Dr. Roach: Period of increased urination may follow chaotic heartbeats

Keith Roach
To Your Health

Dear Dr. Roach: I am a woman, 74 years old and in fair health. Eight years ago I had surgery for lung cancer. The first night after, I was told I had atrial fibrillation due to the surgery being so close to the heart. I was started on metoprolol. Every now and then I would feel that my heart skipped a beat. My pulse was usually normal, and my doctors fluffed it off. I had shortness of breath to a mild degree from the surgery, but now it is pronounced on even slight exertion.

I also have stress incontinence and overactive bladder. I went to the urologist because there were episodes that awakened me with a rush to the toilet, sometimes four to five times in a row with diuresis. It was a large amount of urine.

Dr. Keith Roach

Fast-forward to a new cardiologist who I sought out about the skipped heartbeats. I wore a heart monitor that showed numerous episodes of AFib. My jaw would tighten up during episodes and I felt palpitations. And then I noticed that the diuresis would start when the two symptoms occurred together.

My real object of writing to you is the diuresis. Have you ever heard of this? I am not on a diuretic. Usually the episodes occur at home and at night, but recently this occurred on the way to dinner out. It was really close that I made it to the toilet and then back to the toilet three more times during dinner.

— T.L.

Dear T.L.: Diuresis, your main concern, is just a Greek word meaning increased urination. Frequent urination is a common sign of overactive bladder, especially in a woman in her 70s. The sensation of needing to get to the bathroom right away is suggestive of overactive bladder. However, the amount of urine is usually small.

Atrial fibrillation is primarily an electrical problem of the heart, causing a chaotic lack of rhythm that is sometimes too fast for the heart to work properly. Surgery on the heart or lung is a common cause. Some people are in atrial fibrillation all the time, while others go in and out of it. During a period of fast atrial fibrillation, the heart may be unable to provide all the blood the body needs, and among the first organs to lose adequate blood supply during stress are the kidneys.

Most people don’t notice that they aren’t urinating during the fast atrial fibrillation, but once the heart is back in normal rhythm and the kidneys get blood flow again, they quickly remove a large amount of fluid, causing a diuresis. This large amount of urination, on top of your overactive bladder, is my best guess as to why you are having this combination of symptoms. A repeat Holter monitor (which records all of your heartbeats for 24-48 hours), combined with a record of your symptoms, can confirm or refute this hypothesis.

Jaw pain is a worrying symptom that the heart might not be getting enough blood, so that needs to be further explored with your cardiologist.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.