Male 60 yrs old. Diagnosed with SVT in 2009 and recently been given diagnosis of paroxysmal atrial fibullation and put on Bisoprolol 2.5mg tablets daily. This Monday was like any other - started at the gym for 3km row and 2km bike - both at gentle rather than straining pace. Heart rate pretty normal - 70s rising to 120 on the exercise bike and back down quickly. Spent day cutting, splitting and stacking wood. Felt exhausted by 3 and whilst sitting at laptop at 4 going over music for choir that night could feel HR rising - it wasn't that high and I didn't bother with my monitor strap. Went to choir and whilst rehearsing could feel HR rise again - quite severely - and then went into episode where I thought I was going to faint (this is not that unusual for me, and I never have actually fainted).
This developed into an episode the like of which was completely new - I realised I couldn't move - I was shaking and bent over (I had been standing). People nearby were quite concerned. After about 10-15 seconds that passed and I sat down, gathered myself and went outside to the fresh air. I didn't have my HR monitor strap on so don't know the HR but it has been at 220+ on occasions and this might well have been a new record. It was deeply unpleasant and has left me rather shaken. Because I was due to drive other people home after the rehearsal, I made arrangements for someone else to do this and for my wife to come to drive me home.
Since then, my HR has been high-ish (it has certainly NOT gone back to its normal behaviour) fluctuating between 80 - 140 and also going down (if HR monitor is to be believed) to 40s-50s. This has been going on for 48 hours now. Previous periods were never longer than 24 and nearly always 4-5 hours or less.
I saw a doctor the next morning and she suggested upping the dosage if that episode repeats but I am wondering if I should do something else now that 48 hours have elapsed and the HR is still not settled down.
I am new to this forum - apologies if this is not the right place for this post - I have looked around but haven't found a collection of "this is my experience" stories.
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Flamenco45
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Sounds like an average PAF episode to me if there is such a thing as average with PAF. We are all different and all experience AF in different ways and to different levels of incapacity. Since it sounds from your post as if you are being treated by your GP I would suggest that maybe now is the time to escalate things to the next level and see a specialist such as an Electrophysiologist. You also need to seriously consider your stroke risk as I am sure that you understand that stroke is a major side effect of AF. Go to the main AF Association website and read all the fact sheets including CHADSVASC and do you own risk assessment rather than trust a doctor to do it. You may well be OK but better safe than sorry. You may well need to be on anticoagulation if at risk. Bisoprolol is one of those drugs which don't suit everybody and often make people feel worse than what they are trying to control. It doesn't stop AF ,merely tries to keep the heart rate down during events which is clearly not happening for you.
I would also suggest that if you ever experience chest pain. dizziness or passing out then go to A and E ( not by car!) and get proper treatment. You must also understand that HR monitors etc can't give true readings if you are in AF so best to get an ECG done to find out what is happening rather than giving yourself stress by looking at your own equipment.
Ask any specific question and we will try to help.
Bob - thank you for that prompt response. I will reply with more detail later - (I have been seen by a cardiologist and had 3 ECGs done and will probably go back in the near future.) Where can I find the CHADSVASC fact sheets? I have looked around the AF website and have found a list of fact sheets but not that one.
You can work out your score by choosing ‘patient information’ from the left hand menu, and then clicking on ‘risks of atrial fibrillation’ in the drop-down menu.
You should understand that zero means that you have no 'additional' risk of stroke. Your stroke risk has increased five-fold since being diagnosed with AF. Not wishing to alarm you but though your risk of stroke is still low, don't think that zero on CHADSVASC means your risk of stroke is the same as someone like you in the general population without AF - it's not.
Anti-coagulation should be a serious consideration at least.
I can only say what I would do and that is, if you are still experiencing widely fluctuating rates, get checked out at AE. It's my view that you should have been seen at AE when your symptoms escalated at choir practice.
As Bob says, you should be seeing an Electrophysiologist next.
Thank you, Sandra. I have lived with heart arrhythmia for a few years and have got used to how it feels when it's in "extra" mode as opposed to "normal" mode. Right now, it is in "extra" but staying at the low end and so not giving me any discomfort or anxiety. I have asked my GP surgery to do an ECG on Friday if it hasn't gone back to normal and I will take that printout to the cardiologist next week. I hadn't heard of an electrophysiologist until a few hours ago when I found this website and forum and will definitely do further research.
Well when I was diagnosed with AF at 60 my GP said to go straight onto an anticoagulant and left it up to the EP to decide which one and EP said apixaban in MY case and I was on it within the week. One difference though was that I was already in persistent AF. Until you have had a proper assessment by your EP or general cardiologist you don't know that your CHADSVASC is actually 0 because you don't know if ther are other cardiology issues. In my case just having the echocardiogram threw up moderate to severe leakage in tricuspid valve, minor leakage in mitral valve and some enlargement / reduction of heart chambers. Also if you are on blood pressure medicines then even though it is under control you still score BP.
I agree with Bob and Sandra that you should get referred straight to an EP as they are in a very much better position to assess your AF than the vast majority of cardiologists. It is after all the EP's specialist area and they are much more likely to have seen many of the peculiarities that occur in those with AF. If you need referral to a general cardiologist or another heart specialist (eg valve specialist) then the EP can do it and the EP will normally do the referral to someone at their own hospital which is a tremendous advantage re tests, talking, etc, etc because contrary to popular belief different hospitals mostly cannot access each other's computer systems and notes because nearly all CCGs are separate.
As you read more on this site and others you will see that AF is a mongrel affliction that varies significantly and affects quite differently not only from person to person but from day to day or week to week for an individual.
I was very lucky that I had a GP who referred straight to an EP and is quite happy to admit that she knows very little about AF and that I know far more about AF than she does.
Do your research about EPs firstly on the AFA website and then other websites especially those which are the ones for the ep's private practices.
Yes, I had both the SV Tachycardia & Atrial Fibrillation - severely & only recognized after 50 years with the medical breakthrough.
Its important to have the best of electro--physiological specialists, even at a public hospital. Even then, we have to go steadily & wisely with the medication as some people can tolerate more than others.
Mine was diagnosed as a compound deformity - with a duel AV Node which I successfully had oblated with radio waves!
I still have irregularities increased with old age!! but I was released from the most violent of attacks.
Excessive exertion is the very thing that brings it on, but most often when relaxed after exertion. Its a real !!!!!!!****** is it not?
in reply to
Jansang, I do so relate to your last para. Similarly ,in my 30's/40's I used to suffer with terrible migraines --prostate with pain & dreadful vomitting for 2 days & very often on the first 2 days of a longed for holiday!
Hi Flamenco45, be aware that part of the issue could be down to a panic attack. This has been an issue for me and it took me a while to realise what it was. I got the PAF attack, followed by much increased HR and massive increase in blood pressure, shaking, sweating and a wave of something or other, which I presume was the adrenaline kicking in. Since a January ablation, I've hardly had any AF but I do get ectopic runs followed by the panic attack which I control by lying down and focused breathing. Just a thought!
I am retired and keep fit by swimming and cycling. I had been swimming 3.5K ,4 times a week and a Cycle of approx 30miles every week. I did the Pedal for Scotland a month or so back which ended up 65 miles and had a few spells of dizziness and breathlessness which I had put down to lack of energy. It so happened I had an appointment with my doctor for more allergy tablets and mentioned the symptoms to my doctor he initially put it down to energy levels, but sent me for blood tests and the ECG which picked up the Afib. I was put on the Holter monitor for 24hrs and given an ultra sound scan the next day. The Holter monitor showed the PAF. I cut back on my swimming on the advice of the Doctor (2.5k) I have had no repeat of the symptoms ,that I had during the cycle, and I don't feel ill. I should also mention I have Obstructive Sleep Apnoea.
I am 61, and have also been put on the same beta blocker as yourself 2.5mg Bisoprolol. As mentioned I had been to the doctors a couple of times in the last month my HR was always 60. The specialist Afib nurse at the Cardiology Dept. at my local hospital, did an ECG prior to seeing him and I had HR of 106. I had just drank a coffee which I don't normally drink, big mistake, or it may have been anxiety normally my HR is 60 I don't have my own HR monitor.
Well will see how I get on with the tablets, he has not suggested any anticoagulants at the moment but as you know the main worry is the stroke risk.
Seriously think about anticoagulation. You can raise the subject. I have seen the devastating effects of strokes on many people including at least one in 40s and one in 50s.
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