Kardia says AF

I went out for a 35 mile road ride yesterday.  I took it quite steady with an average HR of 138 and a max of 160.  Later, I visited my mother in hospital, which was quite stressful; she is recovering from an operation on her broken hip and has just come out of a period of post-op delirium and back into her normal TIA induced mild dementia.  She had fallen out with the staff, and was frustrated that she wasn’t getting any better.  She was also upset with me as I refused to take her home.  She told me I was written out of her will.  This is not really a problem as there won’t be much left after the care home fees, and anyway, she was convinced I was my brother.

While I was waiting outside for the nurses to try to get her to stand for toilet purposes.  I took out my phone and tried the Kardia.  I was shocked that it said possible AF.

18-04-15 AF

Apart from the PAC on the left, this seems normal with a slight P wave.  I took another reading straight after which looked the same, but read as normal, followed by another similar one 20 minutes later which also read as possible AF.  These AF readings actually looked a little better than recent ones, e.g. from a few days previously.

18-04-12

There had been a bit of noise on the trace for the last month, including at about the time I went for my TOE.

18-03-30

Prior to this, there had been the occasional dirty trace, but I wasn’t worried, I thought it could have been interference.

18-01-29

There was some noise on earlier traces, including the one prior to the six week check up.

17-11-14

This was not quite as bad as just after the second ablation.

17-10-06

Something similar can be seen from traces after the blanking period from the first ablation.  Here are two traces from the same day, the morning seems perfect, but the afternoon has a noisy trace.

17-09-27-am

17-09-27-pm

None of this is anywhere near as bad as the pre-ablation trace.

17-04-05 HR

I am not now sure what to make of this; perhaps I just need a new battery in the Kardia.  I called the hospital to find out that they only received my TOE through this morning and my next Cardiology appointment is for 16th May; just four more weeks to wait.

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Wobbly ECG revisited

The Cardiologist has been very slow at arranging my appointment for the results.  Its now two weeks since the TOE and still no call; I am assuming he is still golfing after the Easter break.

I have been reflecting on the recent Kardia readings showing activity after the T wave.  I found an interesting book; ECG interpretation made incredibly easy, 5th Edition by Lippincott, Williams and Wilkins.   From this, I have discovered there is such a thing as a U wave, which appears to be caused by either by digitalis use or hypercalcemia, which may by a thyroid issue, potentially a side effect of amiodarone.

U wave

One year after ablation

It is now exactly a year since my first ablation, and 26 months after entering Persistent AF.  I am now due for my next visit to the consultant 6 months after my second (and hopefully final) ablation.  My TOE was over a week ago, but I still haven’t received notification of a date; just before Xmas, I was told that it would be on a Wednesday, the first couple of weeks in April.

Overall, I feel “cured”; I am on no medication, I have no issues with excessive thirst and urination, my blood pressure is normal and my resting HR is steady, although 20 BPM higher than two years ago.  This should return to normal within 9 months of an ablation, but appears to have hit a plateau at the moment.

HR Relaxed 18-04-07

I have returned to the road bike, but heading east for the relatively flat lands; only 60 ft/mile of climbing.  I am staying at an average HR of 145 with a max of 160; I managed my first ride of more than 15 mph this weekend, I am quite pleased with this.

https://www.strava.com/activities/1496085103

I do not want to try any harder without the Cardiologists advice; everything seems OK, but I am just worried about the slightly lumpy ECG on the Kardia.  Hopefully it is nothing unusual.

 

 

 

I am now officially a resource

During a quiet moment, waiting for a return phone call on the first day back after the holiday period I was checking research resources on the American “StopAFib” website.  I noticed that I am now listed as a resource under patient sites.  https://www.stopafib.org/resources.cfm

Stopafib

I wasn’t informed, but I am very pleased and it cheered me up on a dull day.

I am not sure what the status of this website is at the moment; the associated forum seems to have moved over to the American Heart Association.  http://www.heart.org/HEARTORG/   However, the owner of the Stop AFib site is posting on the AHA website as MellanieSAF, so probably still current.

Trans Oesophageal Echocardiogram

I was again poorly motivated during the morning wait for the TOE.  However, most people at work and those likely to contact me were off prior to the Bank Holiday, so not too many issues to respond to.

I found myself drawn to bike radar, where a member had been taken into hospital with fast AF.  It is surprisingly popular these days.

As expected, the TOE was quite unpleasant, although forgoing the sedative meant that I was not stuck in the hospital for an extended period of time the day before a bank holiday.  I was given a new anaesthetic, only introduced to the hospital that week.  It tasted pleasantly of toothpaste rather than the horrific fake banana flavoured one used previously; I also think it was more effective.

They were down there for about 15 minutes; I kept hearing good words like sinus, but really couldn’t concentrate on exactly what was being said.  Afterwards I asked whether they had measured the left atrium (previously 37ml/m2 instead of a healthy maximum of 28).  He said they hadn’t calculated, but it was “prominent”.  They decided it was worth doing an ECG while I was there, “for completeness”.

There was no queue; I think they were winding down for the Bank Holiday.  At the end of the ECG I asked if it was normal, he hummed (positively?).  I said I expected sinus rhythm with perhaps a couple of ectopics.  He hummed again and said that really, he was not allowed to say anything.  I was a little concerned because my ECG had recently been a little wobbly after the T wave.

HR 29-03-18

The worst of it looks like this; this is not quite how it would look with flutter, but definitely not textbook flat. I wasn’t particularly worried before; I thought it may be interference, but now I am starting to get a little paranoid.

HR 29-03-18 wobbly ST

I still don’t have a date for the meeting with cardiologist, but earlier this year he said probably one of the first three Wednesdays in April.

Blood tests

My GGT is now down to 96, which is the lowest since I first started being tested in April 2016.  Perhaps this could have been lower, but is a little elevated after the several drinks I had four days previously at a school reunion (we left school 39 years ago!).

There was talk at the reunion of the Scarlet Fever epidemic in our school and the local area.  In the fifties, before I was born, this disease had resulted in the hospitalisation of a large percentage of our village.  When I caught it in 1970, antibiotic treatment had improved significantly and it was no longer life threatening, although the outbreak caused considerable concern in the older population.   Here is a picture of me on my preferred mode of transport at the time.

001

I did a little research and Scarlet Fever does have an effect on the liver, massively raising enzyme levels.  However, they return to normal after treatment.

I am still puzzled as to the cause of the high GGT; the spike in January 2017 suggests alcohol.  However, my test result of 98 in October 2017 came after 250 days without alcohol, so possibly another cause could also be the remains of the amiodarone in my system.  This may not be borne out by the evidence as the 6th July reading of 99 was taken when the maximum amount of it was in my system.

alcohol and GGT 27-03-18

Perhaps it is the alcohol I consumed several years ago which caused the damage and has only just returned to something approaching normal.  The Doctors don’t seem particularly concerned about it and I have severely moderated my earlier habits in order to avoid the return of AF.   A watching brief remains; I have another test scheduled for September.

 

Useful blog

Afib runner

https://afibrunner.com/

I mentioned this a month ago.  I have just received a fair bit of traffic from this site, so to say thank you, I have reposted the details.

This blog is well worth a read, the author is in persistent AF and is “more or less” asymptomatic.  In addition to his personal reflections there are lots of  reports on various bits of research and other news.

Return to cardiology looming

I am not sure of when my appointment with my cardiologist will be, but it should be at some point in the first three weeks of April.  I will have a TOE (Trans-oesophageal echocardiogram) to check that the LAA closure has properly healed along with the usual ECG etc.  I suspect that this may involve two visits.

As I am now feeling much improved and have not had any AF-like symptoms since New Year’s Day, I have decided that it would be appropriate to notch up the exercise level slightly.   If it gives me a problem, it would be better to happen before my scheduled appointment rather than after.

The singlespeed is now going to be mothballed in favour of my Bianchi (winter bike fitted with mudguards) which means no more canal banks, instead, I will be back on the road.

I managed 28 miles on Saturday and 34 miles on Sunday.  I headed out east to avoid the steep hills of the Peak District and was taking it steady, with no sprinting and I was sticking to the small ring for most of the ride.  In fact, I was in the bail-out gear on some of the relatively gentle slopes, but still managed total climbs of 1800 and 2150 feet respectively.  I generally felt quite good, and progress on the flat was brilliant, but I think the hills were a struggle due to a general lack of fitness rather than heart issues.

Interestingly, I last did the Sunday route in July 2017, when I felt recovered from my first ablation.  Even though this was in nice weather with my best bike and summer clothing, I was still ½ a mile faster on average yesterday.  I think this bodes well for my future recovery.

No longer snowbound

The heavy snowfall between 27/02 and 02/03 had kept us relatively housebound, so no exercise except for a snowy walk around the woods on Saturday.  I am certainly missing the bike.

The last of the snow melted yesterday and temperatures are now a balmy seven degrees in the sunshine.  As I am now five months post-ablation and feeling pretty good, although unfit, I think I can nudge the cycling up a notch.  Nothing too ambitious, but I will get the Bianchi out for a few trips on the road; this should also keep me cleaner than the canal paths.

Slightly recovered

In the morning, I felt slightly better, but cancelled my meeting in Barnsley later in the day and in London the following day.  I managed to work from home in my small office, but downstairs was too cold for me.  It seems that the indigestion followed by flu like symptoms were fairly common locally.  I feel quite pleased, It’s not related to my AF after all.