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Glad you're feeling better, but I still don't feel comfortable with your syncopal attacks being unexplained.
You've been able to exercise without incident, but a cardiac treadmill test oughta be done to see if your dysrhythmia is rate dependent, and an echo to see if you have ASH/IHSS or AS.
I'm not sure what "strange lines" on your app means....a fib is not a big problem, but it doesn't account for syncope...and dysrhythmia + syncope is a nasty warning sign.
Finding nothing doesn't mean there's nothing to be found.
Glad you're feeling better, but I still don't feel comfortable with your syncopal attacks being unexplained.
You've been able to exercise without incident, but a cardiac treadmill test oughta be done to see if your dysrhythmia is rate dependent, and an echo to see if you have ASH/IHSS or AS.
I'm not sure what "strange lines" on your app means....a fib is not a big problem, but it doesn't account for syncope...and dysrhythmia + syncope is a nasty warning sign.
Finding nothing doesn't mean there's nothing to be found.
The cardiologist explained that AFib could result in fainting as my heart is not efficiently pumping blood. However, he believed the most likely cause was borderline dehydration and low sodium due to a Losartan/HTCZ prescription for HBP. He lowered my Losartan dose my 75% with no diuretic.
I have a follow up with the Cardiologist later this month. A stress test is may still be in my future.
Good...don't know about you, but I'll sleep better tonight knowing that.
Overly aggressive tx of HTN in the 60+ crowd is a common cause of light-heartedness/near syncope/syncope particularly on rising quickly....I would have stopped the Losartan and continued the diuretic. ..Watch for fluid retention now that you're on the Losartan without the diuretic. When that fall inbp is the cause of LOC you wake up immediately as you lay down and the blood flows to the brain again.
A very rapid HR is like over-reving an engine, floating the valves and losing compression....but you gotta be awfully fast (180bpm+) for that to happen, and when it does, you're very lucky to wake back up without resuscitation.
Good...don't know about you, but I'll sleep better tonight knowing that.
Overly aggressive tx of HTN in the 60+ crowd is a common cause of light-heartedness/near syncope/syncope particularly on rising quickly....I would have stopped the Losartan and continued the diuretic. ..Watch for fluid retention now that you're on the Losartan without the diuretic. When that fall inbp is the cause of LOC you wake up immediately as you lay down and the blood flows to the brain again.
A very rapid HR is like over-reving an engine, floating the valves and losing compression....but you gotta be awfully fast (180bpm+) for that to happen, and when it does, you're very lucky to wake back up without resuscitation.
Well, for sure it's not a good thing ( unless you're young and running a marathon or something) though my heart rate during SVT episodes before I started on metoprolol would be clocked somewhere between 200 and 210. Fortunately they would usually last only a few minutes, though sometimes they went on and on and that's where the intervention came in ( IV adenosine for me) to restore NSR. It's always been my understanding that a prolonged heart rate that high over time could cause a tachycardia-related cardiomyopathy ( and possibly death over time) and heart failure if not brought under control, and the progression of the tachycardia into being incessant would be the worry for someone having increasingly frequent short-lived tachycardias, so the need to treat them. Of course with rapid atrial arrhythmias like A-Fib, A-flutter or atrial tachycardia with rapid ventricular response there is the danger, I understand, of going into ventricular tachycardia or possibly V-Fib, which is deadly.
Even with the meds I take I still get atrial tachycardias, including A-Fib breakthroughs, mostly lasting a few seconds to a couple minutes with an occasional one ( usually A-fib they tell me) lasting 1-3 hours. I have a pacemaker ( sinus node dysfunction, now with some heart block so bradycardia when its not "tachying") with remote wireless monitoring so my heart activity is picked up on reports sent to my cardiologist and cohorts.
The cardiologist was telling me that they pick up atrial tachycardias ( atrial high rate episodes) on my pacemaker reports, characterized as either atrial tachycardia (AT), or atrial fibrillation. He said that the average heart rate they see on my reports for an AT episode is 170, and the rate for an AFib episode is 130. I don't have a high burden of either one of these, though, so I don't think there is any concern at this point for a tachy or A-Fib related cardiomyopathy or heart failure. I think I have to credit the pacemaker for keeping the old ticker running regularly most of the time.
The cardiologist explained that AFib could result in fainting as my heart is not efficiently pumping blood. However, he believed the most likely cause was borderline dehydration and low sodium due to a Losartan/HTCZ prescription for HBP. He lowered my Losartan dose my 75% with no diuretic.
I have a follow up with the Cardiologist later this month. A stress test is may still be in my future.
I guess it's possible, though as I have read the symptoms of A-Fib more often include feeling tired, light-headed and possibly short of breath, these symptoms result from the the poor perfusion of the blood to the brain and other organs from the inefficient pumping of the blood during A-Fib. The shortness of breath is a compensatory attempt by your body to increase the oxygen to your organs under those circumstances.
What happens sometimes that can result in fainting related to A-Fib episodes is a pause in the heart beat as the A-Fib is ending and the heart is resuming the normal sinus rhythm. Sometimes there will be a pause of anywhere between 2- ?8 or longer seconds after the A-Fib stops and the normal rhythm resumes. If this pause is more than a few seconds ( the heart is not beating during this pause), the person may well pass out, though he/she will regain consciousness as the normal heart beat resumes. That pause doesn't always happen but may do so especially if the person has cardiac sinus node dysfunction- these folks often have A-Fib as part of that problem. Depending on the frequency of these episodes, or other issues a patient has, the person may have a dual chamber pacemaker implanted or the docs may treat the A-Fib and figure the pauses will disappear when the A-Fib is resolved.
Such episodes may well be so infrequent they're not picked up on a Holter or other short-term monitoring. This is why patients who have recurrent fainting episodes for which a cause has not been determined will often have a long term implantable cardiac monitor ( such as a Linq) placed under the skin on the chest. These have a monitoring life span of3-4 years, and will document cardiac activity at the time the fainting episodes are occurring.
A stress test will show your cardiac perfusion at rest and following exercise ( either treadmill or IV medication that gets your heart going like you were exercising) as a function of the coronary arteries, so it's looking at your cardiac "plumbing". Though they also do a continuous EKG with electrodes attached at rest and during the exercise, and can document heart rhythms as they occur relative to rest or may be triggered by activity, the stress test isn't used to diagnose cardiac electrical or rhythm problems. It's important to have that stress test to rule in or rule out coronary artery disease which if present can make any rhythm problems more dangerous, or worse. But in the event your fainting episodes continue and can't be explained from results of other testing, an implanted monitor might show the cause.
There you go-- you have an abnormal cardiac conduction system. CAD &/or valve disease needs to be needs to be ruled out.
An abnormal conduction system can result in simple a fib- easy enough to treat, but the syncopal attack suggests it may be a more comp!icsted situation, possibly including episodes of extreme tachy (fast) or Brady (slow) HR s, V tach/V fib episodes or complete heart block, which may require pacemaker implantation.
As a student, I invented a very small, very powerful battery for cardiac pacemakers, but I naively sold the rights to Sears for just the royalties. It turned out to be a marketing bust...Nobody would buy a pacemaker battery called a Die Hard.
I had Die Hard batteries in my Pickup & fishing boat.
I was in AFib for a little over 8 hours. The nurse gave me an injection that instantly lowered my heart rate to normal, but it also lowered my BP to a concerning level. I remained in AFib for another 20-30 minutes or so before returning to a normal rhythm, narrowly avoiding a cardioversion. All in all, a fun sleepover in the hospital.
Long story short, the cardiologist believes that the loss of consciousness may have been, in part, provoked by a medication that has a diuretic component. He, working with my soon-to-be new PCP, significantly reduced the number of medications that I have been taking and added metoprolol.
He also recommended a few lifestyle changes, most of which I was already doing so it looks like things are heading in the right direction.
My PCP at the VA hospital added Metoprolol for me, & stopped me from taking Atenolol
Well, for sure it's not a good thing ( unless you're young and running a marathon or something) though my heart rate during SVT episodes before I started on metoprolol would be clocked somewhere between 200 and 210. Fortunately they would usually last only a few minutes, though sometimes they went on and on and that's where the intervention came in ( IV adenosine for me) to restore NSR. It's always been my understanding that a prolonged heart rate that high over time could cause a tachycardia-related cardiomyopathy ( and possibly death over time) and heart failure if not brought under control, and the progression of the tachycardia into being incessant would be the worry for someone having increasingly frequent short-lived tachycardias, so the need to treat them. Of course with rapid atrial arrhythmias like A-Fib, A-flutter or atrial tachycardia with rapid ventricular response there is the danger, I understand, of going into ventricular tachycardia or possibly V-Fib, which is deadly.
Even with the meds I take I still get atrial tachycardias, including A-Fib breakthroughs, mostly lasting a few seconds to a couple minutes with an occasional one ( usually A-fib they tell me) lasting 1-3 hours. I have a pacemaker ( sinus node dysfunction, now with some heart block so bradycardia when its not "tachying") with remote wireless monitoring so my heart activity is picked up on reports sent to my cardiologist and cohorts.
The cardiologist was telling me that they pick up atrial tachycardias ( atrial high rate episodes) on my pacemaker reports, characterized as either atrial tachycardia (AT), or atrial fibrillation. He said that the average heart rate they see on my reports for an AT episode is 170, and the rate for an AFib episode is 130. I don't have a high burden of either one of these, though, so I don't think there is any concern at this point for a tachy or A-Fib related cardiomyopathy or heart failure. I think I have to credit the pacemaker for keeping the old ticker running regularly most of the time.
Without getting too technical, heart tissue has a refractory period after each electrical depolarization. Various sections of the heart have different t refractory periods. The refractory period corresponds to the period of time after you flush a toilet and you can't flush it again.
The atria may be able to flutter away at 220/min but most of those beats can't get thru tbe AV node, (the toilet has just been flushed, so to speak) so the ventricular rate doesn't usually go much over 180. If it does, the ventricles don't have time to fill very much between beats, so cardiac output falls and you faint....If the you're not resuscitated or if the heart doesn't spontaneously convert itself, you're down for the count.
When those fast heart rhythms continue to be a problem, the treatment is to implant an artificial pacemaker and set it at 70+/- and then load the pt with things like beta blockers to slow the natural rate way down so the device works full time.
Electrophys studies may show accessory pathways and radio ablation may be done to solve the problem. Most pts require 2 or 3 ablation procedures before it works.
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