Atrial Fibrillation

This hasn’t been my greatest year with regards to health. For the most part I have been fine, but I have also been in hospital 4 times in one way or another. The main reason for my hospital visits has been my heart. I have a hereditary heart condition which has been passed onto me from my mothers side of the family. I was first diagnosed with a heart condition when I was 24 years old. However, I can now remember feeling the symptoms of my heart condition as far back as the age of 14.

12 lead Echocardiogram. The upper line is in Atrial Fibrillation. The lower line is a normal sinus rhythm.

My heart likes to go into atrial fibrillation, in fact it seems to be it’s normal state. Atrial fibrillation is when the upper chambers of the heart (the atria) quiver (or fibrillate), rather than beat normally. This causes my heart to pump blood around my body less efficiently than it should. It also increases the risk of problems with blood clots, which can form within the atria when they aren’t beating properly. All or part of a clot could then break away and potentially cause a stoke.

Conduction

Sinus Rhythm

Atrial Fibrillation

Late last year it was found that my heart was in atrial fibrillation again. I hadn’t noticed it at the time as I am quite use to it after living with it for so long. It was intermittent (paroxysmal), so it was difficult to notice. My cardiologist got me booked into hospital to have a DCR (Direct Cardio Reversion or Cardioversion) done. I had this procedure done once before back in 2001. Basically they place pads on my chest and back. These are attached to a defibrillator. Then my heart is shocked during the R wave of its beat to revert it back into normal sinus rhythm. I am put under for all of that.

My heart rate following the procedure in 2001 was back down to 58 beats a minute. Before that it was in the 100’s. That cardioversion lasted for about 7 years and then my heart began to have episodes of atrial fibrillation again, but as I said I didn’t notice it. I am guessing as to when it started going into atrial fibrillation again.

After the cardioversion in January this year my heart rate was down to 70, which was considerably faster than the previous time I had the procedure done. After a few days of rest I was back to work and back to my normal life. I was feeling fantastic and when I had a check up with my cardiologist 5 months later he was very pleased with how I was going. He told me that he didn’t want to see me for a year. I was pleased about that and was enjoying the extra energy I had from having a normal sinus rhythm.

About three and a half weeks later I was sitting at the computer at home on a Saturday morning. I began to feel off and then I felt my heart go into atrial fibrillation again. At that point I should have gone into accident and emergency, but I was in denial at what was happening. I laid on the couch and rested for a while hoping that my heart would revert back to sinus rhythm, but of course it didn’t. I did nothing till the Monday and even then I wasn’t seen by a doctor. The Monday morning I rang and booked a echocardiogram at my local surgery. I got an appointment for the following morning.

I was doing a lot of things wrong at this point, but I was getting away with it. I could have easily had a stroke during that time, but I was lucky. I did have a splitting headache Monday night, which was later pointed out, could have been a blood clot. That was a scary thing to hear.

On the Tuesday morning I think I knew what was going to happen, but was still deluding myself. I knew that going into hospital was a good bet, but I still packed my lunch ready for work and I drove myself to the surgery for my appointment. At that point my heart had been in constant atrial fibrillation for 3 full days. I was tired and had very little energy. As the nurse was hooking me up for the echo I told her that she was going to find my heart in atrial fibrillation. She was stunned that I was being so calm about it. She asked if I was seeing a doctor after the echo, to which I replied “I didn’t make an appointment, but I don’t think I will have a problem seeing someone”. She did the echocardiogram and sure enough my heart was in atrial fibrillation. This caused the young doctor, that came to see me about the findings, to go and consult with three different doctors in the surgery. I was left to wait for a very long time as they decided the next course of action. Eventually he came back and said I needed to go to accident and emergency. I thought that meant I had to drive there, which I was ready to do, but it actually meant a ride in the back of an ambulance.

By this point I had been kindly told off by the nurse about not coming into the surgery when it happened. I didn’t have to make an appointment if there was something clearly wrong like that. They would fit me in if I showed up with atrial fibrillation, or anything else serious.

It was a little embarrassing being rolled out on a stretcher and put into the back of the ambulance. Other than the atrial fibrillation I felt fine. I was wanting to help the paramedics carry their bags. It was quite a different experience riding in the back of an ambulance. They didn’t put the lights and siren on, which was a little disappointing. I had already rang my wife to tell her what was happening. When I was in the back of the ambulance I texted her to let her know I was heading to the hospital now. She got to the hospital soon after I arrived.

At the hospital I was given priority over the other people in the waiting room because I arrived in the ambulance. At this point I was again told off for not coming into A&E when it first happened. They weren’t as nice about it as the nurse at the surgery had been, but I got the message. You see, if I had gone in on the day it happened, or even on the following day, they could have cardioverted me in A&E and I would be on my way again. But I didn’t, so that meant going on blood thinners and being booked in for the cardioversion approximately 6 weeks later.

They prescribe blood thinners before a cardioversion to try and prevent any clots being thrown during the procedure that could cause complications. The first time I was cardioverted I hadn’t been on blood thinners at all. The second time earlier in the year I had been on warfarin to thin my blood. This time I was going to be on warfarin and clexane. They wanted me to take the clexane to begin with to stop platelets from forming, which help clot your blood. A few days later I would start on the warfarin.

My wife was with me when I was told about the clexane and about the dosage they wanted me to take, so I wasn’t the only one who heard it all. They clearly told me that they didn’t have the correct sized needles so I would have to take 2 injections both in the morning and evening. The doctor even repeated that as I was being discharged. Now I don’t know if he just royally screwed up, or he and the pharmacy didn’t communicate properly, but I ended up giving myself 30 injection in a 1 week period and then it was found that I was overdosed on Clexane. The prescribed dosage was far too high, almost double what it should have been.

Besides the massive bruising it caused to my stomach (my entire stomach was black and blue and still hasn’t fully recovered), the overdose also caused a varicose vein in my right leg to burst causing a very large and painful haematoma on the back of my leg. I ended up being off work for 3 weeks due to the overdose. During that time I was quickly booked in for my third cardioversion.

After my third cardioversion I was told to stay on the warfarin until I saw my cardiologist again in four weeks time. I was also told to take aspirin along with the warfarin. This time my heart rate returned to 58-60 beats a minute after the procedure. It would be nice to say that was the end of it all, but there is more.

About three weeks ago on Tuesday 30th of July, after having breakfast at 6am, I decided to blow my nose. This caused me to have a nose bleed. I had had nose bleeds on the evenings of Friday, Saturday and Sunday caused by the same thing. They had all been minor, but I was going to get it checked out if it happened on Monday as well, but it hadn’t. Tuesday was making up for all that. I spent nearly an hour in the bathroom trying to stop the bleeding. It eventually slowed to the point where I could continue getting ready for work, but it soon opened up again. It was then that I told my wife I wasn’t going to work and that she should ring the surgery as soon as they open, which was at 8am. The surgery advised my wife to take me to A&E as they didn’t have the resources to deal with that sort of bleeding.

About this time the bleeding stopped and I was able to ride to the hospital without blood pouring out of me. My nose didn’t bleed while I was waiting to get into A&E. I was soon taken into A&E and shown to my cubical. I was given a lovely gown and a box of tissues. As I got on the bed my nose opened up with renewed vigour and I was left to stop the bleeding myself with that small box of tissues.

At that very moment A&E had themselves an emergency evacuation drill. I was rolled outside into the cold morning air with my nose pumping blood all over my face and chest. I battled in vain to stop the bleeding with my small box of tissues, but I was fighting a losing battle. Eventually some of the staff noticed that I was in a bad way and started to try and help. The drill was over and I was wheeled back inside. The nurse came back and gave me another box of tissues which didn’t help anything. A doctor came over and clamped his fingers over my nose to apply pressure, but the only thing that achieved was to cause the blood to go down the back of my throat.

While all this was going on I had another guy asking me questions to get my history. He did ask if I wanted him to come back some other time, but I just wanted to get it over with, so I answered his questions while bleeding all over myself. The guy was clearly capable of helping as the doctor got him to do some things while he was standing there, but he didn’t go out of his way to help me.

More doctors started turning up from the Ear, Nose and Throat department. It was looking like I was going to be admitted. The first doctor came back and told me that he needed to put a nasal pack up my nose. The pack is 7.5cm long and it all goes up your nose. I didn’t know that at the time, but I quickly became aware of it as he shoved it further and further up my nose. Then he inflated it. I can safely say that it was quite painful! Sadly this didn’t stop the bleeding. They were going to put a second pack up my other nostril, but I thought the bleeding was stopping. They said they would give me 5-10 minutes to see if it would stop. 20-30 minutes later another doctor turned up and asked why the other pack hadn’t been put in my nose. Moments later I had the second pack inserted up my nose. That hurt more that the first and then it was also inflated. The ear, nose and throat doctor had a look down my throat and saw that I had a rather large clot sitting there. He wanted to try and remove it for me. This caused me to gag a lot and it wasn’t very pleasant. He tried very hard to get the clot out, but every time he grabbed it it would fall apart. My blood was so thin that it couldn’t clot properly. I eventually swallowed the majority of it and my throat was clear again.

The bleeding still hadn’t stopped and I was stuck in A&E waiting for a bed. I was there for several hours. I was very tired at this point, but I couldn’t get comfortable as the blood was still going down my throat. Finally I was moved to a bed on a ward. I was still bleeding and tired, but I was now under a slightly higher attention level of care. I was in a room with 4 other people. I was stuck here for at least 3 nights as they weren’t going to take the packs out until Friday. The doctors figured that my blood was too thin due to the warfarin and aspirin I was taking. I was told to take both by at least two different doctors, but now I was told I shouldn’t have been on both at the same time. They told me that I was having trouble creating platelets which help form blood clots. As such the bleeding wasn’t stopping. My INR was only 2.3 which is in the therapeutic range (Normal INR is anything below 1.5). They wanted my INR to be normal before they removed the packs and that would be Friday and the earliest.

I didn’t have a doctor come out and say this directly to me, but I’m pretty sure the Clexane overdose was a contributing factor to the bleeding. I was told that Clexane was prescribed to me to stop platelets from forming so my blood would thin quicker. It really wasn’t that long ago that I had the overdose and now I wasn’t forming enough platelets.

As far as I could see I was in hospital again because there were a lot of mistakes made. The biggest mistake was mine because I didn’t get myself into A&E when my heart first went into atrial fibrillation.

When Friday came I was ready to get out of the hospital. My INR had returned to 1.1 so the packs were eventually removed later that morning. During the observation period after their removal the bleeding wasn’t stopping. It was barely seeping out, but the doctor didn’t like it. He wanted to keep me in for another night, but I couldn’t put up with another night in there. I had very little sleep for the past 3 nights and was at breaking point. It was decided that he would put Silver Nitrate up my nose to stop the bleeding. It stung for a while and had a smell to it. I was told that if it started bleeding again and I couldn’t stop it within 10-15 minutes I had to come back to A&E.

It has been 3 weeks since I blew my nose and went to hospital. I have begun to blow my nose again, but with a lot of care. I have had a little bit of bleeding each time I blow my nose, but it stops quickly. I have made too many visits to the hospital this year. I can only hope that I won’t have to revisit the hospital again. At least not again this year.

I’m not posting this to garner any sympathy. I am posting this more as a lesson to be learned for myself and others. If you think there is something wrong, don’t ignore it. Deluding yourself that there is nothing wrong could be the biggest mistake you ever make. I have been lucky. But at the same time I have paid the price for not acting straight away when something was clearly wrong. I would like to hope that I won’t have any other problems in the future, but I don’t think that will be the case. I have to learn from this experience so that next time I won’t ignore the signs and act appropriately.

Images courtesy of Wikipedia
http://en.wikipedia.org/wiki/Atrial_fibrillation

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