Good Cardiologist In Pattaya

[dsfbrit]

I have just returned from successful hip surgery abroad. Whilst there the pre-operation ECG tests showed I have an irregular heartbeat.

I am a 56 year old male and I was a bit surprised by this as I dont drink alcohol, I dont smoke, I do eat healthily, I exercise a lot and I am not overweight. The only thing the cardiologist recommended to change my lifestyle was that I give up caffeine. He also recommended I visit a cardiologist when I got back to the LOS.

I asked them to run a lot of tests for me as I had nothing better to do anyway after the surgery and had to remain in the hospital anyway for several days before I was allowed to fly.

All my other toxicology and heart tests showed all my values for everything (ie: cholestrol, blood sugar...)are within limits. He even ran tests for Thyroid Hormone problems, which were clear.

So if anyone could advise where I could go it would be a great help. I have ECG charts and echo sound test results along with a detailed toxicology report so I hope I wont need all the tests run again.

The cardiologist abroad said I should read up about 'Radio Frequency Ablation For Atral Fibrilation', I am doing that now.

Thanks very much for your help.

[Mobi]

There is only one hospital in Pattaya that has decent cardiac facilities and good cardiologists and that is Bangkok Pattaya.

Unfortunately, although the care may be very good, their prices are unlikely to be quite so acceptable.

So unless you have full medical insurance cover ( and I would check with your insurers at every stage of the medical process to ensure your coverage is adequate) then I strongly recommend you see one of the top cardiologists in Bangkok at one of the private hospitals there.

Bumrungrad has always been at the top of my list, mainly due to the ease of getting there from Pattaya (either by car or public transport), but Samitivej is also good as is BNH. All of the them boast a first rate list of cardiac specialists.

These days a round trip to Bangkok is very easy and quick, so no need to stay over night.

PM me if you would like the name of a cardiologist in Bumrungrad, although you can see the doctor's list and bios on the hospital website and even book your appointment in that way.

Good luck

[dsfbrit]

Mobi,

Thanks very much for the feedback.

Yes I agree with you about the Bumrungrad.

Whilst deciding where to have my hip operation I too travelled to Bumrunggrad in a day. With the new Pattaya road link the bus from North Pattaya station to Ekamai is only a couple of hours and then the BTS to Nana is only another 20 minutes. The cost was only 400 baht there and back and I had a nice sleep as well!!

I also visited Bangkok Pattaya hospital to see what they offered in the way of hip surgery options.

Sadly the only reasonably priced and easy to understand part of having the operations in Thailand seemed to be the travel costs. Bumrungrad offered a 'package' price on my operation, but upon closer inspection the package did not include all the costs - the pre-med ECG tests etc... were extra. When I asked how much this pre-med test would cost they could not tell me. It all depends ... was the answer.

Bangkok Pattaya hospital was even more 'interesting'. They would not quote a price at all and

when I went to see the surgeon he could not keep the appointment as he was in surgery - an emergency - fair enough. The reception refused to quote a price without the surgeon seeing me first.

I never got my pricee, but eventually I did find out the surgeon had never actually carrried out this type of hip operation before, well not at BPH anyway How did I find out - well I went to the payment office and asked what the average cost of the hip operation was. She would not tell me. When I smiled sweetly and said oh go on give me a figure - she said she could not even if she wanted to as they had never carried out that type of operation before!!!

I eventually went abroad to a surgeon who had carried out 2000 hip operations and was well recommended by former patients on a hip resurfacing help forum I found.

So Mobi. as much as I appreciate your kind offer of a reputable cardiologist, I was really hoping that someone would be able to suggest a reputable cardiologist that did not work at either of these hospitals and was preferably local to Pattaya.

I know you were recommending the hospital in Sri Racha for certain procedures - is that still a good hospital in your opinion. Is the cardiologist half decent??

Initally I would just like to meet with a cardiologist to discuss my ECG tests etc... and take some tablets to reduce the risks. The cardiologist where I had my hip operation has provided me with tablets for another 3 weeks (Cordiarone, Livein, Betaloc25, Aspirin), so I

have time to find a local cardiologist.

I have a feeling if I do need an operation I may end up going abroad again!!

[Naam]

There is only one hospital in Pattaya that has decent cardiac facilities and good cardiologists and that is Bangkok Pattaya.

but in case of extended surgery (e.g. bypasses) a team from BKK travels to Pattaya. after my quadruple coronary and single aorta bypass (done in Germany end of 2008) i consulted with two cardiologists in BKK-Pat Hospital and selected one for my regular check-ups. i'm not a medic, therefore i can't judge their performance.

dsfbrit

had my surgery done in Germany by an internationally renowned surgeon. was first considering Phya Thai (spelling?) in BBK. wife insisted on Germany where i was told by my surgeon "we visited Phya Thai a couple of years ago. the colleagues there would have done an excellent job too. but then you couldn't have claimed that your coronary remodelling was done by me."

[Mobi]

Of course everyone can relate good and bad experiences at almost any hospital.

Although I have had my problems with Bumrungrad over the years, on the whole my opinion is favourable.

And although I have had SOME good treatment at Bangkok Pattaya through the yeras, my overall opinion is distinctly unfavourable - not only in connection with their pricing policies but also on their after care. They act as though they couldn't care a less, once they have completed the medical procedure and you are in recovery - which of course they don't.

I was once admitted by my cardiologist at Bumrungrad to have stents implanted, but when she did a preliminary angiogram, before inserting the stents, she decided that the narrowing on my artery was not yet sufficient to justify stents and when I was awoken in recovery, later that day, I was presented with a large refund on the deposit I had previously made.

That would never, EVER, happen at Bangkok Pattaya.

Bumrungrad is a very large hospital and has a long list of eminent heart surgeons - undoubtedly the cream of Thailand's specialists.

As Sheryl has so often advised, choose your specialist, not your hospital.

I think you will also find a good list of overseas trained specialists at Samitivej (Sukhumvit), BNH and to a lesser extent St Joseph's, but I would not recommend Samitivej , Sri Racha. It is is a distinctly provincial hospital, (and not particularly cheap as they have many Japanese patients) and while they were excellent with my Dengue fever, I wouldn't trust them too much with cardiac care. They don't even have a diabetic specialist there and the doctor who was supposedly the 'expert' on diabetes couldn't understand why I had to inject insulin 4 times a day. I would say his knowledge of diabetes treatment was about 30 years out of date.

[Phil Conners]

You might want to read though this thread. It's not the same condition as you, but there are a couple of interesting links to cardiologists in both Pattaya and Bangkok that you might find useful.

[dsfbrit]

Thanks for the feedback and the link. Phil your approach your problem seems similar to mine.

Naam, I may end up in Germany as wel!!

Mobi, I could not agree more that its not the hospital thats important but the physician.

It took me over a year to decide on my surgeon to do my hip.

The trouble is with my heart I need to stabilize it first so I can give myself time to find the surgeon I trust.

The major sympton of my problem is an increased risk of a stroke, brought on by a blood clot. One temporary 'solution' to this is to take blood thinning tablets. I have been given blood thinning tablets as part of my post surgery package, so am OK for the next 3 weeks anyway.

I suppose as I am just looking for an interim solution whilst I decide if I need an operation and on the surgeon to perform an operation if needed, here in LOS or abroad, then I could go to the BPH and have an initial consultation with a cardiologist who may then issue me with some pills whilst I decide what to do next.

Does that sound like a good plan???

[FBN]

In the preliminary investgations for an abnormal heartbeat, a 24h monitoring is usually performed by attaching a device (Holter monitoring) to you for carrying around for that period; a compressed recording of the heart beats are done and then analysed by the cardiologist. Choose a hospital that has this facility. Bumrungrad will have.

[dsfbrit]

In the preliminary investgations for an abnormal heartbeat, a 24h monitoring is usually performed by attaching a device (Holter monitoring) to you for carrying around for that period; a compressed recording of the heart beats are done and then analysed by the cardiologist. Choose a hospital that has this facility. Bumrungrad will have.

What does that achieve more than the ECG. I was monitored for 2 days on an ECG and I have the graphs. Even I can see the irregular heartbeat on the graph when it occurs. I can hear it as well when I am connected to the ECG!! Every now and then it misses a beat or comes slightly late.

I have a feeling that unless I go into this with some good technical knowledge, I will be having all kinds of tests I dont need. Sorry to sound so cynical, but my experience of some of the medical facilities in the LOS seem to have a lot to do with making money and not enough to do with just helping the patient.

[FBN]

The 2 day monitoring was probably the same, so most likely no need to repeat; not clear from the initial post but there are also only very few facilities that can perform an ablation so keep that in mind also. As Sheryl always says, "be an informed consumer..."; so a modicum of cynicism is probably not misplaced but don't let it lead you astray..

[Mobi]

Hm.. yes not a bad plan and as FBN has said, a degree of cynicism can be a good thing.

So.. going down the cynic's route, I personally would not consult any cardiologist at BHP. If he runs true to form my guess is that he will overcook the diagnosis and probably recommend immediate surgery.....

Personally, I would feel far more comfortable in consulting one of the Bangkok based specialists. I do believe they have more integrity than their colleagues have in Sin City, where they seem to think there is a large dollar sign in the middle of every farang name...

[Sheryl]

I was really hoping that someone would be able to suggest a reputable cardiologist that did not work at either of these hospitals and was preferably local to Pattaya.

A cardiologist not only reputable but with the specialized experience required, you will definitley not find in Pattaya outside of BPH if even there.

My advice is don't even think about Pattaya, come to Bangkok.

There are some viable and much lower cost alternatives to Bumrungrad in Bkk.

1. See Phil's thread again for details of the prof at Chula who did his stent. Dr. Taworn is one of the most eminent cardiologists in Thailand, US trained/Board certified (UCLA) and a Professor at a major medical school. He is comparatively young and throughly up to date. I would expect him to be experienced in ablation but if not, he'd say so and also be able to tell you who among his colleagues is.

I would trust him to operate on me, which is saying a lot. He has private hours at Bangkok Christian every Saturday which is the easiest way to access him although he would likely schedule any invasive procedures, if deemed necessary/advisable, at Chula, a major government teaching hospital. As described in Phil's thread in that instance you would be admitted through (Bkk Christian (a private non profit)and taken by ambulance to and from Chula for the procedure, bypassing all the red tape normally involved in care at a government hospital.

2. Another option is Saint Louis Hospital on Sathorn, also a non-profit. I have heard they havce a good cardiologist in staff (probably also affiliated with Chula) but am having problems with their website.

http://www.saintlouis.or.th/clinic/index.php

if you want to try, click on clinics, then click cardiology clinic, then click on "make an appointment", this will yield a list of the doctors and clicking on each name will give you a brief CV of each.

Obviously, wherever you go, bring all your records, test results etc. with you.

Would also be wise to read up online about radio ablation for atrial fibrillation. There are pluses and minuses to it, does not always work, and no guarantees. The risk benefit equation varies greatly with the age and general health of the patient. A good doctor will be able to help lay out all the considerations for you but ultimately you'll have to decide, so it will help if you come in already read up on the subject.

I am assuming the diagnosis is correct and that you do in fact have a-fib. There are other arrythmias common in younger people and indeed often aggravated by caffeine use, such as premature junctional beats, but these are usually considered benign. However no-one competent in reading a rhthym strip would confuse the two.

[dsfbrit]

FBN and Mobi,

I have taken your points on board, thanks for that.

Mobi, I agree about your comments about Bumrungrad. I found the surgeon at Bumrungrad to be honest enough. I only decided against him doing my operation as he had only carried out 70 operations, whereas the surgeon I eventually chose had carried out 2000 operations. This meant that the surgeon was less likely to revert to the older style hip replacement operation if he had problems he could not solve.

I think the reason I am 'keener' to go somewhere locally to try to get the process underway is that I am still on crutches at the moment and have to use them for another 4 weeks. So if I were to go to BPH in the next few weeks just for an initial consultation and a prescription to stabilise me that would be simpler.

What do you think???

I could then go to Bumrungrad next month for a further consultation and to see about an operation once I have fully understood the problem that I have. Lots of googling to be carried out I reckon.

By the way thanks to everyone for the comments you made. Sitting here in bed on my own whilst recuperating from the recent surgery would be a lot more stressful if I had not been able to discuss these heart issues with people who have had similar problems as mine.

SO thanks

Dave...

[Mobi]

I think your plan is good. I'm sorry I hadn't appreciated that you were still on crutches.

You will be aware that these hospitals always wish to do their own tests and are usually reluctant to take notice of any reports, ECG's etc that you may bring with you.

But it's always worth a try and you know enough to be forceful if they try to do be unnecessarily pedantic or overdo the treatment.

Whilst you are a semi invalid, you could look at the doctors' bios on-line at Bumrungrad and elsewhere and study their experience.

That's what I always do, But in the end I always go for a pretty face rather than surgical experience....

Good luck, hope you get it all sorted in due course.

[Naam]

Naam, I may end up in Germany as well!

if i had to do it again, knowing what i know now, i'd not follow the orders of Mrs Naam "GERMANY IT IS!" but have it done in BKK.

reasons: because the Mrs insisted i booked the only "suite" in the famous "Herzzentrum München". that cost me the additional "modest" sum of €UR 980 per day for 9 days (at that time ~450,000 Baht). the "suite" was a slightly bigger than normal room plus an attached cubby hole of ~6m² where the Mrs dwelled and worried with her own flat screen TV and broadband internet for her laptop.

that i could order food à la carte, respectively according to my own liking, 24 hours a day was not worth the additional expense.

by the way, i don't understand why you are thinking of surgery because of irregular heartbeat

[dsfbrit]

I was really hoping that someone would be able to suggest a reputable cardiologist that did not work at either of these hospitals and was preferably local to Pattaya.

A cardiologist not only reputable but with the specialized experience required, you will definitley not find in Pattaya outside of BPH if even there.

My advice is don't even think about Pattaya, come to Bangkok.

There are some viable and much lower cost alternatives to Bumrungrad in Bkk.

1. See Phil's thread again for details of the prof at Chula who did his stent. Dr. Taworn is one of the most eminent cardiologists in Thailand, US trained/Board certified (UCLA) and a Professor at a major medical school. He is comparatively young and throughly up to date. I would expect him to be experienced in ablation but if not, he'd say so and also be able to tell you who among his colleagues is.

I would trust him to operate on me, which is saying a lot. He has private hours at Bangkok Christian every Saturday which is the easiest way to access him although he would likely schedule any invasive procedures, if deemed necessary/advisable, at Chula, a major government teaching hospital. As described in Phil's thread in that instance you would be admitted through (Bkk Christian (a private non profit)and taken by ambulance to and from Chula for the procedure, bypassing all the red tape normally involved in care at a government hospital.

2. Another option is Saint Louis Hospital on Sathorn, also a non-profit. I have heard they havce a good cardiologist in staff (probably also affiliated with Chula) but am having problems with their website.

http://www.saintlouis.or.th/clinic/index.php

if you want to try, click on clinics, then click cardiology clinic, then click on "make an appointment", this will yield a list of the doctors and clicking on each name will give you a brief CV of each.

Obviously, wherever you go, bring all your records, test results etc. with you.

Would also be wise to read up online about radio ablation for atrial fibrillation. There are pluses and minuses to it, does not always work, and no guarantees. The risk benefit equation varies greatly with the age and general health of the patient. A good doctor will be able to help lay out all the considerations for you but ultimately you'll have to decide, so it will help if you come in already read up on the subject.

I am assuming the diagnosis is correct and that you do in fact have a-fib. There are other arrythmias common in younger people and indeed often aggravated by caffeine use, such as premature junctional beats, but these are usually considered benign. However no-one competent in reading a rhthym strip would confuse the two.

Sheryl, sorry I missed your reply amongst the other replies so have only just read this. OK, I can see its very clear there is not much enthusiasm by anyone for any venue in Pattaya. I have taken that on board and wont waste my time with Pattaya.

Perhaps you could give me some advice about what to do before I can get to BKK or one of the other venues mentioned here by you and others. I am on crutches at the moment so cannot travel anywhere too easily. I have tablets to prevent blood clots etc... after my recent surgery. The major concern of my problem is the risk of a stroke,so with the tablets I am taking could I continue these for another couple of weeks to keep my blood thinner. To be honest there is an increased risk of a stroke, but its still very unlikely and as I dont drink, nor smoke, I do eat healthily and I am not overweight and I no longer drink caffeine!!!am I overreacting and should aim to go to BKK when I can walk properly again at the end of March.

Thanks again for your help... and yes I am doing lots of reading about all this... lots of it

[dsfbrit]

I think your plan is good. I'm sorry I hadn't appreciated that you were still on crutches.

You will be aware that these hospitals always wish to do their own tests and are usually reluctant to take notice of any reports, ECG's etc that you may bring with you.

But it's always worth a try and you know enough to be forceful if they try to do be unnecessarily pedantic or overdo the treatment.

Whilst you are a semi invalid, you could look at the doctors' bios on-line at Bumrungrad and elsewhere and study their experience.

That's what I always do, But in the end I always go for a pretty face rather than surgical experience....

Good luck, hope you get it all sorted in due course.

Thanks for the support and good advice Mobi. I wont waste my time with Pattaya, I

will get up to one of the venues mentioned in various posts above. I will have a read of the Bumrungrad staff profiles. Could you please give me the name of the cardiologist you saw and if you have time the costs for the initial consultation and any other costs you may think are relevant. I am self funding, so although I do not mind paying for my medical care, like everyone here, I dont like being fleeced!!

Thanks again

Dave...

[dsfbrit]

Naam, I may end up in Germany as well!

if i had to do it again, knowing what i know now, i'd not follow the orders of Mrs Naam "GERMANY IT IS!" but have it done in BKK.

reasons: because the Mrs insisted i booked the only "suite" in the famous "Herzzentrum München". that cost me the additional "modest" sum of €UR 980 per day for 9 days (at that time ~450,000 Baht). the "suite" was a slightly bigger than normal room plus an attached cubby hole of ~6m² where the Mrs dwelled and worried with her own flat screen TV and broadband internet for her laptop.

that i could order food à la carte, respectively according to my own liking, 24 hours a day was not worth the additional expense.

by the way, i don't understand why you are thinking of surgery because of irregular heartbeat

Good heavens Naam, that trip to Germany sure sounds like a 'cheap' deal. I must admit I would not take my wife with me anyway,its hard enough dealing with the stress of an operation, but calming down a worried wife is too much of an extra burden.

Why am I thinking of surgery?? To be honest I am not really thinking of surgery. I am trying to think of a way to reduce the risk of a (unlikely) stroke whilst I read and understand all the issues relating to my problem. I would like a diagnosis from a cardiologist I trust and to explore the options. If possible I would like to be put on some tablets whilst I think about all this.

My experience of some venues is exactly what Mobi mentioned above. They tell you that you must have surgery next week or you will have severe problems. Thats what happened with my hip 4 years ago when it was diagnosed at the BPH Pattaya. They told me I needed a hip replacement then - not only did I wait another 4 years as I should have done, but I also had the newer hip resurfacing operation - which means I can return to a normal life,play sport etc...

Had I followed the advice of the surgeon at BPH 4 years ago my life would have been - well to be honest - ruined - if not ruined then not as good as it could be simply because I researched the subject on the internet and realised what I was being told was simply wrong!!!

So if I can delay surgery I will.

Thanks again for the comments, certainly if you have any info on how to delay surgery with tablets and where/how to get them I will take it on board. The primary way to reduce the chance of a stroke is to take blood thinners to reduce the chance of a clot in the heart. I am currently takig some anyway as part of my cocktail of pills given to me after my recnt surgery. So I am OK for the next 3 weeks...

[Phil Conners]

I don't know. I think if I was you I'd go to BPH with the papers you have, go directly to the heart center and see a cardiologist there. The most it will cost you is a couple of hundred baht. If they start pushing to put you through tests or other things you don't agree with you can always refuse and at that point start looking at Bangkok options. I had a meeting with a cardiologist in BPH, Dr. Kitti Nakjuntuk, and found him both helpful and knowledgeable, he used the papers I had from another hospital without pushing to make his own. One of the big reasons I didn't go any further with it was the price they quoted me for actual intervention, which was 2-3 times what I eventually paid in Bangkok, but if all you need are some drugs to stabilize your situation you should be ok.

The cardiologist I used in Bangkok, Dr. TAWORN SUITHICHAIYAKUL, is supposedly the best in this field in Thailand. The biggest problem is that he is only available Saturday mornings, and he is so famous and popular that people start checking in at 7am, meaning you'll have to leave Pattaya at 4am to have a chance to meet him - unless you want to go to BKK the night before and stay overnight somewhere.

[dsfbrit]

I don't know. I think if I was you I'd go to BPH with the papers you have, go directly to the heart center and see a cardiologist there. The most it will cost you is a couple of hundred baht. If they start pushing to put you through tests or other things you don't agree with you can always refuse and at that point start looking at Bangkok options. I had a meeting with a cardiologist in BPH, Dr. Kitti Nakjuntuk, and found him both helpful and knowledgeable, he used the papers I had from another hospital without pushing to make his own. One of the big reasons I didn't go any further with it was the price they quoted me for actual intervention, which was 2-3 times what I eventually paid in Bangkok, but if all you need are some drugs to stabilize your situation you should be ok.

The cardiologist I used in Bangkok, Dr. TAWORN SUITHICHAIYAKUL, is supposedly the best in this field in Thailand. The biggest problem is that he is only available Saturday mornings, and he is so famous and popular that people start checking in at 7am, meaning you'll have to leave Pattaya at 4am to have a chance to meet him - unless you want to go to BKK the night before and stay overnight somewhere.

Thanks Phil, sounds like a good plan. I have to say I am totally torn as to what to do. I went off to solve my hip problem and came back with another problem. I have read in some blogs that my irregular heart beat is not immediately life threatening and just increases my chances of getting a stroke. SO blood thinners like I am taking now should be sufficient to give me a few months to do my research and come up with a plan. To be honest going to BPH as you suggest would seem an easy and inexpensive first step. I can get a lift down there fairly easily so what have I got to lose. If he wont give me some tablets to stabilize my condition I can just smile sweetly, say I will think about it and leave.

Edit: I have booked an appointment online with DR Nakjuntuk for 2 weeks time. I should be walking by then... cheers Phil..

[Phil Conners]

Good luck with it! Don't forget to let us know how it went!

[Naam]

Good heavens Naam, that trip to Germany sure sounds like a 'cheap' deal. I must admit I would not take my wife with me anyway,its hard enough dealing with the stress of an operation, but calming down a worried wife is too much of an extra burden.

easy for you as you are not married to pigheaded Mrs Naam by the way, i had no operation stress whatsoever even when i told two close friends (if something goes wrong) that i want to be buried in the family grave where my parents and our son rest. but i was stressed to the limits during the 2½ days in intensive care where i threatened a male nurse with castration and 9mm bullets in both his knee caps if he tries to lecture me one more time.

[dsfbrit]

Good heavens Naam, that trip to Germany sure sounds like a 'cheap' deal. I must admit I would not take my wife with me anyway,its hard enough dealing with the stress of an operation, but calming down a worried wife is too much of an extra burden.

easy for you as you are not married to pigheaded Mrs Naam by the way, i had no operation stress whatsoever even when i told two close friends (if something goes wrong) that i want to be buried in the family grave where my parents and our son rest. but i was stressed to the limits during the 2½ days in intensive care where i threatened a male nurse with castration and 9mm bullets in both his knee caps if he tries to lecture me one more time.

Your wife is just worried about you - you should be pleased...

I had better avoid intensive care then- the stress could kill me!!

The trouble is the nurses have you at their mercy and I think some of them like it.

I think some of the doctors like to have you at their mercy as well - to find reasons to make you have lots of expensive tests. Yes I am getting very cynical in my old age.

I have been doing a lot of reading today about heart conditions and comparing what I am reading online with my Echo heart test and all the other tests they carried out.

The tests show that all the toxicology values were within range - Meaning I am pretty fit, well for a 56 year old anyway, including my heart, valves etc... the only problem is my heart rate is not even.

What I am reading compared to what the cardiologist said, does not make any sense. He made me feel that if I did not do something about the irregular heart beat immediately, then the risk of an imminent stroke was very high.

From what the sources I am reading at the moment are telling me is that many people have my condition and just live with it - I know he was keen to run a lot more (expensive) tests. It was only because I was so worn out after the surgery and the physio that I asked him not to.

Oh well, back to walking practice and physiotherapy, I have spent so much time on this heart thing I almost forgot that in a few weeks time I will be able to walk normally again - something to really look forward to.

Have a good day Naam - and once again thanks for the comments and advice...its nice not to feel alone with these things...

[bunnaag]

@ Phil

ref Dr Taworn.Do you make an appointment first or just walk in as early as possible.

[Phil Conners]

You can't make appointments, you just have to be there Saturday morning, the earlier the better. I believe they open the check-in at 7am.

Bring a book, it is a long wait before you see him. BCH have wifi but it's only available to in-patients, and it seems they somehow block GPRS, I was never able to get a GPRS signal in the hospital.

[Sheryl]

I have been doing a lot of reading today about heart conditions and comparing what I am reading online with my Echo heart test and all the other tests they carried out.

The tests show that all the toxicology values were within range - Meaning I am pretty fit, well for a 56 year old anyway, including my heart, valves etc... the only problem is my heart rate is not even.

What I am reading compared to what the cardiologist said, does not make any sense. He made me feel that if I did not do something about the irregular heart beat immediately, then the risk of an imminent stroke was very high.

From what the sources I am reading at the moment are telling me is that many people have my condition and just live with it - I know he was keen to run a lot more (expensive) tests. It was only because I was so worn out after the surgery and the physio that I asked him not to.

The urgency in treating atrial fibrillation depends on the ventricular response rate i.e. what your heart rate is. If it is extremely fast then immediate quick interventions are needed to bring it down. If your heart rate and blood pressure are OK then indeed, living with the condition is an option, although with a comparatively young person such as yourself a search for underlying causes is essential, and -- if no treatable underlying cause is found and the condition persists or is recurrent -- ablation may be indicated. Usually control with medications is attempted first and ablation reserved for people in whom medication is ineffective. However, the various medications used all have their potential adverse effects, so ablation is not out of the question as an alternative to long-term use of these drugs, especially in a relatively young person. This is a complex decision that should be taken carefully in consultation with specialists.

Ablation is an elective procedure and need not be done in a rush, and you should spend some time getting different opinions on this from specialists with appropriate expertise. It is not always successful and does carry some risks.

other than a rapid heart rate -- which can be an emergency requiring prompt intervention -- the problems with atrial fibrillation are:

1. It reduces your cardiac output by about 20%. In the absence of other heart disease (i.e. if you have normal cardiac output otherwise) , this is not going to be noticeable to you except possibly on heavy exertion. In people whose cardiac output is already reduced the loss of another 20% can make a big difference.

2. It increases the risk of blood clots and emboli, which in turn can cause strokes, pulmonary emboli, heart attacks etc. For this reason, people who are in atrial fibrillation are advised to take either aspirin or an anticoagulant drugs such as warfarin. The therapeutic range for the latter is pretty narrow, i.e. it is easy to "thin" the blood too much or too little. So frequent blood tests are necessary with dosage adjusted accordingly.

From what you describe -- and understand, having not seen an you your test results, I am limited to what you have said, which is that you are otherwise healthy, were found to be in atrial fibrillation, with echocardiogram showing normal valves and no sign of any structural cardiac disease or underlying metabolic problem -- the only things you need to do urgently are

(1) IF on warfarin or other anticoagulant other than aspirin: get regular blood tests to ensure that the Prothrombin Time (PT) or other relevant coagulation parameters are in the desired therapeutic range.

(2) Check your heart rate once a day and at any time you feel "odd" or unwell. In AF this has to be done for a full 60 seconds, since the rate is so irregular, and is best done by feeling the carotid pulse, not the wrist, as some premature beats may not be felt there. Gently place your fingers on either side of your neck right below the jaw where a pulse is easily felt and just count the beats for a full minute. Don't worry that they are very irregular or that there seem to be "missed" beats, this is typical of AF. (If you find the pulse is completely regular this suggests you are out of AF and back into a normal rhythym, which can occur either spontaneously or due to medications given). Generally speaking rate should be under 100 at rest and stay above 60 unless on a beta blocker medication in which case rates in the 50's or occasionally even high 40's may occur. Should you at any time become short of breath/have trouble breathing, become dizzy or light-headed, or find that your heart rate at rest is over 100, then you should seek medical attention at once. Likewise if your heart rate is persistently slow i.e. below 60 (or,if you are on beta blockers, below 50).

I assume among all the tests that your thyroid function was checked? As this can be a cause of a-fib in people your age.

If your heart is otherwise normal, you don't have thyroid disease or any other underlying cause, then you have what is terms "lone" atrial fibrillation (LAF). This is often triggered by surgery, stress etc. Excessive alcohol and caffeine can also trigger it, as can some foods in susceptible people. It can be "paroxysmal" (occurring in sudden bursts and the resolvin), "persistent" (not resolving on its own, but responding to cardioversion, a type of electric shock administered to the heart in a hospital setting), and "permanent", lasting and not responding top cardioversion. I cannot be sure from the information you provided which you have. Nor can I determine from what you describe why the doctors back home may have urged an ablation procedure. e.g. if you may have had some acute episodes in hospital of a very rapid heart rate whiuch was difficult to contorl.

There is a lot of research going on now on the pros and cons of ablation therapy for "lone" AF versus conservative management. AFAIK the verdict is not yet in,and current guidelines reserve ablations for patients who do not respond to more conservative treatment.

"In spite of the much-improved efficacy and safety of AF catheter ablation, the procedure is still not the first-line treatment for AF. This approach is generally reserved for patients with symptomatic AF refractory to at least two antiarrhythmic drugs. " http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/atrial-fibrillation/

This recommendation may change as the results of ongoing studies come in.

All this being a long way of saying that, if your heart rate is under control,and unless there is more to your problem than your posts have indicated, you can wait until you are up and about to get opinions on the pros and cons of ablation or other interventions aimed at resolving your AF.

But do stay on top of your lab tests if you are on warfarin/other anticoagulant, check your heart rate daily, and get immediate attention if it becomes very fast or you experience light-headedness/other severe symptoms.

[Sheryl]

P.S. Should you need to consult a cardiologist in Pattaya, basedpurely on qualifications on paper I'd try:

Chirapan Chawantanpipat, M.D.

- 1995: Doctor of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University

- 2000: Internal Medicine Bhumibol Adulyadej Hospital

- 2005: Clinical Cardiology Fellowship, Department of Cardiology Royal Prince Alfred Hospital Sydney, Australia

- 2007: Interventional Cardiology Fellowship, Department of Cardiology Royal Prince Alfred Hospital Sydney, Australia

[dsfbrit]

Sheryl,

Thanks so much for spending so much time to provide such a comprehensive reply. I will have to spend some time reading it as it contains so many interesting points.

If only I could find a cardiologist that I feel I could trust to advise me as well as you obviously could - then I would visit them with no hesitation.

I have an Omiron Blood Pressure monitor and I have just run it.

112/64 with a pulse rate of 66.

It also has a 'shaky heart' symbol for when it spots an irregulat pulse - it often shows this - but on this reading it did not.

Thanks very much again for this reply.

[Sheryl]

If only I could find a cardiologist that I feel I could trust to advise me as well as you obviously could - then I would visit them with no hesitation.

I finally got the St Louis website to work

Try this doctor (at your conveniencene rush) . Extensive training in the US (including a faculty appointment) and specialize4s in arrythmias.

DR. TACHPONG NGRARMUKOS

- Cardiovascular Disease Fellowship, University of Medicine and Dentistry of New Jersey, USA 1999

- Electrophysiology and Cardiac Pacing Fellowship, University of Massachusetts, USA, 2000

- Clinical Instructor, University of Massachusetts Memorial Healthcare System, Department of Cardiology, USA, 2001

- Assistant Professor of Medicine, University of Massachusetts Memorial Healthcare System, Department of Cardiology, USA, 2002

- Electrophysiologist, Pacific Rim Electrophysiology Research Institute, 2003

Work Date :

Saturday :: 09:00 AM - 11:00 AM

St. Louis is on Sathorn Rd. Appointment not necessary, just show up a bit ahead of time and register at the desk on the ground floor.

You will find the costs there a considerable relief from that of BPH and Bumrungrad. And the ambience more that of a hospital than a hotel, if you know what I mean. Also the Docs are not under the same pressure to see as many patients in as little time as possible so they are usually able to take time to discuss/explain. Of course, bring all records with you, that is very important.

[dsfbrit]

Thanks Sheryl, I will look into this now.

Thanks again

David