Saturday, February 19, 2011

Understanding Atrial Fibrilation

After a 36-hour raptured appendicitis, the excruciating pain and toxins must have led his heart to 180 beats per minute (normal range is 60 to 100 beats per minute).  At that point in time, there was no other option but to proceed with the surgery.  The procedure lasted for more than three hours, it took a while to find his appendics (it's physiologically not where it is supposed to) and to clean up the abscess in the intestines.

Post operation recovery was more difficult, not necessarily physically but emotionally and mentally.  Morphine kicking in affects your state of mind, even in your dreams.  It would be a difficult condition for someone with a frail fighting spirit.  Everyday was a roller coaster ride, a different symptom comes up every single day.  Blood in the urine, chest pains, bloated extremities... I don't know how he managed to keep a positive outlook, but I was down.  In the middle of a working day, I was in tears.  More so when he starts narrating his will and testament, the thought of it is just so morbid and no matter how much I held back, I can't help but show my tears in front of him.  He's just my strength and my wisdom.

He was diagnosed to have Atrial Fibrilation.  According to wikipedia:

the heart's electrical conduction with atrial fibrilation
Atrial fibrillation (AF or A-fib) is the most common cardiac arrhythmia (abnormal heart rhythm) and involves the two upper chambers (atria) of the heart. Its name comes from the fibrillating (i.e., quivering) of the heart muscles of the atria, instead of a coordinated contraction. It can often be identified by taking a pulse and observing that the heartbeats do not occur at regular intervals. However, a stronger indicator of AF is the absence of P waves on an electrocardiogram (ECG or EKG), which are normally present when there is a coordinated atrial contraction at the beginning of each heart beat. Risk increases with age, with 8% of people over 80 having AF.
the heart's electrical conduction with sinus (normal) rhythm

Atrial fibrillation is often asymptomatic and is not in itself generally life-threatening, but it may result in palpitations, fainting, chest pain, or congestive heart failure. People with AF usually have a significantly increased risk of stroke (up to 7 times that of the general population). Stroke risk increases during AF because blood may pool and form clots in the poorly contracting atria and especially in the left atrial appendage (LAA).

  • Medication for prevention of stroke:
According to his cardiologist, Dr. Viola of Chong Hua Hospital in Cebu, the risk of stroke happens at the moment when the patient shifts in and out from sinus (normal) rhythm to AF.  The risk is managed down to 1% by taking anticoagulant drugs such as Coumadin.

Coumadin (crystalline warfarin sodium) is a brand of anticoagulant medication. "Anti" means against and "coagulant" means causing blood clotting. Coumadin controls the way blood clots inside your blood vessels.  It helps your body control how fast your blood clots. It helps prevent clots from forming inside your blood vessels and heart. If you already have a blood clot, it may prevent the clot from getting larger. It does not dissolve a blood clot; however, the clot may dissolve on its own.

While under medication, regular blood test is necessary, the results help the doctor decide the dose that will keep a balance between clotting and bleeding.  Internal bleeding is a common side effect, however the cardiologist imply, between two evils, it's easier to treat internal hemorrahge rather than stroke.

Large amounts of foods high in vitamin K may change the way it works. It is important to limit foods high in vitamin K to a ½-cup, cooked serving or one 3-ounce, raw serving per day. Foods rich in vitamin K includes anything green: green leafy vegetables, green tea, peas, avocado, seaweed, beef liver, soy oil, tofu, lettuce, turnip greens, seaweed, and spinach.
  •  Rate control vs Rhythm control (Cardioversion):
He had two cardiologists with different schools of thought.  One is very conservative, the other completely aggressive.  The former went for medication while the latter went for electrical cardioversion.

Rate control seeks to reduce the heart rate to one that is closer to normal, usually 60 to 100 bpm, without trying to convert to a regular rhythm through medication.

Rhythm control seeks to restore with cardioversion the regular heart rhythm and maintain it with drugs. Studies suggest that rhythm control is mainly a concern in newly diagnosed AF, while rate control is more important in the chronic phase.

Cardioversion is a noninvasive conversion of an irregular heartbeat to a normal heartbeat using electrical or chemical means 

  • Electrical cardioversion involves the restoration of normal heart rhythm through the application of a DC electrical shock.
  • Chemical cardioversion is performed with drugs, such as amiodarone

Electrical cardioversion was a quick decision to be made.  After consulting with physician relatives in the states, their first question was, "was he shocked out of it?"  That statement made us a little more complacent, it only means that it's a normal procedure, who would have thought, getting yourself shocked is good for the heart!  Possibility of lung failure is high with electric cardioversion and when there are clots, it has to be busted prior to electrical cardioversion.  He was relatively healthy, after talking through the risks with his cardiologists, he was confident with going through it.  I would have wanted to witness it but the team covered the room from viewing.  He was sedated for an hour, the cardiologists checked for any clots and there was none, so they proceeded with electrical cardioversion.    Next thing we knew, he was awake and his heartbeat back to sinus rhythm.  He did not remember anything that transpired during the procedure.

For 36 hours, he was in sinus rhythm.  Unfortunately, it went back to AF.  He feels dizzy with occasional chest contraction/breathing difficulty when it shifts.  They had to go for the next option: chemical cardioversion with amiodarone.

At this point, the cardiologists were left with no option but to continue to manage the AF with medication out of the hospital and slowly go back to his usual routine.  One cardiologist suggested, if he wished to jog tomorrow, go ahead  while the other insisted on taking it slow.

When he was given clearance to move out of the Coronary Care Unit, his heart beat went sinus rhythm.  It has been like that since, but when he started to reduce the dosage of his medication, the other day, he was at AF again and out.  AF is a condition that may not necessarily be treated (unfortunately) and needs to be managed.

P.S.  Aside from the above, other more invasive options includes ablation and pacemaker.  Do consult your doctor.


Dr. Viola, John Reynaldo M.D.
(032) 2561850
Chong Hua Medical Arts
[Mon-Sat, 2:00pm-6:00pm]
Room #306

Entienza, Roy M.D.
(032) 2561850
Chong Hua Medical Arts:
[Mon-Sat, 2:00pm-6:00pm]
Room #306

Association of Private Duty Nurse:
Rate: P800/8 hours + P100 home service + P50 night duty

Omar 091762358741  (absolutely recommended)

Nenette 09228646382

Other independent nurses:
Orland 09224242457
Celia 09228001117


Sun Jun said...

from touching and heartwarming to nerdy and scientific to advertising ^^

I hope your dad gets better in time. I guess at their age, taking management medications really isn't that unusual anymore. meron nga iba in their 40s pa lang meron na. :-(

get well soon uncle! kaya mo yan ^^

freeze said...

thanks sun jun! we'll he's trying to let go of those meds and wanting to go for vitamin therapy.

Search This Blog