Stress, Medical Procedures, and Centrals

[mesenteria]

I'll try to be brief:

I suffer from paroxysmal atrial fibrillation.  A recent severe episode, where they tried an electrical cardioversion, and which failed to restore rhythm, was easily the worst since my original event that led to the diagnosis. It eventually calmed, but it was a horrible two weeks, and my cardiologist was apprised by the ER what had transpired.  He referred me to an electrophysiologist, the MD's who specialize in the electrical function of the heart.  

As part of the pre-screening, the electrophysiologists want several diagnostics done: ECG, Echo-cardiogram, chest x-ray, MIBI stress test (on a treadmill with two sessions in a CT scanner.  Gasping through an N95 mask when they take you off the treadmill after one full minute at maximum is an experience you have to live through to describe.), an MRI, and finally an angiogram (where they run a thin catheter up your radial artery and into the left atrium to inject a radio-opaque dye while they flourocscope your chest).  All this took place over six weeks, and I still hadn't seen the specialist.  Oh, and by the time these diagnostics took place, it had been four months since the attempted cardioversion.

Needless to say, with all the trips out of town to see these services, submitting to all sorts of pokes, bores, and prods, and still experiencing debilitating fibrillation (getting to sleep at night was difficult while my heart was beating erratically), I was under a good deal more stress than normal.  I didn't feel like it was stressful, just a break in routine more than anything, and no pain to speak of that I can recall, but I was still under quite a strain.

A week prior to seeing the specialist, I had the angiogram.  That night, even though I had received no sedation (it was offered just prior to puncturing my radial artery), I found myself gasping awake just as I was falling asleep.  This happened numerous times, and I think I managed maybe three hours of sleep in total.  It even happened when I fell asleep for about 1.5 hours near 0400 (thank God).  Further, this went on for several weeks, but less regularly and more intermittently.  It got better.   By the fourth week, it was gone entirely.

I believe this was a new experience of 'sleep onset central apnea.'  When I consulted my RT, he looked at my data remotely.  He called and said I was being well treated, my horrible new experience notwithstanding.  He stated that, as we age, many of us will develop this phenomenon.  He agreed that it was probably due to stress, perhaps also to the various injections I had received.

My message, in case it isn't clear, is that a substantial change of any kind, in routine, in rest, in how you feel and sleep, and not least in how healthy you are, can cause you to experience changes in your other indicators of well-being.  Apnea would be one of them.  If you're at all like me, you will have short-lived changes that abate with time when your routine is largely restored.  When you regain equilibrium, you should also return to your regular sleep regimen, including your machine's service to you.

[StevesSp]

You have my sympathy. That battery of cardio tests would have been an awful thing to go through, based on my own much less rigorous cardio testing. I too have had (three) angiograms over the years, plus two angioplasties (stenting), and they're no fun. That sedative should be administered half an hour or so BEFORE you're taken to theatre if it's going to help. That happened to me when I had my second set of stents and made the whole experience quite terrifying. They gave me the tablet in theatre - way too late to have any effect.

Likewise the stress test, which I assume included an echocardiogram? That's where, as you say, you have to go as fast as you can on the treadmill then jump onto a bed for the echo - and then having to hold your breath! I found that very hard indeed.

I know nothing about atrial fibrilation, but do get periods of severe ectopic beats (some people call them palpitations, which they're not) and I find that stressful enough. God knows what it's like to have even worse symptoms on a long-term basis.

I do know how stress and anxiety can make cardio issues much worse though, in a horrible vicious circle. Palpitations, rhythm problems or angina are scary, raising your stress levels, which in turn makes the cardio symptoms worse, and so on. My first bout of heart problems was in my late 20s, leading up to the discovery of a leaky valve. I was suffering chest pain, but while having a battery of tests and facing various frowning specialists, I too experienced severe palpitations, especially at night, which got worse and worse. However, once the cause of my angina was found and the prognosis looked OK, the palpitations all but went away. It was anxiety.

Good luck.

[mesenteria]

Thanks, Steve.  Ectopic beats was what the surgeon performing the catheterization called out to his colleague behind the glass panel monitoring my vitals and the flouroscope display. I got the impression he was looking for more, but my heart was completely off beat and thumping erratically.  I don't think the dye process was all that good, but it was good enough that he leaned over and said, "No blockages, only minor deposits."  That was good news for a nearly 70 year old male.

Both my MIBI tests were thusly: CT scan on an empty stomach, then the stress test on the treadmill.  When I reached around 90% of max heart rate for my age, they injected the radio-opaque dye into my IV, and then I had to sustain the effort for one full minute.  Not so bad, but when I lay on the gurney to recover.....a nightmare through that ......mask.

I had to eat and drink at least half a liter in volume, and then wait 45 minutes for a second CT scan.  I'm not clear on this, but the fuller stomach might have changed the image in a deleterious way if something was wrong.  I must have done okay.

BTW, I glow slightly in the dark now. 

Atrial fibrillation is a slower cousin to atrial flutter. The flutter must be more dangerous because a 75 year old male who had it come on suddenly just before last Christmas was whisked away immediately to Royal Jubilee in Victoria, southern tip of Vancouver Island, and he had an ablation right away.  He's since had a second when they learned his right atrium was also involved.  They only learned that when he wore a Holter Monitor over night six weeks after the first ablation to check things out.

Paroxysmal AF is brought on sporadically, often by stress of several kinds, including neural, or by cardiac effort.  Another characteristic is that it is very often self-limiting for some reason.  If I have a bad spell, it lasts for several days, but one morning I wake up and I'm fine for days or weeks afterwards. Cyclists and runners are noted for having a high incidence.  It is relatively well understood, but it's better understood than it is how to deal with it.  I have heard of patients going back for a fourth and fifth ablation until their normal rhythm was restored.  A second ablation must be performed in about 20% of cases, so they're common.

Funny how, when you seem to get over the worst of one problem, another crops up that is out in left field.  This was the case when the angiogram went surprisingly well, and the rest of the day was pain free and 'normal', even into the evening.  But, when I wanted to fall asleep a couple of hours later, I kept awakening in a near panic and gasping for breath. Very unsettling.  And this was not post-anaesthesia.