Venkat's Posts

In my last post, I was looking forward to no longer having atrial fibrillation based on an EKG and stress test prior to beginning cardiac rehab. I was hoping to stop the coumadin an a few weeks once a 24 hour holter monitor test confirmed I was out of AFIB. However, when I started exercising during the cardiac rehab session, a heart monitor they attached revealed a heart rate of 130-140 beats/minute prior to exercise. They immediately had me stop my exercise and shipped me off to the nearest cardiologist in a wheel chair. They couldn't wait to get me out of their facility before something bad happened to me. The cardiologist indicated that I did not have Afib, my heart rhythm was regular, it was just racing very fast. The confusion was that my pulse rate measured by my pulse in my wrist or hand by a blood pressure monitor read a normal pulse of 60-70 whereas an EKG or heart rate monitor which directly measured my heart rate much higher. In fact the heart rate was exactly twice the pulse rate. It took a couple of cardiologist visits including a visit to a electro physiologist (EP) (a cardiologist who specializes in the electrical rhythm of the heart) to clear up this confusion. I had been exercising regularly every day, slowly building up duration and intensity and was feeling very good prior to this incident. So, I am not sure how long this problem had been going on since the surgery. The electro physiologist diagnosed the problem as atrial tachycardia. He said my this was most likely due to inflamation of the heart caused by the surgery which has not yet fully healed. He indicated it may take 2-3 months for the inflamation to heal. What I am beginning to realize is that with minimally invasive repairs (which I had) is that while the external incisions heal quicker compared to a full sternotomy, the trauma to the heart itself is no different and takes a lot longer for the heart to heal than the external incisions. The EP said he would first try to treat it with medication and if that is unsuccessful, then we would have to consider more invasive procedures like a cardio version or catheter ablation. He prescribed me a medication called flecainide acetate and started me on 200 mg. After only one dose, within half an hour, my heart rate came down to a normal 80-90 beats a minute, a veritable miracle. Hey are in the process of adjusting my dosage and I may be on this medication for a couple of months to make sure I don't slip back into atrial tachycardia. I have been asked not to exercise for a few days, which is a downer. Hopefully, I can resume the exercise in a few days once my dosage and heart rate is stable for a few days. The EP has also recommended that I continue the coumadin for another couple of months, just in case the AFIB returns, since it appears I am susceptible to heart rhythm problems. I have appropriated my wife's heart monitor. She is a dedicated spinner and exercise nut obsessed with her heart rate during exercise and am wearing it and montoring my heart rate frequently. This amply illustrates the point that Adam makes often in his book about the constant ups and downs during recovery and the need to be patient. I admit that I was down for a few days since this started to unfold. I am real pleased that the problem was diagnosed, a solution found which was effective for me. I have attached a few links on this problem and some related heart rhythm problems. https://emedicine.medscape.com/article/151456-overview https://www.webmd.com/heart-disease/tc/supraventricular-tachycardia-overview https://www.emedicinehealth.com/supraventricular_tachycardia/article_em.htm

Just celebrated my one month anniversary after surgery to repair my mitral valve (mini thoracotomy, port access). Just had my first cardiologist visit. As my surgeon predicted, the EKG indicated my heart was in sinus rhythm and that my Afib/flutter is no longer present. I got the same feedback from a stress test which was done prior to beginning cardiac rehab. Just to be on the safe side, I will wear a Holter monitor for 24 hrs later this week to confirm that Afib is gone. If this is confirmed, I will be able to stop the coumadin in a couple of weeks. Which is great news since my dosage-INR has not yet stabilized at the therauptic range of 2-3. At first it was too low (1.5), now it is too high (3.6) and having trouble getting it down. Both the cardiologist and my family doctor cannot hear any sign of a murmur, which is a good sign. I used to have a very loud murmur before the surgery. I had an echo the day after surgery and the next one is scheduled for early March. I seem to have contracted a case of superficial phlebitis, an inflamation of the veins in my left hand below my wrist probably caused by an IV or repeated blood draws from that location during my hospital stay. A venous doppler of the arm did reveal a blood clot at that location but my doctors are assuring me that this is not a cause for concern. Eventually the veins will establish new paths around the clot. I am just treating it with warm compresses. There is no infection. Just a minor inconvenience in the general scheme of things. I have started working from home half days and if everything goes well for two weeks, I will start work full time. I begin cardiac rehab next week. A little concerned if I am taking on too much too soon between the rehab and work. We'll see. I still have occasional shortness of breath and occasional minor chest pain and palpitations. But then there are days when I feel very good. I walk about an hour a day and have graduated from flat terrain to several hills. I feel very good while exercising. I still have some soreness/numbness in my right chest area where most of my incisions are. I feel the internal stitches pulling and tugging when I move my arms. I sometimes have shooting pain under my right nipple for short periods, my main incision is just to the right of my nipple. But I can't really complain compared to what some of the sternotomy patients go through. All in all, I am very pleased with my recovery so far.

I am now approaching the end of three weeks since my surgery. I am doing well all things considered. I am now walking 1/2 hr at a time twice a day. I am able to do light housework and cooking. I have been out to the grocery store a couple of times. I am able to take a shower by myself without Debbie's assistance. My incisions seem to be healing well, no infection. It does feel raw every so often and hurts when I cough, sneeze or run over bumps when I am in the car but not bad overall. I am not taking anything for pain. I still tend to get tired in the afternoon and need an hour nap. My appointment with my cardiologist is next week when I will find out if I still have AFIB. Once I meet with him, I will make a decision on when I can return to work. Currently, my medical leave has been approved through Jan 9. The biggest nuisance right now is getting my coumadin dose adjusted. My INR is still too low at 1.8, need to get it up to between 2-3 and my coumadin dose is 7.5 mg right now. Yesterday, I finally logged into my work computer, checked emails and talked to Nicole to get an update.