Sunday, January 16, 2011

Atrial Fibrillation Revisit

At the end of lunch on Tuesday I felt my heart start racing. “Uh-oh,” I thought and paused to pay attention to what my heart was doing. Desmond was finished with lunch at this point and was playing under the table. It took me a minute to realize he just peed and pooped while I wasn’t paying attention. (He likes to go under or behind things.)

So I was cleaning up poop while on the phone with Kaiser advice. The nurse on the other end was calm until I mentioned I was also 24 weeks pregnant. Then she sounded a bit flustered and wasn’t sure who to transfer me to. We got it figured out though and as I thought they wanted me to go to the ER. “Here we go again!” I thought as I packed a bag of entertainment and snacks for Desmond and an overnight bag for me with my knitting, reading and personal items I missed last time I was in the hospital. I felt winded going up and down the stairs.

Davin rushed home because I’m not supposed to drive in a-fib. It was nice not doing this in the middle of the night, but the inconvenience this time was Desmond missing his nap. Still he was a trouper and did great. He remembered last time and wasn’t quite as worried this time around. He did cry when they left me for the night, though.

It was nice having familiarity this time which made it a bit less scary. I saw the same ER doctor and the same Kaiser doctor as last time though they see enough people they didn’t remember me. My heart wasn’t beating quite as intensely as last time though it was still up in the 100-120s most of the time with higher spikes into 160s.

The doctors talked sooner about cardioversion this time. We wrestled with whether or not to try shocking me out of it, but I didn’t like the idea of shocking the baby. The other option was trying to control my heart rate with more medication, but that gets to the baby too, so I really felt stuck. They said either option was most likely safe for the baby, but there aren’t any studies on pregnant women so they didn’t really know what option to suggest over the other. In the end we chose not to do the cardioversion because my heart could go right back into a-fib and then we’d be back in the same boat needing medication anyway. My prenatal doctor I’ve been seeing was told I was there and stopped in during her shift. It was perfect timing and I felt comforted to talk to her and go through my options again.

All through Wednesday they had me on more Metoprolol, the beta blocker I’ve been on since September. There wasn’t really any change though. I think it was Wednesday evening when they started Diltiazem, a calcium blocker to see if that would drop my heart rate. The only problem was my blood pressure. The lowest I saw it was 83/44 and I could tell it made the nurses nervous when the systolic pressure got below 100 so sometimes they wouldn’t give me any more meds. The cardiologist came in on Thursday morning and “cracked the whip” as he said to tell them to keep giving me the medicine as long as I felt okay. I’m a lot younger than their usual patients so I can handle a lower blood pressure. I never felt dizzy or lightheaded though when I saw the low blood pressure numbers I felt like I should have felt something different, but I felt fine. The Diltiazem started working (I was on an IV to get a quick and steady dose) and my heart rate went down a little though it was still high I was still in a-fib.

Mom came up on Thursday to see me and help out with Desmond. That was a huge help. Our friend Sarah was able to watch Des on Wednesday and he had fun playing with Chloe all day. Thursday and Friday he got lots of time with Nana and that freed up Davin to stay with me.

On Thursday evening while Davin was settling everyone in at home my heart went back into a regular rhythm. It was 6:18 pm and the nurse who worked all three nights I was there came in and gave me the good news. Whoohoo! It lasted 54 hours this time; the longest yet. I can feel when a-fib starts but it kind of slips back to normal quietly so I can’t tell the moment that happens. They still wanted to keep me one more night to transfer me from the IV to the pills and see how I tolerated the medication.

I rested much easier that night and early Friday morning they said I could go home and I was discharged around 9:30 am. It felt so good to get all unhooked from everything, especially the circulation leg cuffs that squeezed me for three days. I have a sore, itchy rash from those because my legs sweat so badly.

I’m so relieved to be back in a normal heart rhythm. It just doesn’t feel good to have a racing, skipping heart when I’m just resting. It’s like when you get startled and it makes your heart jump and beat fast except it never calms down.

The downside is that now I’m on all this medication. They’re being a bit more aggressive now that I’ve demonstrated the ability to go back into a-fib. I’m taking an aspirin a day to thin my blood since a-fib increases my chance for a stroke. (I turned down the blood thinner injections they suggested.) I just hope thinner blood doesn’t negatively affect my labor and delivery. I’m also on more Metoprolol, three times a day instead of two which can cause a low birth rate and they added the Diltiazem which can cause cardiovascular birth defects. The pharmacist was really concerned to give me my medication since I am pregnant, but it’s the safest stuff they’ve got.

I’m looking forward to seeing my prenatal doctor on Tuesday to go over how things are now and how the next few months might be. I wish I was delivering sooner so the baby wouldn’t have to be on my medications so long. At least I’m in the second trimester where a lot of the major development has already happened. It’s nice to know a good and all-powerful God is in control of both my heart beat and the baby’s growth. I just sure hope the next time I’m in the hospital is to meet my baby.

P.S. We hoped to hold off until May to meet my deductible and out-of-pocket maximum for the year since we're still recovering from our new roof, but here it is. We'll be paying it now instead. The upside is that there's a good chance the labor and delivery will be free now.