What now?

[Gordonsmummy29]

Hello everyone!

I had a 12 hour run of fast AF 6years ago. Went to A&E, stayed the night. No treatment. Went back to sinus rythmn and went home! Since then I've seen a cardiologist once who said "nothing to worry about dear" and gave me Bisoprolol 1.25mg at night because it drops my B/P too much in the morning. Throughout those 6 years I've had the occasional ectopic beat and tiny runs of " fast beats" and palpitations.

Anyway.....

Yesterday morning I went into AF. It was much slower than last time and made me feel terrible. Dizzy and nauseous. Called ambulance and went to A&E. They gave me IV Flecainide which sorted the AF within 15 minutes. I was told to increase the Bisoprolol to 2.5mg. Was home again within 3hours! The A&E consultant said to make sure if it happens again to come in within 48 hours of it starting so I can have the Flecainide again.

My questions to you lovely people are...Have I got AF? Should I be having anticoagulants?

I am a 58 year old newly retired nurse practitioner who should know the answer to these questions!! I don't smoke but do like a glass or 2 of wine. Hadn't been drinking when either of my episodes occurred!!

Thank you in anticipation of some really inspiring opinions and observations!!

[BobD Volunteer]

The short answer re anticoagulants is yes. The slightly longer answer is to go to the main AF Association website and look at CHADSVASC and work out your risk score . AF makes you five times more likely to have a stroke and these risk scores underline that by adding extra points.

The next stage I would suggest is to see an actual specialist in heart rhythm disorders who is an EP or electrophysiologist. Yes you have AF and it will progress, never not be there but it won't kill you. Just maybe feel like it some days.lol Bisoprolol sadly seems to be the fall back drug for most doctors but should never be prescribed if you have any tendency towards asthma and even in those who don't can cause side effects which often feel worse than the AF. It really is important with AF to take charge of your own treatment. Read all the fact sheets on the main AF_A website and go prepared to fight your corner. Sadly treatment is very hit and miss and one needs to become your own expert in order to point your doctors in the right direction. You may not be popular in some quarters but it is your heart and you only have one! Good luck and ask any specific questions her if you need support or advice.

[Beancounter Volunteer]

Hi Gordonsmummy

Have you got AF? probably but remember that it can only for sure be diagnosed by an ECG (lack of p wave etc, I am sure you know this stuff)

But 6 years ago and then a short attack that was brought under control really quite quickly?, I am not sure I would be quite as blasé as your A & E consultant, I would want a referral to preferably an EP. I would want an echocardiogram to check the heart and maybe even a Cardiac CT to ensure the underlying heart is good, and then I would want a treatment plan with the EP ideally.

Re Anti-coags, you need to score CHADS2Vasc, but me? Zero or Two I am and would be on them like a shot, stroke scares me a great deal more than any other likely problem. (I score zero and am on warfarin)

Not sure I can raise to "inspiring" but hopefully informative at least

Be well

Ian

[Gordonsmummy29]

Thank you for your advice. I'm a bit confused. I could definitely feel my heart in AF and knew exactly when the episode started and stopped. Do some poor people have AF continuously? I just could NOT live with that feeling! If my heart is beating normally how is that still AF?

Since my little "attack" yesterday, and increasing the Bisoprolol to 2.5mg I have had fairly annoying chest pain. Feels like a pulled muscle. All else is normal and I managed to go shopping etc.

Could it be the Bisoprolol?

Thank you.

[Basia12 in reply to Gordonsmummy29]

Hi ,don't know if this is helpful but if you are in sinus rhythm now you could have paroximal AF. That's when it flips in and out of rhythm .You need to make an appointment with your gp and discuss your A&E admission and hopefully get a cardiology referral .I made a note of all my episodes and could see a pattern .The next time you have an episode you could get an Ecg from your gp ,I did this and it secured me a referral to the specialist cardiologist,or EP .In my case my paroximal AF gave me chest tightness and chest pain symptoms .upping the bisoprolol should help control the heart rate but not rhythm so you may be feeling an adjustment to the higher dose .Of course best to see gp to discuss your ongoing symptoms.hope this was helpful .good luck!

[AnticoagulateNow]

Hope to see a specialist cardiologist? Never mind hope, it's your right! It's likely that you know more about AF than your GP so the sooner you see a specialist the better. In the worst case, you might have to wait up to 18 weeks for that, but you should be on anticoagulants a lot sooner.

[Gordonsmummy29]

Hello

Thank you all for your replies. I can see that the general consensus is that I should be on anticoagulant. I have a GP appointment this morning and will discuss with her. In your opinions, what would be the best way to anticoagulate me? Can she just start me on something and see what happens? Or do I need to see a cardiologist first?

You wouldn't believe that I used to run a warfarin clinic at the surgery would you!

It all seems so different now that it's affecting me. Selfish nurses we are!

[CDreamer in reply to Gordonsmummy29]

Firstly yes some people are in constant AF, Ian is one of them, but not everyone experiences AF the same way so some have AF but don't know they have it as they are not symptomatic, luckily you are so you can do something about it.

Secondly your GP could start you on ACs but it is always a risk/benefit judged between HASBLED and CHADSVASC2 which Bob mentioned.

Thirdly you have choices between Warfarin and the NOACs so my advice is to research, research, research. Bob is correct you need to become your own expert, we probably know more about AF than the average GP or ER Doc.

Best place to start is to look on the AFA site and download leaflets and go to the CAREAF site and read that.

There are treatments, both medical and procedures but everyone responds differently.

I couldn't get on with Bisoprolol but there are lots of other effective drugs.

I took Flec as a PIP (pill in pocket) effectively for about 5 years, but you need to see an EP as unless your GP was one with special interests which although I didn't know it, turned out to be VERY unusual, GPS tend not to prescribe anti arrythmic drugs, because guess what? They don't know enough to do so safely.

Getting used to AF takes time, it is is very scary but it is manageable. It is not until you develop a condition yourself that you realise just how life changing these conditions can be.

You are not on your own, not the first or won't be the last to develop AF but there is life with AF, I had to amend my life and I can't do, or choose not to because of the consequences, do what I used to, but have discovered new things which has enhanced my life.

This bunch are brill so ask away anything you want or just have a moan anytime you like.

Oh and welcome to our 'don't really want to be a member' group.

[CDreamer]

Oh, forgot to say, ask for a 48 hour ECG holter, without that no Dr can really diagnose any arrythmia. If you are sensing palpitations at night you could be having short runs of AF without the symptoms.

[Gordonsmummy29]

Hello again.

I went to see my GP this morning. She was lovely and very patient when I went on about Dr Google! Anyway, she is fast-tracking me to a cardiologist who specialises in arrhythmias. I said about the anticoags and she wants to wait until I see the consultant as I have other blood issues with my Sjögren's syndrome which she needs to take advice on. Thank you all for your help and advice.