AF Association
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Af worries

How long should you wait to go to the emergency room if in afib.My heart doctor says I’m safe for 24 to 48 hrs. I’m on 240 mg of diliazem 2x a day and 150 mg of flecainide 2 x a day. I’ve been in a fib now for 6 hrs

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Unless you have chest pain, extreme breathlessness or faintness you should follow you Doc's advice. Many people don't go at all.

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My EP's advice IS to go to A&E if the medication doesn't work.

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I've been in fast AF since Saturday evening (It's now Thursday afternoon) resting HR has been between 120-130 but aside from the occasional wave of dizziness, no shortness of breath or pain. Just very over-fatigued. This will be the second occasion I've had one of these episodes and not attended ED.

The really severe symptoms don't really present until HR is 150+ (if I've exerted whilst in AF) and then I usually attend.

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If I was you call for help they can help

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I find these threads very interesting, because I have been given very explicit instructions from my EP that is in complete contradiction to most people's advice on this forum.

I have PAF, and take Flec only as PiP. My EP has written to my GP saying that if the Flec doesn't work within 3 hours, then I am to present to A&E. I've also asked my GP what she'd do if I came into the surgery instead, and she said she'd tell me to go to A&E.

I don't want to clog up the NHS, but when all the medical people I've spoken to are telling me to go to A&E, I feel reasonably justified in intending to do that.

When I last went to A&E with AF, I was quickly taken in, and taken seriously. If the Flec hadn't fixed it that time, I was to be electrically cardioverted on that same day. From my pre-AF experience the A&E department are quick to get rid of you if you shouldn't be there. I made it clear I had no chest pain or dizziness, but I was whizzed through triage and given a bed nonetheless.

My advice to anyone unsure of what to do is to at least get some advice ASAP. Phone a Dr, or 111, or your cardiologist/EP. Give the experts some say in the matter.

Longer term, get a plan. Ask for explicit instructions on how long you should wait before seeking help. I don't think you should put up with it if you don't have to. EDIT - I've just noticed you said "My heart doctor says I’m safe for 24 to 48 hrs" - that sounds like you've already asked this question?

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Hi - I was told by cardiologist after reverted at A & E /overnight in cardiology for first afib episode in March to take 50mg Flecanaide within hour of starting and if not stopped within an hour to go to A & E, have had two more episodes since (once while away on holiday so different hospital) had to go to A & E both times but no-one seemed surprised so guess we can't be the only ones told this.

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I agree, advice is very conflicting. I was told to call 999 if my afib lasted longer than 15 mins. All afib is different and can change its habit from one episode to another, so cannot be relied upon to stay stable. I ended up on the kitchen floor at 9pm last Christmas day with a pulse of 250 because I did not call 999 and tried to sit it out . Play safe.

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I am somewhat surprised by the 3 hour limit as it takes around that time for Flecanaide to hit the system and 6 hours to reach maximum strength.... I went in once with a HR OF 180 after 12 hours , was put on a drip , given more Flecanaide and then discharged next day ....my Cardio says 48 hours unless pain or breathless.

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OK so what do the people in permanent AF do? AF is a chronic condition and not an emergency unless you have chest pain or are passing out. Yes it can be distressing but fatal it is not and few hospitals will ever be prepared to do cardioversion at short notice.

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They will have gone to the GP, cardiology, and/or A&E, and presumably had cardioversion attempts that didn't work (or decided not to have one), and at that point, I agree you can't present to hospital again when it starts, because there is no start.

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If in the US, Little Rock, AR. Arkansas Heart Hospital, this hospital is owned by a group of Doctors. when you go into ER, they take you back within 5 minutes and begin assessment. I have had cardioversion fairly quick once lab is back and INR in range 2-3. My EP also is one of the Heart Hospitals EP Doctors as well. The previous cardiologist I had from a different city....No. The heart hospital and Doctors there are specialized and awesome!!!

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Over the years my experience and advice was to present at A&E if my AF would not respond to PIP within 24 hours.

My AF was never at a very high heart rate and I was always treated with respect and on numerous occasions cardoverted.

I would add that I am always very symptomatic when in AF.

As I had PAF for so many years I was under the care of two different hospitals in different parts of the country with the same advice being given over many years and by about 6 different specialist EP departments.

We are all different so be guided by your EP at your hospital.

It may not kill you but QOL can be unbearable.

We all have different tales to tell.

Pete

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people all have different views on this- I think you should go now if your heart rate has been high- 130 plus and if your symptoms are making you feel ill. Obviously too if you have any chest pain. Also if your BP s very high- these are all things that shouldn't go on for too long. To put time limits on things is not sensible as it all depends on what your condition is at the time. A and E can monitor you in safety

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just seen the point about if you have permanent AF- same advice applies- you wouldn't be left with a HR of 130-150 permanently and it would need addressing even if they couldn't get you back into NSR

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The only opinion that matters is yours. If you feel you should go, then go. And I’d add that if you’re not certain whether to go or not, then go. Then review with your EP when you see him/her. That’s what I’d do I think.

Hope you feel ok soon.

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I just went and saw my heart specialist nurse she said you have 72 hours before you need to worry about blood clots she put me on a blood thinner and if I haven’t converted buy Monday come in and they will convert me.

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Good work, making the call got some results. I hope AF naffs off long before Monday and you can enjoy the weekend.

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Thanks everyone for being so nice

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I have permanent AF and I am sometimes symtomatic and sometimes no real symtoms. I have been admitted to A & E on a few accasions with HR very high but the main problem was breathing issues. on these occasions I could hardly breathe and my oxygen levels were very low, one time I had fluid on my lungs, I was always kept in for 3 or 4 days.

Otherwise I wait for my HR to eventually settle to a more normal level (90 for me) no cardioversions for me as I am in permanent AF.

Cassie

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cassie46 , I’m in almost exactly the same position as you, and couldn’t give exactly why I go to A&E when I do, symptomwise, but I’ve always been admitted and kept as long as it takes to get BP raised, oxygen level raised, and fluid reduced.

I always apologise in Triage for being a nuisance, and am always assured that it was the correct action to take, so my instincts have been correct so far.

Have you been offered Entresto? It’s a combination of two drugs and is the first new one for treating heart failure for many years apparently. I’ve just been put on it and so far, so good. It apparently has nasty side effects for some people but I haven’t developed any. (I haven’t asked what they are as I have a vivid imagination and would probably develope them even if given a placebo 😀)

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Hi POrtnahapp1e

Not heard of that drug before - will have to find out more about it. At the moment it is being suggested pace and ablate is my best option - still waying up the pros and cons of that.

Cassie

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I haven't read all the responses so excuse me if this has been said already. I did read Bob's response though.

I was told (by 2 cardiologists) if you are in rhythm (having not been in a-fib before and also not been on meds) and then go into a-fib it is safe to have a cardioversion within 48 hours (the risk of clotting in that short space of time is low).

But if you are on a blood thinner or anti-coag (someone correct if only one is relevant) then you can stay in a-fib....for ever (as per Bob). I had an ablation in Jan and went into afib soon after and was told to wait 6 weeks to come in again for a cardioversion. I was on an anti-coag from before the cardioversion. My EP was not phased in the least that i was in a-fib.

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My doctor put me on blood thinner just to be on the safe side until Monday the he will convert me back to rhythm. He is one of the top leading heart rhythm specialist in the country . I trust him

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Cardiologist told me only to go to A&E if I had chest pain or had passed out. He said he has sent people home from his clinic with HR of 160.

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Only you know how a particular event is making you feel. I have been told to wait 45 mins(GP) then go, go straight away we don't mind, better safe than sorry ( coronary care) , try and get back to sleep and come in the next day but earlyish and nil by mouth in case I need cardioversion (cardiologist). All with the proviso if no chest pain in which case 999 job. Haven't had an episode since but will follow the advice that feels ok at the time!!!

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So much use of the term blood thinners!

Anti-coagulants are not blood thinners, they do not thin the blood. Poor BobD will be banging his head on the wall at the moment 🤕.

Seriously, it was calling them blood thinners that deterred me from using anticoagulants initially. But when I learned on here, and the NHS website etc, how anticoagulants actually work, and that they do not thin the blood, I felt reassured.

Koll, Anti-Blood-Thinner Police 😎

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OUCH!!!! and thanks Koll. My blood duly boils.

I would argue that there is no real safe time limit if cardioversion is expected. 72 hours is plenty or time to form a clot but of course I have had DCCVs when out or INR range and unprotected but with the aid of a TOE to check that there are no clots to flick out. I stand by my assertion that many smaller hospitals will not do DCCV on demand anyway. My local one which is actually quite large has done two for me but not via A and E and each time needing admission to MAU and at least 24 hours waiting for a suitable slot in the theatre recovery room to do it. Neither were for AF and both almost brought the system to crash as I had short circuited the paperwork by getting an email instruction sent to the local head of cardiology by my EP. There are now pictures of me all round the hospital with warnings to security not to let me in.

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I feel there may be a business idea in selling fake moustaches to people with AF... :D

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Hidden , are you BobD in disguise? 🤣

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Sorry, I hadn’t seen BobD ’s reply when I posted!

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Koll - when I was emergency addmission last xmas whilst waiting to be addmited, had three hour wait in hospital corridors, was chatting to my paramedic who told me he had AF. We discuused various things and blood thinners came up. I said the usual they do not thin the blood ect ect but he was quite adamant that they did. He said that all the medical staff refer to them as that and I was wrong. This went on for some while, in the end I made a bet with him to ask the doctor when I got to see him. Doc said he was wrong but most people did refer to them as thinners which is incorrect and explained to him what they do. Practically every medic, nurse I have come across refer to them as thinners. I have given up the battle of correcting anyone now.

Cassie

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Yes it’s true. On the NHS website they have or had a page about blood thinners. Then another page explaining how anticoagulants do NOT thin the blood!

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Hi, I am in permanent af and I stay home unless something just feels different to my "normal" . I had a dull ache on my left hand side for a few weeks and finally went to see my gp. Her response was, well you are normally a person who manages her condition and we don't see you here very often so I am going to ask you to go to a and e. Get there my hr was averaging 200. Member of my ep s team changed my meds and thankfully no need for another visit.

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This is a question which has been posed frequently.

At the end of the day it will amount to how YOU feel and the advice you have been given by your medical advisors. We all suffer in different ways and I really don't think we can be too dogmatic.

Almost all of my 18 dc cardioversions have been short notice emergency ones after presenting at A&E. One particular episode when I had been sent home after a short stay on ccu with a reduced rate .....to go on waiting list for DCCV......resulted in my return 2/3 weeks later in heart failure.

More recently I've been warned of stroke/heart attack by paramedics and a locum GP when I had expressed reluctance to attend A&E with my last 2 episodes. Both resulted in dccvs ..

Sandra

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i was told to seek emergency help if went on longer than 15 minutes! But i usually gave it a few hours before going and my HR was usually around 160

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Lots of differing answers. All I can contribute is that in my experience of being sent to A&E, by paramedics or GP and nothing happens and wasting hours waiting in waiting rooms with people coughing all over the place (I am immune suppressed) so going to A&E is the LAST place I ever want to be when in AF, no matter how long or how fast.

Having spoken to my GP yesterday about no action being taken by A&E - despite GP sending me with copy of letters from EP, Neurologist and herself with a treatment plan and nothing happens - the only option is to contact my EP’s secretary or Arrythmia nurse for an appointment ASAP and they are very good at arranging for me. I have been told the AF is not an emergency in A&E so apart from observation, nothing happens.

The only time I was admitted was a couple of years ago when I had AF with very low BP - heart rate exceeded 180+ every time I lifted my head off the pillow - I was admitted to Acute Cardiac Unit and was observed for 3 days. I refused Bisoprolol which was the only treatment offered - had a stand up row in the middle of ward rounds. My notes now specifically state no beta blockers!

I would say the times to not hesitate would be when you have chest pain, when you have syncope, when you are very concerned because you feel very unwell.

Stay calm and carry on as best I can is all I can now do but currently my episodes don’t last more than 7-8 hours, I know I would get very weak if they lasted longer.

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i once said there didn't seem any point going as they just gave me more stuff that didn't work but it always went ok within 24 hours but they said i must go as i would be monitored for any complication like stroke or heart attack. i have been in and out at least 8 times in the last year but had an ablation in Sept which has improved things as i still go in AF but HR is around120 and it reverts to sinus within 3 or 4 hours.

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I have AF episodes about every 2 months or so and they result in low BP, feeling very week and , breathless and generally not good. They last 2 days then correct themselves. On Apixaban and Sotalol. Discharged back to GP by EP, and asked GP when does it become an emergency, he said use common sense !!!!. Did see different GP who said if BP goes below 80 systolic, go to A&E.

I do feel a bit isolated as most on here seem to have good contact with EP or nurse.

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One can obviously be ib AF for a long time without concern. My second event, recently, I was in AF for 13 days...going from 35 to 155, weak and feeling awful. I spoke with EP office several times, but because I had not been on anticoagulant long enough no cardioversion until that 14th day of AF...then I was prescribed flecainide and went into NSR within hours.

EP did order more diltiazem each time I called, to no effect, but aside from asking if I was in pain, not much concern. If not for this site, I might have lost my mind. I had no idea what to do, or not do. Noone said don’t drive or exert yourself. The assumption of knowledge is scary!

No one has ever suggested ER since my first event, when I was sent quickly from doctors offce!

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I would think it depends on your heart rate as well as length of time in AF. Although I have frequent episodes (every 5-6 days), my heart rate rarely exceeds about 130 and I've never made a trip to the emergency room (A&E).

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Does your blood go up during afib mine is 123/95

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My blood pressure went ridiculously high (much much higher than that) when I checked it last time in AF (i'd never thought to check before).

It stayed so high it got me concerned, so went to a & e to get checked out. They were really helpful and said I did right to come in for the AF, but they said never to even try to take blood pressure when in AF because the heart is always under pressure. Just ignore it. That sounded odd to me,so I asked my cardiologist in my next appt and he totally agreed. Said just don't take BP during a a PAF event, there's no point...

I'm not overly confident about that tho- and I'm not sure most people on here will have had this advice!

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Mine last for 2 days, I was told not to go to the A&E unless I had chest pains etc. I just wait till it goes back to normal on its own.

Keith.

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Just went and got Cardio converted feel great

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Brilliant! That's great news :) Stay well x

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