Second episode of PAF - do I need to go to hospital?

[JacqRobs]

Hi everyone. I'm typing this feeling a bit of a fool as I've managed to bring on my second ever prolonged episode of AF, presumably caused by overindulgence of food and drink over Christmas. I had my first prolonged AF episode in July which lasted 30 hours (with an associated very high HR of 160bpm. My resting HR is usually 50.). This was very scary and landed me in hospital. I'm only 39 and had no clue what was going on. They gave me bisoprolol to slow my HR and then the AF seemed to splutter itself into NSR before they'd given me any flecainide or similar (much to the doctor's surprise!). Since then I have had some heart wobbles and flutters and very short (less than 30 minute) episodes which passed on their own. Things were getting progressively better and better. Until last night. I awoke before 3am with very 'wobbly' AF and a HR of 90. It's still going. I feel a bit woozy due to the racing feeling in my chest, but not dizzy or faint. What do I do? Wait it out? I have been on 1.25mg of bisoprolol per day just to help keep my HR low (over-exertion while exercising brought on my first episode). I've just taken my daily dose. Should I just sit out the AF and wait for it to go back to NSR? Or do I need to go to the doctor/hospital? It's been nearly 6 hours now. Thanks, in advance, for any thoughts or comments.

[jeanjeannie50]

I would ring your GP for advice this morning. He may suggest increasing your Bisoprolol. A heart rate of 90 is not considered as overly fast and as a general guide between 60-100 is considered normal. I have been sent home from hospital, pending a cardioversion, with a heart rate of around 120. However if your heart rate is making you feel ill then you need medical advice from your GP.

Let us know how you get on.

Jean

[Rellim296]

Hi there JacqRobs. Sorry you have been struck down

Whilst there can be advantages in having an ECG taken while you have AF, what else would you gain?

Personally I don't go to A & E because I am an old hand and a) have not had much joy on the occasions when I have gone/been taken to A & E and b) haven't come to grief when I didn't go.

You'll be more experienced and wiser when this resolves itself.

[BobD Volunteer]

If you have any chest pain or feel dizzy or faint then go to A and E. If not they will not thank you and likely get quite annoyed that you bothered them with such a low heart rate. Up around 200 then yes but 90 is hardly racing.

Yes AF is scary and to make th9ings worse it is almost always progressive so you do need to speak to your doctor. sadly GPs are not always the best trtained where AF is concerned so as things progress you may well need to see a specialist Electrophysiologist who does know how to treat AF. (Ordinary cardiologists are plumbers. these guys are electricians.)

The most important thing is that you have discovered something about yourself and will be able to limit progress by diet and avoiding over exercise in future.

[JacqRobs]

Thanks, everyone. It's so difficult to know what to do for the best when advice can be so conflicting. The four docs I've seen have all said different too, but I always feel bad about going to A&E when it's so busy. That said, when I ended up in there last time (via the GP) I got a mild telling-off for not going earlier! I'll sit this one out a bit longer and see how I feel this afternoon. Thank you.

[lancebombadier]

Over all the years of PAF I have had conflicting advice. Personally I would leave a 24 hours time and then failing reversion would go to Aand E without hesitation. My experience with bisoprosol was hopeless . You will doubtless get mixed reception at A and E . Sometimes sympathetic , sometimes regard you as tiresome !! Just persevere .

[PeterWh]

If in doubt go. Best way is 999 rather than car since paramedics do a lot of tests when they arrive and they are more trained than some of the A&E staff. Also as the one who came out to me in the middle of the night said he is focussed on doing all the tests and recordings at the home and handing over a complete package to A&E staff. That way the doctor or consultant will often see you much quicker. In my case he apologised that there weren't any blood sample bottles on the ambulance because he normally took all the bloods as well so they could go straight to the lab. Also by calling 999 the A&E staff know it is not a frivolous call because of all the tests that have been done.

[Pdotg]

My AF is under control at the moment but my EP has told me that next time I must go to A&E to get an up-to-date ECG. He needs it to see what is happening as I'm always in NSR when I have an appointment. And do try to get a copy of the ECG - my first one got lost in the hospital filing system.

Further advice: I've been told to call 999 as the Cardiac Unit in High Wycombe will not admit patients who arrive by car. (You will be sent to Stoke Mandeville to be assessed and then referred to High Wycombe. Ambulance crews can make that judgement on the spot.) Not sure about other counties.

PS I am living in two countries at the moment - in case anyone notices that I am commenting on issues in both South Africa and the UK.

[PeterWh in reply to Pdotg]

Even if someone is in persistent AF and has an "attack" so to speak it is important to get an ECG because that can give a clue and or good information as to what is going on. I am in persistent AF and had problems and pains in the middle of one night, I called 999 and was taken to A&E. There they took an ECG and were able to identity to identify the differences between that ECG taken in the middle of the night and one that was in my file that had been taken two weeks previously at Barts Heart Centre (I had taken my own file with me and copy of ECG was in file). Thinks had settled down during the night and then when they took another ECG in the morning things had returned to my normal and ECG was similar to the previous one. If I hadn't gone to A&E and waited to go to GP's in the morning they would never have known what was happening!!!!!