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AF Association
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Do you always go to A&E when you have an episode?

My husband is now on Warfarin and I just wondered if he still needs to go to the A&E when he has an episode? What are you doing when you have an episode in the middle of the night?

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I think it depends on how you cope with an event, how severe it is and if you can be bothered to go to A and E. Mostly it seems that people just end up sitting or lying around for hours being monitored and then get sent home. Obviously if the person has chest pain or is passing out then a call to 999 is the best advice. Warfarin makes no difference to how he feels it just protects him and that is all the time not just when he has an event. Some doctors say if it lasts more than 2 hours to go but there is no hard and fast rule Some of us never went whilst others ended up with season tickets.

Bob

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Thats what I was thinking as well I would be there everyday otherwise never been and don't want to start really

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I have tachycardia just now. I't s 2:45 been in AF since 11:00 pm. Feel horrible heart rate at 139 just now. I'm on 9 lots of medication for my heart and I'm still going into AF. Thinking about phoning an ambulance however, sometimes you get the occasional junior doctor who is NASTY and asks what you are doing there. My heart rate can go above 200 and crash the equipment. I have had ambulances having to stop in the middle of the road so that both paramedics can try and help me. One year I was in hospital 17 times in 12 months. I've been in resuscitation quite a few times, but mostly stuck in a cubicle on a trolley monitored and blood tested, chesty X-ray, and if they establish no heart attack, usually sent home when they get my heart rate back into sinus rhythm. Although there have been times I've ended up in high dependancy. Or the emergency care ward. The paramedics are amazing. Typing this is keeping my mind off the oximeter round my neck, and my rocketing heart rate. Do I phone nine nine nine, or suffer it. I've heart GTN spray to help with the pain. I always worry that if I go to hospital it will subside and A & E won't be happy. I have coronary heart disease, an anomaly of the heart since birth and paroxysmal AF. It was only when I developed AF that the other problems were disovered during angiogram.

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I have tried various methods to bring about a calm and to stop the sessions going on for too long. I used to go to A&E after 30 mins as I was told to do by my GP as I live alone, but now that I realize its not life threatening and can manage to to quell my fast heartbeat I wait for about 2half to 3 hours, if its intermittent. This is easier said than done, it takes a while to work out whats best for you...For me its deep breathing and relaxation as much as possible, and blowing into a tube are the main ones. Others will use different methods depending on the type of Arrhythmia. Its very important to learn to take your husbands pulse (or get him to do this) which took a while for me to master, this for me lets me know if its time to get help or not. I have SVT (fast heartbeat)

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Is it worse when you lie down? Sometimes AF wakes me up.

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Are you Ok now?. Just noticed his is on a three year old post.

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I echo the other comments - there's no hard and fast rule. In my case, I must have had something like thirty or forty episodes in the last seven years and I've only been to A and E once (and then it was because I'd been told that I needed to be seen by a doctor when I was having an episode to get the diagnosis of AF confirmed). However, I get the distinct impression that the symptoms I get are nowhere near as bad as many others have to suffer - I can still virtually carry on as normal. Therefore, with my heart rate not getting above 90 as a rule, I've been told there is little to be gained by going to A and E unless the nature of my episodes change - for example, if my heart rate went up by 50 beats per minute, I'd definitely react differently.

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I was told to wait for at least 24 hours but not longer than 48 hours, as that was the limit prior to me starting anti-coagulant. If later than that, the theory was that I would be put onto warfarin for a month before cardioversion. Normal rhythm usually returned spontaneously, with only two cardioversions over the years. Now I am on anti coagulant (Apixiban) I can wait for a week or so if I want to, which helps with holidays. Everybody is different so get a set of rules from your cardiologist and stick to them.

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How long have you been on Apixaban? Anything to report since starting? Were you monitored at all at the the start of treatment? Take care

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I have been taking Apixiban for a couple of months, with no apparent problems and no monitoring at all. From the literature I think that I may need an annual kidney function blood test.

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I feel much the same as above. If you feel you want to go, then go. I've been a few times and they always put me through the same procedures. I didn't ever see a cardio and ended up being monitored for a few hours, having blood tests, ECG's, and then sent home. Now I don't bother unless something very different is happening.

Koll

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I only went the first time, then I was diagnosed, since then I have had nine episodes, very debilitating too. But as has been stated, its how you deal,with them and what strategies you have in place to do so that matters. Differential heart beats and skipped beats don't necessarily mean an episode, employ some of the weird and wonderful things to help too.. I know one person who touches ( or as near as they can ) their toes which sometimes 'clicks' the heart back in to rhythm.

Its with us for life as we know. Dealing with it comes in many forms.

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Previously I was told to go if I felt extremely unwell ( breathlessness, chest pain, faintness etc) or if the episode lasted for a long time ( can't remember how long) but my 'new' doc told me that as I am on an anticoagulant now I could go straight away and they might 'zap' my heart, don't think she's right but we'll see! I would say the 'unwell' or 'different' advice is the best.

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i have never been to A&E usually just ride the storm would go if it was producing new or worrying symptoms like chest pains and faints

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I only went to A&E the first time, when I didn't know what it was. My episodes last up to 12 hours and heart rate of around 170. The doctor said to go in if I had chest pain or pain in my left arm, and certainly as people are saying if your husband feels unwell or passing out, definitely go. As it mostly happens at night I try to ignore it, on the whole. Hospital is too far away and my husband is way too cranky to start trekking there on a regular basis :)

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Thank you all very much for your answers. I agree, whenever we ended up on A&E it was very frustrating. Last time we had to wait from midnight till 3am, sitting on wooden chairs. At 5am we finally saw a doctor who sent us home. It was awful!!! I feel more assured now he is on Warfarin.

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Goodness it has never occurred to me to go to A&E. I had a 4 hr session yesterday with heart rate between 200 and 150, felt lousy but never occurred to me that there was anything to do other than lie down and feel sorry for myself! I think the thought of going to A&E would set my poor old ticker off!!

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When I had my first episodes I went to Casualty three times in a week. During one of these sessions the tracings made by the ambulance crew clearly caught the AF event and my EP was pleased to have this "live" confirmation of what was going on. I agree that going to A&E is not a good experience and I haven't been back since -just relax as much as I can at home. I wish all the AF "club" an enjoyable day in this glorious sunshine.

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Yes, enjoy today, the rain starts tomorrow :-(

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I had known that I had a problem for quite a few months but my doctor could find nothing and he sent me to a cardiologist who also found nothing. Several months later an attack happened when I was at home so I thought I would pop into the doctors and see what he thought. He wouldn't let me go home and I had to go by ambulance to a & e Where they attempted to cardiovert me using drugs and finely with a shock. Quite a few of my visits ended up with me in hospital so they obviously took it seriously. With heart problems I have never had to wait and have been dealt with immediately although you can end up lying in bed for a long time if it is a busy night. Once I was put on rate control my symptoms were a lot less severe and I mostly just ignored them. It is occasionally worth going to a&e if you have a problem and just can't get to see your cardiologist, you shouldn't have too but it does force their hand.

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I have been an AF' er since 1992 and have never been to A&E with AF, been with many other things and one heart attack. I have had episodes that have lasted weeks and after a bit of tweaking it seems to get back on track. Until the next one :(

I will go to the GP's when they are open if I do get a long term one. But Like a lot of people have said on here we are all so different.

Stress and panic are not AF's Friend.

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I never go as I am well anti coagulated and what are they going to do that I can't xcept keep me waiting on an uncomfortable chair. The only time I called the ambulance was when I could not stand because my blp crashed but even with that by the time they got there I was getting over it so didn't go with them to casualty.

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Hi, is he on a beta blocker to ? I am on one that I take if I have an attack and hospital said if it does not work in 20 mins go to A&E

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Just as comment, whenever I went I never had to sit and wait, was always taken straight in. Once I was on warfarin I was cardioverted sooner, often straight from a/e.

Eileen

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Same with me, Eileen. I have never had to sit around for more than a few minutes. I have also been refractory to drug treatment and as classed as persistent AF get cardioverted asap Sandra

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What do you mean by having an episode? I have paf so I have everyday where

My heart races then goes back to normal rate about 64 to 70 I dont take my pulse should I ? It seems to me reading the comments on this website that there is no cure for af only meds and ablation should the meds take away the feelings of palpations because I can still feel them is that correct?

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There are lots of different meds as well as ablation and you really should not have to put up with events every day . .I use the word event rather than attack as I always feel it sounds less dramatic. I would suggest that you ask for another consultation with your cardiologist or EP and see if a different drug may be more helpful or even consider ablation. QOL can be greatly improved.

Bob

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Found it thanks bob yes I think I will try to get a earlier appt with dr clague

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Hi bob I cannot open your reply to me could you reply again thanks karen

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When I had my first big episode I just crawled around the house on all fours for 9 hours until it stopped, because I didn't want to risk it stopping before the ambulance arrived. The second time it was still going like a steam train after 13 hours, so I rang the surgery for a house call. Two minutes after I hung up the doctor rang to say he had called an ambulance. When I was in resus the consultant told me not to leave it so long, and to call 999 within fifteen minutes. By the time I'd done that five more times I got a snipe for being a frequent flyer though, so I don't know what I'll do next time.

I'm assuming that those who have had to sit around for hours have made their own way there rather than going by ambulance. I don't have a car, so it's either 999 or a ten mile bus ride, and then where I go when I arrive depends on the circumstances. A heart rate of 230 seems to buy you a ticket straight into resus, but if it stops on the ambulance they take me straight to the observation ward. With a lower heart rate they put me in a cubicle, and then transfer me to the obs ward if they can't get rid of me by the 4 hour deadline.

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Hello I am new to this website. I have been in fairly persistent AF for the last 2 months my GP tells me I have to be on warfarin for 3 months before a cardoversion and the tablet

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I went with my last one back in April and got cardioverted back to NSR on a drip with flecanide...they tried Amiodarone earlier and that never worked...now I just throw down some extra flecanide if I feel I'm brewing for an attack.....I cannot fathom why I was never given any anticoagulant until recently from the EP...which I still have not got yet..

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"now I just throw down some extra flecanide"

How safe is that? Mine's been going since I woke up this morning, that was four hours ago. I took my meds 90mins early, but that was an hour ago. I rang the emergency number at the surgery two hours ago, but they haven't called back. If it's still going this afternoon I'll go to A&E on the bus........

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Hi ectopic1. My GP said only to go to A & E if you are seriously worried so I have tended to sit out any episodes but I do take extra flecainide. You can take no more than 400mg in 24 hours. Thus if you take 150mg twice a day (as I used to) you cannot take more than an extra 100mgs. I used to start with an extra 50mgs and usually that would do the trick. If you feel well enough to take the bus to A & E, maybe you will probably be OK at home. A good reason to go to A & E however is to get an ECG done while your heart is misbehaving as it can be a useful diagnostic tool. Always ask for a copy of any ECG that is done.

But perhaps your heart is back to normal again now.

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When the GP returned my call she told me it's damaging my heart to just leave it, and to call an ambulance straight away. When I got to A&E I asked the doctor to clarify what I should do, and he said that Resus were about right when they told me to call an ambulance if it doesn't stop within 15 minutes.

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I think much depends on one's personal circumstances and one gets to know how best to deal with what one experiences. Some people have quite severe attacks and others quite manageable ones. The advice one gets can vary widely as a result.

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