is being gathered, it is worth each patient discussing these options with their doctor to ensure the most up-to-date decisions.

Answer:

This is something that your doctor should advise you about. First, it is important to know if you have any other symptoms when you have your palpitations, or when your heart rate goes up to 184. These symptoms may include chest pain, shortness of breath, dizziness, lightheadedness or if you have blacked out or nearly blacked out. Second, you should record what was happening when you get palpitations. When you see your doctor, this information will be useful. I would definitely try cutting out caffeine and alcohol completely, to see if that makes things better. Third, these symptoms may reflect many things: they may be normal (at your age, your maximum heart rate with exercise may be up to 200 beats/minute), they may reflect a heart rhythm abnormality, or they may represent one of several problems with other parts of your body that are causing rapid heart rates. I would avoid going to the gym or pushing yourself too much with exercise until you have discussed this with your doctor.