Any point in going to A&E?

Had AF on Saturday evening and tested out Flecainide PiP strategy of 100mg followed by another 100mg an hour later. Didn't make any difference and I returned to sinus rythum after about 12 hours. Then, horror of horrors, it came back last night. Tried the flecanaide gain to no avail. It's been 16 hours now (the longest experience I've had) and I am wondering if it's worth a trip to A&E. I have never experienced attacks in such quick succession. Fortunately, I have an appointment with My EP this Thursday, so will wait for that unless I'm risking anything by not going to A&E. I'm already taking an anticoagulant. I know there is no correct answer but appreciate your views. Thanks

39 Replies

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  • Do you have a fast heart rate?

    Jean

  • Sorry, yes I know from my Kardia monitor that it's around 140bpm and has been since 10pm last night

  • Well, I would go to A & E, or better still as Peter has suggested call the 111 number and they will probably send an ambulance and the paramedics will check you out. I wouldn't personally do the 999 unless you have chest pain.

    Jean

  • It has been going on for 17 hours. Also does Londonant know what BP is?

    I was told by GP and by paramedics to dial 999 rather than 111. The advantage is that you will go lower down the 999 list rather than high up on the 111 list in the event that the service is particularly busy. If not busy then won't make a difference. Either way a paramedic is sent either in a car or in an ambulance. More often around here a car first.

  • Sorry Jean, Re my recent experience of dialling 111 when trying to cope with tachycardia didn't help at all!! Live on my own and they suggested getting a taxi!! The next time tachycardia flared up I phoned for an ambulance, they could monitor readings upon their arrival, Plus A A&E doctors ephamaize always dial 999.

    Mags

  • Hi Mags - Now my experience with the 111 number was really good, but at the time I was fighting to keep conscious with a wildly racing heart. An ambulance came to my house really quick and I spent about a week in hospital. I live on my own too. Whenever paramedics have come to my house they've always told me that I must dial 999 (I never have), so you are right. I just never want to be seen as making a fuss. Very silly I know!

    Jean

  • If you mention any chest pain to 111 they are evidently duty bound to send an ambulance.

  • Hi Jean, story of our lives, living on our own, don't like to feel a burden at all. Albeit I have very good friends and they sincerely mean it to get in touch with them, but hey ho try not to!!

  • 999 once told me to take a taxi one morning around 6am. I hung up on them. They then phoned back and said if I felt worse on the way not to hesitate to call them again!

  • Definitely call 999 or if you don't like that 111 and get them to send a paramedic who will immediately be able to do ECG (rolling over 5 to 10 mins), BP, etc. If they dem appropriate they will take you to A&E. Again they will do ECG on arrival and before despatch and possibly some inbetween - make sure you take away your own copy and don't let them fob you off that its policy not to hand them to a patient. By doing this the EP will actually be able to see not only that you are in AF but are there other things happening at the same time. Even if you delay by 6 hours some if the other things might have corrected themselves

    I wrote additional info on same topic today.

  • Please let us know what you decide to do and the outcome.

  • Just don't do nothing!!!

  • Isn't it interesting how people have such differing views.

    I was told that unless you have chest pain or start to faint then A and E is not for you. I doubt that other than giving you an ECG they would do much anyway apart from put you on one side and observe.

    If this is your first EP appointment on Thursday then an ECG may be useful but other wise my personal view is that you will accomplish little other than increasing stress. Many people are in AF on an almost permanent basis and to be honest a heart rate of 140 is not very high. Many go into the 200s when in AF and that is a worry for any length of time.

    What I did in the early days was to talk to my GP and arrange things so that I could pitch up any time and have an ECG during events and keep a copy for my records.

    Like you say there is no correct answer but we are always told that A and E should be for emergencies. We have seen in the past many examples of people being quite upset by the offhand treatment in A and E departments being told that it won't kill you so why are you here. On the other hand I know of many who find that they usually drop back into NSR as they walk towards the door of the hospital.

    What I do suggest is that AF is almost always a progressive condition and that you may need to accept that this will happen more and more until you get the right treatment.

  • I agree with some of your comments but I think you are missing some of subtleties of what I am saying.

    Going back some years dialling 999 always resulted in an ambulance being sent and a very high proportion being taken to A&E because the ambulance staff had limited medical training so it was only the time wasters and those with minor injuries who weren't taken to A&E.

    I then thought the findamental change, implemented over quite a few years, applied across the NHS but maybe only some of the regions like London, the east of England, southern England and metropolitan areas with the advent of the qualified paramedics. Over the last 10 to 15 years the competence of the paramedics has increased, the total number of them increased and the sophistication of the equipment they carry. Part of this is in response to the golden hour but also to reduce A&E admissions. The percentage of admissions to A&E has been reduced. It also addressed the closure of smaller and some other A&Es so as to have the larger A&Es with more capabilities. Now for instance a hospital can't have an A&E without a certain level of capabilities across a range of areas (eg as a consequence many hospitals had their cardiac facilities upgraded).

    When the paramedics attend they make an assessment, take readings, etc. They may say that the person is ok or give them some treatment there and then or tell them to see their GP or they need to go to their local minor injuries unit / trauma centre or they need to go to A&E. If the paramedic arrived by car or motor bike then they will call an ambulance. That way the hospital knows that the patient truly does need A&E and that's why those people are prioritised at busy times.

    One GP (not my own) told me that the paramedics today have more capabilities / equipment / experience / etc than many GPs.

  • I just hope never to be lying injured and bleeding in a road accident whilst these paramedics are attending to non urgent cases then. Sorry 999 is for emergencies in my book and unless you are passing out or have chest pain it ain't. Personal opinion only and I can cope with hate mail. ha ha.

  • If you had been in a RTA and were bleeding then they would almost certainly send an ambulance straight away unless there was a paramedic in a car or on a bike that was much nearer.

  • Fully agree, Bob. I had hundreds if not thousands of AF events before my ablation. Each lasting 24 hours or so. I'd have had to live in A&E and had an ambulance permanently assigned if I had called 999 each time. AF is a chronic not an acute condition.

    I was out on a walk recently and an old lady collapsed. We called 999 and I ran to the nearest road. It still took nearly an hour for the ambulance and paramedics to arrive as they were so busy. In the meantime I had flagged down a fire engine that I thought was attending. It turned out to be on a training exercise but it still came along over rough ground and helped carry the lady to a safer spot.

    I would add one other criteria to Bob's list for dialling 999 - the symptoms of a stroke or a TIA (i.e. FAST).

  • good point Mark.

  • As I was told by my GP it is not the actual HR that is key but the number of times normal. The first or second time I saw her she was going to call 999 because my HR was just over 140. My normal pre AF days was around 60 so I was 2.4 times high. She said someone who had a HR of 180 but whose normal was 90 was less of an issue. However sustained at high levels approaching 200 is bad regardless.

  • Over the past years I have been more successful with the extra Flecainide and did not need to go the A&E on most occasions when I had AF.

    I was told, however, that if you are not anticoagulated then during the first 2 days of AF a cardioversion would be possible. After the first two days then you would need to be anti coagulated and have at least 4 weeks of results up your sleeve.

    If, as Peter says, your heart rate ratio to normal is higher than you have previously experience then the cautious approach is to visit A&E who in my experience have always treated me with respect treated me well and taken my concern seriously.

    Your post suggests that you may be near an A&E department so I would concur with Bob's view that 999 is not appropriate nor 111. As far as 111 is concerned this is a post code issue and in my limited experience they tend to over react and the likelihood is that they would send an ambulance which as Bob says may be required for a much more serious case.

    Finally if your heart rate ratio (over normal) is not higher than you have previously experienced then maybe wait until Thursday. I was in AF for a week recently and am here to tell the tale. (I was cardioverted in the end).

    Pete

  • I have been told by various health care professionals 3 totally different responses to having an episode of AF. Cardiac cons said if it's at night then unless I have chest pain try and get back to sleep and maybe be nil by mouth so I can attend And E next morning and be ready for a cardioversion. Daytime wait a while but not so long I would arrive ( driven by OH) "out of hours". GP. Said wait 30mins then attend A and E. Coronary care nurses say come straight in . They'd rather have false alarms than something be missed. I have not had to de ide whose advice to take yet!

    Personally if you are new to the journey then reassurance is needed and I would go.

  • Agree with Bagrat, you are new to AF and reassurance may be all you need. A and E will give it. No doubt they will do nothing but monitor and wait but you will feel safe. Next time (heaven forbid) you will feel more able to cope at home knowing how it 'pans out'. It's odd the differing reactions people report from the hospitals. After 3 days of hr of 160 plus I had to visit GP for INR and he sent me to A and E where they said 'why did you wait so long?'. They monitored me and kept me overnight to see an EP in the morning.

  • A quick way of seeing an EP !!! Though probably not what you really wanted.

  • In a way it was what I wanted, this was 8 weeks after Ablation 1 and seeing the EP, who wasn't mine, but on the same team, escalated my situation and got me booked for a second Ablation somewhat quicker than if I'd waited for my follow up clinic appt. So 2 week's after my follow up clinic appt I had my 2nd Ablation just over 5 months after number 1. So going to a&e saved me probably 3-4 months waiting time.

  • Not always! I had no reaction from several A&E visits, was only ever monitored by A&E and sent home when 'stable'. I certainly did not see a cardiologist or EP and those were at several hospitals, one in London.

  • Just shows what a difference it can make re where and when.

    Both mine have been in the last year but to two different hospitals. Could it be protocols have changed?

  • It could be as i haven't been to A&E since 2014. I do know that there is now an EP at local hospital, which there wasn't and that he monitors A&E admissions for AF for his own research.

  • Not sure if it was down to protocols or just the diligence of the A&E team at a hospital which 'does' hundreds of ablations annually and were aware of my previous procedure just a few weeks previously. They did say my ECG was somewhat 'aggressive'.

  • It would have been on the computer system.

    This is where treatment has become much more personalised than say 10 or 20 years ago.

  • Thank you all for your comments and perspectives. I got a cab to A&E. Was seen very quickly and, after an ECG, initially given more Flecainide and a beta blocker. They contacted my EP who told them to give me a 30 minute drip of flecanaide. No change. Just when they were suggesting that I stay in and have a cardio version tomorrow, BAM, it kicked in and sinus rhythm was restored. So, I am very glad I went.

  • So the answer to your question is Yes!

  • Good result and now the EP has a good ECG!!!

  • Glad you decided to go to A&E and give the old 'jam tart' a shock and frightened it back into NSR yourself. Just the thought of a cardioversion was enough. I have had both scenarios.

    I think that a measured approach is the best. It depends on how the heart rate ratio measures. If it is within a reasonable range then give the AF a day to return to NSR and if a PIP approach is one of your approved remedies - try it. Otherwise after giving it a reasonable period to right itself without success then there is every reason to take it a stage further and seek help at A&E.

    Pete

  • Good

  • Flecainide may not work for you, it doesnt for me. Makes me worse actually. Ask for a change ?

  • Interesting. On two occasions in A and E I've had a cocktail of drugs and several hours later converted "spontaneously" the EPs words. I asked why he said that and he explained that all the drugs tried, amongst them amiodarone, digoxin and a beta blocker, would keep some people in normal rhythm but not stop an episode of AF.

  • When I was new to this list I asked the very same question and received a very brusque reply, something about using an ambulance as a taxi which I found very upsetting at the time and not a useful reply to my question.

    As a fairly old hand with permanent AF now, I've found my own method of deciding which I put to the test as recently as yesterday.

    My personal way of dealing with flare ups of extra fast AF is to take a prescription indigestion remedy and do the breathing exercises I've been given for another condition. So far it has worked for me.

    PS Am I the only one on this list who's never seen an EP?

  • Fairenough I have not seen one either, have asked but got nowhere and I know that I have to go privately to get this to happen. But trying one more time, my heart failure nurse has informed me that I should be able to get on the Palpitation Pathway to Papworth so having a go at that. also told by my arrthmyia nurse that I should get to A&E myself if my h/r stays over 140 for any length of time, I have permanent AF.

    Last time I as addmitted to A & E May 2014 heart rate was 160 to 180 but I did have trouble beathing. Been to GP earlier with breathing probs, he said it was chest infection, anitibitic given back five days later probelm worse. His words I donn't think we can do anymore for you can you go to A & E now and wrote a letter. Hubby took me.

    Outcome did not have chest infection it was fluid on the lungs because heart not pumping properly, hr high had to stay in for 5 days. One of he docs in A & E was cross that the GP did not send me for a chest xray given my track with fluid tention an that I had said that I did not think it was a chest infection and it came on so quickly, no cold, throat symtoms at all.

    Cassie

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