AF Association
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When to dial 999 and/or go to A & E - and when to just ride it out at home?

Hi, I had a nasty 8 hour AF episode this week. It affects me badly - chest pain, nausea, dizziness, weakness - and I can hardly move. At first I thought it was fairly mild, pulse up to 140, but later it really kicked in, pulse up to 220. At that point I'd had enough and was scared and for the first time ever with AF, I went to my local hospital. They called an ambulance and I was transferred to the nearest A & E where I stayed for a few more hours, until finally spontaneously going back into sinus rhythm. After the initial aspirin and GTN spray (which did help) all they did was monitor, give a saline drip and keep looking at whether to give me Bisoprolol or not. The AF resolved before I was given the beta blocker. My question to them was - am I wasting your time, should I have come in or not? . . . and their answer was that I should be in hospital with a raised heart rate. But they didn't specify how raised. So my question is: at what point in terms of symptoms or heart rate, do people call 999 and/or get to A&E? When is it ok just to ride it out at home? I don't want to call 999 unnecessarily, but I don't want to be stupidly heroic about it. Do people have their own measure for when to call for help and when to do nothing and wait for it to pass?

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This is always an emotive subject and you will get lots of different views. There are some . like me who comment that A and E stands for accident and emergency. and AF is neither. It is a chronic condition. That said if you have any chest pain. feel that you are likely to pass out or have a heart rate over 200 then you should either call NHS helpline so you can be triaged or if able make your way to hospital.

If you are in the early stages of AF and so far not managed to get a full diagnosis then A and E and an ECG can be a way of doing that. I believe that most of us who are established in the condition just ride it out at home unless the above symptoms present.

I am interested in why they gave you aspirin which as we all know has no place in stroke prevention in AF. One can only assume that they were covering all bases including an MI (heart attack) using the shotgun approach of trying to hit everything at once. Sadly A and E staff are seldom up to speed on this mongrel condition of ours and this is not uncommon.

Next time you see your arrhythmia expert you should ask for some guidelines. I find most GPs will err on the side of caution as it gets the patient off their conscience as that has always been my experience.

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Yes, part of my decision to go to hospital was to get the ECG records to go to the cardio for a definite diagnosis. And the aspirin and GTN spray was to cover all bases as the chest pain was confusing. Luckily blood tests at A&E showed no heart attack or damage. I'm due to have a CT angiogram in a couple of weeks to see whether anything else is going on. A first appointment with the AF clinic is in mid August, so I'm relieved I saw the cardio privately and have got things moving.

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AF affects people in different way and could also be accompanied by a panic attack. You need to chat to an Electrophysiologist (EP) about your experience. I can ride through exercise induced AF in the gym without a problem or medical intervention, but that won't apply to everybody.

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You did the right thing.

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It's a dilemma but with chest pain and such a high heart rate, I would certainly be concerned enough to seek help. The fact that your hospital called an ambulance indicates that trained people also felt help was needed.

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I think you were right. 220 probably needs monitoring especially with chest pain. Who wouldn't be scared with what you describe? A&E can be pot luck but they do keep an eye on you.

For the record I have been told to go by how it makes you feel. When I have been paroxysmally in AF then I find I can cope up to 130 -140 BPM by taking extra bisoprolol and waiting and not panicking. Not sure why you have not been told to take the beta blocker? They have a calming effect and act quite quickly to bring pulse rate down.

Now I'm in persistent AF which is another ball game entirely.

Good luck. This is tough to cope with.

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While accompanying me to see my GP, my friend asked the question that if we were out walking the coastal footpath and I had an attack at what stage should he call for help. The answer was if it was over 130, but I know that's a different rate to that which you would need help if you were sat at home.

With lots of years of experiencing AF and tachycardia I would say if your heart rate was over 140 for more than 6 hours then you should go to A&E. If over 160 for an hour or more straight to A&E.

Sometimes we get to know our attacks and how long they will last and if we know this is just for a few hours then we can sit it out.

If I had any chest pain (with or without AF) radiating to my back, arms or neck and making me feel sick, or dizzy I would hope that I would dial 999.

Without doubt you certainly did the right thing going to A&E.

Jean

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Thanks for all your replies and comments. Very helpful to hear that there's a range of responses and it depends on symptoms, where you are, how comfortable you are dealing with AF etc. When I got to my local hospital, they told me off for not calling 999, as did the paramedic in the ambulance and then the A&E doctor in Gloucester, who said 'next time, don't wait, call 999 sooner'. So I think in this area they must tend to play it very safe. I will take both their and your comments on board and see how to gauge it next time.

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I also live in Gloucester and have been to A and E three times with A F (first as diagnoses and other times when I slipped out of NSR) On each visit to GRH they have said it was the right thing to do and have been successfully cardioverted and home within a few hours - being an HGV lorry driver AF has complicated my licence and I've now been put forward for an ablation - can't fault Gloucester Royal for their handling of AF and how they prioritise treatment

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I got told off for leaving a HR of between 110 and 130 for four days- but it did take that long to start feeling dizzy, I'd hoped it would resolve itself.

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I can usually cope for 24to36hours but after that time hr goes higher and start to feel really unwell so off to Ed if I had pain I would not hesitate to go to Ed

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When you THINK you need to go to the hospital, you go!! Period. You are never wasting anyone's time. I used to feel the same way, but now I don't. I see all the local addicts calling ambulances and taking valuable medical staff time and I got over not wanting to go to the hospital pretty quickly)....you should do the same. I used to work as an EMD and I was appalled at how many people use the medical system that are addicts (about 70% of the medical emergency calls coming in!!) Then when I left the ambulance, I decided that my ailments were more important than a junkie's that keeps overdosing time and again while I stay at home and deal with my heart palpitations/issue...not saying ALL ambulance calls are from addicts, but here in BC and Canada...A LOT of them are!!! Not sure where you reside, but please go to the hospital when you feel you need to!!! X0

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My experience with the B.C. Canada, atrial fibrillation section, specifically with the Vancouver General Hospital, is that the department is in the middle ages letting you progress while in persistent fibrillation to long standing persistent due to extended waiting time and without being concerned at all. Furthermore, there is only one nurse because the consultant nurse is on a one year leave, meaning that the regular nurse and the pharmacist in the department have to do her job as well, causing a short-staffing and substandard care as the patient deteriorates. Yes, drug addicts here get better care than atrial fibrillation patients even thought there are 44,000 AF patients in B.C.

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Langley memorial is a joke hospital! Our medical system is quite primitive overall, I agree. I had to go to the US for knee replacement because even with that, Canada is a decade behind! Scary....

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Prolonged episodes of A/F should be medically treated. A/F caused me to have a stroke, the Cardiologist treating me stated that anyone with prolonged and rapid heart rate should call 999 and go into hospital via ambulance, anything 8 hours or more is prolonged, you would then be taken into casualty where heart and heart related problems are coded as priority. Please have a look at this information because it could help you. guysandstthomas.nhs.uk/our-...

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A doctor I had told me to dial 999 if my beats go to 120. But if I were to do that, then I'd be on the phone every day !

I have permanent AF and Deviating Waveform.

My HR can go from 47 to super fast. Can't seem to control it with Bisopralol.

Bobby

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I was told if I had a raised heartbeat after 15 mins to make my way to hospital or to call 999 and get an ambulance! So I suggest the same for you too. Especially since with your symptoms you had chest pain as well. Like you after a drip mine goes into NSR. Don't leave so long !

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Don't ever let anyone think you're a time waster, no one here is an expert in how you feel, besides if you're new to AF how on earth will you get into the process line of sorting your symptoms out, some of the drugs cannot be prescribed by a GP flecainide being one of them, you need monitoring in hospital for that. I've had it for 14 years and in the time I know if I feel pressure in my nose it is going to be fairly short episodes, my last 3 episodes all saw me in a&e one of them called for by my gp, but my rate is always above 220bpm, the longer the attack the more damage you can be doing so never ever feel you shouldn't use the service you have paid for. I am told I have a heart of an 80 year old I'm 46 and only just recently been put onto any drugs, my initial episode 14 years ago I was prescribed asprin daily, maybe that's why I have an old heart 😢

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This such a big issue, I used to work in A & E as a nurse, and I'm now having to be the patient with persistent AF.

I first went to A & E four months ago, before having had any tests done - was given an electric shock and sent home. (Back in AF the next day.) The second time I went to A & E, I was kept in for three days, had my meds changed and not allowed home until in SR. Last week I was awoken at 1am with chest pain and feeling lousy, so off to A & E once again. After MI had been ruled out, staff asked a cardiologist to see me; she tripled my meds then sent me home, still with an irregular HR of 150. The opinion is that the Apixaban will prevent clotting, I'll be given a date for ablation, and in the meantime there's nothing they can do about the persistent AF.

So it all depends on where you are in the 'AF process' - plus how ill you feel at any given time. If my HR was over 200 I'd be rather worried. Chest pain is also a concern. I find it difficult because I'm okayish one minute, managing to potter about - then having left arms pains and sweats the next, then okay again. Distraction is good! And I'm so lucky to be self employed. And taking time to enjoy life's simple pleasures helps :o)

Kath, hope you feel better soon. Sending positive vibes to all of us AF-ers :o)

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As has been said people's opinions on this vary, and it is a personal thing. Best I can do is give you my own experience...

The first time it happened, one morning, I was scared and didn't know what it was - I consulted a colleague and ultimately dialled 999.

The second time I was walking my dog to groomers. Ended up walking to A&E.

Third time I was tidying up, felt awful, friend visited took one look at me and I relented and dialled 999.

After this and 3 cardioversions I got listed for ablation and it did seem to settle on the 3rd combination of tablets.

Because I began to know what to expexct, sometimes sleeping 20 hours the day before, I started to second guess when it would come on. One Friday I attended A&E feeling unwell but nothing was picked up. I was back 6 hours later in fast AF.

I had 2 ablations in the year after that, and my need to rush to A&E abated.

However in the last 18 months its come back, and has been a lot more intense than I remember in those early days. I have never felt unwell enough to dial 999, though I have gone via 111 and they have noted my history and called one for me.

Equally back in March I had a 2 day long spell of fast HR, which I ignored and still carried on as normal, though when I overdid it I was on the verge of collapse. I never got myself checked out as it "settled" ie HR 120 when I sat down for 5 minutes.

It was a HR of 200+ in my worst episode recently that made me attend A&E on the orders of 111 and my girlfriend, deep down I knew I should go but it took someone else saying go before I did it.

No matter how it starts or how you get there, you always feel you're wasting people's time. We all know how busy the NHS is, and with me working clinical in the same hospital I attend, I feel equally bad for "getting in the way"

But I must say EVERY time I've mentioned to staff in resus, A&E, 999 crews, first responders, nurses on cardiology wards, cardiac outreach, A&E registrars they have ALL said the same, without exception.

NEVER feel like you're wasting someones time. Although AF is not considered a "life threatening" condition... it is very different for different people and if I ever feel unwell with it attend A&E without question. Don't bother with GP or urgent care or 111, attend right away and get it looked at and/or resolved to make you feel better.

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As a newbie to this AF business I will be following my cardiologist's advice. The next attack I have I'll take the Flecainide and Bisoprolol as prescribed (PIP), and if it doesn't clear in a couple of hours then take myself to A&E.

I'm sure if/when the attacks get more frequent and I'm more experienced, I'll be leaving the trip to A&E until later and later, but for now that's my plan.

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Is it possible to have an upda.te as suffer A- fib & feel as if left in limbo .How are you doing ?Live near you - Stroud?

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Hi - sorry you're feeling out on a limb. I haven't been very active in Healthunlocked or with AF, as nothing much has happened for me for a while. I had a half hour episode last December and an hour's episode in the beginning of August, so although when it happens it's scary and I can't move, it isn't occurring very often. I don't take any daily med for it, but have Bisoprolol and Flecainide as pills-in-pocket and they work well. The cardio said that it wasn't bad enough for an ablation, so I've no further appointments to see anyone about AF. I'm 67, so on Pradaxa (the lower dose of 110mg) as an anti-stroke measure. How about you - how are you doing and what's happening? I do live in Stroud - are you close by? Sending best wishes, Katherine

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I was always told to call 999 with high heart rate going on to long.

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The questions are: what is 'high' and what is 'too long' ? I can tolerate 150bpm for an hour or so, but approaching or over 200 is too much for me. But luckily my pills-in-pocket mean I can manage it myself and don't need to call 999.

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