First Visit To Cardiologist

[Arkwight]

Just thought I'd update on my AF journey...

I was diagnosed with AF back in June after a visit to my GP for a feinting episode I'd had that day. He put me on 1.25mg of Bisoprolol to keep my heart rate steady and referred me to the local hospital for a cardiologist appointment which I was lead to believe was to get an echocardiogram done to check the structure of my heart.

My appointment was yesterday. Upon arrival I had my blood pressure checked (all ok) and was weighed. I then had an ECG which showed I was still in AF.

I then had my consult with a very nice eastern European gentleman who asked me to relay my story so far and checked it was consistent with my GP's referral. He then talked to me about AF, but in truth didn't tell me anything I hadn't already established from this forum. He then did a Chads2 assessment and like my GP said based on the result would not consider any anti coag treatment as in his opinion in my particular case he felt the risks outweighed the benefits, although my Hasbled risk is also very low. I did express my concerns about having a stroke, but he was adamant the risks weren't increased in my case. I tried to argue that surely having AF was a risk in itself even in the absence of any other indicators, but all to no avail.

He then said I would need an echocardiogram but that wasn't being done there and then, I would be called back for another appointment to carry it out. Explained I thought that was one of the reasons I was there, but apparently not.

He went on to talk about having a Cardioversion and asked if I wanted to get that booked in while I was there or whether I wanted to go away and think about it. I said that it had been my intention to seek out an EP when it came to any treatment regarding my AF and I was only seeing him as a first step to establish the general health of my heart and for him to refer me to an EP. He didn't seem over enthusiastic about my plans, but didn't object to them entirely. I wonder maybe if cardiologists take it as a bit of an insult when you suggest you want someone else to deal with your heart problem?

He then listened to my heart in the good old fashioned way doctors do with a stethoscope and declared that he didn't pick up anything unusual or concerning and that the echocardiogram would give him a better picture once it was done.

Unfortunately he then dispensed with the 'good old fashioned' way of doing things when it came to checking my heart rate. He pulled out his smartphone (yes it really was an smartphone and I know this because it rang twice while we were chatting.) and asked me to put my fingers and some attachment fixed to the back of the phone to read my heart rate. It eventually settled at 88 bpm

Because of this reading he told me he wanted to increase my Bisoprolol from 1.25mg to 2.5mg. I was a little annoyed at this suggestion because I felt that based on my own pulse readings taken twice a day for the past three months, my rate had never gone above 80 at rest and was more usually at 75 which I was lead to understand was a perfectly acceptable rate for someone in permanent AF. However, my cardiologist suggested his phone was more accurate than me taking my own pulse and he never offered to take my pulse as he clearly had faith in smartphone technology.

Am a being unreasonable on this particular point and am I wrong in thinking taking your pulse is a fairly accurate way to measure heart rate? I ask this, because I really don't want to increase the Bisoprolol if I can help it. I'm only on 1.25mg at the moment, but even at that dosage I'm sure I'm suffering some of it's side effects like tiredness and cold hands.

So to summarise... I'm waiting for an appointment to get and echocardiogram done, I've been instructed to increase my Bisoprolol, I've been asked to consider a cardioversion and have been invited back to see him in three months time.

Does all this sound familiar to my fellow sufferers and is there anything I should be doing/asking at this stage?

Many thanks for everyones continued support.

[BobD Volunteer]

Are you sure he wasn't using Alivecor device on his mobile?

Actually sounds like you are getting quite good treatment to be honest, Many people have to struggle to get any at all. Yes Cardiologists seem to be reluctant to let go of people once they have them in their grasp. One must also consider the guidelines regarding anticoagulation. There are risks in taking such drugs and if your stroke risk really is that low (did he do Chads or CHADSVASC by the way as the latter is more accurate) most doctors would shy away from adding risk. O K I know that many of us think that AF should mean anticoagulation full stop but there is no consensus on that as of now.

You are clearly not happy with your treatment thus far so maybe now is the time to put hand in pocket and pay to see an EP for a second opinion.

Bob

[Arkwight in reply to BobD]

Hi Bob

He may well have been using Alivecor, maybe I should have asked. He definitely used CHADS2 VASC as I did ask that specifically.

I didn't intend for my post to come across as suggesting I was 'clearly not happy.' In fact the whole experience from entering the Cardiology department to leaving was very efficient, very quick and everyone was very kind and supportive.

I guess I was just typing what I was thinking and having read many posts on here and elsewhere, I maybe was over worrying the stroke issue too much.

With regard to the Bisoprolol issue, I'm happy to go along with his suggestion if these modern technological devices are that accurate, I just thought because my GP and a subsequent check by a cardiologist nurse had taken my pulse the old fashioned way to establish my heart rate, suggested that it was more accurate. I will have a chat with my GP about that one to see what his thoughts are.

Unfortunately it wouldn't matter how far I put my hand in my pocket, I wouldn't come up with much more than a couple of shillings and some old bus tickets. I'm one of the Tories working poor I'm afraid and keeping the wolves from the door is a daily struggle.

[jennydog in reply to Arkwight]

You raised the question about a Cardiologist's referral to an EP.

My Cardiologist suggested it. He acknowledged that my AF problem was electrical and that I should see an EP. I actually asked him if the new cryoablation was the best and he told me that he didn't know enough about it to comment.

I guess that I struck lucky with my Cardiologist!

Best wishes.

[Pacific]

I worry about anyone who has not been prescribed an anticoagulant. I am 62 years old, with a Chadsvasc score of one. I have been taking atoravastatin for 10 years; I have normal BP, and I am not overweight.

My GP and cardio felt that I was low risk, but unfortunately I did have a stroke in May of this year. I left hospital with Dabigatran and then I paid to see an EP.

I was diagnosed with AF in 2007, although I suspecy that my first episode was in 2004.

When I had the stroke it was caused by thelongest episode that I'd ever had before; 12 hours or more; I fell asleep after it started (I rarely feel breathless) and because I felt fine the next morning I was walking around in AF ( the day of the General Election). It must have been too late by then, as although the AF stopped by mid morning, the stroke occurred at 6: 00 AM the following morning.

Personally, I feel that the risk of stroke ( with the experience of hindsight) outweighs everything else.

[jennydog in reply to Pacific]

Yours is a cautionary story - the worst nightmare for everyone who has AF.

I was half tempted to press the "like" button but that didn't seem appropriate. I do, however, want to thank you for sharing your experience with us.

I hope that you have been able to overcome the effects of the stroke.

Best wishes.

[Pacific in reply to jennydog]

Thank you so much, and although I did have to relearn some skills I now feel like my old self again.

[checkmypulse]

Just a thought....If you wish to see an EP on NHS, your GP can refer , you don't need the cardiologist to do that.

[pip_pip in reply to checkmypulse]

Not sure they can checkmypulse. It has to come from cardiologist, as far as I'm aware. But don't quote me.

Phil

[checkmypulse in reply to pip_pip]

Certainly in my case on two occasions, one, this AF and a few years ago Prostate cancer, after initially seeing my 'local' hospital and on both times not being satisfied with outcome, I researched and my GP referred me to consultants of my choice elsewhere. I think this is covered by 'NHS Choices' as long as it's not an emergency you should, on most occasions, be able to choose your treatment location and team.

Martin

[Dodie117 in reply to pip_pip]

My GP referred me directly to an EP

[Hidden]

Is your cardio a rhythm specialist or not? Yes or no. If No, then I would want to see an EP because it's a rhythm problem!

PS. As stated above, I was referred by my GP direct to an EP of my choice (privately in my case).

Koll

[AnticoagulateNow]

Yes, I agree with much of the above. It is your decision whether or not to be anti-coagulated - hopefully in consultation with your cardiologist - but at the end of the day, you can insist upon it. Too right, you shouldn't have to pay for an EP. We have the NHS in the UK (I assume you are in this wonderful land) and though it has its faults and you may have to wait a bit longer than private, you can insist on a referral to the specialist of your choice at no charge.

I have never been a fan of CHADS (or its successors). You only have to look on this forum to see the considerable number of affibers who have had strokes/TIAs before being prescribed an anti-coagulant. I can't recall a single post from someone who had a life-threatening bleed - life threatening, mind you - because of anti-coagulants! Of course, there will be some out there but the risks are not balanced, not balanced at all. With atrial fibrillation, there is a far greater chance of stroke without anti-coagulation than life-threatening bleed with anti-coagulation. I accept that will shift as one becomes very elderly and more susceptible to bleeds but from your low CHADS score I'm assuming you're not in that category.

Lastly on the bisoprolol, it's probably worth going with the 2.5mg to try and get your HR into the 60s. It is a rate control drug and it serves its purpose better to get it down to that sort of number. You can discuss that further with your EP when you get one though you should also look forward to the day, post ablation, when you can come off it for good.

I promise you - that will feel great!

[Hidden]

i have an app on smartphone that just records pulse dont understand why he didnt use some medical equipment that has been tested and calibrated. Or indeed his fingers to assess pulse rate and rythmn. I would ask for another opinion re anticoagulant if you check your CHAD risk but i agree AF may be enough. My ploy in past not just anticoagulants has been to ask the doc for a letter saying they deem me not at risk of whichever im asking about sometimes not happy and prescribe. Always go armed with enough info to back arguments up.

[hydrangea]

I don't know if it helps, but I was in hospital for 5 days and I have an app on my phone which takes my pulse (also by putting the finger over the camera aperture) - it was 100% accurate with the readings on the monitor and I was connected to the monitor the whole time.

Having said that, it does seem very unusual for a doctor to use it!