Help wanted (Score so far related)

[Jersey Girl]

I wouldn't worry about being sent to a clinic without a cardiologist given the risks associated with your afib diagnosis--no doctor is going to be that negligent!

And with all the stress you're feeling, could you try getting an earlier appointment? Or even an ER visit, and request a consult with a hernia specialist?

I know but do they know what level shock to put me back into rhythm? I don't know the answer to that. I'd already be under propofol during the procedure. If I get afibby at home, I'd be off to the ER and have to skip the procedure. That's one of the reasons why I was thinking about hospital admission. The logistics of things, the need for a contingency plan, and being where they could do whatever was needed quite easily.

I can wait until Sep 11th providing that isn't a bad omen. I slept like a baby last night and it if weren't for the construction crew nextdoor with their godforsaken back up signal, I would have slept longer. Ate the usual type of breakfast and two slices of margherita pizza for lunch (small slices, not Jersey size), and will have dinner in another hour or so. That's a good day for me. And...I can't feel my heart beating which makes it a perfect day in my book.

I keep meaning to search up that piece by Edgar Allen Poe about the beating heart. You know the spooky one. That's how I feel some days! Like I'm being tortured by my own heartbeat. Because I am.

[Marcus]

I wouldn't worry about being sent to a clinic without a cardiologist given the risks associated with your afib diagnosis--no doctor is going to be that negligent!

And with all the stress you're feeling, could you try getting an earlier appointment? Or even an ER visit, and request a consult with a hernia specialist?

I know but do they know what level shock to put me back into rhythm? I don't know the answer to that.

Please tell me you're kidding. What kind of ER doctors do you have in your hospitals out there?????????

ETA:you know what? Never mind. Just get your cute self back to NY and have this diagnosed and taken care of by doctors who know what they are doing. All this talk of medical personnel putting you under anesthesia without a cardiologist monitoring your afib, or going to an ER where the doctors may not know (!!!!!!) how to properly resolve your afib is making me really, really uneasy.

[Jersey Girl]

I know but do they know what level shock to put me back into rhythm? I don't know the answer to that.

Please tell me you're kidding. What kind of ER doctors do you have in your hospitals out there????????

No, I mean the docs in the stand alone gastro scoping clinics! That's why I'd rather have the preparation and procedure done in a hospital. The ER docs know exactly what to do and of course the hospital (if admitted) have cardio on staff round the clock.

ETA:you know what? Never mind. Just get your cute self back to NY and have this diagnosed and taken care of by doctors who know what they are doing. All this talk of medical personnel putting you under anesthesia without a cardiologist monitoring your afib, or going to an ER where the doctors may not know (!!!!!!) how to properly resolve your afib is making me really, really uneasy.

Turn the heat and humidity down and I might be up for it!

ETA: I just was searching online and there is a gastroenterology clinic right in the hospital where my cardio is! Victory is mine!!!

[msnobody]

If you can find that metoprolol link without too much trouble, please post it. Don’t go to a lot of trouble though. I’m going to hubs appointment tomorrow. I’ll let you know what the EP says.

[Jersey Girl]

If you can find that metoprolol link without too much trouble, please post it. Don’t go to a lot of trouble though. I’m going to hubs appointment tomorrow. I’ll let you know what the EP says.

Just saw this. I'll get right on it. I can give you about eleventy billion. I'll make sure you get something from the US because that's all US docs will pay attention to. There are only THREE published papers on the NIH website. I've posted excerpts here but I will put them here in a list for you. It's really a thing.

When you are looking at medical terminology you are looking for VM-AF. Keep that in mind.

[Jersey Girl]

msnobody the paper I posted in red is the one you want most I think.

Sorry about all the emphasis I used. I wanted to make it easy for you to pick out what you need.

If you can find that metoprolol link without too much trouble, please post it. Don’t go to a lot of trouble though. I’m going to hubs appointment tomorrow. I’ll let you know what the EP says.

Here are the only 3 papers I could find on the NIH website. I posted these links and excerpts for Gunnar but I think they may be of use to you. Note the parts I bolded.

NOTE: The second paper contradicts the first re: beta blockers used for VM-AF. The US has no clue what it's doing yet on this topic. Where the UK and Europe already know about it.

2012 Beta blockers and digoxin are not only ineffective but are contraindicated, as they tend to precipitate the arrhythmia by shifting the balance toward vagal effects on the atria.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153084/

6/2020 (This is the paper I shared with my cardio guy after I was already taken off the medication...Metoporolol/Lopressor/Beta Blocker by the EP)

In animal models, VM-AF was defined as AF caused by stimulation of the vagus nerve with observed atrioventricular block, asystolic periods, sinus bradycardia and an increase in heart rate variability 14,15. In humans, VM-AF was defined as paroxysmal AF that occurs with predominant vagal activation, such as, during sleep, after eating a big meal, or in relationship to other recognized vagal triggers, usually preceded by bradycardia 8,15,16. Patients may have no underlying heart disease or other systemic disorders that could explain the AF 17.

The original observational study of 18 VM-AF patients by Coumel et al 1 showed a predominantly male population with a ratio of men to women of 4:1. These patients were younger; the ages of first symptom onset were 25-60 years. The frequency of AF episodes was variable from patient to patient, ranging from sporadic events to recurrent daily events, and lasting from a few minutes to several hours. The AF episodes usually occurred during the night, after the digestive period of a large meal when vagal tone surged, and often ended in the morning. Interestingly, many patients in this study reported that AF episodes were preventable by exercising, but the resting or relaxation period following emotional distress was often followed by onset of AF episodes and symptoms 1Table 2.

Here's the money shot msnobody. This is Table 2 where it compares symptoms, characteristics and treatments for VM-AF and Andrenergic AF (the typical AF diagnosed which is likely in error because our docs are mistaking VM for Andrenergic AF. Look at Table 2 so you can see the side by side comparison.

Table 2
Vagal-mediated AF

Worsen by beta-blocker[/quote]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533140/

12/2020

Rare and unusual presentation of gastrocardiac syndrome

Gastrointestinal pathology can cause cardiac symptoms and disorders. We present a case of a patient who had worsening of her palpitations with food intake. She was found to have a high burden of premature ventricular contractions in the setting of hiatal hernia and gastro-oesophageal reflux disease. After extensive investigations and ruling out cardiac causes, her arrhythmia resolved with the surgical correction of hiatal hernia.

Gastrocardiac, also known as, Roemheld syndrome is a disorder where maladies in the alimentary tract, usually the upper gastrointestinal tract, are found to be related to cardiac symptoms. The causes of the gastrocardiac syndrome include gastro-oesophageal reflux disease (GERD), transverse colon gas, gall bladder dysfunction and hiatal hernia. Atrial fibrillation is the most commonly described arrhythmia in the setting of GERD and hiatal hernia. Multiple case reports and observational studies have reported these findings, but gastrocardiac syndrome remains a neglected and underdiagnosed factor in the workup of arrhythmias.1 Since there is rarely a cause traceable to a cardiac condition, patients often end up getting extensive workup before it can be recognised. Herein, we report a case of Roemheld syndrome in the setting of hiatal hernia and GERD presenting as palpitations secondary to premature ventricular contractions (PVCs).

https://www.ncbi.nlm.nih.gov/pmc/articl ... 20symptoms.

[Jersey Girl]

I don't think I'm fully ready to wrap up this thread but I want to say a few things in review.

I'm glad I went out on a limb in a period of duress and posted about myself. I believed that you guys would at least give it a shot reading this and you all did. I appreciate that so much!

Also appreciate the suggestions and information. I had hoped that someone had first hand experience with hiatal hernia but the truth is I wouldn't wish that on anyone to start with so I'm glad that no one did.

Also happy (it's hard to be happy but still...) that some of the issues I raised seemed to be useful to a few others on the thread and behind the scenes. Many times I disclose personal information on this board because I think it could be of use to someone else. This wasn't one of those times. It was all about me and.....hellllllppp meeeee I'm disintegraaaaating!!!

I've got an invite from Marcus to go to NYC. So I'll be packing my bags and taking the first available flight out of DEN.

In. My. Dreams!

I've had a great couple or more days here and feel like me again. Appointment coming up and I will pursue testing. I'm fed up with the ups and downs of this and if there is a better solution than me just toughing out the hard times then I really want to find it.

Thank you all for being kind and accepting e-friends, and for putting up with my crazy. Just know that I edited out some of my crazy for this thread so it's really worse than you ever imagined!

[msnobody]

Thank you all for being kind and accepting e-friends, and for putting up with my crazy. Just know that I edited out some of my crazy for this thread so it's really worse than you ever imagined!

You know we can read between the lines.

I imagine a fib is not fun to have. Both of my parents had it, and I knew then that I hope I never have it.

I wish you well, Jerz. It’s always good to share things like this, as it can often help others.

[Jersey Girl]

Thank you all for being kind and accepting e-friends, and for putting up with my crazy. Just know that I edited out some of my crazy for this thread so it's really worse than you ever imagined!

You know we can read between the lines.

I imagine a fib is not fun to have. Both of my parents had it, and I knew then that I hope I never have it.

I sometimes think if I had just plain parasoxymal afib I'd be okay with it. It's the RVR part that is hard and I also think that's what causes the red hot poker burning in my chest. But...I am not a doctor and the docs aren't familiar with what I have re: VM-AF so when I do have to go to the ER, I have to explain it to them and just hope they believe me.

I wish you well, Jerz. It’s always good to share things like this, as it can often help others.

That's why I usually share things of a somewhat personal nature and I do think some folks got additional information they hadn't previously had, but honestly, this time it was all about me. True story.

I've had 3 super good days with no anxiety, no feeling my heartbeat, and no ache in my stomach.
And I feel like myself again! What blessed peace!

[Jersey Girl]

Tomorrow is my long awaited appointment with my primary. I haven't dealt with much anxiety since I started this thread. Just a little low level anxiety here and there but nothing paralyzing. I'll weigh in tomorrow but I think I'm at about average 95 pounds now. Haven't had any heart rhythm incidents either.

I think it really helped me to release a lot of pent up frustration and anxiety by writing down all of what was going on with me in this OP. I'm so thankful for everyone who was willing to hear me out and posted here or contacted me in messages. I won't soon forget that, I promise. You guys threw me a rope when I was sliding into a mental health hole. I just got on here and started telling it like it was, and that I definitely wasn't okay. So thank you once again for helping me.

Hoping for the best tomorrow!