First visit to cardiologist due today. Advice

[Elaine1951]

My first visit to see cardiologist is today. Does anyone have advice about what I should ask for. My own thoughts were to ask for any tests which confirm condition of the heart. Whether I should have blood tests with Apixaban and whether dosage could be reduced as I've had no further AF attacks in the last ten days first onset lasting three days over Xmas. All advice welcome. Thank you

[Barry24]

Hi Elaine,

You already seem to be well prepared for your meeting, I take it that your cardiologist is an EP?

Kind Regards

Barry

[BobD Volunteer]

Firstly apixaban does not need regular blood tests like warfarin but you should have annual check on kidney and liver functions. I would not stop drugs in case you have another event. Paroxysmal AF means that it comes and goes and it may be a while before the next even but if the doctor feels that you are at risk be guided.

Regarding tests, you should ideally have an echocardiogram to check the general condition of your heart and a thyroid blood test in case that is affecting your heart.

I always find it useful to take somebody with me at such meetings and one is often overwhelmed and a second pair of ears and memory can be helpful.

Good luck

Bob

[Elaine1951 in reply to BobD]

Thank you

[PeterWh]

You should ensure that you have full blood tests including, liver, kidney, thyroid, cholesterol, etc if you haven't already had them. If you do you have a baseline to measure against. Also my pharmacist said that you should have a test at three then six months and thereafter annually after starting any of the NOACs or statins.

[Elaine1951 in reply to PeterWh]

that's helpful thank you

[rmclachlan]

Why not let the Cardiologist determine the best tests based on your signs & symptoms. I would have an open chat about your condition rather than go in with a list of demands, you have to approach it on the basis that they know their subject.

[Elaine1951 in reply to rmclachlan]

Indeed

[maxred1 in reply to rmclachlan]

I would disagree with that RM. go to the cardio and EP, fully briefed and up to speed on your overall condition. Within reason, I would not let them dictate the process. I, and others, have a road map that we set up ourselves. There is more than enough information, here, and on line to enable this. Also keep a folder and log of everything....

[Elaine1951 in reply to maxred1]

Thank you.

[PeterWh in reply to maxred1]

I agree.

In any event a good consultant (EP, cardiologist or other) will sit down with you and work with you to determine options and solutions. They will not dictate. The majority are very happy indeed that you have done your homework so to speak by research, questions, mapping routes, etc. It is the old school approach that consultant knows / determines what is best regardless (and it is not necessarily the older ones it can be the very young ones and older ones can be very good at working with patients).

My own EP was brilliant in this respect. We had previously discussed ablations and what it involved and the risks, etc and he knew that I had done my research. When I saw him after I had reverted into persistent AF 24 hours after my cardioversion he said that the only realistic option was an ablation which was the conclusion I had come to. However he would not accept my agreement on the spot but said to wait until I had received his letter, then wait a few days before contacting him with my decision as whether or not to go down the ablation route. I did go down that route.

[rmclachlan in reply to maxred1]

Of course your google search trumps their medical expertise...

My point is that it is a dialog and my experience is that your are trying to work with the consultant to get the best possible care. Going in with demands leads to defensive medical care and that is most certainly not in the interests of the patient.

[maxred1 in reply to rmclachlan]

Firstly, no one mentioned a Google search. There are blogs, this forum, videos, Wikipedia logs, many EP and Cardio have put their most recent research on line.One read of this forum, will show you the amount of ignorance, lack of knowledge, differences of opinion, within the medical profession. A number of consultants do not wish to work with you. They operate to current, and in vogue, guidelines. These change like the weather, therefore extremely important to keep yourself fully abreast of ALL techniques, process. I have met cardios who frankly, did not have much of a clue about our condition, and it has been my GP who has assisted and guided. Again, no one mentioned demands. A well researched, thought out plan, which may of course alter, and a constructive discussion with the Cardio, is the best, IMO, way forward. My last visit to the EP, he advised NOT to have an ablation, quoting less than a 40% success rate, he has stopped doing them, BUT, if my QOL deteriorated, and I wanted to go ahead, he would put me on the list. He also suggested I visit Bordeaux......

[rmclachlan in reply to maxred1]

My point is that it is better to approach a first visit as an opportunity for discussion between the the patient and the expert consultant. The patient is unlkely to be fully conversant with the medical condition no matter how many blogs they may read. Sometimes a little superficial knowledge is not necessarily a good thing.

Yes no one mentioned "demands", but how else would the list of tests required as dictated by some unknown blogger who has no knowledge of the patient signs and symptoms to be viewed.

Again no one mentioned Google per se, but how else do you get the information or indeed find this forum other than by most likely a Google search.

I think we both agree that discussion is the best way forward, and also an understanding of techniques and outcomes. In all honesty unless you are reading the medical journals everything is anecdotal and forms a poor base for proper medical care. I suppose what I am trying to say is to treat everything you read on the net with a healthy dose of scepticism with the caveat that it is also very useful to understand your condition through the lens of those who have gone before.

I am not trying to be antagonistic but feel a measured approach to a first visit us in order.

[dave1950]

I had my first episode just before Christmas. How have you managed to see a cardiologist so quickly? I've had one more anxiety triggered episode since and despite having an urgent referral my appointment isn't till April!

[Elaine1951 in reply to dave1950]

I am paying privately - that's the reason. Shameful but its the system. I wish you well. At least you know it was anxiety triggered. v v best

[meadfoot in reply to Elaine1951]

Don't feel bad about going private think of it this way you are leaving an nhs appointment free for someone else.

Hope your consultation went/ goes well.

[seasider18 in reply to Elaine1951]

Very wise as you see the person of your choice. Too often with NHS appointments you get a registrar or assistant registrar who only has text book knowledge and no patient knowledge of how different our conditions are.

I had one who told me that I could not have a second ablation as the first one had failed. She then said that as I did not want to take amiodarone due to having had problems with it before that I could not have the ablation anyway when her senior colleague had previously told me it was all right to stay with Bisoprolol.

My GP wrote to her about that and other errors in her letter to him. She wrote to me saying we will discuss it at your next appointment probably knowing full well that she would have finished her time there by then.

[dave1950]

After speaking to the AF Association Help line a lovely lady suggested ringing our local hospital directly, having given me the name of a specialist. The Secretary was very helpful and said if my Dr. referred directly to him I could be fitted in much sooner so fingers crossed. If not I am considering going private. Elaine, would you mind saying the approximate cost in case I have to. I understand if you don't want to say. I hope things went well for you today.

Dave