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Rapid heart beat. Done with stress and echo tests. Prescribed Verapamil. Was in atrial fibrillation

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Last Nov I experienced a rapid heart beat running to catch a bus. I had to stop several times and once on the bus it took ten minutes to breathe normally. Two days later walking to home same thing happened. I went to cardiologist after two stress and echo tests and twice wore a halter monitor. He said my heart was strong and no apparent blockage. He did say I had atrial flutter not atrial fibrillation. I was on Diovan 160MG, Crestor 10MG and baby aspirin and Vitamin D 1000MG. In the next couple of months he gave me VERAPAMIL 120 M, stopped changed to RAMIPRIL 2.5mg STOPPED WENT TO MATTZIM 240mg STOPPED AND WENT TO DILTIAZEM 240 MG and stopped Diovan. I continually feel short of breath. He thought I may have lung hypertension. I went to pulmonary doctor who took all tests chest scan etc. Ruled out everything except small nodules on lungs but no treatment required. in XXXXXXX while walking my legs gave in and I had to hold on to wall and my wife helped me walk to restaurant.I could only walk a couple of blocks before having to stop and rest. Few days later both ankles and feet swelled up like a balloon. EKG now showed that I was in atrial fibrillation. He gave me FUROSEMIDE 20mg and XARELTO 20MG , stopping baby aspirin and added Divan 80MG.It took a week for swelling to clear up. In July I had cardioconversion which was successful in returning to normal rhythm. He also gave me Multaq 400MG. A few weeks later I was back in afib. He gave me another echo test and found hearth to be strong. He stopped Multaq and gave me Furosemide 10MG to take for two weeks and then may try cardioconversion again on Sept 23rd appt. I continue to feel short of breath everyday and he can not find the cause. It seems I am getting nowhere with his trial and error. Should I get a second opinion? I am 79 year old male, 5'7" 165 lbs do not exercise.

Posted Wed, 2 Oct 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 7 hours later
Brief Answer:
please see details.

Detailed Answer:
Respected Sir
1. Atrial fibrillation (AF) in old age with possible high blood pressure is more likely to stay (or come back again) rather than converting permanently to normal rhythm. It depends on many factors though. Left atrial size/ degree of left ventricular hypertrophy/ age are few of them.
2. AF definitely contributes to shortness of breath by various mechanisms.
3. Yes. Since you have persistent shortness of breath without relief you should seek a second opinion. I would like you to be evaluated for restrictive heart diseases (a group which is often missed by many echocardiographers).
4. Beside lung and heart, systemic causes for shortness of breath should be looked into. These are low hemoglobin, low iron, deranged kidney functions, muscular weakness, obesity etc.
Hope this helps.Feel free to discuss further for more clarifications.
Above answer was peer-reviewed by
Follow-up: Rapid heart beat. Done with stress and echo tests. Prescribed Verapamil. Was in atrial fibrillation 15 hours later
Dr did say echo showed left ventricular was larger. Should I do another conversion? Please expand on what is restrictive heart diseases. Should my cardiologist do evaluation or who? I did tell my internist about shortness of breath problem. He took special blood test and said results were negative. I do have muscular weakness in left leg. I had polio when I was two and left leg is 1-2 inches shorter than right leg. Would this have any bearing on my condition.
Answered by Dr. Sukhvinder Singh 12 minutes later
Brief Answer:
please see details

Detailed Answer:
Respected Sir
1. If your left ventricle is larger than normal ? That has an entirely different meaning. Please upload your ECHO report (right hand top of the page) because I sincerely feel that something is missing.
2. The decision for cardioversion depends upon many factors. Your treating doctor will be the best judge. I will provide you insight & better understanding of the things.
3. Restrictive heart diseases is a group of cardiac diseases where relax-ability of heart is reduced. This presents with AF and shortness of breath at times. Your ECHO doctor and your clinical cardiologist can evaluate for this. ECHO will be diagnostic to a large extent. Beside AF, patient will have valvular regurgitation, enlarge atrias and normally functioning small ventricles.
4. No, polio of leg will not effects your breathing now at this age.
Hope this helps. I am waiting for your ECHO report. Please do write if there is anything else in your mind.
Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Rapid heart beat. Done with stress and echo tests. Prescribed Verapamil. Was in atrial fibrillation 21 hours later
I don't have an echo doctor and I don't have an "echo" report. My cardiologist did all 3 echo tests. He just said at last echo test that left ventricular seemed to be larger. What are implications of larger ventricle ? Also a number of times I feel "achy" over my whole body and get light headed and have to sit down.

I do very much appreciate your trying to help me but I don't know where to go from here. As I said I am scheduled to see my cardiologist on Sept 23rd.

Thank you.
Answered by Dr. Sukhvinder Singh 12 minutes later
Brief Answer:
please see details.

Detailed Answer:
Respected ma'm
1. A large left ventricle can belong to 2 different disease processes; with normal pumping function and with decreased pumping function. Causes for enlargement with normal functions are mainly severe valve leakage, congenital holes and causes of hyperdynamic circulation (like anemia or hyperthyroidism). Causes for decrease pumping function with enlargement can be many (a large number of cardiac diseases like anginal heart disease, valve related diseases etc.). This category literally means heart failure.
2. At times our patient confuse thickening of heart wall with enlargement of ventricle! be sure that it was enlargement of ventricle only.
3. AF definitely needs a good understanding of disease process on part of your doctor or any doctor including me. If you feel he is trying to understand things and is able to convince you too, its fine. Else seek a second opinion.
4. At times when heart rate is too high or too low (which can happen in AF) you may feel lightheaded for a while.
I really apologize that in absence of ECHO reports I will not be able to throw more light on disease process. However You are most welcome to discuss about your illness any time in future with more details.
Above answer was peer-reviewed by
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