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AF Association
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How long do we keave AF episode before A and E

Just wondering,out of the blue have been in Af since 5pm now 830,BP 148/128 pulse 77,

Taken my usual dose of 50mg Flecnaide 5pm,and taken an extra 50mg as advised I coukd if necessary by EP. Not doing the trick yet,so have tried cold water ideas,deep breathing etc.

Wil sit it out but was curious how long people feel is reasonable?or is there any point going to a and e? I have always gone back into nsr by myself..so far!

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Well I am no medic but your rate is not fast and you have reverted to NSR by yourself in the past so I wouldn't say there was any need for A&E unless of course you have chest pains or undue breathlessness.

Presumably you are on anticoagulant s so see how you feel tomorrow. Meanwhile just try to relax with slow deep breathing. Sleep propped up a bit with an extra pillow...that might help.

Hope you feel better in the morning.

Sandra

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Thank you,its a lonely place sometimes with AF I was just thinking yesterday how I felt so much better and had had no episode for weeks! Asking for trouble eh?! i only have a blood pressure monitor to show me the heartrate,funny it feels a lot quicker! Thank you for your reply, and suggestions, I will try the extra pillow tonight.Tomorrow is another day as they say....?

Dawn x

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BP monitors are not very accurate if you are in AF Dawn so try counting your pulse in the old fashioned way . Count for half a minute and double usually works well.

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Thank you Bob x

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Hi Bob. I also use a BP monitor to check my heart rate however it will show if I have an irregular beat but not confirm if it's AFIB. Is that acceptable or not? Actually that's how I first picked up something was wrong with my heart rate and then went to ER who took an ECG and confirmed it.

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I don't need a machine to tell me if I am out of wack,. A simple pulse check does it. 30 seconds is all it takes.

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Thanks Bob, im still very new to this and learning. Will try checking pulse manually as well. Thanks also for taking the time to reply.

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Once in AF in hospital I had two nurses together telling me they couldn't 'find' my pulse - I said I didn't have one! But seriously, when in AF it comes and goes and moves and becomes quite unreadable to an amateur like me. I was horrified to discover how high it was actually going when I got a Kardia. Now I use the Kardia everytime.

So be patient Bob - It isn't that simple for everyone! (There is an expression to describe the problem, but I don't remember it).

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Im the same Polski,try very hard to find pulse,in my neck,both wrists......useless!! Must get a better heart rate monitor,as Im told my blood pressure monitor is no good when in AF for heartrate readings.

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Yes I am on apixaban xx

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If you are just relying on your bp monitor then your rate will not be very accurate if you are in AF.

If you are by yourself then it can be more worrying when the heart misbehaves and yes a lonely place, particularly at night when many problems are magnified and we lie listening to every beat.

Should you be concerned at all try phoning 111 for advice but meanwhile let's hope that a nights sleep will return your rate to normal.

Sandra x

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Thank you for your kind thoughts.Yes I am alone tonight but hubby back early morning .It is settling down, definetly think I will get a better monitor of some kind.

Thanks again xx

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This is a common question to which I will give my standard answer. A and E stands for accident and emergency and AF is neither. It is a chronic condition and should be treated as such.

BUT! If you have any chest pain. feel faint or are passing out then go . There are exceptions of course and if you are struggling to get a proper diagnosis a trip to A and E for an ECG can be useful other wise take your drugs as advised and ride it out until next day and go see your GP. That rate is far from high and will do you no harm. Once went to France for a short holiday at 140 bpm and survived.

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Interesting that when I once presented to my GP in fast AF, they referred me straight to A&E who subsequently told me I'd "wasted my time" and in future to go straight to A&E.

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I asked the ambulance paramedics if I had done the right thing to ring and they confirmed that AFib readings spiking over 120 should be handled by them. They took me straight in.

I guess everyones AFib symptoms are different.

Hank

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As one of our members once commented "If I called an ambulance every time I went into AF it would be stationed in my road 24/7",

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I think I will add to Bob's comment that for anyone's first episode of AF they should go to A&E to check that it is that, but as it sounds like you've already been diagnosed I'd just go to bed and try to sleep it out.

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Thanks Mike,did go up ,read for a good bit and it subsided slowly overnight.

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After 36 hours I went to my GP, who called an emergency ambulance for me to go to A&E.

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Thank you,thankfully began to subside after 6 hours after an extra 50mg of flecanaide.

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As above - I've been told by GP and those in A&E to not bother with GP to go straight to A&E.

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We I went to A&E for the only time, once I was successfully converted the Dr said to come back if I was over 120 for 5 minutes! When I mentioned this to EP he was horrified and said to try sleeping it off.

Just cruised up the Rhine at 140 but took my PIP and eventually settled down

Di

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Thank you Hylda

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Should have read 15 minutes. Di

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(I love that picture - You've just cruised up the Rhine at 140 - Was that Kmph? Or mph?!)

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Only wish it was. But I had had a Rudesheimer coffee. Never again! Told you I was the black sheep of the family.

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Hi I recently had my 2nd AF episode 6 months after my first.I take little medication for the AF. I had a rotten virus for 2 weeks and in AF for 7.5 days. I discovered BP readings inaccurate particularly lower reading but irregular heartbeat consistent with how I felt. This forum so helpful as I just didn't know how to react. Basically I listened to my body & got my hubby to do the things I couldn't.I really couldn't see what a & e could do to help.

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I know,just felt vulnerable and anxious but thankfully calmed down by 1200 am xx

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Piece of string territory here. I suppose it depends on how you feel. I would concur that if you can cope and there is no chest pain associated with it, then it is not an emergency.

Your blood pressure monitor measures your heart rate by 'seeing' the rise in blood pressure with the beats that raise the blood pressure. In AF, not all the beats of the heart have this effect, as the Atria is initiating a beat of the heart when it is empty and cannot raise the blood pressure. This is similar to the problem with those wrist monitors that measure the colour of your skin with a LED and 'camera' cell, such as on a FitBit. My Fitbit read 78 bpm when my Kardia showed AF at 156! I trust the Kardia, as it is measuring the electrical activity emanating from the heart, and seeing every 'instruction' to beat, coming from the Atria.

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My Chinese imitation Fitbit is very accurate according to my Kardia, don't know how it does it!

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Thank you Momist

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This very much depends on the individual. When in AF my heart is around 130 bpm, but if I move it shoots up to 250. The longer the episode goes on, the worse the sensitivity to movement gets, so I usually go to A&E and am always dealt with immediately. There is a great difference between fast AF and AF.

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Heartily agree with your last sentence!

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Yes, a great difference between AF and fast AF!

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Heartily agree with your last sentence !

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When I've had an AF episode - it's always been fast. On average 120-130, at worst 200 and at lowest 110.

Last occasion I was 120 resting, increasing to 180 on exertion. With dizziness to boot. So I presented to A&E within an hour.

There have been times I've left it as late as 24 hours, back when I had been able to spontaneously cardiovert after a day or so, but this was frowned upon by the doctors in A&E.

Basically they said they would always recommend I came in with a HR that high, that I wasn't wasting anyone's time, that a HR that high for any length of time uncontrolled isn't healthy and I need to get treated sooner rather than later.

If it was just a case of being in AF without the fast part, I probably wouldn't be as symptomatic and the "OMG THATS A HIGH HEART RATE" I always get wouldn't be present.

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I have never been to A&E even during my long symptomatic episodes of AF but so far they seem to terminate in less than 24hours .

Firstly , although breathless with a pulse of 155+ I don't have chest pain. I am an hour away from an A&E and living alone would need an ambulance and I worry my episode might stop before I get there so I would be wasting their time . If I do go to A&E I may have to spend many hours on a trolly in a corridor, not the best place or someone who needs to pee every 5 minutes and is scared of hospitals.

My AF makes me very anxious and the last thing I need is a trip to a chaotic A&E which would be sure to raise my already high blood pressure and make my condition worse so I try to stay calm/do breathing exercises and sit it out.

I normally text my son and let him know I am having a bad episode and to get him to text occasionally to check on me and in case I need someone to look after the dog.

When at the arrhythmia clinic the other day I asked the staff about going to A &E they said it depends on a number of factors, if there is chest pain /you are having trouble breathing /think you are going faint dial 999. Also consider what other health conditions you may have that may affect your body's ability to cope with an episode. Do not let an episode continue too long without help if you have a fast heart rate, it can put a lot of strain on your heart.

My episodes seem under control at the moment but when I have a bad one I will continue to stay at home if at all possible.

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Thank you x

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Good call, as I discovered, ambulances have terrible suspension!

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The bit about you peeing every 5 mins made me laugh. Last time I was in A & E was xmas 2016. There was a 3 hour wait in the corridors and when I did get to a cubicle my HR had gone mad and the need for frequent peeing set in. I asked for the commode, which arrived and I said to the nurse could have it on standby as I will need it again shortly. She said we only have two in the whole of A & E!!!! I did not see it again for the next 8 hours. Was not allowed to walk to loo which was only a few steps away so had to make do with the cardboard bedpan. Not easy to use on an emergency trolley when your a female especially if you have a painful dodgy hip at the time. I even asked if I could put it on a chair and perform the deed but no not allowed. When hubby arrived back in the morning I sneaked out to the loo with him in attendance. For the record my reason for going to A & E was very bad breathing problems, fast AF and the paramedics were concerned that I had sepsis, I was borderline. I did not phone 999 but 111 and it was their decision to send the ambulance. I was there for 5 days.

Cassie

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It depends on how you feel. On Monday I woke up with AF which I suspect had been going for a while because I had woken briefly several times before. My HR was over 132 (my 'limit') and I really didn't feel well with a pain in my neck so going on my GPs advice and because my cardiologist wanted a recording of my AF, I called for an ambulance. Soon after I put the phone down I began to sweat and felt very nauseous so I was glad I'd called. Just before the ambulance arrived the AF stopped. I was embarrassed but the crew were very kind and weren't happy with my ECG and BP (and probably the fact I was struggling to put a sentence together!) so I ended up in A&E for the day anyway, had a chest x-ray, blood tests and a scan of my abdomen, looking for an aneurysm, and my kidneys. They obviously thought something bad might be going on, didn't find anything as far as I know. At least I know now that if I feel the same again I can safely stay at home in bed 😊

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An episode woke me at 6am on Tuesday, heart rate 135bpm. I took 100mg flecainide and four hours later there was no difference. I took another 100mg and within a couple of hours I was in NSR albeit with a heart rate in the high 90s, but this slowed to my normal 60-70 bpm within a few hours. I must admit to being a bit worried as we are in rural Spain at the moment where very little English is spoken and I was wondering what the next step would be if the episode just didn’t stop. But all was well!

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Glad you settled down! I used to work in the hills above Javea,beautiful! My heart rate felt a lot higher than 77 must get a better monitor,as I am useless at taking pulse! Enjoy your time there x

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I was told anything above 130 BPM come back to A&E - by A&E .

Problem is when in fast AF the blood pressure monitor can show half he actual rate ( in my case as compared to that shown by my garmin running watch). The other reason to go to A&E is if you are not on A/C then the hospital will not cardiovert you if you have been in AF over 48 hours. Consequently if you are not certain you will go back I to NSR yourself, then its a good idea to go there fairly soon. You will be be 4 hours in A&E before the doctors start to think about cardioversion, probably another 4 hours in assessment and you need 12 hours nil by mouth (at my hospital anyway) before they will do a cardioversion . Then there can be issues with anethsatist avaiilbility (again my local hospital experience they are quite scarce - this may not be general) . All this soon eats the 48 hours up.

None of this is a criticism of my local hospital by the way - overall they are brilliant- it's just the way it works out They are busy.

Incidentally although I believe if uncertain then go to A&E, when I found a way to get back to NSR myself I had 11 occurrnces of AF where I never went near A&E in over 20 months.

Then the AF evolved/developed futher, and I could not go back to NSR by that method and ended up there 3 times in a week with rates 140 to 190.

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Thnk you KMRobbo.Several people have mentioned that my heart rate readings woild not be accurate using my blood pressure machine,when in AF.It certainly felt a lot faster! I get Flutter too. I was taken in by paramedics twice just befire Xmas with sustained rate over 150 and chest pain.This had a good result,as I was finally given anticogualants and rythym control drug,which has helped.

I am now howevergetting more frequent episodes of AF,awaiting ablation and on usual medications,and lifestyle changes..

Uusually,it starts to settle down after an hour or so but the last few times a fair bit longer.

I get your point about cardioversion timings, and staffing etc.Think I will ring my arrythmia nurse for clarity on our hospitals stance.

What kind of heartbmonitor do you have please?

Thank you again for your time

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