Atrial fibrillation Doctoring

Friday’s lessons: The heart’s resilience

It has been a very busy few weeks.   Medicine is like that; seldom is ‘business’ steady.  Like rainy weeks in the southeast when you think it will never be sunny again, there are weeks when you think everyone’s atria are fibrillating.

So, there were shocks, and burns, and wires installed.

The heart rhythm was rocking, and so were we.

But in all this fury two cases standout as a reminder that in spite of, not always because of, what we doctors do, the human body can right itself.   Like it did before their were drugs, procedures and surgery. (Keep this quiet, though.)

Case 1: A semi-emergent consultation for atrial flutter (AF’s crazy sister) came in. “Something has to be done, Dr M,” was the message.  She was symptomatic and scared (not necessarily in that order), but after a bit of simple doctoring (a pill), the heart rate had slowed and the symptoms abated somewhat. Then after a heavy dose of an AF doctor’s greatest weapon, reassurance and education, we mutually decided on one of my secret treatments for acute AF/AFlutter: a deep breath, a chair, a book and time. Just in case though, a cardioversion (shock) was set-up for the next morning.  I knew since this was a first episode, that given some time, the heart may right itself, without any fury.

Bingo, the text message came the next morning: “cardioversion cancelled…patient converted to sinus rhythm right after you saw her yesterday.” Grin.

Case 2: An elderly patient who was confined to assisted ambulation by birthday-related skeletal detonation presented with yet another episode of symptomatic atrial fibrillation.  There had been years of this pattern, numerous potent AF meds were tried and yet the irregular heartbeat persisted.  Presently, his heart rate was too slow, and the BP too low–the treatment had become worse than the disease.  So we conversed and decided on less medicine and more reassurance of the symptomatic palpitations. “The body adjusts to the irregularity over time,” I said.  Surgery or aggressive ablation were not appropriate; this hammer too big for such a small nail.   The patient and clipboard-carrying spouse reluctantly agreed.

However, just 48 hours later a surprise occurred.  Upon walking into the patient’s room, I was greeted by smiles. “I feel great, thanks for stopping those medicines,” he said.  I looked up at the bedside monitor: Sinus rhythm!!  Who knew that withdrawing AF meeds could be so effective.

The body righted itself.   We just let it.



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