question-icon

Suggest treatment for afib, severe sleep apnea and high heart rate?

default
Posted on Mon, 9 Mar 2015
Question: I am 48, had Afib event 3 times within 3 weeks 1 year ago and then had to have cardioversion. Stress tests all good, determined severe sleep apnea and have been on machine with no issues for year. taking lopressor 25mgx2 a day as well as lisinopril 20mg for BB. 2 weeks ago after eating my heart rate spiked, tachycardia in sinus rhthym at 105-110 beats. after 3 hours it calmed down. Went to Cardiolgist and increased Lopressor to 50mgx2 to address a potential anxiety and prevent the sympathetic system from overpowing. A few days ago after eating had same epidode and went to ER, rate of 105-120 for 6 hours and then went down slowly with cardizem. Nuclear stress done all good, thyroid good, no structual issues and always in Sinus. I feel something is not right, I go up a stairs and my pulse races to 95, I think about it it goes up. It just appears that I am really sensitive and my pulse reacts to quickly. Could this be IST or something worse. I actually feel I am more nervous lately because of this so I recognize anxiety could be it but feel there is more happening. Any suggestions?
doctor
Answered by Dr. Ilir Sharka (2 hours later)
Brief Answer:
Please always keep an eye open to sleep apnea

Detailed Answer:
Hello! Thank you for your question on HCM! Regarding your concern I understand how do you feel and I recommend you to view the problem without anxiety and be calm.

As you said, you had a history of Afib and now continue in sinus rhythm. All the test performed are normal. The decision of your doctor to increase the dose of beta-blocker seems reasonable in face of an icreased sympathetic system overshoot. On my opinion I would continue and keep trying to find the possible explanations for this predisposing sinus tachycardia.

As all tests resulted normal I would issue the offending role of your severe sleep apnea, as current opinions, emphasize its important role in occurrence of different types of cardiac arrhythmia some of them even life threatening. It is accused too for an increased stimulation of sympathetic system that predisposes to tachycardia. So after excluding other remaining causes like anemia and fighting possible overweight, I strongly recommend you to always keep an eye open to your sleep apnea and talk to its specialists on how to treat and maintain the adverse effects under control.

hope to have been helpful to you.
Feel free to ask me whenever you need.. Greetings from Dr. Iliri
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
default
Follow up: Dr. Ilir Sharka (11 hours later)
Thank you, the ER Dr also was concerned about cpap. i also was waking up 3-4am for no reason. i am getting a pulse oximeter for weekend. i changed mask and slept great. still concerned why tachycardia would occur at lunch time after im
awake. is it normal for pulse to go from 70 to 85 eating? im 6'4 and 300 pounds so i am 50 pounds over where i should be. last question, i have appt with family Dr tomorrow. any recommendations for further studies or adding a channel blocker. i teally dont want anxiety medicine but just something to calm release of adrenaline. great site! appreciate your hard work!
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
Build your strategy to fight sleep apnea.

Detailed Answer:
Hello!
I am glad to hear that your CPAP therapy is doing well. As I have emphasised you before the appropriate management of sleep apnea is the mainstay therapy of its potential cardiac complications.
Regarding the increase in your heart rate when eating (from 70 to 85 bpm) I want to confirm that it is a physiological reaction seen in almost every normal person. In your case it is not even a tachycardia (those values are within normal ranges). So relax, there is no evident abnormality here.
The best strategy I recommend is to lower you weight as it would make more efficient the respiratory drive, and release the stress connected to eating and raised diaphragm. For this purpose I recommend a scheduled diet program and exercise. The best for your condition is aerobics and yoga. Exercises also relief anxiety and stress and that way lower adrenaline levels.
Regarding drug options for tachycardia management I don't recommend you calcium channel blockers, as they are proven to reduce the effective sleeping time.
I don't recommend you sedatives too, as they aggravate apnea.
There are some drugs that Improve night sleep and reduce daytime sleepiness (modafinil, provigil, etc), but you shoud consult an neurologist expert in the field.
Regarding your appointment with Dr tomorrow I recommend you to talk with him about the etiology of you sleep apnea (is it from the obstruction of the breathing airways or from a central mechanism? )
Some tests and exams would help to differentiate like polysomnography, fiber-optic pharyngoscopy, head CT scan, etc
To conclude I wish you a good health and feel free to ask me again. Greetings.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Ilir Sharka (1 hour later)
thank you so much, very helpful! last question before i close thread. if i have another tachycardia below 120 but above 100 should i take the rythomol (4x150mg) for afib (pill in pocket) or take another 25mg of lopressor. the ER Dr indicated rythomol was only if in afib to correct. i thought i heard that taking another lopressor would be better to reduce tachycardia. Also how long before i go to hospital if tachycardia occurs again .thank you so much for your hard work and detailed answers. all done
doctor
Answered by Dr. Ilir Sharka (22 minutes later)
Brief Answer:
Glad to have been helpful.

Detailed Answer:
Hello! I am glad to be helpful to you.

If you experience sinus tachycardia you may safely take an additional dose of lopressor. Rythmonorm is not indicated for sinus tachycardia, so I don't recommend its use.
When you have only sinus tachycardia try first breathing exercises (deep breaths) performing yoga (it is often proven effective).
If you have persistent disturbing tachycardia more than 30 min after lopressor than an alternative is i/v beta blocker applied in hospital.

If you have other questions feel free to contact me.

Greetings.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7717 Questions

premium_optimized

The User accepted the expert's answer

Share on
Suggest treatment for afib, severe sleep apnea and high heart rate?

Brief Answer: Please always keep an eye open to sleep apnea Detailed Answer: Hello! Thank you for your question on HCM! Regarding your concern I understand how do you feel and I recommend you to view the problem without anxiety and be calm. As you said, you had a history of Afib and now continue in sinus rhythm. All the test performed are normal. The decision of your doctor to increase the dose of beta-blocker seems reasonable in face of an icreased sympathetic system overshoot. On my opinion I would continue and keep trying to find the possible explanations for this predisposing sinus tachycardia. As all tests resulted normal I would issue the offending role of your severe sleep apnea, as current opinions, emphasize its important role in occurrence of different types of cardiac arrhythmia some of them even life threatening. It is accused too for an increased stimulation of sympathetic system that predisposes to tachycardia. So after excluding other remaining causes like anemia and fighting possible overweight, I strongly recommend you to always keep an eye open to your sleep apnea and talk to its specialists on how to treat and maintain the adverse effects under control. hope to have been helpful to you. Feel free to ask me whenever you need.. Greetings from Dr. Iliri