AFIB & What are you doing about it?

[Still Hunter]

AFIB & What are you doing about it? Just had a episode. Hasn't happened again in about 30 days. Trying to decide whether to put in for the Elk draw or not.

 

[Marbles]

AFIB & What are you doing about it? Just had a episode. Hasn't happened again in about 30 days. Trying to decide whether to put in for the Elk draw or not.

As in atrial fibrillation A-fib? Or something else I'm not cool enough to be aware of?

 

[Still Hunter]

Yes, Atrial Fibrillation .

 

[fatlander]

I’ve got AFIB. Doc says I’m otherwise healthy, and just keeps an eye on it through a yearly check up. Says one day I’ll probably need an ablation, but I come out usually just as fast as I go in. As low of risk for stroke as one could be otherwise. Young, low resting heart rate, great BP, low cholesterol, etc.

I run a lot, lift a lot, and hike a lot. Eat pretty clean and don’t drink much at all besides a glass of red from time to time. Cardio has never been a limiting factor for me on any hunt.


Sent from my iPhone using Tapatalk

 

[Marbles]

This is just general information. I'm not going to try to personalize it because unless you are in the state of Alaska I don't have a license to treat you, and even if you are I don't take that responsibility for free.

This may be way too detailed, I'll try to trim it as best I can while still providing enough detail that you can make a better decision.

A-fib is one of those things that really depends on the person. Some people don't know they have it until we find it on an EKG and their rate stays in an appropriate range, some people feel absolutely horrible when they are in it, and some feel bad if their heart rate is too fast, but fine if it is slowed down. This leads to two different management strategies, rate control or rhythm control. Selection is pretty much solely based on how a person feels with A-fib.

Rate control is simple, use either beta blockers (metoprolol, bisoprolol, carvedilol, Etc) or nondihydropyridine calcium channel blockers (diltiazem or verapamil). Most people feel fine on these medications, some people do not, which can lead to a change in strategy. If A-fib is rare, short acting versions of these can be used on an as needed basis (also called a pill in pocket approach).

If A-fib is really rare, and short duration, oftentimes watchful waiting is the correct approach.

Rhythm control can be as simple as a cardioversion, some people will go years between episodes and this works well for a while. The other strategies are either antiarrhythmics or an ablation. In general both of these work pretty well, however all antiarrhythmics are high risk medications with rare, but very serious side effect and any time we are freezing/burning someone's heart there is the possibility for major complications. This is why we limit rhythm control to people who have degraded quality of life in A-fib.

With any strategy, stroke risk needs to be assessed to guide the decision for anticoagulation or not. In this there is no zero risk option, the goal is to find the lowest risk option for each individual. Anticoagulants are commonly called blood thinners, though they do not actually change the thickness of bleed.


A little more detail on A-fib. It is a problem in the electrical system of the top chambers (atria) of the heart. The electrical system is composed of a network of cells that reside on the inner surface of the heart. Each cell can generate a heart beat as a back-up to the primary pacemaker, in a healthy heart they do not because they are constantly being triggered to fire earlier then the rate they would go if left alone (this is called overdrive suppression, because the default rate of the cell is suppressed as it is driven to operate at a faster rate).

With time we accumulate scare tissues in our hearts, eventually some cells stop getting a signal from other cells (you can think of it as the cell becoming deaf), it no longer hears the marching leader and thinks no one else is calling cadence, so it starts to fire. Just like we can still hear a deaf person, most of the time the rest of the hearts electrical system can still respond to that cell. Get enough cells doing this at one time and you get chaos, that we call A-fib.

Now, in A-fib the atria do not contract effectively, however atrial contraction only provides about 10% of the ventricles (the main working chambers in the bottom of the heart) fill volume, so most healthy hearts don't notice that loss. However, this leads to blood sitting in some pockets in the atria, and when blood sits it tends to clot, which is why A-fib has an increased stroke risk. Usually, what makes people feel bad is a ventricular rate that is too high.

The ventricular rate differs from the atrial rate in A-fib because of the AV node, which is a normal heart is the only electrical connection between the top and bottom chambers. The AV node will not let every electrical impulse through as it cannot reset and respond at the rapid rate set in the atria, but it will randomly let impulses through. Rate control basically focuses on slowing down the AV node response.

The randomness of the impulses to the bottom chambers results in them being fired at various stages in the filling cycle, so some heart beats will be strong while others will hardly generate a pulse (this is predominately what causes people who feel bad in A-fib regardless of their rate to feel bad).


My general take, once something is causing you to avoid something you want to do, it is time to fix it. However, the question you need to answer (and would be best answered with the help of a cardiology provider who has a patient-provider relationship with you), is should this limit what you do, or should you just role with it for now.

Anyway, there are more nuances to management, but I think this post is already overly long.

Good luck. The following is not advice because I don't know enough details on your situation, and see the first paragraph, but if it was me, I would put in for the tags.

 

[5MilesBack]

I first had A-fib at 26 in 1991 a few months after getting back from the Persian Gulf, along with all the other unexplained ailments and symptoms from being over there. But it took quite awhile before it was actually diagnosed. I wore a heart monitor several times and couldn't seem to replicate it. It seemed to happen a lot during or after working out, except when wearing the monitor. It would last for a few hours generally and then disappear. It is very uncomfortable for me, and the best I could describe it to the doctors besides the heart jumping around or fluttering was "it feels like nausea in the chest".

It was finally diagnosed when I was driving my wife to her doctor's appt and it started while on the way there. I had the Dr. listen to my heart and he put me on an EKG. He wanted to put me on blood thinners for the rest of my life and I declined. I've seen a few cardiologists since then and they've all agreed that it's best to just monitor it at this point. A stress test did show some minor episodes, but not enough to cause them much concern I guess.

It's been a few years now since I've noticed an actual episode. I do get a bunch of PVC's pretty frequently, but those only last for seconds instead of hours. I did have an episode that I thought was A-fib early last year, but it turned out to be PAC's.....which I guess are fairly harmless. I have never changed my plans or planned my hunts around any of it though. But I would let your Dr. dictate any concerns about that. Good luck.

 

[Still Hunter]

I really appreciate the input guys! I am putting in! Archery Elk is my absolute passion!!

 

[VernAK]

My AFIB got to the point where I couldn't do much of anything so my Dr lined me up with an ablation in Anchorage. It worked so well that I shot a dall ram 94 days later.......I was 69 at the time.

 

[AK_Skeeter]

My AFIB got to the point where I couldn't do much of anything so my Dr lined me up with an ablation in Anchorage. It worked so well that I shot a dall ram 94 days later.......I was 69 at the time.

I have 2 hunting partners who have been happy with the results from ablation procedure in Anchorage.

 

[VernAK]

I have 2 hunting partners who have been happy with the results from ablation procedure in Anchorage.

I was apprehensive about Alaska Heart Institute and inquired about having it done at Mayo. They told me Dr Compton teaches the procedure there and many other places.

 

[Spoonman]

I’ve had afib for years. The doctors can not determine why I have it. I’m very healthy and have none of the typical things that afib is associated with. I take my blood thinner and beta blocker and live my life. I am scheduled to do a cardio ablation later this year.

In the event you have an episode you can try coughing it back into rhythm. It works for me.

When hiking I take it a little slower just to keep my heart rate down a bit. I have always been the one hauling as up the mountain but now I take it easy.

Sounds like you are in controlled acid so Keep hunting, keep living your life. Look into what makes sense for you and your family.

 

[Still Hunter]

I’ve had afib for years. The doctors can not determine why I have it. I’m very healthy and have none of the typical things that afib is associated with. I take my blood thinner and beta blocker and live my life. I am scheduled to do a cardio ablation later this year.

In the event you have an episode you can try coughing it back into rhythm. It works for me.

When hiking I take it a little slower just to keep my heart rate down a bit. I have always been the one hauling as up the mountain but now I take it easy.

Sounds like you are in controlled acid so Keep hunting, keep living your life. Look into what makes sense for you and your family.

Great Response. I really appreciate the positive feed back.

Getting a lot of push back from the spouse and my employer. Spouse because she loves me and likes my paycheck every week (typical woman) , employer because he doesn't want to get stuck with all my projects if I should happen to die in the Mountains, LOL!

 

[Spoonman]

Great Response. I really appreciate the positive feed back.

Getting a lot of push back from the spouse and my employer. Spouse because she loves me and likes my paycheck every week (typical woman) , employer because he doesn't want to get stuck with all my projects if I should happen to die in the Mountains, LOL!

Originally my wife was not a fan of me going on hunting trips. I’ve done multi day bear trip up in the Cascades in Washington for years and it’s absolutely my favorite thing to do. I was not going to allow this to stop that. I continued to take care of my body and take the two medications I mentioned earlier and live my life. Having Afib and hunting is no big deal, the biggest thing you need to worry about is if you are on blood thinners is to steer clear of hitting your head. I’m on year 8 with Afib and I’m 45. Do not let this derail who you are and what you love to do. If you stop doing the things you love to do that will kill you faster than Afib (Afib not likely to kill you if you take care of yourself)!

I’ve had two Afib events in the backcountry. It sucks and is kinda scary. I was able to to get back in rhythm by taking a good long break, coughing really hard,(on purpose), getting cooled down, and reducing my heart rate.

Both reasons you mentioned by your wife and employer were selfish reasons. I’m sure you were particularly kidding but also there was truth behind it. You need to be selfish a bit as well and do what makes you happy.