appointment with Cardiologist quetsions to ask.

[Johnw]

I have my first out patients appointment with my cardiologist, have been diagnosed (Febuary) with paroxmal AF and i am haveing frequent attacks almost daily i have had 4 visits to A & E with bad chest pains. any advice on questions i should ask at appointment.

[Beancounter Volunteer]

Hi John

Very sorry to hear you are having so many bad attacks, I remember from some of your other posts, you are on Bisoprolol,. firstly please reassure me are you on an anti-coagulant?. If not that is the very first question, and an urgent one, why not? Doesn't matter if it's warfarin or one of the newer ones but not aspirin.

I suspect you are going to probably have a lot of tests, certainly another ECG, maybe an echocardiogram, and/or a CT scan as they will want to then find out what else is happening in your heart and this will inform them.

Questions I would be asking.

(Carefully worded) Are you an EP Doc? or do you specialise in arrythmias?

Suggested next steps Doc, what are the pros and cons of rhythm control drugs versus an surgical procedure. Particularly what are the potential side effects and prognosis of both?

Is there any other factor about my personal medical status which influences that advice?

Which surgical procedure would you recommend and why, again side effects and prognosis.

Talk me through the following please Doc

Cardioversion

Internal Cardioversion

Ablation, are there different types?

And of course these need to be in your words, and with your thoughts.

OK these are the first ones I can think of, more importantly, what is most concerning YOU, as that is the burning question you need to ask.

I am sure others will come up with some excellent suggestions.

Good luck with the Cardio

Ian

[Johnw]

Hi Thanks for the quick reply after my lasy visit to hospital they put me flecanide 50 mg bd this has helped and i get less etopics and palpatations still just on asprin and not on anticoagulant yet. i get very tired by 6 to 7 pm try to hang on but ready fro bed by 10 pm. Not sure about asking about cardiac ablation. when i have been to hosptal i have gone back into NSR i haVe had two events of af traeted in hosptal the first time i had a cardioversion of flecanide by an infusion and 2nd time i went back into nsr after several hours. the recent atacks last for about 20 min and leave me very tired and sometimes with bad chest pains.

[Beancounter Volunteer in reply to Johnw]

Hi John

I would be personally very worried to be only on aspirin, unless there is another underlying medical condition as to why you cannot take warfarin or similar. And I would want that explained to me in great detail

You have read this here often enough, the biggest risk is stroke and aspirin is not enough to prevent that usually.

The flecanide is a rhythym control drug, at this stage I am not suggesting anything, simply giving you a list of things to ask the doctor, I would not suggest anything like ablation until you have a lot more information, BUT you need to know what all the alternatives are, and the risks/rewards of each.

You need information at this stage, not to be making decisions, and it was on that basis I suggested ablation and it's still a possibility

Stay healthy

Ian

[Lal531]

Hello John, I have PAF also, below are the questions I asked my cardiologist. Might be something there for you?

1. How is the Cardioversion procedure carried out?

2. How long will it take?

3. Will I be awake / sedated?

4. Gas / or drug?

5. What is the success rate?

6. What is the longevity of the success rate?

7. What will the post procedure medication be and how long for?

8. What next if it fails or the effects wear off?

9. How many times can the procedure be repeated?

10. What would be the next alternative step?

11. What type of exercise should I take?

12. I am going on Holiday on 22nd June, any special precautions?

13. Do I need to follow a particular diet?

14. I have had instances of Potassium deficiency, apart from a normal diet with a banana most days, how can it be monitored / prevented.

15. Sport, can I still play Golf or stick to walking?

Cheers

Lal

[BobD Volunteer]

Listen to Ian John! My biggest concern would be my stroke risk. There is a scoring system, or two to be precise which assesses your stroke risk. Aspirin works on the platelets in the blood and does not stop the sort of clots which can be formed during AF attacks due to blood pooling in parts of the heart. If you have any kind of stroke risk then you should be on a proper anticoagulant not aspirin. It is fair to say that the connection between AF and stroke has only really been understood since about 2007 and also that many doctors are still behind with current thinking and research so it is very important for a patient to know all the is about his or her condition and can fight their corner.

BobD

[Offcut]

I agree with all the above and find that you not being on warfarin strange? As far as I am aware the biggest problem is bleeding/bruising to much. Once you get to know what keeps it stable with regular diet etc. and you do not take up cage fighting, juggling knives or similar. I was put on Warfarin back in 1992 with only the rare clitch in all that time. Ask as much as you want you may find loads of leaflets at the cardiologist to take home and digest.

[Beancounter Volunteer in reply to Offcut]

"you do not take up cage fighting, juggling knives"

What with those, rugby and full contact kick boxing that's all my leisure activities out the window Offcut

[Offcut]

I was a black belt karate instructor and won a bronze medal in the British open. Back in the day before my ill's

[TheStand in reply to Offcut]

Remind me not to upset you... Don't want you going all chuck Norris on me!