Heart & Cardiology/a-fib

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QUESTION: dr ahmed,im 80 years old and have a-fib.in  3years currently takinf amplodinepine and labetalol 100mg.lately I get stresses when taking my blood pressure and for 10 miniues os so my pulse is 150.when I calm down it goes back to 80.anxiety is cause.think instead of labetalol I should take tambocor.as the [pulse readings are 147 I get stessted out.when pulse is 147 no symptons at all.can you ride a a-fib out without going to emergency room.maybe I should not take my blood pressure at night

ANSWER: Hi, (here is some reading on a fib http://blog.myheart.net/2014/06/29/afib-with-rvr-when-the-heart-races-out-of-con)

Firstly i should stress that the heart rate on the blood pressure machines in the setting of atrial fibrillation is often innacurate, and you should check it by manual palpation also to confirm.

There are 2 major methods of controlling atrial fibrillation. One is rhythm control and the other is rate control. Tambocor is a rhythm control medication and is used to try and restore normal rhythm. Labetalol is a beta blocker, and while it wont make the atrial fibrillation revert to a normal rhythm, it will act to slow the heart down and thus act as a form of rate control. Currently, for those people in chronic atrial fibrillation unless overly symptomatic from the atrial fibrillation a rate control strategy is preferred.

In your case it would be worth wearing a monitor for a 24 hour or longer period and seeing the adequacy of rate control and whether the labetalol needs increasing or another rate control medication required. It sounds like you need to minimize stressors as they are a trigger for your atrial fibrillation. The decision to ride out atrial fibrillation depends on factors such as your stability, blood pressure, and symptoms such as dizziness, shortness of breath or chest pain.  If you are concerned and the fast rate persists over a several hour period or you have symptoms, you should probably seek medical attention. If it is a short lived period and you dont have symptoms, then the need for urgent care is less.

Hope that was helpful,

---------- FOLLOW-UP ----------

QUESTION: I have had a-fib for 3 years.it shows up on most ekgs I take,but in 3 years I have not had a a-fib attack.i need prostate surgery with epidural as anesthesia.even though I have never had chest pains or other symptons my cardiologist wont give me clearance unless I take stress test.is there a danger with a-fib and local or epidural anthestic/

Answer
Hi, some reading regarding stress testing http://blog.myheart.net/2014/03/17/do-i-need-a-stress-test/.

Unfortunately a lot of the reason people get stress tests before surgery in the US is not evidence based, but rather habit, or for a presumed medico-legal reason. In general, its reasonable to obtain stress testing in people that are at a high risk of heart disease or have a history of it. In those with active symptoms further testing should certainly be performed. In most people that are able to perform activity such as moderate exertion, house work, gardening etc. further testing is not required prior to operations.

The stress tests are useful in that they may help in risk stratification. The issue is what to do when something is found, as there is not much evidence that testing or heart procedures to fix things are very useful in that setting. Anyhow its worth discussing with your cardiologist what exactly is the utility of the stress test and how it will affect management.

In terms of the a fib, it should be well rate controlled prior to the operation.

Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

Organizations
http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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