Follow up appointment...

Just thought I'd update all you wonderful folk on my follow up appointment with my GP after my diagnosis three days ago.

My heart rate was down to 78bpm which was attributed to the Bisoprolol my doctor put me on over the weekend. He recommended I stay on this drug at least until I get an appointment with a specialist.

Another ECG was taken and my heart beat is still irregular, but not as irregular. Not sure if that's a good thing or not. In my mind irregular is irregular and therefore can never be a good thing.

He said that even though I was still having an episode, he didn't feel the need to do anything to get it back into NSR and that he was happy to leave it until I saw a specialist.

He said he had completed a stroke risk assessment and that he didn't consider I was at any increased risk so was not planning to put me on any medication to help prevent a stroke at this stage.

Finally he said he was only referring me to a specialist because I had fainted, which led to me attending the surgery on Friday, and that without that symptom he would have probably just monitored the situation. (DOES THAT SOUND RIGHT?)

Anyway that was about it... Is there anything that strikes anyone as unusual or odd in his course of action?

Many thanks for all your help and support.

20 Replies

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  • The important thing is that he HAS referred you and if you do not end up seeing an electrophysiologist rather than a normal cardiologist then in my opinion you should ask to be referred on again to an EP. It is your right to be treated buy whoever and wherever you wish so you may have to fight your corner on this matter.

    Do study the fact sheets on AF Assoociation website as you really need to drive your own treatment with AF as so few GPs and quite a lot of normal cardiologists are not up to speed on the latest ways forward. Good luck and ask any question you may have.

    Bob

  • Hi Bob.... Thanks for the reply.

    He wanted to refer me to the cardiologist based at my local hospital and said that if the cardiologist wanted to refer it to an EP then he would.

    I explained that I have a very good friend who is a highly respected cardiologist and she has given me the name of an EP who she believes to be one of the best in the country.

    He said he was perfectly happy to refer me to whoever I wanted and asked me to forward him the contact details which I have just done.

    So I guess it's just a waiting game now...

  • Who is this EP - I would like to see someone else too who is recommended at being very good - many thanks

  • Excellent advice again from Bob D.

    Perhaps phoning up the cardios medical secretary might speed things up and reiterate your concern, and as Bob wisely suggested you can also mention you want an an EP referral.

    Depending on the med sec some of them are really clued up and can respond with amazing alacrity.

    You can phone your hospital and ask to speak to the med sec's cardiologist/heart specialist.

    my GP/ and the surgery reception told me this; and then you get a message directly from a specialist.

    My cardio referred me to an EP, I had not even heard of such a thing until then, and as Bob states there are great resources out there.

  • i only just saw your response; so pleased about the referral:)

  • I still think I'll take your advice Pacific and chase up the EP's secretary once I know my GP has sent the referal.

    I may also abuse the relationship I have with my Cardiologist friend to see if she can have a word with the EP she's recommended, a bit naughty but when needs must :)

  • When do you get to see the specialist?

    If I were you, if at any time symptoms deteriorate, I would take myself off to A&E - preferably when the Cardiology Dept is working.

    As for anti-coagulation, that is my security. It depends on your, age, sex, condition etc. but better safe than sorry.

  • I've no idea when I'll get to see the specialist Jenny... I guess it will take as long as it takes.

    I will take on board your advice about deterioration of symptoms.

    The anti-coagulation issue is bothering me somewhat, but not sure what I can do. I did make a point of it when I had my appointment, but he insisted it wasn't necessary based on the risk assessment. This is the one thing more than anything else that's causing me anxiety at the moment. I'm walking around thinking I'm going to have a stroke at any moment.

  • I'd have to agree with you on the anti-coagulation comment.

    Considering you are in persistent AF - its good your BPM is at a reasonable rate but as you say AF is AF.

    With that in mind I would question your GP's wisdom on not prescribing any kind of medication for this?

    That does concern me.

  • I was considered low risk of having a stroke - had a stroke December 2010 ( had been taken off warfarin two months prior to that) definitely question it

  • What I was going to say has been said already!

  • Just repeating what's already been said, but do get referred to an EP/Heart Rhythm Specialist. No-one else really understands what they are doing.

    I don't think your GP is on the ball if he/she thinks you don't have to do anything when your heart beat is irregular. If I'd had that advice I wouldn't listen. My GP is about the same, and I ignore them when it comes to AF. It shouldn't be like that but it is. Your ticker is supposed to go tick-tock-tick-tock. If it doesn't then it needs some help. Simples.

    A couple of years back I had trouble getting past my GP's and eventually I simply insisted on a private referral to an EP, which I got (£150-250?). I saw him quickly and got onto some effective drugs within days. Prior to that I wasted nearly a year piddling about talking to doctors who hadn't a clue and at times being quite ill, and who would invariably put me on beta-blockers, which are not the drugs for me at all.

    Koll

  • Hi Koll

    I might not of communicated exactly what I meant by suggesting my GP doesn't think anything needs doing regarding my irregular heart beat. He does agree it needs looking at and had decided before i had chance to ask that he was going to refer me to a specialist.

    The point I was raising was that he didn't feel the irregular heart beat needed attention to get it back into NSR before I saw the specialist and that point does , I admit, sit a little uneasy with me.

    I would like to add that the GP has been excellent since I presented myself at his surgery without an appointment on Friday evening and I don't want it to appear that I'm criticising the care I have received so far, was just looking for opinions on a couple of points.

  • Sorry I misunderstood your post. Good you are seeing an EP, that's where things start IMHO.

  • Hi Arkwright, check out the conditions which may result in pooling. This, if my lay knowledge is correct, is the potential issue for stroke. Check out your CHADS2 score which attempts to define whether or not to anti-coagulate. No doubt your GP has already done this which is why he/she is not concerned at this stage.

  • Hi Mikey

    I checked out my CHADS2 prior to going for the appointment and came up with the same result, 0% risk. So in that respect his assessment is correct.

    Not quite sure what you mean by "pooling conditions", could you possibly enlighten me further?

  • The uneven, rapid beating of the atria don't allow time for the blood to progress efficiently through the heart and so some blood remains behind or pools in the atria. It is this pooling that can lead to clotting and stroke.

  • I spent days and days worrying about this when I was in AF and mine used to last for 3 to 12 days prior to an ablation.

    I should have trusted the medical opinion and not allowed the anxiety make the condition into a worse one.

  • The heart has an appendage ( evolutionary throw-back) and if the heart is not beating correctly can pool blood which then begins to coagulate and a clot can be thrown off - hence stroke.

    There is a procedure called left appendage occlusion to deal with it - but all procedures carry risks.

    Also there is ablation for atrial fibrillation.

  • When I was diagnosed with AF I was considered ow risk of stroke ( female aged 51)

    I was placed on warfarin & bisoporal awaiting cardio version.

    Was found to be I regular rhythm when I went for cardio version so take off warfarin. Kept on reduced amount of bisoporal.

    But - had a stroke two months later inDecember2010 - though made a good recovery - having worked hard at it - Not allowed to return to work so retired from teaching on grounds of ill health.

    Now going to have ablation for flutter in August but so very unsure of ablation for AF - really need to talk to people who have been I similar situation.

    Thanks .... In anticipation

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