Coumadin, high pulse rate, and exercise

[rossi]

First, thank you and the other MDs for this valuable service.
Can you please see Mr. Terk's question below on 9/3 re: the "frequency of afibs" question and a comment by debra? She noted Coumadin in reference to Mr. Terk's frequency. I thought bloodclotting was not a concern unless afib lasted for 48 hours -and then only if it was continous during that time.

Next, I read where afib sufferers had bouts that lasted 10-12 hours with a pulse rate of 180 bpm. Can the heart take this kind of "pounding" for so long? How long should we let this high rate go on before going to the ER?

Last, I've been "babying" my heart since my Afib diagnosis and I've been corrected that this not the way to go and that exercise is better. I want to start but I still have a concern that I will overtax my heart and start more afib bouts. True? And do the typical target pulse rates for exercisers to strive for still apply with those with afib? Again, thank you all.

[RTFLY]

Hi...I am curious. I was reading some of your other comments and I am confused. You say you had a run of a-fib that you didn't know you were having. It seems that the cardiologists are the "bad guys" because you weren't on coumadin. How could you have been put on coumadin if you didn't even know you were having a-fib? I am guessing your a-fib may have been secondary to your mitral valve problems? While I agree with you on the importance of anti-coagulation therapy in patients with a-fib, studies that I have seen do not state using anti-coagulation for younger patients with no cardiac abnormalities who present with lone a-fib. Those who are less than 65 with no structural heart disease and low risk factors who have lone a-fib are at extremely low risk for stroke. These patients need an aspirin a day or nothing at all according to a recent Mass General study. The same study states that actually 1 out of 5 people who have a stroke may be related to a-fib. That's only 20%. What do the neurologist's say about the other 80%? Also, your mitral valve repair... The importance of rate control in patients with MV insufficiency with a-fib as a secondary problem associated with the MV is to be controlled with digoxin or Cardizem(diltiazem). It isn't stated anywhere that anticoagulation therapy is strongly recommended in these cases. Again, while I agree with some of your comments, I can certainly appreciate the words and advice of the CCF physician that hosts this site. In the professional opinion of the MD, not all patients may need anticoagulant therapy who present with lone a-fib and have no other heart structure problems and who are young. I am sorry of your unfortunate situation and I am glad to hear you are recovering. But the "knee-jerk" comments that ALL patients who have a-fib need coumadin coumadin coumadin may not be correct. Take care...
  
                                                J.C.I., BS RRT

[wingtip]

I was diagnosed with lone cronic a-fib several years ago, and think I started with it in my early 30's.  I finally got over my fear of over-doing it, and just completed my second marathon yesterday.  I feel a lot better , and notice my crazy heart rythm less when I am exercising.  My father has had lone a-fib for years and never stopped working in the factory.  So far, the only problem that seems prevelent is the added risk for stroke, which can be taken care by several different options ( I'm on coumiden)

[debra21784]

I find you response rather cavilier especially from someone who has not suffered a masssive CVA.The cardiology community is at odds with the nuerologist,those who treat us after the stroke because the cardiologist didn't use coumadin in atrial fib becausthey felt the risk was low.Let me refer you to some world renowned researchers who have discussed this very issue.Dr.Greg Albers,Dr.Harold Adams,Dr.Phillip Wolf and Dr.Daniel Singer from Boston Mass and Harvard along with Dr.Alan Go ,Dr.Stephen Kittner ,Dr.Allison Biard,Jeffery Saver, Dr.Bo Christianson,C.Pettygrew,Dr.JWhinsant to name a few.You see sir ,while recoving from a massive stroke because coumadin was not used since the risk was low,I have read the literature and more,as well as taking part in clinical research both as a master's prepare RN and a stroke survivor.If you would like to continue to debate the issue I would be glad to as well as send a literature review listing.Irresponsible I am not ,overly cautious ,you bet

[CCF-M.D.-RCJ]

rossi,

I saw Debra's response the day she posted it.  I think her response was irresponsibly placed and not fully accurate.  Many patients with afib do not require coumadin.

I have seen patients who have had heart rates above 150 for weeks without knowing it.  After some length of time, however, most of these patients develop tachycardia-induced cardiomyopathy.  This condition is a reversible weakening of the heart muscle that most often resolves with heart rate control.  The majority of patients with afib and rapid ventricular response should seek medical attention soon after its onset; exceptions do exist, however.

An otherwise healthy patient with lone afib would generally be free to exercise as vigorously as someone without afib.  The particulars of someone's medical history need to be examined, however, by their doctor before instituting the exercise program.

Hope that helps.