I have found a "non-interventionist" cardiologist I like working with. His general approach is to do only what is necessary given the facts of my condition. He does not take an "aggressive" approach. I am very glad I found him.
In my first visit to the clinic, he took and examined an EKG. He prescribed:
- One 81 mg aspirin per day (dinner, for me); anticoagulant.
- One 50 mg Metoprolol, time release, at breakfast; heart rate suppressor.
- One 0.125 mg Digoxin (which he suggested after seeing it in my typed list of questions -- I had taken it from Dr. McDougall's article on afib and Coumadin), swallowed 75 minutes after breakfast, to avoid high fiber (which is all my meals!); this is a "cardiac glycoside," which means in part that it regulates heart rate.
In the office, in midafternoon, my blood pressure was 120/80, but my heart rate was about 105. (Normal was about 60, before this episode began.) Too high. That is why he increased the dose from 12.5 mg Metoprolol 2x daily to 50 mg once daily with time release. Apparently the reason for taking it at breakfast is to make sure I get the lowest amount at the end of sleep (about 24 hours later), which is when the heart rate is naturally low anyway.
He explained that the risk of death or stroke from atrial fibrillation, with my CHADS ranking (0 on a 0 to 6 scale), is very low. We talked about the fallacy of relative advantage/disadvantage, a concept Dr. McDougall's writings introduced me to.
The best news is that the doctor called me at home the same evening (he was still in his office). He said he had reviewed that day's EKG and the hospital's Dec. 24 echocardiagram and had decided that what I have is atrial (?) flutter not atrial fibrillation. The flutter, unlike the fibrillation, is (possibly) curable with medication taken at home. He said the pills are expensive and he will try to get sales samples for me to try. So, I won't need to wear (a very expensive) home, mobile heart monitor.
I am also scheduled for a routine in-office stress test, in a few weeks, just to see if there are any other abnormalities.
P. S. -- I was in his waiting room, off and on, for two hours. I was the only thin person there. In that two hour period, two of his patients had to be taken downstairs to the hospital emergency room because he had diagnosed their conditions as being too dangerous for them to walk.
(I pay in cash, for a cash discount. His financial office was very glad to meet me and do business with me -- no headaches of dealing with Medicare or government-regulated insurance companies.)