Q. What are the symptoms of atrial fibrillation?
Hello doctor,
Last weekend, I had an overdose of THC capsules. It was a very scary experience. I suffered from very bad chest pain, shortness of breath, tremors, etc., for about five hours. I had an ECG done in the hospital which said sinus tachycardia. My blood was taken (all fine apart from low magnesium and potassium), chest X-ray was done (all fine). I was given Diazepam and on discharge had another ECG done and it said sinus rhythm although my heart bpm was still over 100 bpm. The doctor said it is probably due to anxiety and let me go. Two days after this experience, I started getting weird symptoms (slight pain in the chest, lightheadedness). So, I went to my doctor, and he measured my blood pressure, heart bpm, etc., all fine but put this machine in between my hands and could see my heartbeat was irregular. He prescribed me Digoxin for five days to see if it would get under control. I went back again because I was concerned about the lightheadedness, he again measured heart bpm, etc., all fine, listened to my chest and said it is back in more of a regular beat and prescribed Digoxin for five more days and to come back again but at the moment, he is not overly concerned. I think I do not have bradycardia or tachycardia but I think I could have developed atria fibrillation from my experience in the hospital, is this possible?
Please help.
Hello,
Welcome to icliniq.com.
Yes, it is possible, but a likely possibility is of ventricular ectopic (or other causes) rather than A-fib (atria fibrillation) which could also cause irregular heartbeats on the machine. Even in normal individuals, the machine may falsely show irregular beats. Few points which are against are fibrillations are normal ECG especially if you had it done while having symptoms, even examination by a doctor for pulse and auscultation will help in diagnosing A-fib. Also, the pulse rate is expected to vary to a large extent and cross the 100 bpm. You may also feel irregularly beating heart within your chest. Also, you can keep a finger over the pulse and feel irregularity and missing pulse. So, it could be an ectopic which is now settling. The only way to definitely confirm is ECG (electrocardiogram). If this continues, you may a get an ECG done or buy a home-based rhythm monitor device which records the ECG for interpretation. So, overall unlikely to A-fib, but either ECG or examination by the doctor can confirm this. The other cause for pain in such settings is gastritis or reflux, which can commonly cause such symptoms. Also, ectopic may cause pain as well. Anxiety can also cause similar symptoms. Have plenty of water and adequate intake. If you are having these drugs for a long time then the possibility of withdrawal should also be kept.
Hope this helps you and get back if you have any doubts.
Thanks and regards.
Hello doctor,
Thank you for your reply.
When I feel my pulse it is normal to me and when I look at my chest it seems to be beating normal and in the rhythm I do not notice any irregular heat. However, I am not sure what could be causing the lightheadedness and chest pain which I think is a symptom of an irregular heartbeat. I noticed after being in the hospital that I had some stomach bloating as well which does not seem to have gone down, so perhaps I could also have some stomach issue. Would I need to stop taking Digoxin to get ECG done? I have attached some images.
Please help.
Hi,
Welcome back to icliniq.com.
In that case, it is unlikely to A-fib (attachment removed to protect patient's identity). The reason for symptoms in A-fib is high heart rate which leads to low BP and dizziness, shortness of breath and chest pain. And with heart rate well controlled, A-fib becomes a less likely cause. Also, tracing which you attached appears regular so unlikely to be A-fib. There is no need to stop Digoxin for ECG. In fact, I do not see any indication for Digoxin at present as heart rate is well controlled. Have some antacids and consider the possibility of withdrawal as well. Also, get BP checked.
I hope this helps.
Thanks and regards.
Hello doctor,
Thanks for your reply.
Unfortunately, the tracings I have attached was taken when I was on Digoxin who perhaps the rhythm is only controlled with digoxin. Doctor did check my blood pressure, says its normal and BPM is normal (checked twice). Digoxin was only prescribed for the unusual rhythm. At the moment I am trying to take it easy and rest (no drugs, alcohol, caffeine), take magnesium supplements and eat a banana a day for potassium as blood report showed low levels of both and doctor in hospital was concerned with that. I am going back to the doctor next week when I finish Digoxin. Are antacids safe to take with Digoxin?
Please help.
Hi,
Welcome back to icliniq.com.
You may take antacids with Digoxin. But, Digoxin is for rate control than rhythm control. And also initial ECG also showed sinus rhythm when you were not on Digoxin. Also, Digoxin takes time to act, so overall it is unlikely to be A-fib and must be sinus tachycardia which was controlled. Repeat ECG if necessary.
Thanks and regards.
Hello doctor,
Thank you for replying.
My concern is that I have done permanent damage to my heart by ending up in the hospital which has now caused the irregular heartbeat and maybe it was not picked up on initial ECG's as they were done when I was in the hospital and not the days after. I am just very worried and overthinking it as chest X-ray was fine, blood tests were fine and two initial ECG's are fine. I will take some antacids in the meanwhile and try to relax.
Please help.
Hi,
Welcome back to icliniq.com.
It is not permanent damage usually. Even if we consider, you had A-fib initially, then it was likely a drug-induced due to stimulation by the drug which is reversible in the majority of the cases. Also, the lack of ECG changes makes the possibility of permanent damage unlikely. Rhythm disturbances are transient usually. So, overall, does not appear a worrisome issue.
Thanks and regards.
Hello doctor,
Thank you for your reply.
Yes, it was drug-induced sinus tachycardia. I also think I had a panic attack as well due to the drug. What to do?
Please help.
Hello,
Welcome back to icliniq.com.
Levels reduced to nearly one fourth after four days and it is not therapeutic. So, yes four days is sufficient time. Importantly, as I mentioned earlier, Digoxin does not significantly help in maintaining sinus rhythm, but it is for controlling heart rate.
So, you may stop it now and see ECG after four days. Delaying ECG by another two to three days would be further better.
I hope this helps.
Thanks and regards.
Hello doctor,
Thank you for your reply.
I bought an ECG portable monitor and have been testing myself, it always comes up as "possible bradycardia" as I am always under 60 BPM resting. I am only 25 years old and I am not over weight but I am not active so not sure if under 60 BPM is okay for me. This is my second day off Digoxin so maybe Digoxin is still slowing my heart rate. I am still light headed and feel a bit weird. Rhythm looks okay to me though.
Kindly help.
Hello,
Welcome back to icliniq.com.
The rhythm is not good on this. It is junctional rhythm, not normal sinus rhythm. This is probably caused by Digoxin and should settle after its effect wane off. So, obtain routine 12 lead ECG from local doctor for confirmation as soon as possible, because monitor sometimes may be fallacious. If possible, upload your yesterday's ECG for comparison.
Thanks and regards.
Hello doctor,
Thanks for your reply.
My ECG at the hospital showed sinus tachycardia yet I am never over 100 BPM when I measure myself at home. He measured my blood pressure but it was normal. I am still bloated and a bit dizzy. I have attached a chest ECG from today. What does this look like to you?
Kindly help.
Hello,
Welcome back to icliniq.com.
This tracing is absolutely fine. There is normal rate and rhythm. This type of rhythm will not cause any symptoms like dizziness. Sinus tachycardia may be due to nervousness. I suggest you take some antacids, and take care of your diet. Just confirm, your hemoglobin is normal.
Kindly update with the above question.
Thanks and regards.
Hello doctor,
Thanks for your reply.
I only had blood report done when I ended up in hospital and they said magnesium and potassium levels were low. However, I was hungover in hospital, so I think that might have contributed to that.
Please help.
Hello,
Welcome back to icliniq.com.
Yes, the tracing is a bit unusual, but since this is not the 12 lead ECG, these changes may be seen. If you are not on any potassium supplements or potassium-rich diet then hyperkalemia is not expected in otherwise normal individuals. If you are on it then you should resume normal diet and get potassium levels done.
I hope this helps.
Thanks and regards.
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