Thanks for clearing that up.

OK: I don't plan to monitor this thread, but may step in from time to time to offer advice or suggestions, based on my experience of about 40 years of practice in general cardiology. The specialty has changed dramatically since my training, but not a lot since I retired from full-time practice 10 years ago. Here are some "pearls" based on that experience:

1. Could you be having a heart attack?
a. The typical symptoms are a sensation of pressure or fullness in the anterior chest. If there is radiation to another area such as the left arm, or associated shortness of breath, weakness, or fatigue, it increases the chance the pain is cardiac. If these or similar symptoms occur with exertion, but are relieved with rest, that's called angina or angina pectoris. There is a 95% chance of significant blockage in a major heart artery if you have those symptoms. Parabellum can tell you about that.
b. Often, patients--especially men--will make this works through delay or denial. With today's medical technology, the biggest problem is having the patient get quickly and safely to advanced medical care: i.e., a hospital that offers primary angioplasty and stent therapy for an "acute MI". Thinking the pain is GI; thinking the pressure is not "pain"; having your wife drive you instead of calling 911 and getting an ACLS (advanced cardiac life support) ambulance to your house where they can do an EKG, defibrillate if needed, and start other therapy such as blood clot dissolving medication--these are all potentially fatal mistakes. I've seen them all. Thinking you will take care of it tomorrow. Going to your primary care physician instead of an ED--I've had friends and relatives as well as patients die from this.
c. What are the costs of delay and denial? Permanent damage to the heart muscle, resulting in congestive heart failure (CHF); an out of hospital cardiac arrest, with about 5% chance of survival.

2. What if I have CHF?
a. Treatment for this may restore part or all of cardiac function; but more often, it compensates for the damage by lowering blood pressure, making it easier for the heart to pump.
b. Some forms of CHF are reversible: sometimes viral myocarditis will go away; replacement of a damaged heart valve may cure the CHF; prolonged rapid atrial fib (AF) can result in a fall in ejection fraction (EF) that may be reversed when the rate is controlled.
c. Modern medical therapy--or in some cases devices such as dual chamber pacemaker (resynchronization therapy) may improve EF.
d. Even if the EF is very low, survival can be dramatically improved by placement of an implanted defibrillator (IACD).
e. Research is being done with stem cell and other novel therapies that may someday reverse damaged heart muscle; we're not there yet.

3. Atrial fibrillation (AF): is it dangerous? How to treat it?
a. The major risk associated with AF is stroke. This is because, with the left atrium not contracting normally, blood clots can form, most often in the little finger off the atrium called the left atrial appendage. A stroke is damage to the brain, often in the area in which speech is located, opposite the side of the body that is dominant. So if you're right-handed, a stroke on the left side of the brain can affect speech, for example.
b. Over the years, treatment options for AF have changed dramatically. It used to be that the choices were (1) rhythm control with medications such as sotalol or amiodarone; or (2) rate control with beta-blockers such as metoprolol or calcium channel blockers such as verapamil. Years ago a very good study demonstrated that mortality rates were similar--as long as all patients were treated with anticoagulation (in those days, only warfarin was available).
Now, ablation, which causes a scar around the "cap" of the left atrium and prevents abnormal irregular rhythm (AF) from reaching the rest of the heart, has become the most definitive treatment, but not the only one. Ablation I think is still considered about 70% successful with each procedure. So if it failed the first time, it still has a 70% success record the second time. I may not be completely up to date on that, I'll try to find out.
c. Anticoagulation, these days usually using non-warfarin blood thinners such as apixaban (Eliquis), is the most important primary treatment. Ablation is not required for everyone. It depends on the frequency and duration of AF, the symptoms felt, the ability to control the heart rate, and ability to tolerate anticoagulation.
d. Another therapy becoming very common is a device called the Watchman: this is a small device implanted through a catheter (so non-surgical) that closes off the opening of the left atrial appendage. For the vast majority of people, anticoagulation can be safely stopped some time after implantation. This is for people at risk of stroke, who prefer not to take lifelong anticoagulation, and whose AF is otherwise minimally symptomatic.
e. There is another approach being tested in a clinical trial called REACT-AF. Subjects in the treatment group are given an Apple Watch, which can detect episodes of atrial fibrillation with high sensivity and specificity (in other words, accurately). If AF is detected lasting hours, they take Eliquis for I think three months. The potential advantage is avoiding lifelong anticoagulation in patients (like my wife) who may have only rare or brief episodes of AF.

4. What about statins?
a. The potential benefit/risk ratio for statins depends on your risk of a heart attack. If you've had one; you have angina; you have diabetes, which equates to a similar risk as someone with known heart disease, then the ratio comes down strongly in favor of taking statins. That's what we call the "number needed to treat (NNT)": how many patients need to take the medicine to decrease the event being measured over some period of time.
b. I checked with Grok: for primary prevention, the NNT can be around 100-200 to reduce overall mortality over 5 years or so. For secondary prevention, the NNT is much lower, around 20-50.
c. What dose: usual recommended dose for primary prevention is 5-10 mg, with general LDL goal of 100 mg/dl. For secondary prevention, starting dose 10-20 mg, going up to 40 mg, goal LDL is 70 mg/dl.
d. What if my cholesterol is not high? A high-quality randomized trial called the JUPITER study showed major reduction in relative risk of cardiovascular events and about 20% reduction in relative risk of total mortality in the treated group. The important thing is the subjects had normal cholesterol levels, but high risk of measures of inflammation (hrCRP).
e. The implication of that study and others has been that statins have benefits beyond cholesterol reduction, and are given to help reduce inflammation in the blood vessels, known to be a contributor to atherosclerosis.
f. What about absolute risk reduction: in JUPITER, the group treated with rosuvastatin (Crestor) had an absolute risk of 2.2%, vs. 2.8% in the placebo group. For me, the lesson is that treatment should be individualized to the best estimate of the patient's risk of a cardiovascular event; arm-twisting may be appropriate in high-risk patients, perhaps not in low-risk patients. For right now, it's our best known pharmacological tool to reduce cardiac risk.

That's all the free advice for now, perhaps worth the price you paid.
Your friendly SigForum cardiologist (retired)

sjtill - I appreciate you taking the time to visit this thread and give all of us some valuable info. I have a son in law whose father is also a retired cardiologist, probably about the length of time you as you, and he still volunteers at a clinic once or twice a week. Not only is your knowledge of the subject valuable, taking the time to help others after years of service shows what your hearts are made of as well. True professionals. Thank you.

Congestive Heart Failure/AFIB at 62 went to the ER with a HR of 163, a cardioversion worked. No other occurrence in three years thanks to my daily cocktail of meds.