AFIB1

I am 82. I have had an ischemic stroke due to AFIB. I have a Watchman in my heart to minimize future strokes, but I have arrhythmia. What should my cardiologist and I be doing? 

 

CHATGPT

Thank you for sharing that. You're clearly thinking ahead and advocating for yourself, which is essential in managing complex heart conditions, especially at age 82. Given your medical history—ischemic stroke due to atrial fibrillation (AFib), implantation of a Watchman device, and ongoing arrhythmia—here’s what you and your cardiologist should be focusing on now:


1. Ongoing Rhythm and Rate Management

Even with the Watchman in place, managing the AFib itself is important.

  • Rate control: Ensuring your heart rate stays in a safe range, often with beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., diltiazem), or digoxin.

  • Rhythm control: Depending on the severity of the arrhythmia, your cardiologist may consider antiarrhythmic medications or procedures such as cardioversion.

  • Holter monitor or event recorder: To evaluate how often and how severely you're having AFib or irregular rhythms.

2. Stroke Risk Monitoring Post-Watchman

The Watchman device is used to close the left atrial appendage, reducing the risk of stroke associated with AFib. However:

  • You should have regular imaging (e.g., transesophageal echocardiogram or TEE) as recommended, especially within the first year, to ensure the device is adequately sealed.

  • Your cardiologist may have you on short-term anticoagulation or antiplatelet therapy (like aspirin or clopidogrel), especially in the first 6 months after placement. Ask if you need to continue taking blood thinners.

3. Medication Review

At your age and with a history of stroke, it's important to regularly review your medications for:

  • Effectiveness

  • Side effects

  • Interactions with other conditions (like kidney or liver function, blood pressure, dizziness)

4. Symptoms to Watch For

Discuss with your doctor what symptoms should prompt urgent attention. These may include:

  • New or worsening palpitations, shortness of breath, dizziness, or chest discomfort

  • Signs of heart failure (swelling in the legs, fatigue, rapid weight gain)

  • Recurrence of stroke symptoms (numbness, speech changes, visual disturbances)

5. Lifestyle and Preventive Care

  • Blood pressure and glucose control: Crucial for reducing vascular risk.

  • Sleep apnea evaluation: Common in people with AFib and a hidden contributor to arrhythmia.

  • Diet, exercise, and hydration: Tailored to your abilities, but keeping active and eating heart-healthy matters.

  • Fall prevention: Especially if on any blood-thinning agents.

6. Advance Planning

It’s also a good time to talk with your cardiologist about:

  • Your goals of care: How aggressively do you want to manage your heart rhythm in the future?

  • Whether invasive procedures (like ablation) are appropriate or not given your age, preferences, and risk profile.

  • Advance directives and how your cardiac condition should be factored in.

A Suggested Question List for Your Next Visit:

  1. How well is my current heart rhythm being controlled?

  2. Do I still need any anticoagulation or antiplatelet medication with the Watchman in place?

  3. Would I benefit from a rhythm control strategy or is rate control enough?

  4. Is it time for another scan to check the Watchman device?

  5. Are there any concerns about my medications interacting or affecting my kidney/liver?

  6. Do you see any signs of heart failure developing?

  7. Should I be screened for sleep apnea or other hidden risk factors?


Signs of heart failure developing.

The signs of heart failure can develop gradually or suddenly, and it's important to know what to watch for—especially in someone with a history of stroke, AFib, and advancing age. Here are the common early and progressing signs to be aware of:

🚩 Early Signs of Heart Failure

These may be subtle but are worth mentioning to your cardiologist:

  1. Fatigue or reduced exercise tolerance

    • Feeling more tired than usual doing normal activities

    • Needing more naps or rest during the day

  2. Shortness of breath (dyspnea)

    • Initially with exertion (like walking uphill or climbing stairs)

    • Later, possibly at rest or while lying flat (orthopnea)

  3. Swelling (edema)

    • In the ankles, feet, or legs

    • Sometimes in the abdomen (bloating or discomfort)

  4. Weight gain (fluid retention)

    • Rapid gain of 2–3 pounds in a day or 5 pounds in a week may signal fluid buildup

🚩 Moderate to Severe Symptoms

These usually mean heart failure is progressing:

  1. Waking up at night short of breath (paroxysmal nocturnal dyspnea)

    • Needing to sit or stand up to catch your breath

  2. Persistent cough or wheezing

    • Often worse at night; may produce white or pink frothy sputum (if severe)

  3. Chest discomfort or palpitations

    • Irregular heartbeats or a fluttering sensation in the chest

  4. Mental confusion or memory problems

    • Reduced oxygen flow or low output from the heart can affect brain function

  5. Decreased appetite or nausea

    • Blood and fluid backing up into the liver and gut can reduce hunger

  6. Cool extremities or bluish fingers/lips

    • Especially in more advanced stages, due to poor circulation

🩺 What You Can Do

  • Track weight daily: Same time, same scale, after urinating, before eating. Report sudden increases.

  • Monitor swelling: Check socks or shoes for tightness.

  • Note breathlessness: Especially if it changes or worsens.

When to Call the Doctor Immediately

Call your cardiologist or seek care if you notice:

  • Sudden weight gain or swelling

  • Difficulty breathing when lying down

  • Waking up gasping for air

  • Confusion or sudden fatigue

  • New or worsening irregular heartbeat


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