I have recently been diagnosed with af but have not been referred to a cardiologist
I have been prescribed bisoprolol apixaban and ramipril
After two weeks my pulse rate has reduced and I feel a little less tired but light headed when I stand up
Is this normal treatment and will it control my symptoms or can I expect to get worse over time
Bisoprolol is usually for heart rate control, but some health care professionals use it for blood pressure control. Apixaban is an anticoagulant helping to minimise stroke risk. Ramipril is used mainly for blood pressure control.
Whether it's gonna worsen - who knows - how long is a bit of string. Sorry, I am just not into predictions because mine has very significantly improved over some 9 years and now no longer bothers me. But I am a fortunate one.
My meds are basically the same. I take Warfarin instead of Apixaban.
John
Yes your treatment is normal. It sounds like your blood pressure is falling when you stand up because of your treatment. Is your AF persistent or do you have episodes? How old are you?
Can I ask why your GP is not referring you to a cardiologist? Referral to an electrophysiologist for a treatment plan is a sensible way forward to get best advice on medication to prevent episodes, and on possible ablation.
It sounds like you need to get used to your medication. What I mean is to work with your GP to work out the correct dosage. Bisoprolol is certainly something that needs 'tuning'.
Also, you need to make sure you get a referral to a cardiologist or better an EP the sooner the better.
Lastly imho the NHS treats AF as primarily a stroke risk not a heart issue which may be counter intuitive for new patients. Remember it's not of itself fatal and some of your best friends will have hearts that do the cha-cha-cha.
Best of luck.
I hesitate to question the humble opinion of the Omniscient 1 (in itself surely an oxymoron) 🙂
I just wanted to pick up on your comment about AF not being seen as a heart issue by the NHS. The NICE guidelines and flow charts are very comprehensive with regard to managing paroxysmal AF (much less so on permanent AF in my opinion). New EPs are being trained as fast as funds allow. Ablation techniques are being refined, sophisticated pacemakers with complex algorithms are available, pace and AV node ablation is established.
National screening for AF to reduce stroke is round the corner, and largely “symptomless” people with permanent AF (in reality many accept how they feel as normal ageing) will be considered for ablation
Separately, and this may be pertinent to your situation, there is talk around the forum that AF may be a pointer to another (as yet unidentified) systemic problem leading to ischaemic stroke. Developing this argument, there is a feeling that the default position on anticoagulants (AC) should be that everyone, regardless of CHADS2VASC2 score, with primary AF should be offered AC unless there is a contraindication.
healthunlocked.com/afassoci...
By the way I am somewhat miffed that you pinched my preferred screen name back in 2013. 😂
HI Oyster
This is a fair point, and I'll try and make mine clearer. What I meant is that although the headline issue is a heart issue and the heart IS treated the NHS (in my experience - which leads to my opinion) is that if the heart is happy to beat along then they'll just let it. They will intervene to try and lessen the (increased) risk of stroke. Some years ago I went to an AF specialist session and the only thing they spoke about was stroke.
Hi Omniscient
I edited my reply to include a link to a recent discussion you may find interesting. By the way, my opening sentence was in jest. Are you still living in Yorkshire? I’m in the East Riding, but lived for nearly 20 years in the Keighley area.
HI - thanks for the link. Yorkshire - Yes, Keighley, in fact Steeton, in fact about 400m away from Airedale!
Took my boys back to Stanbury last summer. Excellent curry in Silsden!
Omniscient has got it spot on - the only treatment for AF is prophylactic anti-coagulation as having AF significantly increases your risk of having a stroke. Any other treatment is purely to reduce symptoms and increase quality of life.
There is a huge amount you can do to help yourself, as Carneuny will testify. Improve your lifestyle through eating plan, stress reduction, improve sleep and exercise will all help ‘to reduce the AF burden’ - medical jargon. The current advice is to firstly control any underlying condition ie diabetes, thyroid - did your doctor give you a blood test for thyroid? Then lifestyle first, drugs second.
You can find out a huge amount from downloading the information leaflets and absorbing from AFA websit - patient resources - lots of explanations and treatment options and explanations.
heartrhythmalliance.org/res...
heartrhythmalliance.org/aa/...
Hope that is of help.
Ask your GP why no referral to cardiologist. GPs are good but not experts in all fields. There are other, life style, ways to get your BP down which I assume is why you're on ramipril. The dizzy on standing could, as someone else said, be a drop in BP. Can you check your BP at home and go back to GP if it is low.
Let us know. Good luck
Amanda
I'm not sure why you wouldn't at least get a consult with a cardiologist even if it wasn't an EP seeing as you're newly diagnosed.
Just my experience but I didn't see a cardiologist until I said to my GP, 'Should I see a cardiologist?' and he said, 'Probably,' and then arranged the appointment. The cardiologist prescribed a different beta blocker and some other adjustments which made all the difference to me.
Could be the dose of Biso making you feel lightheaded, although AF can also do that. What dose are you on? GP can alter to try and suit you. My dose of 1.25mg did nothing to subdue AF but 2.5mg brought my H/R too low and brought on dizziness and light headed feelings. GP IMHO should refer to Cardio and if not satisfied with treatment plan ask for EP referral. Lots of research, this site is so good. Knowledge and understanding is half the battle.
Lots of good advice already, as always impressive. I would just add as an overall comment that you need to step up the AF education process so that you don't get boxed into a corner later on. I mean of course a measured approach but there is a lot to learn and the sooner the better. Speaking personally, I feel much better when I know the subject the options and what to expect.
Hello. I wasn't referred to a cardiologist when I was first diagnosed 18 months ago by my GP, she didn't think it was necessary. However, I requested to see a cardiologist privately
who said I was on the right medication but wanted me to have a 24 hour ecg and ultrasound scan under the NHS. All the results came back as normal and he did not think it necessary to see me again. I take Digoxin, Bisoprolol, Antenalol and Apixaban. I have an attack every month or so but at most my heart rate goes up to 80/90 and seems of no concern to my GP. His answer is if I have chest pains or feel faint call an ambulance. However, if the attacks get worse I will ask to be referred back to the cardiologist but at the moment I feel I can cope.
Request a referral to a cardiologist
Hi Eastmids. No 80/90 is when I am in AF, around 60 is my normal resting heart rate, I don't know what it would be when I am walking. When I was first diagnosed my heart rate in AF was 150, but thankfully the medication now controls that. Good luck I know how scary it all is when you are first diagnosed, but you sort of get used to it although it is still not pleasant when you have an attack.
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