Don’t ignore your symptoms

When my symptoms began, I dismissed them. Stress, I thought. Something I ate. Even when my episodes became more frequent, I was cavalier about seeing my doctor. I could almost certainly have avoided my trips to the emergency room if I had paid attention to my symptoms and taken action sooner. If you have symptoms, don’t wait. See your doctor as soon as possible and get a diagnosis. Not only can the symptoms of atrial fibrillation be associated with more serious health issues, but leaving your atrial fibrillation untreated can make you more susceptible to future episodes.

If you don’t know what’s going on in your body, it’s better to be safe than sorry. See your doctor.

Doctors are not the final answer

While I have the utmost respect for my doctors, I quickly came to the conclusion that they couldn’t be the last word on my condition. Doctors have a natural bias toward pharmaceutical and surgical interventions and little knowledge or enthusiasm for alternatives. Listen to your physician, but don’t let them prevent you from exploring other options.

Take responsibility for your own health

This follows from the last point. Your doctor knows a lot, but it’s your life. Ultimately, you will have the make the decisions about your treatment and live with the consequences of your choices. There are many options that are worth exploring that your doctor won’t tell you about. I quickly learned that if I didn’t want to take drugs or entertain the possibility of an ablation (a medical procedure that destroys areas of the heart responsible for causing abnormal heartbeats), I would be on my own. I pursued other methods for managing my atrial fibrillation and that’s how I found the most relief.

Avoid drugs whenever possible

I’m not advocating that you ignore your doctor’s advice, but always ask if there are other options. Almost all (if not all) drugs have potential side effects (many vitamins, herbs, and supplements can have side effects, too). Many of these effects are not fully understood when drugs are prescribed (consider the case of Fosamax, an osteoporosis drug now linked to atrial fibrillation). Once you begin taking medications, you’re on a slippery slope. Many people take medications to manage the effects of other medications they’re taking.

As soon as I began taking Diltiazem, I began the search in earnest for alternative treatments; I didn’t like the way the drug made me feel. If you haven’t started taking drugs yet, and your doctor says it’s okay to wait, explore your alternatives first. If you’re already taking medication, ask your doctor if the alternatives you’re considering are safe. If they are, try them. If they help, ask your doctor about reducing or eliminating your medications.

Absence of evidence is not evidence of absence

One reason your doctor is unlikely to be supportive if you want to try alternatives to conventional treatment is that most vitamins, herbs, and other supplements have not been extensively researched. Most physicians practice evidence-based medicine; they’re reluctant to prescribe something that doesn’t have validation from controlled studies. Ignoring the fact that much of this research is itself questionable, and that the main reason there is a dearth of research on non-pharmaceutical alternatives is because they can’t be patented, keep in mind that the absence of evidence is not evidence of absence, i.e., just because something isn’t proven to work doesn’t mean that it doesn’t work.

If you ask your doctor about a supplement, they’re likely to respond with, “There’s no evidence for that, but if you think it helps, it’s okay.” I’ve had three doctors tell me this almost word-for-word. If they don’t tell you outright that something you want to try is harmful, or interacts with medication you’re already taking, don’t be afraid to experiment. No one knows everything.

Treat the whole body, not the parts

Doctors like to break the body down into its constituent parts. If you talk to a cardiologist, he’s narrowly focused on the heart. Specialization is great—I don’t want my family doctor doing open heart surgery—but it also has it’s limits. Your cardiologist may not know anything about nutrition, for example. If you have other symptoms, he may not know if—or how—they relate to your atrial fibrillation. There’s no question in my mind that improving your health generally will improve your atrial fibrillation. Don’t be narrowly focused on treating your symptoms; take the initiative to do everything you can to become more healthy.

Start with your diet

The first thing I learned when I saw the cardiologist in the hospital was that my diet was a likely culprit in my atrial fibrillation attacks. I was dehydrated, had low potassium, and high blood sugar. When I got home, I read the packages of my recent diet of frozen pizzas, chips and salsa, cereals and ice cream. All of these processed foods were extremely high in sodium (which depletes potassium, necessary for healthy heart function), high in simple carbohydrates (which raises blood sugar, a risk factor for atrial fibrillation), and inflammatory (which may have contributed to my pericarditis, which exacerbated my atrial fibrillation).

One of the healthiest things you can do is eat a healthier diet. Change your diet, change your life.

Everyone is different

A medication, vitamin, or herb that works for someone else may or may not work for you. The same is true for other alternative treatments. I have a brother who can interrupt his episodes by bending over and bearing down as if he’s going to the bathroom. I’ve tried it; it didn’t work for me.

This principle applies to diet and nutrition, too. While there are general guidelines for healthy eating that apply to almost everyone (eat less, eat more fruits and vegetables), your constitution and current state of health requires a diet tailored to you. The principle is called bio-individuality. You’re unique.

How do you know, then, what’s right for you?

Learn to really listen to your body

Pay attention to your body. You don’t have to become a hypochondriac, just become intimately familiar with how your body feels and what makes you feel better or worse.

For example, I noticed that I felt worse at night if I slept on my left side. I later read that this is a common experience for people with atrial fibrillation. So I tried sleeping on my right side. Sure enough, that felt better. I also noticed that I felt worse if I stuffed myself at dinner, especially if I ate later in the evening. Again, I’ve since read that this is also a fairly common experience. I now try to eat dinner around 6:00 PM and to stop when I’m comfortably full.

I took this a step further and bought a stethoscope and began listening to my heart when I was relaxed and in normal sinus rhythm. Later, when I was having symptoms, I would sometimes listen to my heart with the stethoscope and remember what my heart sounded like when things were normal. I found it surprisingly comforting.

Go slowly and keep things simple

Try everything, but do one thing at a time and pay careful attention to your body. Your body is your lab. Experiment and notice what works or doesn’t work. It’s a good idea to take notes. Track how you’re feeling, what you’re doing when you experience symptoms, what you’ve been eating and what supplements you’ve been taking.

If you try supplements, try one new supplement at a time, take a small dose and slowly increase it to the recommended dose. If you’re desperate for help, then try several things and, if you begin feeling better, cut back on them one by one. Notice the effect on your body.

I’m a big believer in taking vitamins, herbs, and other supplements, but I’m not big on taking more than necessary. These substances can also have side effects or deleterious effects that are not well known. Some of them may be useless and a waste of money.

Don’t be afraid to try different options. Keep learning.

Status: Draft. Last edit: 05.27.08

First, note these warning signs of heart attack:

1. Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
2. Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
3. Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
4. Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

—From the National Heart Lung and Blood Institute’s site, Act In Time to Heart Attack Signs

If you have these symptoms, be safe, not sorry. Call 911.

If you feel comfortable enough not to call 911, here are some alternative steps you can take that may help you convert to a normal sinus rhythm (normal heartbeat):

Drink a glass of water. Palpitations are sometimes caused by dehydration. Don’t drink any alcohol, coffee, tea, or soft drinks. Alcohol and caffeine can trigger atrial fibrillation, and the phosphorus in soft drinks can deplete magnesium (see below).

Eat a banana. Atrial fibrillation can be caused by a lack of potassium, usually because of too much salt in the diet. Bananas are high in potassium, as are tomato, prune, and orange juices. But read the labels; some juices have high amounts of salt. Stay away from salt! See this list of high potassium foods. Note: Most vitamin supplements that have potassium also include large amounts of calcium. I don’t recommend taking extra calcium if you have atrial fibrillation; calcium is excitatory to the heart.

Eat some pumpkin seeds. Magnesium is essential for a normal heartbeat. Try eating some pumpkin seeds, which are high in magnesium. If you don’t have any pumpkin seeds, try brazil nuts, almonds, cashews, pine nuts, or any of the foods on this list (scroll down to Appendix B-7). If you have a magnesium supplement, you can take that, but only if it doesn’t include calcium. If you have some epsom salt, you can take an epsom salt bath. Epsom salt is magnesium sulfate; you’ll absorb it through the skin. If you can’t take a bath, try adding water to the epsom salt to make a poultice and apply it to your wrists.

Dunk your head in cold water. Fill a sink with cold water and plunge your face in it. Sometimes this little jolt can help.

Lie down. Or, do some exercise. Some people find that symptoms improve if they lie down and try to relax. Others find that doing a little exercise, which makes the heart beat faster and then slow down, helps even more. You’ll just have to experiment to find out if either of these suggestions work for you.

Try some belly breathing. Lie down or sit comfortably, and relax. Breath through your nose to a count of four, slowly filling your belly. Exhale through the nose or mouth for the same four count. Breathe deep into your belly, not your chest. Make the inhalations as long as the exhalations and breathe in a circle, i.e., don’t hold your breath on the inhale or exhale. You can also try breathing into the belly and holding the breath for a count of ten (stopping if you feel uncomfortable), then resume breathing rhythmically to a count of four.

Listen to a normal heart. If you’re not alone, ask someone if you can listen to their heart. I know this sounds strange—and you’ll want to be selective about who you ask—but I have found it surprisingly helpful. The phenomenon is known as entrainment. Your heart will tend to slow down to match the slower, normal heartbeat. Try it.

If your symptoms continue or worsen, go back to the top of this post. It may be time to call 911.

When you’re feeling better, come back and read my other recommendations for managing atrial fibrillation.

Status: Draft. Last edit: 05.26.08

Though all of these recommendations should be helpful—and safe—for almost everyone, be sure to consult with your physician before trying them. If you have not already seen a physician, don’t wait; these symptoms may be indications of more serious conditions.

Recommendations

First, eliminate potential triggers: alcohol, caffeine (coffee, tea, chocolate), and any stimulating herbs (ephedra, ginko biloba, ginseng, guarana, horny goat weed, etc.).

Check for side effects of any prescription medications you’re taking. Also, check for stimulants in any over-the-counter drugs you’re taking (e.g., pseudoephedrine).

Reduce sodium. This is difficult since almost all packaged foods contain added sodium. Read the labels. Intake should be less than 2400 mg per day. Stop using table salt. Sodium depletes potassium, essential for the heart.

Increase intake of potassium. You can take supplements (try Source Naturals Potassium Amino Acid Chelated 99 MG – 100 Tablets), but it’s best to get as much potassium as you can from food: bananas, prunes, oranges, tomatoes, raisins, etc. Two of the best sources are blackstrap molasses and coconut water.

Increase intake of magnesium (this is the single most helpful thing I have found). Deficiency is common and magnesium is necessary for a normal heart rhythm. Food sources include dark green, leafy vegetables and nuts, whole grains, and fruits. But if you’re having symptoms, you’re most likely deficient and would benefit from supplementation. I use magnesium citrate (Natural Vitality Natural Calm OZ – 16 Powder), an inexpensive and easily assimilated form, and experienced improvement almost instantly. Start with a spoonful mixed with hot water and work up to as much as 1200 mg. per day (stop if you get diarrhea; magnesium is a laxative). It’s best to divide the dosage into two or three drinks per day. If you take it an hour or so before bedtime, it will help you to relax and you’ll be less likely to experience a racing heart or anxiety in the middle of the night.

Take a good, low-dose multi-vitamin (more is not always better), such as Nature’s Plus Source Of Life Multi-Vitamin W/Whole Food – 90 Tablets.

Experiment with other helpful supplements. We’re all different; what works for me may not work for you. I also take taurine (try

Jarrow Formulas Taurine 1000 MG – 100 Capsules) and CoQ-10 (try

Nature’s Life Coq 10 30 MG – 60 Softgels). These are both helpful for the heart.

Eat a heart healthy diet. Simply put—eat more fruits and vegetables. I consider these three books essential reading: Eat to Live and Eat for Health, by Joel Fuhrman, M.D., and Prevent and Reverse Heart Disease, by Caldwell B. Esselstyn, Jr., M.D.

Get some exercise. Walking even 15 or 20 minutes every day will help.

Drink ample fluids. Dehydration can contribute to atrial fibrillation.

Status: Draft. Last edit: 05.23.08

Causes of Atrial Fibrillation

1. Aging
2. Alcohol
3. Caffeine
4. Cardiomyopathy
5. Coronary Heart Disease
6. Dehydration
7. Heart Valve disease
8. High Blood Pressure
9. Hyperthyroidism
10. Illicit Drugs
11. Mitral Valve Prolapse
12. Pericarditis
13. Pneumonia
14. Prescription Drugs
15. Sick Sinus Syndrome
16. Stimulants

Status: Draft. Last edit 05.20.08

A Little History

I went to the emergency room with atrial fibrillation on February 15, 2008. I’d had a few mild episodes of rapid, erratic heartbeat several years before, sometime in 2002. I would feel my heart begin to race, feel anxious and weak, and have to lie down. Within an hour or so, I usually felt a bit better and went about my business. I did ask my doctor about it and he hooked me up to an ECG (electrocardiograph) machine, pored over the paper as the graphs sputtered out, and said everything looked normal. Probably stress, he said. If it really bothered me I could go to the emergency room when it was happening and they should be able to tell me more. I had a few more mild episodes after I saw him, but nothing that would make me want to go to the emergency room, and sometime later, without my really doing anything, the episodes went away.

Last fall, the episodes began again. They always started at night, either sometime before I went to bed (usually around 10:00 or 10:30 PM) or in the middle of the night. My heart would start to race, I would feel anxious and weak, maybe a little lightheaded. I would lie down and feel a bit better after a while, but I would toss and turn all night or be aware, even in my dreams, that my heart was leaping. Usually, after I got up in the morning, sometimes after breakfast, I would begin to feel normal again and wonder, What the heck was that all about?

I also noticed around that time that I had a chronic pain in my chest, a kind of dull ache. I had taken up archery in the fall and thought I must have pulled a muscle or strained something. It never seemed very serious—some days I would barely notice it—so I didn’t pay much attention to it.

The episodes began to come every month or so, then every few weeks. I wondered if it was something I’d eaten. I thought I was a pretty healthy eater—no sodas, no candy (well, a little chocolate and some Chunky Monkey ice cream), limited red meat—and I took a handful of miscellaneous supplements (whatever was touted in the latest Men’s Health magazine). But I began to wonder if I was low in calcium, or wasn’t eating enough salt, or maybe I was allergic to something? In other words, I didn’t have a clue. But I recognized, after the episodes continued to become more disconcerting, that I needed to see a doctor, something I am always reluctant to do.

It took me a long time to see a doctor. My old doctor had switched to a concierge plan, limiting his practice to those patients who would pay a yearly fee to be under his care, with an emphasis on prevention. A good idea, but I always thought of myself as too young (51) and too healthy. I had to do an intake interview with the nurse practitioner to be a new patient with my new doctor and because of various scheduling issues it took me a couple of months to get in. I finally saw the nurse and told him about my symptoms. He took copious notes and said he’d fix me up with a treadmill test, whatever that was, to rule out cardiovascular disease. I had little idea what he was talking about, but at least I was finally taking some steps to solve the mystery.

Emergency

I never made it to the treadmill test. At least, not to the test the nurse practitioner scheduled for me.

The evening after my appointment, I begin feeling anxious. My heart starts racing and I feel weak. It’s almost bedtime, so I think I’ll just go to bed and sleep it off as I have so many times in the past. But this night is different. I feel slightly better for a few minutes—and then it gets worse again.

My wife, Meg, hovers over me, checking in. Should she take me to the hospital? No, let’s wait a few minutes. I already have an appointment to have things checked out. It’s always passed before.

But it continues to get worse. Finally, I relent. We get dressed and get in the car. The hospital is only about five minutes away; no need for an ambulance. I’m ushered into the emergency room immediately. They hook me up to the ECG. They take a chest x-ray. They take a blood sample.

My heart rate is about 190. The doctor comes around—a slender, gentle woman with a soothing voice—and explains patiently (no pun intended) that I have atrial fibrillation. She gives me a simple explanation, very similar to the description on my Discharge Instructions:

“Atrial Fibrillation” is a condition where the heart beats in an irregular pattern. It is due to a disturbance in the electrical pathways of the heart. It is a sign of heart disease or other health problem affecting the heart.

The most common symptom is “palpitations”. This is the feeling that your heart is fluttering or beating fast or hard or irregular. When the heart beats too fast it does not pump blood very well. This can cause other symptoms such as anxiety, fatigue, shortness of breath, chest pain, dizziness or fainting.

Atrial Fibrillation may come and go, lasting from a few hours to a couple of days. Or, it may become chronic, lasting for months at a time or longer.

I’m given a drip of Cardizem and “convert” (my heart returns to normal) a short time after. They keep me awhile to make sure I’m okay, then send me home with a prescription for Diltiazem (Cardizem) and the number of a cardiologist. I’m scolded for having Meg drive me to the hospital. I’m instructed to take one 120 mg tablet “if rapid palpitations recur”, wait and hour, then take another one. “IF LIGHTHEADEDNESS, SHORTNESS OF BREATH, CHEST PAIN, NAUSEA, SWEATINESS, THEN CALL 911 IMMEDIATELY.”

But I think I’ll be good for another month. A few weeks, at least.

911

The next night, I wake up in the middle of the night to pee. When I crawl back into bed again, the race horse breaks out of the stable. I give Meg a little nudge and tell her my heart is at it again. Should we call 911? No, I’ll just pop one of these tablets.

A few minutes later, my heart is still galloping and I begin shivering. Should we call 911? No, let’s give it a few minutes to work.

Minutes later, I’m shaking. I can’t lie still. I feel nauseous and lightheaded. My chest hurts. What did they tell me in the hospital? “IF LIGHTHEADEDNESS, SHORTNESS OF BREATH, CHEST PAIN, NAUSEA, SWEATINESS, THEN CALL 911 IMMEDIATELY.”

Meg calls 911. Within a few minutes, the doorbell rings and five athletic guys walk in with a stretcher. I’m not sure why it takes five guys, but they’re young and buff and Meg isn’t complaining, and they hook me up the ECG and begin quizzing me about my symptoms. I don’t feel any worse, but I can’t stop shivering. I’m rattling the bed. They can’t get a read because the electric blanket is on, but they give me some nitro and cart me out to the ambulance. I half expect the neighbors to be out, standing on their lawns in their pajamas and bathrobes, but it’s probably about two in the morning and the cul de sac is quiet. In the ambulance, they give me some more nitro for the chest pain. I’m still shaking, they don’t know why, but I’m beginning to relax.

At the hospital, my heart rate is only around 120. Why was I lightheaded and nauseous? Oh, that’s probably just a side effect of the medication. But since I’ve had episodes two nights in a row they decide to keep me for the day and overnight the next night. They have to move me from the emergency room, though, and most of the hospital is booked. I get an upgrade to a private room in Intensive Care. I think I may have the IC Unit to myself. They hook me up to the ECG and the blood pressure cuff and tuck me in.

Do I Hear an Echocardiogram?

It’s now Sunday afternoon. As I’m undergoing an echocardiogram, the cardiologist arrives. They have trouble getting a clear picture of my heart from every angle—something about my rib cage getting in the way—but one thing is clear: I have pericarditis, inflammation of the pericardium, the thin membrane that surrounds the heart. Oh, and pericardial effusion, fluid in the pericardium. This in itself, I discover later, can cause arrhythmias, including atrial fibrillation.

On Monday morning, the cardiologist stops by again. He wants me to wear a Holter monitor, a device about the size of a beeper that records the heart’s rhythms, for 30 days. In the meantime, I should also have a treadmill test. When that’s out of the way, I should see him in his office for a follow up appointment.

He prescribes Cardizem CD 180 mg once a day, plus an aspirin (81 mg once a day). I’m given my discharge papers.

DISCHARGE DIAGNOSES:

1. Atrial fibrillation in sinus rhythm.
2. Hypokalemia [low blood potassium], resolved.
3. Normal lipid status, except low HDL.
4. Borderline elevated blood sugar of 109.
5. Mitral valve prolapse [a heart valve defect], anterior mitral leaflet mild.
6. Small pericardiac effusion, probably due to pericarditis.

This post will be updated. There’s more to the story.