Answer:

Thank you for your question. Often when you are young and get into a warm shower or bath that causes you arteries to open up and dilate. This can drop your blood pressure slightly. When your blood pressure drops even a small amount your heart will start beat more forcefully or faster or both. Pruning of your hands and feet typically is from saturation of the skin with water. This later finding is usually more related to the time your hands and feet are exposed to water rather than a manifestation of the heart or a potential heart problem. You could try lowering the heat temperature of the shower and/or the time spent in the shower to minimize these symptoms. If your experience heart pounding forcefully, rapid, or pausing the next step is to consider wearing a heart monitor to truly understand the heart response to various conditions. You can’t wear these monitors in a shower, but they can be used immediately before and after. Another option to try is making sure to stay very hydrated, minimize periods of fasting, and use more salt in your diet. These measures will bring up your blood pressure and allow you to tolerate stress likely being exposed to hot water and having your arteries dilate. Finally, if your chest pain get worse, you should see your doctor. Chest pain even in somebody that is young like you can be significant and your doctor may need to evaluate it further with some routine tests.

Answer:

Thank you for your question. When you feel racing and pauses in your heart the best approach is to first understand what is happening with your heart. Sometimes a fast heart rate can be your normal pacemaker cells working in an exaggerated fashion (inappropriate sinus tachycardia) and other times there can be an abnormal heart rhythm. Sometimes what your are feeling is a normal heart rhythm but a forceful contraction. When you feel your heart pausing it can be extra beats. If these extra beats come very early it will feel like your pulse or heart just stopped or missed that beat. If you have are experiencing an abnormal heart rhythm, when this stops, it takes a period of time for your normal pacemaker cells in your heart to stop beating. In this case there is literally a pause in your heart. This pause can become longer over time as our normal pacemaker cells take longer to start beating. Sometimes everything that you are feeling is associated with a normal heart beat. Then we have to look at other causes for your symptoms. The best approach at this time is to gather more information. We do this by using heart monitors that you can wear over a period of days and push a button when you experience your symptoms. This will tell your doctor exactly what is causing your symptoms. Without this information, any physician regardless of how they treat a problem (medicine, natural therapies, catheters, etc), would largely have to guess of how to treat you best. Since a lot of the therapies have risks and side effects, I would recommend getting to the bottom of understanding your symptoms by using an ambulatory heart monitor.

Answer:

Thank you for your question. I am glad that you are interested in carefully managing your diet while taking Coumadin. When I start Coumadin in my patients, I tell them they need to carefully plan their diets each day, similar to a diabetic patient. You may want to meet with a dietician not only to understand quantify of vitamin K in a food source, but also learn meal planning strategies that will allow you to have a diverse diet. Sources of vitamin K on the web are: 1. http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=1 (United States Department of Agriculture) 2. http://nutritiondata.self.com/ (A comprehensive nutrition and supplement resource) 3. http://www.ars.usda.gov/main/site_main.htm?modecode=12-35-45-00 (nutrient data laboratory for specific quantify information) 4. http://ods.od.nih.gov/ (Office of dietary supplements)

Answer:

Thank you for question. There are a number of potential medications for atrial fibrillation. If you heart size and function are normal and you have no evidence of coronary artery disease then we can use all of them. If you have coronary artery disease then we can use – dronedarone, dofetilide, sotalol, or amiodarone. If you have heart failure, then we typically need to use amiodarone or dofetilide. The newest medication available is dronedarone. It is like amiodarone (an analog). It is not nearly as strong as amiodarone, but it also does not have the same risk of injury to the lungs and liver. It also does not interact with the thyroid gland like amiodarone. Dronedarone is only safe if you have not had any recent episodes of heart failure and your atrial fibrillation is such that it comes and goes. If you have heart failure or are in atrial fibrillation all the time you should avoid it.

Answer:

I believe we only have part of your question. It appears that your atrial fibrillation is progressing in severity to a more persistent subtype that requires cardioversion. This pattern is not surprising since you have valvular heart disease with both ventricular and atrial remodeling. Although amiodarone is a relatively cardiac safe medication in the setting of valvular heart disease, your age and pulmonary disease to me would be reasons to consider other options. These options include a washout of amiodarone followed by use of a less toxic medication versus catheter or surgical ablation. With you valvular heart disease and moderate-severe left atrial enlargement, if you are interested in a catheter ablation it should be performed by an operator that is experienced not only in pulmonary vein isolation, but also in mapping both micro- and macroreentrant tachycardias that are often seen in those with a surgically modified heart. The operator should take every possible precaution to minimize your exposure to fluoroscopy during the procedure and rely heavily on a 3D mapping system to avoid placing you at risk for various radiation-relative malignancies over your anticipated long life span. I would consider a percutaneous catheter-based approach before surgery since your prior procedure would preclude a minimally invasive approach.

Answer:

1ans. You have really been through a difficult course with you atrial fibrillation. Although atrial fibrillation typically develops with age, high blood pressure, sleep apnea, it can occur in the young with no additional risk factors. There is a subgroup of people at high risk that tend to be athletic, with a low resting heart rate when in a normal rhythm, and more often tall in stature. Success of your procedure will depend on how long you have been in atrial fibrillation at this point. Although you have had two prior procedures, our tools have evolved and are more effective and our mapping systems are more precise in comparison to 2008. The basic endpoints of the procedure are similar in that we want to first electrically isolate the pulmonary veins from the left atrium. In your case the electrical isolation may not have lasted or you have triggers for atrial fibrillation that are outside of the pulmonary veins in some other region in the heart. Most high volume centers will be comfortable with a person with you history that has had more than one prior ablation. In our center, success rates for those with a prior ablation that are now in chronic atrial fibrillation that undergo a repeat ablation are approximately 60-65% that we can get you to remain in a normal rhythm over the next year and off of all heart rhythm controlling medications. 2ans. I can understand your frustration as you have done everything you can to keep your heart healthy. In people like you there are unique risk factors, some of which we cannot control, such as our genetics. I have been interested in nontraditional therapies for atrial fibrillation for many years. Many have been proposed such as vitamins, antioxidants, and anti-inflammatory agents. For the most part, none appear to help with atrial fibrillation recurrence with the exception of fish oil, which in higher doses does help reduce abnormal rhythms of the heart. Also, there is an elegant study that examined the role of yoga after ablation and found that patients that actively participate in yoga had less recurrences of atrial fibrillation. From my standpoint, the yoga likely targets both physical and mental aspects of health and stress reduction. People that have kidney failure or advanced kidney disease are at higher risk of atrial fibrillation. If your kidney function is normal however, we have not observed an increased risk. Assessment of kidney function is common with routine blood tests. If you have been told you have excess biowaste products or abnormal levels of certain products in your body I would suggest to get a second opinion. The initial tests may be correct and you may have a specific need, but unfortunately we frequently see patients that have been involved in various schemes that take advantage of their desire to be treated naturally or have been given hazardous treatments from tests that were not standardized. 3ans. The Cleveland Clinic has an outstanding atrial fibrillation ablation program and will be very comfortable with your unique history and the fact you have had prior ablations. They also are a high volume center from which the best outcomes after ablation are achieved.

Answer:

Thank you for your history. Management of atrial fibrillation in patients with hypertrophic cardiomyopathy can be challenging. We found at Mayo Clinic, similar to work by Andrea Natale that patients that undergo ablation can experience favorable long-term outcomes in regards to control of the atrial fibrillation and quality of life. However, patients often require more than one procedure to achieve results similar to patients without hypertrophic cardiomyopathy. In addition, in patients that have more aggressive variants of hypertrophic cardiomyopathy, arrhythmia recurrences are more frequent and a more aggressive atrial fibrillation ablation approach used. There are limited data regarding the use of antiarrhythmic drugs in patients with hypertrophic cardiomyopathy. Sotalol and amiodarone have shown benefit in improving symptoms. Since your heart rate is slow and you are already on a very high dose of sotalol, you options largely are to consider another ablation (catheter based or surgical), try amiodarone, or also consider an AV node ablation with a pacemaker. I think that your idea of meeting to discuss a repeat ablation is a good idea not only to feel better but also to reduce your sotalol dose.

Answer:

I completely agree with you. I’m not a fan of drugs but when they work, why not using them. We have to keep in mind that the aim is to reduce the impact of AF on quality of life. If rate control doesn’t fulfil that goal, AA drugs have to be tried. You can even continue Propafenone at the same dosage. There is no dugs able to cure AF. What we look for is to reduce the number of episodes and their impact on your quality of life. I therefore don’t consider the 2 episodes you had as a failure. You can certainly increase the dosage up to 900 mg per day if your kidney function is normal and shift to Flecainide when Propafenone will be inactive. It may or may not work. Ablation is to be considered if at least one drug has failed. In other words, if you consider the present situation not acceptable with Propafenone, you could go for an ablation. I would suggest to wait a little longer with an increased dosage of Propafenone. Don’t wait too long as once the AF is permanent, ablation is more difficult and less successful.

Answer:

Yes, this is frequently observed and is probably due changes in the autonomic nervous system by ablation. The interruption of AA drugs may also explain it partly. But keep exercising and training and it will improve.