Answer:

Your endocrinologist is going to give you the best advice regarding the most ideal thyroid hormone replacement. You should mention your symptoms to them. In general, it is more a question of not being over replaced – that can be tested with a simple blood test. If you are still having symptoms despite this then you should consider seeing an electrophysiologist to discuss the treatment options for your tachycardia.

Answer:

There are several theoretical reasons why this could be. Chiefly, a change in blood supply to the kidneys and also there are hormones secreted by the top chambers of your heart in response to stretch (when you get AF). These make you pass more urine.

Answer:

Changing posture changes the blood return to the heart. It can stretch the heart which in the appropriate individual be a stimulus for extra beats. There are also several normal physiological reflexes that occur particularly in sleep that can aggravate this – please see the previous question. The chest pain on walking is concerning and you should see a cardiologist.

Answer:

It is likely that blood pressure is what is causing your heart to become abnormal such that you get AF. You should see a doctor to commence blood pressure medications and get advice on simple measures such as diet, exercise and weight loss that may help control the blood pressure. There are several reasons why AF is more common at night – largely related to how the nervous system affects the heart. That is, at night the relative influence of the nerve supply to the heart is altered and may favour the development of AF. There are a number of other things that can exacerbate this – lying flat increases the stretch of the heart chambers and one should also consider the possibility of sleep apnea. You should see your doctor to discuss these further.

Answer:

Your sister is receiving an accepted form of initial therapy for AF. Flecainide is used to keep her in normal rhythm but it can occasionally make the episodes of AF faster. Hence Digoxin is added to slow the rate during those episodes. She should keep in contact with her Cardiologist as there are a number of options if this first line strategy is not suitable.

Answer:

the evidence for interventional treatment for af is really in symptomatic patients. it is possible that in years to come that we may have evidence to treat asymptomatic patients – but this is not currently available. if you have no symptoms then your treatment would be appropritae. recommend that you keep in touch with your cardiologist to make sure that your rate control is adequate and that your heartremains structurally sound (usually a regular echocardiogram).

Answer:

the single lead that the paramedic had would have been adequate to diagnose af. the symptoms that you are describing are fairly typical of af. you should see a cardiologist to have an echocardiogram and an examination. you shoudl also have your thyroid function tested. there are several means of managing these symptoms – medication when you get an episode, regular medication or even interventional procedures to get rid of the af. these could be discussed by the cardiologist when you are reviewed. most electrophysiologist and cardiologist see patients where it has been hard to capture the arrhythmia.

Answer:

you are describing a typical natural course of af. it is likley that your heart has remodelled adequately such that your heart preferes to remain in af. the internal cardioversion is very likley to get you back to sinus rhythm. however, the real question will be is how long it keeps you in sinus rhythm.
usually flecainide is given in addition to another drug which slown the heart rate. recommend that you check with your specialist that you have got these instructionss correct.
if you have symptoms that are limiting what you want to be doing then it is worth considering af ablation. however, this is a much harder procedure than someone who has short episodes of af – so recommend that you see someone who undertakes may of these procedures.

Answer:

it is very likley that you self converted to sinus rhythm. there is no evidence that wither the cardizem or digoxin that you were put on has any impact in terms of restoring sinus rhythm. they simply work to slow the heart rate down.
warfarin is really used after assessing your risk of having a stroke. there is no doubt that if you have af you have a greater risk of stroke. it is really a question of whether your individual risk is greater than the risks associated with warfarin. this risk depends on other conditions you may have – previous stroke, high blood pressure, diabetes......etc. it would be crucial that you have an echocardiogram and be reviewed by a cardiologist for further advice on this.
in terms of other medications or ablation it really depends on how often you are going to be troubled by this. you should discuss with your cardiologist and make a plan on how you will manage af if it were to occur again.