AF Again

[Drounding]

I just wanted to share my latest experience with people that understand. Sometimes I feel alone in the Afib world.

So please excuse the rambling, I apologise in advance ... but it makes me feel better.

After a busy long day out with the family I started to feel a bit tired and unwell. I didn't think of AF at the time, although I normally would have.

After getting back late I couldn't remember if I'd taken my Bisoprolol in the morning so decided as it was late to take one then.

I went to bed then woke up suddenly a short while later and felt my pulse and realised I was in AF again. Generally I only get very short bursts that I can either control by bearing down or is preceded by ectopics that the Flecanide pip can stop, but in this case it was fast AF that I couldn't stop. I took my Flecanide pip and thought I'd just wait a while. I took a trace with my alivecor which confirmed suspected Afib.

After a short while I couldn't handle the fast beats and shortness of breath and asked my wife to take me to A&E.

Thankfully they took me straight in and I was seen right away even though there were 8 ambulances outside queueing and at least another 8 or so patients on beds in the corridors (what is our NHS coming to?!).

The first doctor I saw gave me no confidence at all. I was given another Bisoprolol which at least slowed the rate a bit. Eventually another doctor came along that seemed to know what I was talking about and understood things. She said if I was still in AFib later she would give me an electrical conversion. (I've had this successfully before and also been converted with Flecanide IV).

Eventually after about 7 hours or so just as the doctor came around to try the conversion my heart went back into normal rhythm. I felt like jumping for joy.

Whilst I was in A&E I experienced a couple of emergency life saving actions of the staff on other patients. I also overheard them say "oh he (me) only has AF".

This sort of made think of three things.

1. AF was not so important to them in the scheme of things in A&E, although it was to me.

2. The staff can be fantastic when it comes to life saving emergency care.

3. Most importantly though. It made me realise first hand just how stretched the staff and NHS facilities really are.

Again sorry for the rambling, it's nice to talk to those that understand though. Thanks for reading.

[Hidden]

When I was diagnosed It was at A&E. They rushed me straight into the coronary ward, no waiting, straight past everything else, and kept me there till they got me stabilised on the right drugs. 8 days in all. Amazing the variance isnt it?

[SRMGrandma Volunteer]

Well, since I'm a "glass half full" kind of person, it's reassuring to know that the crew at A &E who are used to seeing all sorts of critical situations, are saying that the guy with AF will be fine. But I totally understand your fears and frustrations. Hope you are feeling well now and that your NSR continues!

[Hidden]

Hi Drounding, I would say your AF is influenced by the Vagus Nerve - heavy day and then collapse into bed & back into NSR just when the Doc appears to convert you - exactly the same has happened to me i.e. brain via Vagus to heart.

I would suggest you learn to make sure you are not dead beat (pun intended!) at any time particularly at bedtime but have energy left, may require relaxation exercises and supplements e.g. Mg. Good Luck.

[Lizty in reply to Hidden]

I agree with above reply. If I have a busy day and get over-tired it is a classic trigger for chronic AF. As I have always enjoyed a hectic lifestyle, it really upsets me!

However, now

I try to plan one busy day followed by one relaxing day.. on a regular basis and where possible.

My EP has told me that as long as I am on warfarin, I shouldn't need to go to A and E.... so that is one little piece of reassurance!

Note - I updated my optician in January that I had AF... and she said ...'not another one..!' So there are clearly a lot of us out there!

[Hidden in reply to Lizty]

Yes Lizty, I think it is quite common to enjoy pushing to the limits on family life, work, exercise or social. I think you can get a different satisfaction from a more even lifestyle....at 62 I just remind myself more often I'm not 32.

[Elaine1951]

I was seen with AF in my local a and e. They couldn't have been better. Glad you're feeling well again. Phew !

[dave1950]

I seem to be getting completely the opposite reassuring but nonchelant view of my AF from our NHS. I was first aware I had it when my knee replacement op was cancelled, virtually on the way down. The anaethesist seemed very concerned. Since then December I have had about 5 episodes, all lasting about 36 hours. Fast but sometimes slow, erratic pulse. Now everybody I see says it isn't a problem other than increasing my stroke risk. I'm on 2.5mg of bisoprolol which doesn't prevent it but slows my heart rate from 58 to 48 when normal which might be making me slightly breathless. I seem to get it when my heart rate goes above about 90 which is when I get anxious about something - like going to see a Doctor or I go to hospital! SO - I was in AF when I saw my first electrophysiologist who was supposed to be the top man. He just said do you want to go on Warfarin, it's up to you really so I haven't -yet at least? Again when I went for my echocardiogram I got it and the technician said it didn't matter and often happens and my heart functions were otherwise ok. Although I am visiting the top cardiothoracic specialist unit in Essex they seem totally unconcerned and say in itself it is not life threatening. I don't understand why people on here go to A&E when they get it or am I getting wrong info from everyone I see? I just get on with life (feeling a bit nervous) while I've got it till it passes.

I am currently quite confused about it all to be honest.

Dave

[Drounding in reply to dave1950]

Hi Dave.

Personally I go to A&E because I'm scared and short of breath. My heart races to about 150 even when on 5mg Bisoprolol.

I think it affects people in different ways.

I've been converted in A&E twice before which couldn't have happened if I'd stated at home.

[Rellim296 in reply to dave1950]

I've had mixed reception at A & E and have not been in the last 3 years, partly because my AF isn't very severe, partly because I now have the phone number of the Ambulatory Care Unit and can ring them for advice, partly because I know what to do (take flecainide) and it works and partly because the last time I went to A & E I was kept there for ages for no good reason.

[dave1950]

Yes, I hope I didn't sound flippant Drounding. I do get a bit scared but I think mine is a lot less severe and even so when I first got it I did wonder about going to A&E. I suppose as I can carry on and (at the moment at least) I know it will be ok in 36 hours I doubt they would do anything for me in A&E anyway.

My biggest disappointment from the specialist cardiac unit is that they seem completely uninterested in ME ! I know exactly what is triggering it and when, how long it lasts and what my normal pulse and BP are. Yet they just say " do you want to go on Warfarin?" No discussion as to why I'm on bisoprolol, if the dose level is right, if there are alternatives etc.

Dave

[Buffafly in reply to dave1950]

Hi Dave, when you say cardiothoracic do I take it you are seeing a cardiologist, not an EP?

I only ask because cardiologists generally seem to lose interest once they have established you do not have a physical heart problem such as incompetent valve, blocked artery etc. If your heart is chugging along nicely in general they give you the standard treatment and wave you goodbye until you develop a physical problem such as heart failure, or keep turning up in A&E needing cardioversion.

The anaesthetist was right to stop your operation because he didn't know why you were in AF but once your heart has been thoroughly checked you can have an operation.

If you are not satisfied with your treatment (and I see you have seen an EP) then I guess the only answer is a second opinion from someone who comes with a recommendation! Maybe your GP could help? Mine told me to go to A&E after 12 hours because I was not on an anticoagulant at the time.

[zara1977]

We are all different and there are degrees of AF but I have never gone to A and E with mine - I just head to bed and do some deep breathing and take a hot water bottle. Perhaps I am wrong but I am relying on good anti coagulation to keep me safe and I don't really worry about the shortness of breath or the stupid ridiculus things my heart does (loves to beat all over my body esp down my side). I really would avoid a and e unless you have other issues or health where these periods of af are dangerous. Instead I would ask your EP for the best way to cope with them at home but I would also keep a diary to discuss with your consultant. I think the key is good anti coag that you can rely on and to remember it will pass after some rest and above all, not to get too tired.

I've had three ablations and numerous cardio versions and will never be free of af, I am in my late fifties with a relatively physical full time job so I have to manage my days and my symptoms.

[dave1950]

Thank you Zara and Buffafly. I have to say at this early stage I am a bit confused. I have an excellent GP who said I shouldn't worry about it too much but maybe go back and see him if it lasted more than three days. The EP and my GP said that AF in itself wasn't harmful so I'm struggling to see why I would need to do anything about it, other than it is a bit unpleasant? My normal resting heart rate was 58 which is now 46-48 with the beta blocker. Not convinced what good that is really doing.

The stroke risk is more of a worry. The EP said that once your heart has missed even just a few beats the risk is there forever and isn't related to how often or severe you get it. I asked when I was at risk - i.e during, after, or what and he said nobody knows but possibly slightly higher when you flip back in. As it is about pooling and clotting why can't they measure that? Anyway he just said the same as my GP that I am 1 on the scale because I am 65 and it was up to me if I wanted the hassle of going on Warfarin - to which I thought well no - unless it was really going to reduce the stroke risk. I haven't even seen a cardiologist yet but had an echo cardiogram while I was actually in AF and the technician said unofficially my heart was pumping really well and all the valves were working properly. I suppose I will get a report from the cardiologist that I can give to the anaethesist and surgeon and see what they say about my knee op. Can you believe the EP said "knees are nothing to do with me I'm just here to talk about your AF" which was overly blunt and he didn't have any time for me anyway.

Sorry to whinge on, others seem to have things a lot worse than I do at the moment and my heart (well someone else's might be better!) goes out to them.

Dave

[Buffafly in reply to dave1950]

The more I hear about your EP the more he sounds like an arrogant s***! However I found my EP pretty unsympathetic and I wonder if some doctors become EP s because they are fascinated by the technology but are not empathetic - I read somewhere that many great surgeons (and other 'greats') are psychopathic which is how they are able to cope with performing risky procedures day after day.

When I was offered a big back operation I had to have a cardiology assessment and the cardiologist was very pleasant, told me I would go into AF but it could be dealt with, which is what happened. So I hope you can get your knee fixed asap, good luck!

[PeterWh]

Re warfarin it really isn't that much of a bother or hassle. Tablet every evening and then blood tests. Initially probably twice a week for two or three weeks then possibly weekly for a month then after that could be up to 12 weeks although personally I would want max of 4 to 6 weeks. I have been on weekly testing since start of January last year apart from holidays (and then I used my Coaguchek.

You could ask about taking one of the NOACs.

It is your choice but personally having seen the devastating affect of strokes on a number of people I definitely would never stop taking an anticoagulant now. You have probably seen some of the experiences in my responses in other posts.

[constabule]

no body should ever feel alone - hope even you dont see fellow AF ers you get a bit of comfort and support and dont feel alone on this forum

[Chris147]

Very interesting my cardiologist said to me tongue in cheek as I was so stressed about going into af ending up in resuscitation three times "sorry but you are not going to die" the meds will help and we have a long way to go meaning more meds I am on low dose of flec and 5mg bisoprolol and no ablation. I think af is the poor relation thousands of us have it. It is a very lonely place when you are feeling different sensations in your chest but this site is supportive and informative.