AF and tiredness - is this normal?

Hi all. So I was diagnosed with paroxysmal AF after an episode where I was in AF for 27 hours just over 2 weeks ago (but have been having milder symptoms for years). I was really lucky in that 2.5 mg bisoprolol put me back into regular sinus rhythm and I was sent home with just the bisoprolol, only to be used as pill-in-pocket if I get an episode/palpitation lasting longer than half an hour. This hasn't happened and I've not taken anything since I was in hospital. I have been off work since then (I was told to rest). I am due to go back to work on Monday. But I'm still very tired, scared and anxious which is most unlike me. I'm anxious when leave the house, and I feel very 'unusual'!'unusual' but can't finger on What's wrong with me. Is this normal after an 'episode' lasting just 27 hours? I can see from this site that people obviously have far worse symptoms than me but are still able to get on with things better than me. Is this fatigue I'm feeling normal? Is it a physical symptom left-over from the AF episode and I need to give my heart longer to recover? Or am I experiencing some depression? I'm still having 'mild' palpitations (lasting from a few seconds to a few minutes) up to a few times a day but I have had a few (2-3 days) palpitation free. I am taking it VERY easy and haven't really left the sofa! My sicknote runs out this weekend after 3 weeks off resting at hone and the thought of being away from my house and going back to work terrifies me and I'm anxious about going back to my (quite stressful but usually very enjoyable) job. Should I see my GP again and ask for more time off? Or am I being pathetic? I really don't feel like myself but I can't decide whether it's the shock of the diagnosis making me worried and anxious or whether it's something physically wrong - I mean, is it normal to be this tired and feeling so down over two weeks after a 27 hour AF episode (heart was all over place, up to 160bpm resting heart rate compared to 55bpm normally, and very irregular and leaping out of my chest!). I am 38 and have always been very active and this was my first prolonged episode. Am I tired because I'm depressed? Tired because my heart is not yet 'recovered' from the last episode? Worrying needlessly and making myself unwell? Or am I just being pathetic for thinking I need more time off work? :-( Has anyone else ever had anything like this? Any advice? Thanks in advance, and thank God for this forum!!!

19 Replies

  • YOU ARE NORMAL!!!! Yes Af is very scary and the psychological impact of being told there is something wrong with your heart is massive. AF won't kill you but sometimes it feels like it.

    What I would say is to check out AF Associationn website and read up as many fact sheets as you can absorb because knowledge is power and helps you to understand this mongrel condition.

    Next target is to see a specialist in AF called an electrophysiologist who is a special cardiologist who understands rhythm disorders. There is a list buy area under patient information.

    Yes many people do live fairly normal lives but have to learn to manage energy levels. Many athletes still compete so life goes on.

    Bisoprolol will make you tired but it is unusual to be on pill in the pocket with that drug which merely slows down your heart during events.

    One major problem for us AFers is that we get very aware of our hearts and those ectopic "missed beats" can be very stressful so be assured you are normal.

    Hope you feel better soon.


  • Thanks, Bob! This forum really is so reassuring and helpful.

  • Jacq - you sound just like me when I was first diagnosed and my episodes lasted only an hour or so. My first outing to Tesco was weeks later and was like climbing the proverbial Matterhorn. Fear is a really limiting factor too and the worry of another episode is something to contend with.

    The tiredness and short runs of arrhythmia go together - have you been offered any follow-up, such as a 24-hour monitor to find out exactly what is going on? The best advice I had from this forum was to see an Electrophysiologist (cardiologist specialising in heart rhythms) to have my condition assessed and treated.

    Try a little bit of venturing out to see how things go and if all is OK, it does give one confidence to proceed. No-one with this condition is pathetic - if you decide to see your GP, it's because you need to, to get advice about returning to work.

    Best wishes

  • Thank you! I've literally just taken the 24 hour ecg back to the hospital and, unlike last time 3 years ago when I was getting palpitations but managed to not have anything at all while wearing it, this time I know I had some flutters while wearing it so hopefully I'll no more soon. But not seen or been referred even to a cardiologist yet, never mind an EP! Still, at least I now have a diagnosis,.whereas last time (3 years ago) I was.just told I was fine and it was.'one of those things'... Now I've found you guys, and the AF association website, I've read more and feel a bit.more clued up but still scared. Hopefully I will get there soon!! Wherever there is!! Thank you x

  • Yes fatigue is normal, and then there will be anxiety over the condition and how you will be if you go out, or back to work...., combined with frustration in the fatigue, and then the bisoprolol can make you tired also.

    I got quite low when in prolonged AF for a few months whilst awaiting cardioversion. And felt a complete failure as Amur as my teenage children were worried about me and also as a family we couldn't plan activities with them, I had to watch them go ape and take photos and we daren't book a holiday etc, it all adds to the feeling of being low.

    I would suggest an appointment with GP to discuss your feelings and medication and also decide how you feel about work. Gp's can do a sick certificate that is 'phased return ' which means you could return on shortened hours like half shifts for a week or two to see how you go before returning properly. getting some sort of normality may help you feel better in yourself.

    Hope you feel better soon x

  • I have found any length of episode of af makes me tired 1 hour or 1 day. I also think with me I get depressed a little after the event which makes my mood low and tired. I am 35 years old and this is still new to me but what I have learnt is that you have to get back to normal sooner rather than later. The good people on this forum will surely tell you there is light at the end of the tunnel with af for most people you just have to find the right lifestyle and medication regime that suits you. Mines a pill in the pocket (flecainide), I feel rough after taking it but it works, again part of this is my mood due to doing 10 rounds with af. All the best J

  • You are normal - 27 hours of AF is like running a long race without any training! And as you are having little runs of AF etc you are not getting a proper rest to recover. Add on the uncertainty of it all and you are likely to be an emotional mess as well.

    All I can say is it gets better, last time I had a 'bad attack' I was so unconcerned I resisted going to hospital until my GP gave me a stern warning I might actually be having a heart attack - THEN I panicked! (I wasn't, my heart muscle was hurting from overexercise)

    Best wishes, hope you are feeling better.

  • Yes, AF is difficult when first diagnosed but you gain experience and expertise and it becomes more of an annoyance than the removal of the carpet from under your feet.

  • Hi and welcome

    AF and anxiety just go together and unfortunately feed from each other so you must be proactive in addressing the anxiety. Please seek help with this as anxiety is also very tiring and not going out is the fast track to depression.

    You say an episode of 'just' 27 hours - that is a long time and would mean 2-3 days of rest to recover from, if it was fast AF. Some people are more symptomatic than others so AF is very individual.

    AF does leave you tired and fatigued but you should be able to function. What sort of work do you do? I worked normally for the time I had AF apart from a few occasions when I had long episodes and had to take a break for a day or so. My AF was controlled by a PIP - Flecainide an anti arrythmia drug - whereas Biso is a rate control which may help reduce your heart rate if you go into fast AF. Do you monitor your own HR (heart rate). If your work relatively sedentary you should be OK, if it is very physical maybe speak to your GP.

    If you continue to be so tired and fatigued for so long after an AF episode I would suggest you might push for more investigations and do ask to be referred to an EP, I got nowhere until I did and only knew to do that through this forum.

    I invested in a small device called an AliveCor which fits into my IPhone but also works with an iPad with which I monitored my episodes, both my GP and y EP thought it was great as the traces gave very good ECG traces without the hassle of having to go into the surgery.

    Become your own expert, the AFA information and support is just superb and the gang here very knowledgable and always here for support.

    Best wishes CD

    PS I no longer have AF following 2 procedures called ablations, it really is worth knowing and understanding all your treatment options - available from the AFA site.

    PPS - has anyone mentioned anticoagulation? If you are in AF for more than 24 hours you can be at risk from stroke as clots can form in the atria leaving you at high risk - please ask your doctor ASAP.

  • I agree you are 'normal'. I would also add get used to tuning in to your own body rather than dismiss it. If you feel odd that's the signal to do something. The first 3 steps I took were research, see a cardiologist and take a Magnesium supplement (my high profile London Naturopath recommended Nutri Ultra Muscleze for Mg and he also said take CoQ10).

    3 months later I felt a lot better due to all 3 actions above.

    Good Luck and accept you have to work at it and it will change some of your lifestyle but I found lots of positives in that one.

  • Hi you sound exactly same as I was when diagnosed!! I was so anxious that I could not use my bought flight tickets to see my dear daughter and 2yr old grandson in australia 😭 indeed I could not even attend my dear nephews wedding in UK!! Never wanted to go out the house

  • Ooooo I wish I could give you a hug to make you feel better. I can't add to the excellent advice of others only I was frightened tired quality of life had changed. I had to rest when tired. I also had to give myself a talking to to get out walking. That was hard work. I'm now through that phase and just had an ablation. Read up on here and follow lead of others. We're all in it together.

  • Hi and welcome, you sound exactly like I was when diagnosed. i was due to fly to Australia 5 months after and I cancelled my tickets immediately, not even confident enough to even think I may feel well enough by then (what a waste of £900, I disappointed my daughter and 2yr old grandson, I could not even attend my dear nephews fairly local wedding, indeed like you I did not want to even leave the house, my wonderful GP suggested short term antidepressants for my anxiety and after six weeks I felt my normal self, it's now 15 months later and just finished very slowly weaning myself off them and feel fine. As for tiredness, I only experienced that whilst on bisoprolol, which I stopped after a month. I get bouts of tiredness now and then still.

    Hope this reassures you that you are not the only one, maybe sertraline for anxiety will be option for you to, go have a chat with GP anyway, who will advise you.

    Take care and keep in touch with me directly if you want a chat

    Best wishes Lynn

  • Thank you, Lynn - thank goodness for this forum xx

  • Hi Jacq. I can totally relate to your post. We are of a similar age (i am 36) and i have AF episodes for between 5 and 7 hours a day. My AF has progressed over the last 2 years and seems to be increasing the past month or so. 27 hours of AF must have been absolutely rotten. Was it fast AF? The most i have ever had is 15 hours and it knocked the stuffing out of me! Maybe your mood has been a bit affected by it all. I know mine has at various times. I go for CBT now as i have become very anxious. CBT is helping me though. AF is so disruptive and unpleasant. I do not think for one second you are pathetic. Your health and well-being is vital so regardless of whether it is your mood or residual fatigue from the AF, take the time off when you need it. And just to absolutely clarify about the anticoagulation, an episode of 24 hours plus has no bearing whatsoever on whether you should be on anticoagulation therapy. That is calculated through your ChadsVasc score andwhether you are in AF once a year, one hour a day or 24/7, your score remains the same. Your stroke risk is calculated by your overall risks. I am not on anticoagulation. AF does carry an increased risk of stroke, but so does warfarin so it is decided upon risk vs benefit ratio and you are such a low risk if you score 0. Best wishes and be kind to yourself:)

  • Thank you so much! Yes, my HR was fast for what actually (now I've counted!) was close to 29 hours. My normal resting HR was previously 55 bpm, but during that episode it was between 140 and 160 bpm (sometimes higher). I've felt a bit more positive today but still very weak and tired. No more long-lasting AF but still getting palpitations at least 2-3 times per day, lasting from a few seconds to up to 20 minutes. I was brave and made a GP appointment for tomorrow morning to discuss things with her. Fingers crossed (although not sure what outcome I'm hoping for!). Thanks again for your response.

  • Update!

    Following everyone's good advice on here I visited my GP on Friday. I explained that I was still having mild heart "flutters" each day and that I was anxious and not feeling too good about things. She was lovely and pointed out that regardless whether anxiety was causing the flutters or whether it was the flutters causing the anxiety, it would be best to try to relax and avoid them as best I could until I go back to the hospital to discuss all my results (echo, ecg, bloods, 24 hour monitor), which isn't until the end of next week. So she signed me off from work again. I've never had this much extended sick leave before and am feeling quite guilty as my job isn't really physically demanding but I mostly feel relieved... She's also suggested a possible phased return until I feel as back to normal as I can.

    Thanks for all the advice, folks. I am finding it very helpful to be able to come on here and vent and express all my worries and concerns. I'm avoiding doing this with the people in my life as I think they're more scared by the whole thing than I am. My parents flew out on holiday when I was taken into hospital the first time (the 29 hour AFib incident!) and so I didn't tell them until they got back and now they're ringing every day to make sure I'm not over-doing it. Which is lovely but adds to the guilt when I can sense how worried they are... I think my husband's getting better with it now - he keeps leaving me jobs to do while he's at work....

  • Good news Jacq. I was off work for 5 months on 2 seperate occasions. Dont feel are only a number in the workplace. Your wellbeing comes first. Enjoy relaxing in between palps:) xx

  • I can totally relate to your experience. Im 53 and had palpatations while watching tv one night at the beginning of June. I sat and tried to ignore it expecting it would subside as usual, as id had mild palpatations lots of other times over the past years. This time they persisted to the point i began to get a headache, so i decided to take some painkillers and turn in early expecting a good sleep would remedy all. I had trouble getting to sleep because of the intensity and feeling uncomfortable tossing and turning but finally dozed off. I woke up around 4 am to the same strong palpatations not able to go back to sleep.

    I decided to get up and have a hot drink of tea and took some more painkillers (ibubrufen), deciding to get myself sorted and ready for work convinced they would ease off after moving around, and that walking in the fresh air to work would do the trick.

    As it got near to the time of going out to work at 8.25am i became unsure if things were totally right as i still had the palpatations and hesitated at the door debating wether id be ok being reluctant to ring in sick as we'd only just had a staff meeting about moniterd sickness abcenses. I again convinced myself id be fine when i got some fresh air so i started to walk to work which was only 10 minutes away from where i live.. I only got half way and as i was walking started to feel breathless and quite light headed, i started to feel tingling in my arms and began to feel nauseus and my legs started to feel heavy with each step. I knew i wouldnt make it to work realising for sure something was wrong and thought i was about to pass out so i had no option but to turn back and slowly walked towards home again with the feeling every step was in slow motion. I managed to get in the house and still thought that maybe it was just low blood pressure and if i sat and put my feet up id start to feel ok, but that didnt work, so i finally relented to phone the doctor for an appointment but when i spoke to the receptionist decided to ask for a telephone consultation instead.

    When the doctor rang me back and i told her my symptoms she instructed that i get to the surgery immediatley for an ECG. After managing to get a taxi straight away i got to the surgery and was ushered in to see the doctor who instantly prepared me for an ECG . she instructed the nurse to call for an ambulance urgently and gave me a pill under the tounge informing me she suspected a heart attack! i was terrified! and the nurse offered to call my son for me.

    I was blue lighted to hospital after being given another ECG in the ambulance which showed normal rythm as the pil under the tounge obviously had calmed things down.

    I was given a heart scan and then placed on a monitor in A & E i spent almost the whole day recounting my symptoms to different doctors and then finally a consultant told me i have an arrythmia, and prescribed betablockers and instructed i only take one whenever the symptoms occurred.

    For the next month I felt no more strong palpatations apart from a mild flutter and thought it was a one off so never felt i needed to take a betablocker, also after having read the side effects was actually scared to. and they ended up being put aside somewhere.

    Then mid July i sat again watching the tv in the evening relaxing when the palpatations started again, only this time they were extremely fast and a lot more intense and never let up. I shouted my son who became alarmed as he said he could actually see my body moving with each beat and quickly phoned an ambulance. Again i was blue lighted to hospital this time with a HR ranging between 145-180 and kept in all night long being adminsterd intrevenous drugs and then informed they may have to perform cardioversion...which i was in shock and terrified about! untill finally at 11.15am the next morning finally levelled out to 80-85.

    Afterwards, this experience and the shock at being informed and explained to it seems now..very casually... by one of the doctors during the night that i had 'AF' and five times more at risk of having a stroke, while i was feeling very confused, frightened and totally exhausted and not having a clue what was going to happen to me, left me in total shock. Then after being given another prescription of betablockers that I MUST take (every day) then discharged and sent home to cope with taking in what i'd just been through and what id just been told by the doctors, was a feeling thats hard to comprehend when thinking hours earlier i'd only sat enjoying watching tv....made me realise life is so fragile and when on my own was overcome with emotion, and still am at times.

    The saving grace is we are not alone! and Thank God! for this site and the wonderful help and support from the people who are part of it.

    Keep safe and wishes for the best


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