atrial flutter event and now testing

Hope the tests do not find anything concerning

by Gemita - 2024-05-31 05:31:57

Islandgirl, firstly I am so sorry to hear about your atrial flutter episodes although I am relieved to know that they stopped on their own without any intervention.  I can imagine how symptomatic you were with such high heart rates and how you feared getting a defibrillator shock. 

I don’t have an ICD or "confirmed" diagnosed heart failure, at least not yet, but my atrial heart rates can go briefly to dizzy heights during longer periods of atrial tachy arrhythmias.  I have a recording in the last few months of a 6 hour episode of an atrial tachy arrhythmia showing a maximum heart rate in the atrium of 545 bpm and in the ventricle of 174 bpm.  With heart failure, a high heart rate will clearly be difficult to tolerate and I hope adjustments to your settings and treatment for any acute illness might help to better control atrial high rate episodes so that they don't trigger ventricular tachycardia and a shock from your defibrillator.

My ventricular tachycardia rate monitor is just watching and set at more than 150 bpm before it triggers an event warning.  I have had several episodes of non sustained VT.  I am extremely symptomatic to all "irregular" heart rhythms, like AF, although I can tolerate regular heart rhythms much better, even sometimes at extremely high heart rates.  It is the “irregularity of rhythm” that really affects me.

Of course you must have been so frightened of getting a shock but your ICD clearly was able to determine this was an atrial arrhythmia at the time.  Yes high atrial rate episodes can happen for many reasons and I am sure they will make some important checks to see how your heart is functioning.  A decline in heart function or another health condition that may be present can quickly trigger a tachycardia event, so try not to imagine too much at this stage.  Stress in any form won’t help you at all.  Arrhythmias thrive on stress.  You seem otherwise to be in good health with low blood pressure, low cholestrol, good diet and no evidence of CAD.  I think you have every chance of stabilising your condition if your heart failure hasn't worsened.  Good luck and I will be keeping my fingers crossed for a good outcome 

Flutter

by AgentX86 - 2024-05-31 14:07:52

An atrial rate is quite normal for flutter. Actually, it's not really a rate, in that the atria aren't really beating at all. They're just sort of quivering but the electrical impulses are that high.  Often flutter is in the high 200s to low 400s. The AV node is responsible for limiting the conduction between the atria and ventricles, keeping the ventricals at a safe rate. Since you have a dual chamber pacemaker to "wire around" the AV node, your PM does the same thing.  All dual chamber pacemakers do the same thing (maximum tracking rate). It limits the rate, as you note, to prevent Vtac. This is its job. As long as your PM is doing its job, and it sounds like it is, I don't think there is a real danger of Vtach. or a shock.

I wouldn't worry too much about the flutter.  Yeah, it really sucks, BTDT, but I would be concerned about the troponin levels in conjunction with chest pain.  I'm surprised that they haven't been all over this. Maybe they have, and have come to a reasonable explanaton for it?  The nuclear stress test should give them a good picture of what's going on.

Good luck on your nuclear stress test, and let up know what you find out.  At least  what you know in the detail you're willing to share.

Troponin

by Selwyn - 2024-06-02 15:41:14

Troponin levels are used to support a clinical dagnosis of myocardial damage -therefore  this excludes angina.

Causes of raised troponin:

Congestive heart failure, acute or chronic Stable coronary artery disease Myocarditis (and endocarditis, pericarditis) Tachy- or bradyarrhythmias, or heart block Hypertension
Cardiac contusion/trauma including surgery, ablation, pacing Aortic dissection
Aortic valve disease
Hypertrophic cardiomyopathy
PE, severe pulmonary hypertension Renal failure
COPD
Diabetes
Acute neurological event Drugs and Toxins

You will note tachyarrhythmias  and heart failure are on this list.

Flutter comes and goes.  I have had atrial flutter twice associated with Covid. I think excessive exercise may trigger flutter. I must say anxiety can cause it or stop it . The shock of having my grandchildren stay with us ended a flutter of 1 months duration. Like yourself, havimg my wife drive me to hospital  was enough to stop one atrial tachycardia episode within 400 yards of driving.  So much easier than electrocardioversion! You can certainly try things like carotid sinus massage ( if there are no contra-indications- it is important to know there is no atheroma of the carotid artery) - this may help stop an atrial arrhythmia, as may other 'tricks'

(http://www.heartrhythmcharity.org.uk/app/webroot/files/file/factsheets/AA%20Physiological%20Manoeuvres%20Info%20SheetV2.pdf)

( https://www.wikihow.com/Perform-a-Carotid-Massage)