Your heart rhythm | Cardiac Health

Palpitations, arrhythmias

A Bloody Pericardial Effusion

Question:

My father was recently hospitalized with a pericardial effusion and atrial fib/flutter with a rate of 160. Rate was decreased over 24 hours to 110-115 on amiodarone and diltiazem. His cardiologist wanted to perform a chemical stress test. (He had a negative cardiac cath 2 years prior). My father felt that he was unable to tolerate the test, so he requested to speak with the cardiologist (who never came back to seem him). Two days later, 750cc of bloody fluid was removed via pericardial centesis (needless to say by another cardiologist). My question is – Why would the cardiologist want to perform a chemical stress test on a patient who has a heart rate of at least 110 and who has 750cc of fluid around his heart? Would this not be detrimental to the patient and what was to be gained from performing this test when clearly CAD was not an issue and the pericardial effusion SHOULD have been priority?

Good question, so why don’t you ask that cardiologists? When the pericardium becomes inflamed, the amount of fluid between the heart and the pericardium increases. This squeezes the heart and restricts its action and in his case, may have caused the AF/Flutter.

Sick Sinus Syndrome Treatment

Question:

I am 76 years of age and have been diagnosed with sick sinus syndrome. The suggested treatment is metoprolol and a pacemaker. I have not had any symptoms such as, light headedness, fainting, or tiredness, other than the feeling of the sometimes erratic heart beat.
I am concerned of the possible side effects of the beta blocker and wonder if there are some natural beta blockers that could be used instead.

Patients with Sick Sinus Syndrome may develop alternating too slow and/or too fast heart rhythms, also known as tachy-brady syndrome:

Like in your case, often patients don’t have any symptoms, or if not, may present with fatigue, dizziness, palpitations, and (near) fainting. Sick sinus syndrome may be aggravated by some drugs that include Beta Blockers.

Pectus excavatum afib genetics

Question:

I’m 27. I had pectus excavatum that became noticeable at puberty . I had the nuss procedure done at 19 years old and the bar removed at 21 . It went well and I noticed I had better exercise tolerance afterwards. My dad and family members have no history of pectus however my dad was just diagnosed with afib atrial fib after he got sick and went to the dr. He is 72 and for all he knows this was his first episode. He also has sleep apnea and an underactive thyroid but otherwise healthy and they said his heart was normal.
I’m wondering does having had pectus excavatum increase my risk of afib later on and also since my dad just got afib at 72 does that increase my risk . The last time I went to the doc for a regular checkup the dr felt my heart and didn’t say there was a murmur or anything wrong, however I’m just wondering how genetic is afib . I read one article that said 2/3 of ppl who had lone afib had some degree of pectus . Does my risk go done now that the pectus has been repaired for several years ? Thanks

Hi Ben,

A pectus is sometimes associated with cardiac conditions such as Marfan’s Syndrome and Mitral prolapse.

So-called lone atrial fibrillation sometimes develop in younger patients without any evidence of cardiac or other disease, with a higher incidence occurring in patients with a pectus excavatum. It has been postulated that mechanical compression may be a cause for chronic irritation of the heart, hence AF. I don’t know whether patients with a successful repair run the same risk. Genetics play a role in Marfan patients.

Hope this helps,

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Is an abnormal EKG with LBBB dangerous?

Question:

I am a 78 yo male who has been a long distance runner for over 30 yrs. I have been healthy; 5’7,127 lbs. My blood pressure has been borderline hypertensive over the last year so I take the smallest dose of HCTZ and take 5mg of simvastatin (chol 178, Hdl 79). Last week I had severe dehydration due to food poisoning and went to urgent care after I passed out. They did an EKG which showed LBBB. The next day I went to my Dr who did another EKG, which was perfectly normal and gave me IV fluids to rehydrate me. He sent me for a cardio lite stress test and today I had that and when I first started on the treadmill my EKG was normal then as I progressed my EKG converted to LBBB. I have no symptoms and had resumed biking and running after I got over my GI upset without problem. I thought all was ok so should I be worried?

(from: Training for a Heart Attack)

A Left Bundle Branch Block (LBBB) that comes and goes when you are stressed may be suggestive of coronary artery disease.

When Are New PVCs Dangerous?

Question:

Have PVCs, more when relaxing, had holter am going for stress test and echo. No pain or shortness of breath. Given 20 mg of propranolol. On meds for HBP, now BP is very low 121/53. Should I discontinue the BP meds? Am 62 yr old female. Are these PVCs life threatening. They came out of nowhere two months ago.

The cardiac tests are done to find out whether you have coronary artery or other heart disease, the most important factors to exclude when new onset PVCs occur. They include blood tests, an echocardiogram and often a cardiac stress test.

Should I have an ablation for Afib?

Question:

I have afib that is gradually getting worse.Several years ago i had an IVC filter placed after my second PE I failed tykocin and amiodarone The only two options i have been given is to have the filter removed and a catheter ablation or a surgical ablation They are not sure they can take the filter out Would like to avoid the surgery Any suggestions The only med they suggested was maybe Sotalol

Hi Kari,

Hold on a minute! These are the issues:

An IVC filter is placed to limit blood clots from below to travel to your heart and lungs and potentially cause a pulmonary embolism, but is otherwise unrelated to a AF and/or the need to perform an ablation.

Recurrent Rhythm Problems After Cardiac Ablation

Question:

I have had 2 ablations to treat afib – after the second ablation last October, after a rough start to the blanking period, things calmed down very nicely. About three weeks ago, the arrhythmias returned and are now 24-7 (I was paroxysmal)and are not what was traditionally afib like for me (high pulse/very high bp), now when the arrhythmia occurs my pulse is likely to be relatively low (low 100s) and my bp is skewed (120/100). My EP has moved his practice to another state and I would rather not to go through all the testing again when it may be nothing more than a anomaly of a prolonged blanking period. Is there anyway to more definitively access what is happening? During this past month, I have also noticed a marked breathlessness when doing any sort of exertion even walking a short distance.

Electroanatomic map of the posterior left atrium, illustrating the pulmonary veins: right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). The red circles represent actual discrete radiofrequency applications, predominantly delivered in a circumferential pattern around the pulmonary veins. This ablation strategy can isolate pulmonary vein foci that initiate atrial fibrillation, and/or alter the substrate of the left atrium to inhibit fibrillatory activity due to reentry. Image courtesy of American College of Cardiology Foundation.

Cardiac Health Video Q&A 4/25/2014

Even though I had some techncal problems before and during the presentation, I believe this video session was a worthy first endeavour:

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