He has always had very low blood pressure and yet has been on a low dose of Atenolol for about 10 years, given for essential tremor. However after a stay in hospital over New Year [and a subsequent diagnosis of cancer of the common bile duct ] A stent was fitted to by-pass the blockage and he is well for the moment. On discharge it was recommended that he drop the atenolol due to hypotension.
He also takes pyritostigmine for myasthenia Gravis which he has had since 2005. It was the neurologist he was under at that time who put him on the atenolol . It is well controlled although he now has pain and weakness in the shoulders and arms which he just put down to old age. The dr told him to make an appointment to see a specialist via 'choose and book' and it transpired that he is to see a neurologist whereas he thought he was going to see a cardiologist for the AF.
My question is - is the AF not being treated what with all the other problems? I understand it is quite common as you get older and although it is a risk for stroke he already has a terminal diagnosis of cancer. Are there different degrees of AF ?
Thank you for your reply Shirlygirly. About 2 years ago after a previous stay in hospital [with sepsis] he was discharged with AF: this was noticed by the GP who sent him to a cardiologist but by that time [I think it would be about 2 months] the problem had righted itself which I understand is not uncommon. I understand now that the dr is looking into the best treatment for him.
By anticoagulant, I assume you mean warfarin? Someone I know was on this treatment and had to go the hospital frequently to have her blood checked, a frightful bore ! Given all his other problems it makes me wonder what the dr will recommend, thankfully we are lucky to have a really good GP. We had wanted to go on a short holiday what with the cancer diagnosis but now have to wait until a decision has been made about the AF.
In the last few years four new anticoagulants have been approved which do not require testing but many of us are on warfarin and have little problem with it. My testing is only done about once every couple of months usually.
What I must say is that whilst in younger people if you have AF then anticoagulation is a good idea, as we get older the risks associated with it may increase, especially if there are other health factors and there comes a tipping point when the risk of major bleed exceeds the benefit. For this reason it is very important to have an expert work through all the risks and contras to decide. There are two scoring systems they will use, CHADS, or CHADSVASC which looks at the risk of stroke and HASBLED which looks at the risk of bleed and if the HASBLED score exceeds the CHADSVASC score then anticoagulation will not be given. Nothing is one size fits all I'm afraid.
May i refer you to the main Atrial Fibrillation Association website where there are lots of handy fact sheets you can download about AF as knowledge is power.
Hello Bob, I have filled in a stroke risk calculator online and am not certain what it is saying! The CHADSVAS total score was 3 and the CHADS 1. It says annual risk of stroke is 2.2% which is 9 times greater than average. The HASBLED score is 3 so where does that leave him? I really don't understand what this is about. I assume I've filled it in correctly.
He is waiting for the GP to get back to him and she said it would probably take a fortnight of which a week has already gone. I assume she is wanting another opinion regarding the anticoagulation meds coupled with the limited time he has left due to the cancer. [So far that is not a problem]. I know he would really resent all the hospital appointments necessary for warfarin treatment. Are the newer meds that don't have to be monitored available or is warfarin the standard? Presumably it is cheap and that is an issue.
I'd really appreciate your interpretation of these numbers.
I am not an expert on these matters as I have no medical training. just many years at the game. What your results say if I understand correctly is that your husband has as greater risk of bleeding or bleeding stroke (haemorhagic stroke ) as he does of thrombotic (clotting ) stroke so there does not appear to be much point in anticoagulation. There may however be risks which you have not put into the formula so best to wait for a doctor's opinion I think. What I do know is that once given, a score cannot be removed , so for instance if you have high blood pressure, that does count even if it is treated and controlled. I do wonder if the cancer may add to the risk element. I had prostate cancer a few years ago and the operation and subsequent treatment did at first cause all sorts of secondary problems for a while.
Thank you Bob, I'm guessing that you are probably a bigger expert than the average GP!
It is indeed highly probable that there are risk factors which I have not put into the CHADS formula, although I would probably know if he had heart problems, hypertension or diabetes. Other than the actual diagnosis of AF, his age was the only blip. The HASBLED score was a little harder to estimate so I may have got that wrong. I do wonder what the delay is in the dr deciding what to do about the AF.
I read that AF can be paroxysmal, persistent or permanent. When the GP noticed on his discharge notes from hospital 2 years ago [in there for sepsis], that he had AF, she sent him to a cardio where he was given an ecg. which showed nothing so he was discharged. He was told that AF can disappear so never gave it another thought. Now I read that if you are not in AF at the time of the ecg then it won't show. Presumably that was the case.
I also read somewhere that one of the symptoms is tiredness in the upper arms and shoulders which my husband has had for some time - over a year in fact - if that is so it could account for what he was putting down to old age.
Thank you Bob, really helpful. I will certainly read up on the Atrial Fibrillation site. As you so rightly say 'Knowledge is Power'. I had already realised there was an alternative to warfarin but will look into it further. No doubt warfarin is the cheaper option but with a terminal cancer diagnosis too I wouldn't like it if he was messed abut for months on end trying to get the right warfarin dose and then find the cancer had spread.
I'm intrigued by the fact that your husband has essential tremor and AF. I too have essential tremor and AF. Because of side effects I have come off Beta Blockers and although my tremor seems worse I feel much better. I still wonder at the poossible link between AF and essential tremor although I am told there is not one. I hope you can both go on holiday soon and welcome to a lovely supportative group.MaryC
Hello MaryJC I'm really on a steep learning curve in regard to AFib and have no idea of any relationship between essential tremor and AF. My husband was put on Atenolol for the tremor roughly ten years ago. He'd always had low BP and each time he had a review at the GP for various drugs and pills, each one was just renewed. I was unaware what Atenolol was until I was discovered to have hypertension and made it my job to find out about all the drugs used to control that. I was amazed to hear Atenolol was one of them knowing that my husband was on it for a different reason but also knowing he had low BP. He is now off the Atenolol which he didn't feel was doing much good for the tremor anyway.
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] A stent was fitted to by-pass the blockage and he is well for the moment. On discharge it was recommended that he drop the atenolol due to hypotension. 
EDIT : Stop betablockers
Lightheadedness With AF
been on bisoprolol & flec since April; Apple Watch told me new trend for my heart is lower 
Ablation time frame - diagnosis to procedure 
PAF FLECAINIDE AND SHAKING
