Suggest treatment for atrial fibrillation and paroxysmal atrial tachycardia
I would explain as follows:
Welcome and thank you for asking on HCM!
I carefully passed through your medical history and would explain that there is not a clear clinical difference between short episodes of atrial fibrillation and paroxysmal atrial tachycardia.
Both these disorders are clinically perceived as palpitations, a rapid heart beat, fatigue, shortness of breath, dizziness and fainting feeling.
Besides, episodes of this duration do not need to go to the ER (for possible conversion), because they are not really harmful.
I would recommend you to closely monitor your heart rate and blood pressure. In case of an increased, irregular heart rate, associated to low blood pressure, you should go to the ER.
From the other I would recommend performing a new cardiac check up:
- cardiac ultrasound to examine your cardiac structure and function and exclude possible cardiac failure
- a new ambulatory 24-48 hours ECG monitoring (as it has been a year since the last one and your rhythm may have changed)
- some blood lab tests ( complete blood count, thyroid hormone levels, blood electrolytes) to exclude possible chronic anemia, electrolyte imbalances or thyroid dysfunction, which may trigger cardiac arrhythmia.
I would also recommend discussing with your attending physician on the possibility of increasing the dose of metoprolol, or adding a calcium channel blocker like diltiazem, to control possible cardiac arrhythmia better.
I would also recommend starting aspirin 81mg daily, to prevent possible cardio-embolic events. If there is evidence in the ambulatory 24 hours ECG monitoring of repeated atrial fibrillation, you may need to start oral anticoagulation (warfarin or new oral anticoagulants).
Hope you will find this answer helpful!
You are welcome!
I remain at your disposal for further discussions whenever you need.
Feel free to ask me again, in case of any other uncertainties!
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