Q. I have Afib, but I also have cardiomyopathy. My doctor wants me to take Amiodapone or Flecainide. I had a cardioversion in early January but it didn't work. What do you think? I am 66 yrs old and feel great. Am living a very normal life, working, playing golf, walking, eating well. I was in Florida for 5 weeks and enjoyed myself. Marie, Stoneham
A. If you have cardiomyopathy, then Flecainide is not a safe drug to maintain Sinus Rhythm. Amiodarone would be the safest and most effective but it has a long list of potential side effects and you would require a cardiversion after the drug is loaded. Amiodarone may take several weeks before it becomes effective. If you are leading a normal life and doing all the activities you describe while you are in AFib, then maybe you should take Warfarin (coumadin) and remain in AFib. Dr. Charles Haffajee, The CardioVascular Institute
Q. My husband has been in A-fib for over 10 years. He's had three cardioversions and two ablations. A couple times, he was in sinus rhythm, only to revert back to A-fib within a few days. He's been on so many meds, I've lost count long ago. He is getting sick of doctor appts. and getting stuck with a needle to monitor his warfarin. I feel his doctor isn't doing enough, but my husband doesn't want to start new with another doctor. I worry about him constantly. Is there something more that can be done than just meds and monitoring, or since the other procedures didn't work, is this what we have to live with? Lori, Attleboro
A. If your husband has had 2 ablations for AFib then it is unlikely that he will maintain rhythm and thus, to be protected from stroke, he should be on warfarin. In the next 1 to 2 years newer blood thinners will become available that will obviate the need for frequent blood tests. It would also be helpful to know where your husband had his ablations and when. Dr. Charles Haffajee, The CardioVascular Institute
Q. I have idiopathic cardiomyopathy with no symptoms. I do see a cardiologist every 9 mos. My efp is in the low 30's and has been there for almost a year. I am a 57 year old female with no other health conditions or concerns. I have known that I have it for over a year now. I exercise vigorously with no problem, (do everything with no problem) and passed my stress test with flying colors. I take Toprol XL 50mg per day. Everything I read says most people with this disease die within 5-10 years. Is this true or are some able to live with it much longer than that? Is there any hope? Sherry, Putnam, CT
A. No patient is merely a "statistic" to be told her chances of dying are this or that specific number. However, as a group, patients with reduced left ventricular ejection fraction do suffer increased chances of dying or requiring hospitalization as a result of a cardiac-related complication. The good news is that the fact that you passed your stress test with flying colors and are essentially asymptomatic puts you in a much lower risk category than an individual with similar extent of heart disease who has symptoms such as easy fatigability or shortness of breath. That having been said, it is of great importance that, together with your cardiologist and health care team, you maintain a proactive management approach to your cardiomyopathy, including optimal medical therapy (which, in your case, might also include a type of medicine called an ACE-inhibitor or ARB, unless you have had an adverse reaction to that kind of medication in the past), a heart healthy diet, and exercise. When optimally treated by a clinician with expertise in the management of cardiomyopathy, people with your type of condition can and do recover to lead long and healthy lives. Dr. James Chang, The CardioVascular Institute
Q. I have had two cardioversions and with the second I stopped drinking totally---are my chances better now to stay afib free? Ann, Kingston, NH
A. Once you have had AFib you are always likely to have it again in the future. Alcohol is certainly a trigger for your AFib and by abstinence you may prolong the time between epiosdes significantly. Dr. Charles Haffajee, The CardioVascular Institute
Q. I have a condition in my legs that is chronic. They burn and ache like toothaches. My doctor and others in Worcester don't seem to be able to give me something to help the pain. I have a hard time sitting for a long period of time and walking. I've had MRI's but it shows nothing. Vicodens only help for a short time. I feel like my life is wasting away. If it's nerve damage, is there anything that will help make my life more comfortable? I think some of the doctor's I've seen think it's all in my head. Carolyn, Charlton
A. Leg pain is very common and can be very difficult to treat. In addition there are multiple possible diagnoses. If the pain or burning occurs in the large muscle groups with activity/walking than it may be related to decreased arterial circulation or peripheral arterial disease. If it is a burning, radiating pain it may be related to issues with nerve compression by degenerative disc disease or sciatica. There are also conditions such as peripheral neuropathy or fibromyalagia that can produce leg pain. There are medications that can help and other treatments possible based on the proper diagnosis. A physical exam and complete evaluation with further testing may find the cause and hopefully allow relief. Dr. Allen Hamdan, The CardioVascular Institute
Q. My friend had an aortic value replacement in 1999. He has had some minor AFib issues since, several over the last year. He also has problems (a lot) with his vision blurring. He considers these migraines although he does not have headaches. Any changes in light brings them on. Should he be concerned about strokes? A, Ipswich
A. He should certainly pay attention to all of the stroke risk factors, including cholesterol, blood pressure, not smoking and getting regular exercise. Dr. Carolyn Bernstein, The Headache Center at BIDMC
Q. I take Synthroid 0.100mg, Atenolol 50mg, aspirin 325mg, Pravastatin 20mg and recently (for 5 weeks) Amlodipine 5mg. I believe that the Amlodipine was making my ankles swell, and I was very cold most of the day and had a stomachache. When I called my doctor to report this, the secretary took my message and then called back to say to stop taking the medicine but he did not recommend any other medicine. I do monitor my pressure and I can tell you that I have more energy and feel much better without this medicine even though it has been 2 days without the pill. Is it the best decision to not take any medicine for my blood pressure (average 130 to 137)? I am 78 years old and a active woman. Stella, Fairhaven
A. Hi Stella. If your systolic blood pressure is less than 140 on average, you are feeling well, and you have lots of side effects to the medication, I would advise you to stay off the medication. Dr. Joseph Kannam, The CardioVascular Institute
Q. At times I have multiple "runs" of PVCs and PACs that are overwhelming and interfere with my life. I am not a candidate for ablation tx. Are there other options? Joanne, Sharon
A. There are medications (such as beta blockers and calcium blockers) that can help with APC's and PVC's. Also, try to avoid caffeine, alcohol, stress, and lack of sleep. Dr. Joseph Kannam, The CardioVascular Institute
Q. I am a 63 year old woman and around Christmastime I had a funny feeling in my heart. It felt like a wave...not palpatations, but like a wave for a few seconds. Could it be anxiety? It also happened again about 2 weeks ago. It's a little scary. Helen, West Roxbury
A. Symptoms such as the ones you are describing are often benign and not heart-related. However, they may also be a sign of an underlying heart problem, such as an irregular heart rhythm. Your doctor can further investigate your symptoms with a physical examination, an EKG, and possibly a heart monitor - a device you wear on your belt for anywhere from 24 hours to a month. Dr. Eli Gelfand, Director of Ambulatory Cardiology, The CardiVascular Institute
Q. My son has a congenital heart condition: 3rd degree heartblock. Do you know of any cases where this was reversed or corrected surgically? He is 14 years old, healthy, playing sports and visits his cardiologist annually. No treatment has been necessary to date, but I'm always concerned about how much activity his heart can handle. Sheila, Rindge, NH
A. Thank you for your question. I should preface this by disclosing that I am an adult cardiac surgeon, and this involves a pediatric patient. I assume that since a diagnosis of 3rd degree heart block has been made, the patient has already been evaluated either by a cardiologist or electrophysiologst and that associated conditions have been ruled out (i.e. other congenital cardiac anomalies, metabolic disorders, electrolyte disturbances, etc.). To answer your question, there are not any surgical options for this condition, unless you consider pacemaker insertion a surgical option. Typically, a cardiologist or electrophysiologist would do this procedure, so I would consult with them to see if this is indicated. Dr. David Liu, The CardioVascular Institute
Q. My episodes of AFib have always occured at night and I seem to see a connection between laying on my right side or indigestion. Are these triggers? I take betapace, accupril and warfarin. Thank you. Donna, New Bedford
A. There are definitely patients (usually without any heart disease) that experience AFib at night. This is often referred to as "Vagal" AFib. It appears that a slow heart rate at night triggers AFib. AFib can also be triggered after alcohol or big meals at night. Reflux (Gerd)/indigestion can also trigger AFib at night, hence lying flat or on the right side. Patients with sleep apnea are also prone to experience AFib at night. Addressing these triggers (alcohol, heavy meals, indigestion) can reduce Afib as can treating sleep apnea. Dr. Charles Haffajee, The CardioVascular Institute
Q. After a bypass operation, what happens to the artery that is bypassed? Does it, over time, because of a change in diet and exercise reverse and now allow blood to flow through? Also, is collateral cir. around a clogged artery in time as effective as a bypass artery? Thanks for taking my questions. Tom, Humarock
A. The artery that is bypassed remains in place; it is not removed but simply bypassed. During bypass surgery an area of the diseased artery is opened beyond the blockage and the new bypass graft is attached here. The other end of this graft is attached to the aorta. The graft supplies a new source of blood to the blocked artery. The blockage in the artery that is left behind remains. It may get worse unless risk factors are kept in control. It does not usually regress. It is very important to control the risk factors that caused the coronary disease since the bypass grafts themselves will be affected by the same process. Collateral circulation is produced by tiny newly formed blood vessels by a process called angiogenesis. There are quite small and not as effective as a bypass graft. Dr. Senthil Nathan, the CardioVascular Institute
Q. What would qualify a patient for the Maze procedures vs. the ablation procedure? My mother is a 78 yr old woman with a one year history of AF with episodes of rapid heartbeat which have gone from one per month to 3 in the last month (two of which lasted 16 hrs with a heartrate up to 197). She is currently on Coumadin and Metoprolol. Lynn, Middleton
A. A specific form of atrial fibrillation (paroxysmal atrial fibrillation) and no prior heart and lung surgery would qualify her for for the minimally invasive procedure. The traditional Maze procedure can be done for any type of atrial fibrillation. Please consult a cardiac surgeon with experience in both procedures for further details. Dr. Robert Hagberg, The CardioVascular Institute
Q. I am presently on Coumadin and it has been suggested that I get a cardioversion. What is your opinion of cardioversion, the benefits and the risks? Claire, Peabody
A. Patients with atrial fibrillation may be advised to undergo "cardioversion" - which is the process of restoring a normal heart rhythm. This can be done "chemically" (with medication) or "electrically" (by passing a current across the chest to reset the heart's mechanism back to normal). The decision of which method to use depends on the patient's individual medical issues - but electrical cardioversion is most commonly used.
Cardioversion is very safe - but does include some small risks. For example, the procedure can dislodge a blood clot - which can then travel to cause a heart attack or a stroke. That is why it is critical to minimize this risk by taking blood thinning medication for several weeks prior to the procedure or by having a special ultrasound (called a transesophageal echocardiogram) immediately prior to the cardioversion. If properly performed, cardioversion is extremely safe. It is noteworthy that patients with atrial fibrillation have a small risk of stroke even in the absence of cardioversion necessitating blood thinning medication.
Cardioversion is very successful at restoring a normal rhythm (generally > 95% chance). However, electrical cardioversion does nothing to maintain a normal rhythm. Your doctor may recommend that you take medication or undergo a catheter procedure (called ablation) if you have recurrent episodes of atrial fibrillation. Dr. William Maisel, The CardioVascular Institute
Q. I am a 54 year old female who has been diagnosed with AFib. It seems to come on without warning. I've been told it could be stress, diet or who knows why. Is it unusual for someone my age to have this type of problem? It seems to be happening more often than it used to. I now take atenolol 50 mg and an 81 aspirin daily. Should I be concerned that it will continue to happen more often? Is there something else I should be asking my doctor to check? Lu-Ann, South Easton
A. It is not unusual for some one your age to have atrial fibrillation on and off. The treatment would depend on how often you get Afib and how long it lasts. We usually check and echo and thyroid function and use at least 325 mg of aspirin. Options due include the atenolol, more powerful antiarrhythmics or an atrial fibrillation ablation. The right treatment should be guided by a doctor with expertise in atrial fibrillation. For more information, you may want to consider attending our free Atrial Fibrillation Information Session on March 20th at the Newton Marriott. Visit our website at www.bidmc.org for more details. Dr. Joseph Kannam, The CardioVascular Institute
Q. I have chronic AF. I take warfarin and digoxin. Can my AF be cured so I don't have to be on drugs? Mike, Mystic, CT
A. Depending on your age and other risk factors you may need to stay on coumadin even if you are returned to sinus rhythm. Whether or not you can be cured depends on how long you have been in atrial fibrillation and the size of your atria on an echocardiogram. You may ask your doctor to see a doctor with expertise in atrial fibrillation. For more information, you may want to consider attending our free Atrial Fibrillation Information Session on March 20th at the Newton Marriott. Visit our website at www.bidmc.org for more details. Dr. Joseph Kannam, The CardioVascular Institute
Q. Good day. I have had AFib for thirty years and I am very much afraid of stroke and heart attack. I want to get the surgery done but I am afraid I might not wake up. I am 59 years old. My question to you is, is it safe to have the surgery? Rosetta, Boston
A. Rosetta, you sound like a good candidate for the surgery which is called the Maze procedure and would require the usual incision and the heart lung machine to create the various lesions throughout the heart. The surgery is quite safe and very successful. The risk really depends on how healthy you are in terms of you overall health and heart function. Sometimes you may be a candidate for the minimally invasive surgical procedure which is much less invasive and does not require the heart lung machine but you have to have a certain type of atrial fibrillation to have a high degree of success with the procedure. I would recommend seeing a surgeon who is experienced in this type of Maze procedure to discuss in detail. I hope this helps. Dr. Robert Hagberg, CardiVascular Institute
Q. Hello, I am an 84 year old woman with Atrial Fibrillation. I've been on Warfarin now for almost a year and my doctors are recommending Cardioversion. What are your thoughts on it? Claire, Peabody
A. Hi Claire, it depends on if you have been in AFib throughout the year or if you have just gone into AF recently. If you have been on coumadin for a year and have been in continuous AFib in the past year, then it is NOT worth cardioversion. However, if you were in SINUS Rhythm for most of the year and went into Afib recently and you are symptomatic, cardioversion is reasonable and should be safe. Dr. Charles Haffajee, CardioVascular Institute
Q. I'm a 50 year old female and had an atrial fib ablation one year ago September. I'm wondering what are the stats that it will come back? I'm working out a lot now - feel good but was asymptomatic when it was dicovered in a routine physical. Can I work out like a normal person? Should I be concerned while getting my heart rate up? I was taken off coumiden after one year and do you think I should take asprin daily? Mary, Newton
A. There is no good long term data in terms of success documented in the literature. That said, you may not have symptoms if the atrial fibrillation comes back whether you had them to begin with or not. The only way to make sure that the atrial fibrillation has not come back is to have some kind of long term monitoring done either with an implantable device (such as a Reveal XT) or some kind of long term monitoring through external patches connected to an external monitoring device for periods of 2-3 weeks at a time.
I don't think you should be concerned with exercising and getting your heart rate up. Whether you continue to take warfarin or take aspirin is a decision that should be made between you and your primary care physician and your cardiologist. If the atrial fibrillation does come back, you could have another catheter based ablation, minimally-invasive surgical Maze procedure or the traditional Maze surgical procedure. Please contact a cardiac surgeon experienced in the last two procedures if you would like to consider surgery. One thing that surgery does that the catheter based procedure does not do is remove the left atrial appendage which is where the clot usually forms to cause a stroke in patients with atrial fibrillation. That is why your doctors had you on Coumadin to prevent the clot from forming when you were in atrial fibrillation. I hope this helps and good luck. Dr. Robert Hagberg, Cardiothoracic Surgeon at the CardioVascular Institute
Q. What does it mean when I can hear my heartbeat in my ears when I lay down at night? Patricia, Quincy