Fast heart beats wtih angina?

Are there any medics out there who can help me understand what is happening. Kept in hospital (3rd time in a month) for normal attack of atrial fibrillation - heart beat 129 (normal rate 50); pain in jaw (lack of oxygen), low potassium. Given oxygen and potassium. Monitored remotely all night. Doctor then said my Afib is changing - now in clusters and will be more frequent. Discovered I had been in sinus rhythm all night - regular beats of 119 slowing down. In the morning Consultant said I had angina - this has been queried before.. Does heart beat increase this much with angina? Can Afib be regular? How can I play table tennis for 1 1/2 hours with no effect and walk my dog for 45 minutes ditto? Awaiting nuclear scan but will be at least another 6 months. Am at the high end of medication - beta blockers, anti-arrhythmic + warfarin so only beta blockers increased- now 5mg night and morning. I am an active 70 yr old. I have a GTN spray but never need to use it except when in A fib.

Wait for the nuclear test OK, and lets see your ejection fraction.
Than talk to your consultant about the limit of physical activity and take life easy OK.

Im similair to you I will wait your answers you have put it all rather well ~~

Angina is the condition that results from suboptimal blood supply to the heart muscle. When severe , it can cause a heart attack (myocardial infarction). Atrial fibrillation is one of the causes of angina. It usually manifests by episodes of increased heart rate (as in your case 119 bpm), and can certainly be regular (i.e. sinus rhythm). This happens when the sinus node (that generates the heartbeat is itself over functioning (although there are other causes too). Increased heart rate causes lesser relaxation time for heart muscle and poor blood supply, because heart muscle receives blood supply in diastole (relaxation phase). Anti-arrhythmics and beta blockers tend to reduce the excitability of the sinus node, and thus reduce heart rate, improving the perfusion. GTN is a short acting drug that improves heart blood supply, especially used in Case of unstable angina.

Here's what's happening- You may be in a sinus rhythm for awhile, then convert into a-fib. When you are in a-fib- the heart quivers more than giving a "squeeze" to push blood out of the heart. You have been on warfarin to thin the blood because if you are in afib- blood has a tendency to pool- meaning that blood can sit and clot. As for the increased angina- the angina was probably brought on by the increased heart rate- increased heart rate = increased demand of oxygen. If the heart cannot pump efficiently to deliver oxygen( even to itself) or if inadequate blood suppy is delivered because there are blockages in the cardiac vessels- that leads to the cardiac cells being "hungry" for oxygen. This causes the pain. If the cells are not fed oxygen after several minutes- the muscle will die. The nitro spray causes dilation of the vessels and allows more blood flow to go through the vessels =increased oxygen. As for your activity- while exerting and tolerating well, you may have been in a sinus rhythm. As for AF- it can be regular but can easily get out of control ( atrial fib with rapid ventricular response). Atrial fib can sometimes be treated with cardioversion (shocking the heart). Otherwise it is treated with the meds you described.

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The simple answers to your SPECIFIC questions (without resorting to more than minimum Latin and Greek) are:-

(1) yes, pulse rate can easily increase to that level (and even higher!) with the onset of angina. That's exactly how you'd expect the cardiovascular control system to respond when the heart is receiving insufficient blood supply, -it increases both pulse rate and stroke volume to try to deliver a greater cardiac output.

(2) Can Afib be regular? Yes, of course. Why not?

(3) You will be able to cope with physical stress absolutely normally when not in Afib, playing table-tennis etc. Why not? It's when the abnormal heart-beats occur that the efficiency of the heart's pumping action deteriorates, because it's not ejecting the correct volume of blood at each stroke, so the brain makes it beat even faster in an effort to deliver the right systemic arterial flow. It may succeed, or may not (aside to the doctors...pulse pressure readings would give the exact answer to this, -if you were physicists, -not doctors)

The process of temporarily stopping the heart and then re-starting it (described by the previous Answerer, cardioversion) sounds horrific, but in fact it's not, and my wife has had it done twice with brilliant results.

Beta blockers are virtually dosage-insensitive and you'd expect no difference taking 5mg twice a day from taking it once. For that matter, it wouldn't make much difference which beta-blocker you took; if one doesn't do much, neither would another.
( Ref: "ABC of HYPERTENSION" published by the BMA).

I hope this helps you understand it, and good luck

You have described my experiences for the last seven years. Finally, I found the correct cardiologist a Electrophysiologist who diagnosed my situation. he immediately implanted a defibrillator/pacemaker, and, no more erratic heartbeat, less medication, and all the activity I can stand as long as my heart does not exceed 140 beats per minute. This is invasive, but not to the point that it is an annoyance. Live long.