Dehydrated: Anybody been there?

An old friend of mine has chronic a-fib, for which he
takes a number of medications, including the
anticoagulant Coumadin, a prescription form of rat
poison [warfarin], as a preventive of stroke.

In about 10-15% of a-fib patients there is no other
condition responsible. Anything which cause the heart
to be enlarged, like untreated hypertension or valve
problems, can cause a-fib.

My oversize friend with a-fib actually has a 25% undersize
heart, for which his doctors blame his two-month premature
delivery as a baby.

Goes to show that there are no absolutes in this business,
but I wonder if his atria are actually large or normal sized.

I don't know offhand, but he and his wife are hosting a dinner
party tonight, so I'll ask.

Okay, I asked, and he said his atria are "not significantly enlarged".

--
"Bicycling is a healthy and manly pursuit with much
to recommend it, and, unlike other foolish crazes,
it has not died out." -- The Daily Telegraph (1877)

On Sun, 10 Oct 2004 18:48:50 -0700, LioNiNoiL_a t_Y a h 0
0_d 0 t_c 0 m wrote:

[snip]


I don't know offhand, but he and his wife are hosting a dinner
party tonight, so I'll ask.

Okay, I asked, and he said his atria are "not significantly enlarged".

Dear L.,

Of course. What else would your friend to say, with his wife
standing right next to him, ready to deflate his male ego at
a party if he starts boasting about his big--

Oh.

Never mind.

Carl Fogel

On Sun, 10 Oct 2004 18:48:50 -0700, LioNiNoiL_a t_Y a h 0
0_d 0 t_c 0 m wrote:

[snip]


I don't know offhand, but he and his wife are hosting a dinner
party tonight, so I'll ask.

Okay, I asked, and he said his atria are "not significantly enlarged".

Dear L.,

Of course. What else would your friend to say, with his wife
standing right next to him, ready to deflate his male ego at
a party if he starts boasting about his big--

Oh.

Never mind.

Carl Fogel

writes:

On Sun, 10 Oct 2004 18:48:50 -0700, LioNiNoiL_a t_Y a h 0
0_d 0 t_c 0 m wrote:

[snip]


I don't know offhand, but he and his wife are hosting a dinner
party tonight, so I'll ask.

Okay, I asked, and he said his atria are "not significantly enlarged".

Dear L.,

Of course. What else would your friend to say, with his wife
standing right next to him, ready to deflate his male ego at
a party if he starts boasting about his big--

Its true. Most men are mistaken about what is an "average" sized
atria.

writes:

On Sun, 10 Oct 2004 18:48:50 -0700, LioNiNoiL_a t_Y a h 0
0_d 0 t_c 0 m wrote:

[snip]


I don't know offhand, but he and his wife are hosting a dinner
party tonight, so I'll ask.

Okay, I asked, and he said his atria are "not significantly enlarged".

Dear L.,

Of course. What else would your friend to say, with his wife
standing right next to him, ready to deflate his male ego at
a party if he starts boasting about his big--

Its true. Most men are mistaken about what is an "average" sized
atria.

In article ,
Jim Smith wrote:

writes:

On Sun, 10 Oct 2004 18:48:50 -0700, LioNiNoiL_a t_Y a h 0
0_d 0 t_c 0 m wrote:

[snip]


I don't know offhand, but he and his wife are hosting a dinner
party tonight, so I'll ask.

Okay, I asked, and he said his atria are "not significantly enlarged".

Dear L.,

Of course. What else would your friend to say, with his wife
standing right next to him, ready to deflate his male ego at
a party if he starts boasting about his big--

Its true. Most men are mistaken about what is an "average" sized
atria.

Crap! Now I'll start getting "N.large yr Ao.rta!!!!!" spam.

--
B.B. --I am not a goat! thegoat4 at airmail.net

In article ,
Jim Smith wrote:

writes:

On Sun, 10 Oct 2004 18:48:50 -0700, LioNiNoiL_a t_Y a h 0
0_d 0 t_c 0 m wrote:

[snip]


I don't know offhand, but he and his wife are hosting a dinner
party tonight, so I'll ask.

Okay, I asked, and he said his atria are "not significantly enlarged".

Dear L.,

Of course. What else would your friend to say, with his wife
standing right next to him, ready to deflate his male ego at
a party if he starts boasting about his big--

Its true. Most men are mistaken about what is an "average" sized
atria.

Crap! Now I'll start getting "N.large yr Ao.rta!!!!!" spam.

--
B.B. --I am not a goat! thegoat4 at airmail.net

In article , Pete Cresswell
wrote:

I had a scary experience yesteday.

About 30 minutes into a morining ride, I started feeling sick to the stomach
and
my heartbeat became noticibly irregular. Sat down for awhile, felt a little
better, decided to turn around and ride home...felt worse immediately,
experienced some dizziness.

Called my wife to come and drive me home.

Felt lousy most of the rest of the day - extremely quick to tire, heartbeat up
around 140 just sitting in a chair... Slowly got better over the course of the
day.

snip
So, bottom line, was my little adventure consistant with dehydration?

Yes, this is very scary, especially when one doesn't know what was
actually causing it. There are a few terms you use that point towards
a cardiac problem, but not the sort for which you were tested recently.
You wrote that your heart rate was fast and irregular. These are the
hallmarks of atrial fibrulation: picture the upper chambers (atria)
wrigling like a sack of worms. When this happens in the ventricles
(that do the real pumping; V-fib), it's fatal. With the atria, it just
means that the ventricles don't fill properly, and they don't get a
nice, synchronized signal to start squeezing. This results in "an
irreglularly irregular" pulse, with overall decreased blood pumping
capabillity. Often people feel pounding of the heart, tire easily, can
be nauseous, etc.
A-fib is not immediately life-threatening, but blood can pool in the
atria enough to clot, and then break off, potentially leading to a
pulmonary embolism (death) or other thromboembolic event (e.g. stroke).
If it persists more than a few hours, or recurs, one can use blood
thinners to prevent this.
A-fib usually is an on-off situation. It's unclear how the symptoms
resolved in your case, but not everyone is aware of when they flip
in/out. There are other cardiac arrythmias that could also account for
your symptoms. They're virtually impossible to detect if you're not
experiencing the symptoms at the time of the test, but it sounds like
you've had at least one other episode like this, and it may have been
contributing to the chest pain for which you had the major workup.
Just like a car, it's difficult to identify or fix an intermittent
problem if it isn't occurring when you get to the doc/mechanic.
My strongest recommendation is to get to an ER the next time this
happens. An exam and EKG while it is occurring will be the most useful
investigations (and they can also rule-out other causes). The
alternative is a continuous recorder that you wear for a day or two to
capture these events, but if they're not that frequent, you might just
get 24 h of normal EKG.
Dehydration is exceedingly unlikely in such a short period of
time... unless it was unusually hot, you were working very hard, and
you were already dehydrated from a long night of hard drinking that
ended mere hours before you got on the bike. Dehydration can cause
rapid heart beat, dizziness (especially when first standing up), and
eventually nausea, especially if there are significant electrolyte
abnormalities. Again, I really believe this is *not* what you
experienced.
Disclaimer: I don't usually work with adults, and it's tough to
diagnose accurately via usenet. Good luck with this!

--Kurt Griffin
Rockville, MD

In article , Pete Cresswell
wrote:

I had a scary experience yesteday.

About 30 minutes into a morining ride, I started feeling sick to the stomach
and
my heartbeat became noticibly irregular. Sat down for awhile, felt a little
better, decided to turn around and ride home...felt worse immediately,
experienced some dizziness.

Called my wife to come and drive me home.

Felt lousy most of the rest of the day - extremely quick to tire, heartbeat up
around 140 just sitting in a chair... Slowly got better over the course of the
day.

snip
So, bottom line, was my little adventure consistant with dehydration?

Yes, this is very scary, especially when one doesn't know what was
actually causing it. There are a few terms you use that point towards
a cardiac problem, but not the sort for which you were tested recently.
You wrote that your heart rate was fast and irregular. These are the
hallmarks of atrial fibrulation: picture the upper chambers (atria)
wrigling like a sack of worms. When this happens in the ventricles
(that do the real pumping; V-fib), it's fatal. With the atria, it just
means that the ventricles don't fill properly, and they don't get a
nice, synchronized signal to start squeezing. This results in "an
irreglularly irregular" pulse, with overall decreased blood pumping
capabillity. Often people feel pounding of the heart, tire easily, can
be nauseous, etc.
A-fib is not immediately life-threatening, but blood can pool in the
atria enough to clot, and then break off, potentially leading to a
pulmonary embolism (death) or other thromboembolic event (e.g. stroke).
If it persists more than a few hours, or recurs, one can use blood
thinners to prevent this.
A-fib usually is an on-off situation. It's unclear how the symptoms
resolved in your case, but not everyone is aware of when they flip
in/out. There are other cardiac arrythmias that could also account for
your symptoms. They're virtually impossible to detect if you're not
experiencing the symptoms at the time of the test, but it sounds like
you've had at least one other episode like this, and it may have been
contributing to the chest pain for which you had the major workup.
Just like a car, it's difficult to identify or fix an intermittent
problem if it isn't occurring when you get to the doc/mechanic.
My strongest recommendation is to get to an ER the next time this
happens. An exam and EKG while it is occurring will be the most useful
investigations (and they can also rule-out other causes). The
alternative is a continuous recorder that you wear for a day or two to
capture these events, but if they're not that frequent, you might just
get 24 h of normal EKG.
Dehydration is exceedingly unlikely in such a short period of
time... unless it was unusually hot, you were working very hard, and
you were already dehydrated from a long night of hard drinking that
ended mere hours before you got on the bike. Dehydration can cause
rapid heart beat, dizziness (especially when first standing up), and
eventually nausea, especially if there are significant electrolyte
abnormalities. Again, I really believe this is *not* what you
experienced.
Disclaimer: I don't usually work with adults, and it's tough to
diagnose accurately via usenet. Good luck with this!

--Kurt Griffin
Rockville, MD