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AF Association
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Back in A and E...

In A and E after waking up with a pulse of 131. Took an extra Sotalol as advised which restored the heart to rhythm. Exactly the same as happened 7 weeks ago. This has come as a bit of a blow as I didn’t have any problems and thought the Sotalol had dealt with the problem. I guess this is the shape of things to come. And I don’t know how long I had the Afib (or if I had it) when I was asleep.

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So sorry to hear this. Are you back home now?

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Thanks. I have been discharged and am having a cup of decaf in Cafe Nero. Had a long chat with the doctor who said there was no need for alarm and as I wasn’t getting breathless or feeling chest pain I didn’t need to call for an ambulance after 20 mins (which was what I was told to do when I was diagnosed with PAF 2 months ago). He told me that the condition was not life - theatening but was chronic. The future path couldn’t be predicted but if I had a good diet, moderate alcohol and exercise there was a good chance it wouldn’t cause too many problems. He said the GP should arrange for a halter test as I always seem to get the PAF when asleep.

Nevertheless, I’m a bit disappointed as I had been free of PAF since I started the Sotalol. But Indis reduce the dose a bit which may not have been wise.Thanks again for your reply.

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That sounds like a useful discussion - all good advice. It is very common for PAF to start during sleep. It takes time, after diagnosis, to get the measure of what will usually happen and what will stop the AF. Eventually you become an expert!

Early on, it can be helpful to have a good ECG when it is at full pelt as it will aid an expert eye and that may be why it was suggested you should call an ambulance after 20 mins.

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When I awoke I was aware the beat was irregular but not fast. However Kardia showed it was 138bpm. That’s against 55 when at rest. I took an extra Sotalol and by the time the ambulance arrived it was down to about 86. It’s now about 55 just like nothing had happened. That’s PAF. One worry is that I could be having these episodes when asleep and am not aware of them- it’s not like I feel bad when I wake up with PAF, it’s just the mildish sensation of an irregular beat.

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Yes, a holter monitor may show up episodes that you don't notice. Beware of the 7 day holter monitor. It can be horrendously itchy, and indeed a 48 hour monitor can end up being an ordeal. You can ask for stickers for sensitive skin but if you are allergic, they are only slightly less bad.

Have you had an echocardiogram? This can show up slight enlargement of the left atrium for those of us who have been having frequent bouts of AF and it gives an indication of what may (or may not) have been going on. The good news is that if atrial enlargement has occurred, it can reduce with an absence of AF.

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PS if your GP wants to refer you to a cardiologist (and do push him in this direction) see if you can fast track to one who is a electrophysiologist and specialises in quirky rhythms.

Who suggested you should take Solatol?

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The cardiac nurse who I saw originally after conferring with a doctor. They just said that Sotalol affects rhythm as well as rate. They recommended a holter test but the GP said this wasn’t necessary “for the moment”. When my heart beat was slowed to below 50 at times, I rang another GP who (over the phone) who suggested reducing the Sotalol to below 80mcg per day (which is the lowest recommended

dose for Sotalol)

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There are probably a million people with Afib in the U.K. and if all of these went regularly to A and E this would overwhelm the service. So I guess for practical reasons they try to discourage people from going in a subtle way. After I was given an ECG in the ambulance, they asked me if I *wanted* to go to A and E. When I replied by asking what they would recommend they said “Well, some people would not go.” When I said that two doctors said I should go after 20 mins of Afib, they agreed. So I think both the health service and the patient are in a difficult situation. The staff obviously want to prevent the service from being overwhelmed, and the patients feel quilty about using the service when others may be deprived of its use.

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That is the problem - doctors who are not specialists react to anything about the heart whilst specialists can be blasé. Picking the middle path is an art and it depends on symptoms & the person. They will never turn you away if you are worried.

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I called an ambulance because I was having chest pain plus the red flags of sweating and nausea but by the time the ambulance arrived it had stopped. I wanted to stay home but the ambulance crew were still not happy with my ECG etc and strongly advised me to go in and the A&E doc was also concerned and did some scans.

I wouldn't have felt the need to call an ambulance or go in to hospital with your symptoms but then I am not you and I am an 'experienced' AFer and tbh my GP was concerned about my attitude - not anxious enough! As you haven't had the full battery of tests it is understandable that your doctors want to play it safe.

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What dosage of Sotalol are you on Samazeuilh?

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60mcg after reduction from 80mcg

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