Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board A-FIB ?

I was just diagnosed with "Atrial Fibrillation" which explains why I was short of breath over the last 2 or 3 years when exerting myself (2 weeks ago ran out of breath washing wife's car). Has anyone here gone through A-fib. and come out capable of hiking at altitude again?
I am in the middle of a lot of tests and weekly blood monitoring to get the dosage of a blood thinner optimal.
At least this helps to explain why I was so completely out of breath while hiking up to Cottonwood Lakes a few years ago and also while doing San Jacinto with my youngest son, (the legs still work, but can't get enough air)................steve

A few years ago, the blood bank kicked me out due to irregular heartbeats (5 or more per minute). I had a few tests, my doctor said it was nothing, and after some months, the problem disappeared. Mine, though, was really minor -- I could tell sometimes when it occurred, but that was it.

After it quit, the blood bank literally required a "note from my doctor", saying I was ok to donate again.

So... I hope your situation self-corrects, as well. Good luck!

Afib is a condition in which the top chamber of the heart does not contract in a forceful manner, it just kinda quivers. The net effect is that your cardiac output is lower than if everything worked in synchronicity. You may have up to 30% less pumping action because of this. Though you probably feel it when you start exercising, one of the more serious problems is clots. The quivering upper chamber causes turbulence and pockets of blood that can congeal in your heart. These are blood clots. When the clots get caught in the main flow of blood they can break free and travel anywhere, depending on their origination. If it originates in the right side of the heart it generally will go to the lungs and clog up a blood vessel. Blood will not flow past the clot, the section of lung fed by the blood vessel can die. If the clot starts in the left side of the heart it can go pretty much anywhere else with the same result. Think of an organ in the body and what would happen if a piece of it dies. The brain, the heart, arms, legs, liver, kidneys... etc. That's why they want to anticoagulate an afib person, they want to keep clots from forming. Anticoagulation has it's drawbacks, bleeding problems, the most serious is bleeding in places like the brain.

So, can you hike? Probably, but the usual risks associated with this hobby may have extreme consequences. If you take a pretty serious fall, you may well have a large amount of internal bleeding which would've normally stopped on it's own. You may be more prone to more serious forms of pulmonary or cerebral edema. Since you won't have the extra pumping power of your atria, your heart will generally beat faster to get enough oxygen to the tissues. You may be prone to rapid ventricular rate, IOW, your heart slips into an extremely fast (160+ beats per minute) rate from a relatively minor increase in exertion. Combine that with decreased oxygen availability at altitude and you may be setting yourself up for trouble. Scenario: you push a little too much to make camp early, your heart goes into RVR (rapid ventricular rate) of 180 beats per minute. I can take 180bpm for a short while, but your heart is going 180 and pumping 30% less blood. You feel funny, then pass out, hitting your head on a tree root. Since your blood doesn't clot normally, well, a cerebral hemmorrhage. You can see where I'm going with this. If you put your arm out first, you can get compartment syndrome. If you twist and get a branch in your gut, you get a tear to your liver. Etc.

The question you asked is, can you hike at altitude again? Like anything, everyone is different, you just gotta see what you're capable of. Definitely go easy until you find your limits. One of the worst things you can do is become paralyzed with fear and do nothing except stay at home. Keeping healthy through exercise will keep your heart strong and your circulatory system toned and compliant. You never know until you try, my guess is that you'll still be able to do much of this, most folks can usually continue doing what they like to do at a decent level. If you're lucky maybe only a 30% decrease in earlier ability. There are meds and other ways to control your heart rate, but one step at a time. Everything has pluses and minuses.

Good luck, I'm sure whatever the outcome is that you'll adjust, just go easy on yourself until you know your new limits.

Passinthru, I suspect the blood thinner you are taking is called warfarin or Coumadin. If afib is your only health problem, it may be a mistake to take warfarin/Coumadin, according to the treatment guidelines of the American Heart Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiologists (ESC). I suspect that many cardiologists are either unaware of this or ignore it because most of their afib patients have other health problems that complicate their afib and require warfarin/Coumadin.

Here's a link to the treatment guidelines http://eurheartj.oxfordjournals.org/cgi/reprint/27/16/1979 .

On p. 2002 are Tables 9 and 10 which indicate whether or not you should take warfarin/Coumadin.

If you don't have any other heart problems and you don't have any of the risk factors in Table 9, you should not be taking warfarin/Coumadin, according to these guidelines. If this is the case, I would suggest printing out these guidelines and discussing the tables on p. 2002 with your doctor.

Good luck and good health.

Steve, you need to email my brother. He has a lot of experience with Atrial Fibrillation over the years. He developed Atrial Fibrillation many years ago and ran the western states 100 with Atrial Fibrillation (he has 4 belt buckles) while under drug medication. Over the years, he has had embalation procedure, and the Maze procedure from the Cleveland Clinic (I hope I got the procedures correct). Six months after the Maze he ran a 50 miler up in Oregon.

Brother Ed for not being a doctor is one hell of a resource. Contact him. He is a Whitney board member. Send him a PM. It may be a week or so before you hear from him and you will.... I think he is in Costa Rica

Paul

Thanks, Paul, but as I said, my condition disappeared. It has been gone for six or eight years now. I was trying to offer Passinthru some hope.

I believe my doctor explained that sometimes the nerves that cause the heart to beat get mixed up, and that a pacemaker could help correct the problem if it becomes chronic.

The blood bank has been happily sucking my blood now for years.

This subject has come up before.

Regarding warfarin: My cardiologist had me on it for quite a while because of the stroke issue. Then my internist said he thought the risk of bleeding/death in a mountaineering accident was a more real danger for someone like me. They agreed to let my electrophysiologist break the tie, and I am now off warfarin.

Thanks for all the good information. I did spend quite a few hours on the web getting up to speed after my diagnosis, but you guys mentioned some new things for me. Thanks Lazarus for that informative post, Bob K., the report you cited is good, Paul, thanks about your brother's condition, and Bob R., thanks for citing that old thread re. A-fib and also your story.
Guys, I guess I'm in the 'depressed' state at the moment. More tests from the Drs., w/o any 'enlightenment' from them. Time will tell. Had an echo EKG last Wed., takes a week for the Dr. to get the results, you know the drill. Stress/echo set for May 2, had one of those about 15 months ago, AOK then. I've been complaining about shortness of breath to my Dr. for over 2 years. Three appointments with a pulmonologist = AOK, blah blah blah. AM going to keep my chin up and avoid the big hills and elevation for now.....................steve

Passinthru, Regarding the point that Jonathan made,


I found that a simple heart rate monitor was very useful for that when hiking. I have a cheap Polar that I bought on sale a few years ago for $30. Not only does it give my heart rate but it has a blinking heart icon that is in sync with my heart beat and is an easy way to see if my heart beat is irregular.



In the picture, I think I'm adjusting the wrist strap of my heart rate monitor and checking my heart on the switchbacks. (It inadvertently got in the photo.) I had afib around there for a few minutes and trudged on. When I was a few hundred yards from the summit I got afib again and trudged on again. We reached the summit and noticed that there was a suspicious cumulus in the west that was growing into a cumulonimbus so my wife and I headed back down. The sky was getting darker and so we tried to get down as fast as possible. Unfortunately with my afib, my heart rate which was measured with my monitor would get above 200 and I had to stop occasionally. We wanted to get off the ridge before the lightning started, but my speed was limited by afib. Kind of between a rock and a hard place. By the time we were heading down the switchbacks it started hailing and there was some nice thunder ... and my afib stopped. All in all, the afib didn't seem too bad and it was only an inconvenience.

So I was able to find what my limitation was in that situation and I used the heart rate monitor to help determine a reasonable speed. Also, by looking at the blinking heart icon of the heart rate monitor, I was able to confirm when I had afib and when it was over.

Passinthru,

I have had occasional bouts of afib for probably 20 years, most of which time I didn't know it. If you haven't already discovered affibbers.org I suggest you do so. The guy that runs it does a very good job of gathering and analyzing the research on the subject. He also conducts surveys that are very helpful. Of course, he is also trying to sell vitamins, but I think that as long as you take that into account there is a wealth of good information there.
One thing important about afib that I have concluded is that it is important to get out of it and stay out if you can. There seems to be a lot of research that suggest that the more often and longer you are in afib the more frequently it is to occur in the future to the point that you are in it permanently. There are ways to improve your odds of not going in it if you aren't already, but it is different for different people. Myself, I have found that if I lie down immediately when I feel an episode coming on I can stop it from doing so. It just takes a few seconds and I can get right back up and continue climbing that mountain.
Again, if you can get yourself out of afib in some way, do it and then figure out what tends to trigger it.

BOB K., thanks for the tip re. a H.R. Monitor with a visual of the beats, 'cuz I can't tell when I am in
A-fib, no heart jumping outta my chest, nothing, just get tired. But the tired part can be from sleep apnea TOO, so who knows.
HILLIBILLY, thx, will soon explore that site. I don't know my triggers yet, just know the last 3 times at Dr's, they told me I was in a-fib every time...............steve

Steve,
It sounds like you may be in afib all the time if you always feel tired. In some ways you are lucky, because some people have exploding heart rates on a frequent basis which is even worse than what you are dealing with. I can tell when an episode might come on by a feeling I get. It is similar to minor indigestion. But I can also easily spot it by taking my pulse. It is the difference between a regular pulse and irregular pulse. For example, in afib, I will have, say six regular beats, skip a beat, six more regular beats, skip, and so on. By the way, that site I referred you to will cost a modest amount, but I want to emphasize how good it is. The guy is able to communicate the information in a very readable way, while being comprehensive. While he sells vitamins, as well, I do not think that is his motivation. I think his primary motivation is the public service aspect of it. When I learned I had afib I was in a tizzy over it. His book helped be tremendously by educating me, putting it in perspective and helping me figure out how to deal with it.

This is a bump of this topic, to add new info. I recently attended a lecture at my hospital on this subject, by the local expert electrophysiologist/cardiologist. I shared this with a friend on the site, who though others might find it interesting:

Once you get past the prayer and the
intro, the talk is actually pretty good. (Talk starts about 4:20)

http://www.providencecme.org/Video.aspx?Vid=90

I've had a-fib for several years and have summited Whitney eight times and ridden STP (Seattle to Portland) in one day twice and regularly do 14ers in Colorado since the episodes started. I've been taking coumadin as a blood thinner and flechainide to regulate the heart beat and feel pretty good most of the time. I will say that when the episodes hit, they really floor me, as in I'm laying on the ground and can barely move. In January of this year I spoke with a surgeon about the ablation procedure and he discouraged me from pursuing that path unless and until the episodes become more frequent and more disabling. I'm not sure how much more disabling he wants them to be, I have had several falls both hiking and on the bike since I started taking the coumadin and the bleeding and bruising haven't seemed to be out of the ordinary. I'm reluctant to stop taking it after the husband of a woman that I work with age 57 died from a stroke after quitting taking it. It's suspected that contributed to the severity of the stroke. I'm sure this affects each person differently and you need to try to find out how you're affected and then make a measure judgement as the the risks involved. I'm 63 and my daughter is grown and out of the house. If I had young kids I might look at this a bit differently.
Good luch and Happy hiking.

Passinthru, this is Paul's brother, Ed who had AFib since the '80's. I just wrote a long post but somehow lost it while trying to get you a website. I am an ultra runner and backpacker who endured AFib for many years before getting cured. Yes, you can be cured today with a catheter ablation procedure. Back when I was dealing with my AFib, my only choice was an open heart Maze procedure which I chose to do as I love to run and be outdoors. As others have mentioned, exercising with AFib is not fun and the condition itself can be dangerous. Once you get AFib, it gets more and more persistent. Stroke is a risk, a real one and the drugs can be lethal in the long run.
You need to find a good cardiologist and electrophysiologist. I don't know where you live but there are lots of good ones around. I went to Cleveland Clinic for my maze and Northwestern Memorial for the ablation while I live in Ventura, CA. Try this website for more information: http://health.groups.yahoo.com/group/A-fibcures/ I will hopefully have August Whitney permits for my 13 year old daughter and me this year. Just turned 65 Sunday and will run the Wild West Marathon this May. Life is good. You just need to get informed and move forward. If I can answer any questions, please email me at ewehan@aol.com

ED, Many thanks for the info. I just became aware of the ablation techniques while reading some old posts on the subject (about 2 yrs old). I im'd one of the posters (no permission to use their name), and was brought up to date on what worked for them., R.F. Ablation in a specific area. I am scheduled to see my cardiologist March 11, and now have many new questions to ask him. I am in San Diego County and same age as you. I can pump the iron, walk on the level until the cows come home, but have NO TOLERANCE for going uphill---produces heart rates approaching 160 and WAY out of breath. Got a $30.00 heart rate monitor from Wal Mart, check it throughout the day.................steve
p.s. was cardioverted in August, '08; no A-Fib since.

Passinthru,
I had a cardiac ablation in 2002 at age 34 - but it was for Supraventricular Tachycardia. I had SVT from the time I was 18 and got a little tired and scared of having episodes where my heart rate would reach 230 beats a minute for no apparent reason. I would be able to run 5 miles with no problem but then I could cough or lean over to pick something up and all of a sudden my heart was pounding. I don't know about hiking/climbing as I wasn't doing doing this sort of thing back then but I will say having the cardiac ablation was one of the best decisions I ever made. I climbed my first 14er in 2005 and had no issues but probably would not have attempted something like that if I still had SVT. In my eyes, it would have been too risky to not have access to medical attention with my heart racing that quickly. I don't know much about A-fib but i just wanted to say that the cardiac ablation worked for my heart problem and if you are told by a cardiologist that it could work for your problem - its soworth it.
Leigh-Ann