Husband's adventures

Complaining of severe epigastric abdominal pain and looking really unwell, with vomiting the out of hours doctor referred him to A & E. Until now he has been a healthy 73 year old overweight and has lost four stone in 60 months, just re=educating his palate and being married to me. Still working.

they did X-ray Normal

Blood tests = normal

Scan - everything normal. No dissecting aorta. no gall stones when it was established his aorta is normal and signs of abnormality,

ECG - within normal limits, they did another one - let's get this looked at

Monitor showing slow pulse 50- 60 beats a minute.

Another ECG done normal again, Papworth is contacted.

Fourth ECG done there it is again.

Aspiring given, IV paracetamol administered still no relief from the pain.

Pulse rate still slow.

Morphine administered after three hours to relieve pain.

Admitted to ward at 4am. husband slept soundly. 6am another lot of blood test, all come back normal. ECG done, - normal.

Consultant comes in and starts talking about strokes and cardiac ablation and anticoagulant drugs. Says husband has AF. I asked what is the CHADS2 score. to be told if this had happened two weeks ago he would have been prescribed aspirin as he would have been a medium risk of having a stroke but guidelines have been changed and now he is high risk, as there is only low risk and high risk, still didn't get the score, so I did my own scoring <2. To be told he will be referred to Papworth for a cardiac ablation...WHOA....we want a second opinion, all this for an intermittent blip and slow pulse rate? She also informed us, she has spoken to our GP and there would be no problem prescribing the Rivaroxaban. Omprezole was part of the cause of his massive weight gain, so he is not keen to go there again.

He does not have high blood pressure, he has low cholesterol and creatin levels are normal and no indication of raised blood sugar. BP was raised 142/70 when admitted but dropped to 136/68 after three hours.

Husband was Rugby player for years, he also was a swimmer and is active. I was an ultramarathon runner, my pulse rate is between 52 - 65 and have been told by the sports physiologist this is normal for sports people.

We travel overseas at least three times a year, all long haul and take 75mg aspirin to help prevent DVTS.

The Consultant was going on about DVTS because of his low pulse rate and the need for anticoagulants, went ahead an prescribed Rivaroxaban, Omperazole and Nitrolingual pump spray...funny he still has the abdominal pain. Home he comes after a six hours in hospital. Just told on the NOVA drug he wont need monitoring one tablet a day.

He made the decision not to take the medication and wanted to talk to our GP, but could not get an appointment.

He told the Consultant he does not want any intervention performed as he did not need intervention treatment in hospital and the abdominal pain had not been resolved.

Saturday the original symptoms returned. Diagnosed as gastroenteritis. treated for same.

Wednesday there is pphone call from the anticoagulation clinic he is supposed to have appointmet with them. Was not told this on discharge or at any other time. Clinic nurse informed as he is not taking the medication why does e need an appointment.

I read the discharge letter to our GP, we have a copy, diagnosis AF and low pulse rate with an out patient echocardiogram to done..

Another twist to this tale, husband went through RAF and Army over 25 years service with this cardiac blip known . he has seen active service from Borneo to Northern Ireland and postings to Germany. His only injury? Falling off the wing of an aircraft and hurting his knee.

He is now taking 75mg aspirin daily, it wont prevent a stroke, but at least it may help prevent a DVT.

Another thing we were told if he takes the Rivaroxaban, he could have an intracranial bleed. So between a rock and hard place as far as information.

He does not want to go down the path of no return by starting medication he is not sure he wants to take and really is only a band aid.

Of course if his was in AF all the time it would be a different matter he does not even notice flutters or anything else.

He is back at work and says he feels a lot better and no stomach pain.

21 Replies

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  • Correction CHADS2 was 0 CHADS2 Vasc is 1

  • Your hubby would have got something on the score for his age surely?

  • He got 1. 0.6% chance of a stroke. On the old score it was 0 as he is under 75.

  • I would always say to follow the advice of the experts myself, though you're quite within your rights to ask for a second opinion. Rivaroxaban is one of the new anticoagulants, others will be able to tell you more about that - I'm on old fashioned warfarin.

    I'm not sure why you both are so keen not to take any medication? I don't like medication generally (or going to the doctors), but I see my beta-blocker and warfarin as prevention that lets me carry on my life more or less the way I would like to.

    Stroke could be very disabling and life-changing. There is a way of assessing the risk of a bleed - it's called HAS-BLED, if you Google it you'll find it. You can then balance it against the CHADS2Vasc score. I'm sure others will have much more expert advice, but I'd say to think seriously about the medication, and the potential outcome should your husband not take it.

    Lis

  • Aspirin does not prevent DVT. It will however cause gastritis and epigastric pain.

    No role for aspirin in AF.

  • I realise what aspirin does, we fly quite a bit and this has been recommended by doctors who specialise in aviation medicine. Aspirin stops the stickiness of the platelets.

    My husband went in with epigastric pain, he was finally diagnosed after his discharge as having gastroenteritis. All of a sudden things were taken out of context and he has become a high risk for an AF stroke???? He is not breathless, wasn't when he was admitted, is FIT still works full time in his job. He had NO chest pain, No flutters, just vomiting and abdo pain. He had been eating something he should not have overindulged but he did. His discharge letter says new diagnosis of AF??? Why wasn't this picked up when he had his medical to renew his license last month? he had an ECG. This is why we want a second opinion. A lot rides on the diagnosis. Especially as his private pilot's license could be withdrawn.

    As for not taking the anticoagulents, why start taking something, that may be on the path of no return?

    I have been reading this forum and he has not exhibited any of the symptoms that seem to be commonality. All of a sudden because he has slow pulse rate, it has been slow all his life, things have gone into overdrive. CHAD2Vasc score is 1. there are too many unanswered questions

    Oh the doctor prescribed Omeprozole to be taken at the same time as the Rivaroxaban.

    I will have a look at the HAS BLED as suggested, he does have intermittent nose bleeds and has had his nose cauterised.

    I understand about the Aspirin and epigastric pain. This has never been a problem for either of us. Something is not right, because of the medicals required by the C.A.A. here in the UK and overseas aviation authorities. Until last week there was nothing wrong.

  • The nature of AF is that it comes and goes, personally I wouldn't take the PPI, see my post below, but would definitely take the anti-coagulant and dump the aspirin ASAP.

  • Just checked the has bled score it is 2.

  • You can choose to take or not take the meds or have any intervention, however, you should also know that anyone with AF is at least 5 times more likely to stroke out than if you don't, regardless of fitness. You cannot undo a stroke and if you have AF stroke is more likely to be more likely to be more serious. May I suggest you research for yourselves. Plenty of info on the AFA site on just by googling.

    Taking daily aspirin will cause gastric bleeds and not recommended unless you have a condition that requires an anti-platelet.

    AF is also usually progressive and can lead to other problems long term. According to Bob, long time volunteer on this site, jet pilots and endurance athletes commonly develop AF proportionally more than the average within a population so you are not unusual. You will find many cyclists, swimmers and marathon runners on this site. Read their blogs.

    Taking these meds is always a risk/benefit assessment. I felt very similar to you when I was first diagnosed at 56. I was slowly convinced as my general health declined with more frequent and more intense fast AF episodes that I needed intervention. I took the anticoagulants and had 2 ablations, the 2nd being successful, I no longer have AF. I stopped taking the anticoagulants 3 months after the last ablation but will probably resume taking them next June as I become 65, the magic figure when my risk increases. Many choose to stay on anticoagulants for life because of the high risk of stroke. The risk of a inter-cranial bleed from the NOACs is proportionally much, much smaller.

    May I suggest that if you hubby does decide to take the anti-coagulants do not take the PPIs but instead adapt eating habits. Only take with food but never carbohydrates of any sort. Always drink glass of water. Never eat carbohydrTes for breakfast - ever! Fruit, yogurt or eggs only. Bread, cereal and toast caused me intense gastric problems until I sussed this out after much research.

    Whatever you choose to do, please continue to have your heart monitored at least annually with an echocardiogram which will show any muscle deteriation of the atria.

    Sent with Very best wishes and usual caution that I speak from experience and am not medically qualified.

  • If you husband has PAF, (paroxysmal) it means that it comes and goes so whether or not it is picked up will depend upon when the ECG was performed. Many of us carry our own monitors AliveCor in my case, so we can do our own.

    Many people have symptoms with AF but not all, many have AF and don't know about it or feel it.

  • Thank you for your reply. Funny you mention diet, as his diet has been completely modified and only has carbs ocassionally. never eats bread or the like. he iis gluten free also.

    The echocardiogram showed Nothing all is ok.

    This is the problem, it was the blip when he was stressed and in pain.

    we are going to see PALS and see if we can get further light shed on this. the Night Consultant told him NOTHING was wrong and he could go home, this was the Consultant who liaised with Papworth when he was first admitted.

  • Good luck with Pals, it seems that you are angry with the way you were treated. Unfortunately it is not unusual with AF as it seems many doctors and even cardiologists are not well versed in up to date treatments of AF. It wasn't until I saw an EP (electro-physiologist - the 'electricians' of the heart - that I received anything like knowledgable recommendations.

  • I recognise the sense of disbelief in what you are saying, Fidgetsmum. I was well aware that I had a bit of AF, but I had the feeling that it was not really of such great significance that anticoagulation was required. I procrastinated and then fought tooth and nail for a few months when everyone (except my husband) leaned heavily on me. When I gave in and started taking warfarin it felt like poison and life - no, existence - was total misery. I felt out of step with the medical profession, with my children and extended family and with the world in general. I consider Rivaroxaban to be in a different league and for me it has had much less impact on lifestyle. I feel very comfortable with it and feel that by taking it I'm doing the right thing. Yes, there's a risk of bleeding, but frankly I'd rather bleed to death than have a major debilitating stroke.

    AF can be elusive. One can have a 7 day monitor and have no sign of any odd rhythm and it wouldn't be picked up at a medical. At some stage it would seem that your husband has had an ECG that has indicated AF and whenever AF occurs it seems this puts us all at permanent risk whatever the symptoms. It progresses and can become more frequent or more noticeable or both and it might be that your husband will come to recognise the irregularity. Not everyone notices it and I've never had any breathlessness. I can carry on fairly normally in AF but the heartbeat is fast and irregular for a few minutes or several hours. Others suffer more. Lots of people have it all the time. It is described as a mongrel condition, but if you have it, however mild it feels, it seems the risk of stroke is there.

  • I can see why you are dubious if all ECGs were normal. Did they say why they thought it was AF? Was the consultant an EP?

    He could ask gp to refer him to EP or go for a private consultation to have this diagnosis double checked.

    Also wearing a monitor for a few days might shed some light.

    Finally, I have an alivecor machine (mini ecg) and use it to check heart if I feel any odd beats. It tells you if you are in AF. My EP finds it useful to help look at heart activity over a period of time.

    Good luck

  • No she didn't say why she thought it was AF. I asked she didn't reply. Clearly she did not like questions. She got very short with me. All she would say he has a slow pulse. The original consultant who was in charge of his care the night he was admitted and until hand over said, there is Nothing Wrong you can go home; this other consultant came on duty and this when things went out of control.

    On my husband's discharge letter it states unknown consultant General Medicine. I tried to look her name up on the hospital's consultant's list, her name is not there, so I had on Papworth's list and could not find her name. She did introduce herself to us and said she wanted to have a chat before my husband went home.

    A bit about my background. I worked in Post Graduate Medical Education. it was not a clerical position, the medical reps had access to me, so I know about medications and inducements. Call me wary. This is another reason why we are seeking a second opinion out of this region, actually out of this country. As our second home is not in Europe, we have pay medical insurance for any treatment while we are overseas. I would rather trust the cardiac specialists at Scott and White.

    We need to see PALS to get the copies of all tests and notes to take with us. We also want to see PALS regarding the misdiagnosis by the after hours doctor attached to the hospital, He diagnosed a heart attack. It proved to be a wrong PD and they stopped the ACS protocols when he did not respond and the troponin levels were normal.

    She was so keen to refer my husband to Papworth. Something just does not sit right.

  • As said above strokes can not be undone. I have known two people who had a stroke and it severely disabled them FIRST time. One was very active and fit. If I were in your husband's shoes whilst things are being sorted out I would definitely start on anticoagulants. You can always come back off them later if you don't want to continue but it is an insurance policy in the short term.

    If AF has been picked up you may have been very lucky. Many have no or minimal symptoms and of course those People are more at risk. If paroxysmal you could actually have a seven day monitor and AF is not picked up. Similarly at many medicals. If paroxysmal it may not affect anything. Please don't ignore.

    When my AF was first picked up I was already in persistent AF. With the benefit of hindsight I had quite a few of the symptoms but mildly and easy to attribute to other things including getting old. As you will see on the posts it is much better to pick it up pearly and be treated before it progresses to persistent.

    I am not medically qualified but done a lot of reading.

  • We were told by the Consultant if he starts on the anticoagulants he has to stay on them otherwise he will have a stroke. Conflicting information right from the start. I wrote everything down she said. When I asked about medication to control the AF, she side stepped the question.

    I understand about picking up things up early, but one consultant saying one thing and another saying something else I hope you can understand our confusion and is this really the correct diagnosis?

    I know all about strokes, my mother died from one aged 98. She thought she had a cold coming on, went back to bed hoping to sleep it off.

    Marfan's Syndrome is prevalent in my family and I have had experience of a child with a dissecting aorta.

    I question everything.

    we have tried to get an appointment with our GP. Can't get in to see him for two weeks. This is why it will be easier for us to get the second opinion out of the UK.

  • I fully recognise your dilemma and wanting to get to the bottom of it. See your GP and also anti coagulation specialist.

  • I wish to thank everyone for your replies. I am a lot calmer this morning and my husband is not worrying about anything now that we starting to get things in place.

    We spoke to a relation, (head of emergency medicine at a large teaching hospital overseas) and discussed things. She is going to get the head of Cardiology and an EP to review the reports and tracings when we get them. At the moment her instinct is that the second consultant reviewed the first tracing and not knowing the full medical history also noted the slow pulse rate and age of the patient, decided this was AF, not the extra A systole that has been present all his life. The team over there do not recommend anti coagulents as routine and are still hesitant to Rx the same because the long term effects are not known. As husband has had a significant bleed in the past this also worries her about the wisdom of the anticoagulant. She is surprised that he wasn't asked any of the relevant questions. She explained why they prescribe the aspirin protocol and only prescribe warfarin when necessary and the patient is considered at risk.

    We are still waiting for an earlier appointment with our GP, earliest we can get is 3rd September, so I guess he is not too worried about things..

    Next step is PALS to find out why the Out of Hours GP did not investigate the original symptoms. He diagnosed a heart attack, I guess that is understandable, BUT as English isn't his language, he was more interested in his IPhone and didn't bother to listen to what my husband was saying. I am wishing now I had dialled 999 instead of 111. They originally came up with correct diagnosis and we had to go to the Out of Hours doctor to get Rx for antibiotics. What a mess. Some might say a blessing in disguise, but all we can see is utter confusion. our pharmacist also diagnosed gastroenteritis and on his advice this was resolved. Something else the hospital did not address.

    Out of this mess, when things settle my husband might be more amenable to listening to the concerns regarding his slow pulse but again as it has been there all his life and no effects, he might not.

    We have been married five years, his lifestyle has changed, he is eating more healthily, as I am Gluten intolerant and have a couple of other health concerns, nothing that hasn't been addressed, but he has fallen into my way of life to his benefit. He plays walking football now, instead of good old fashioned rugby. He works full time.

    Once again thank you and I will update you on developments.

  • Please do update, I would be very interested to hear what happens.

    My dad has Paroxysmal AFIB (he was an ultra marathon runner for about 35 years) and a fitter man you couldn't meet. Apparently he started noticing his irregular heartbeat in his 50s.

    At 81 he still runs 10k races and only feels the AFIB if he is very stressed. His pulse has always been in the 50s/low 60s. He leads a full and active life. I didn't even know he had AFIB until I recently started with episodes of rapid heart beat myself and I asked a few questions.

    He's had two minor strokes but isn't on Anticoagulants, and I fear he will die one day from a stroke. He is on aspirin, not sure why his Dr hasn't put him on Anticoagulants ... I asked but he seems happy with his medical care so what else can I do?

    Hope you can get to the bottom of this.

    It is awfully shocking to hear the word "Afib" so I understand how confusing this is for a fit healthy man.

  • Thank you Arlene63. Waiting for PALS to ring back with an appointment. Everything to do with hospital is slow time.

    My husband is not worried now. Just annoyed that they did not address the original symptoms. He also want to address a few issues with the consultant who made the AF diagnosis and how she arrived at it. My husband has never noticed anything like people have experienced on this forum. Even when stressed he iis not breathless. His Sats are between 97 and 100 and during the A & E episode his sats remained at this level, He wasn't hypertensive and isn't. just the extra systole he was born with. Oh and that slow pulse rate.

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