Fast AF - How long to wait before heading to hospital?

[Lewis1234]

Hi all. Currently in a Fast PAF episode. It's not superfast, just feel weak and light-headed. Started 14 hours ago. I normally self-correct after 2-12 hours but usually not longer than 6 hours. Longest episode was my first in Feb 18, I was cardioverted after 18 hours that time, maybe I would have self-corrected. Went to hospital a couple of times after that but don't any more, as I normally self-correct. Had about 30 episodes in last 16 months. They have been more frequent recently. Anyway looking for advice on when to head to hospital if at all, I am not on any blood thinners. I was thinking after 24hrs maybe? but that would be 11 at night on a bank holiday weekend, seems pointless doing that here at Treliske in Cornwall? Any ideas. Thanks

[pottypete1]

Thing is that they will not cardovert you without Anticoagulation for circa 4 weeks.

I would be inclined to call your doctor on Tuesday morning when all is back to “normal”.

Pete

[Lewis1234 in reply to pottypete1]

Hi Pete, they did the first time... injected me in the belly with something if I remember correctly? their main priority was that i hadn't been AF for more than 48 hours, as I was sure they went ahead. I've all but given up on the doctors as they don't really know what to do and just write to the cardiologist.

[pottypete1 in reply to Lewis1234]

That’s the issue if you don’t get to hospital within 48 hours they won’t do it unless they are sure you are anticoagulated. Even then some are not keen as it is the risk of stroke that concerns them.

Pete

[jedimasterlincoln in reply to Lewis1234]

That would have been a therapeutic dose of Clexane/Enoxaparin

[jeanjeannie50]

Hi Lewis, can you tell us roughly what your heart rate is at the moment? I see you posted this to the forum an hour ago, how are you feeling now?

Jean

[Lewis1234 in reply to jeanjeannie50]

Hi Jean. Just had a little sleep as sometimes that helps to get rid of it. But alas it still ongoing. I feel ok, fine lying down, just weak and lightheaded if I potter about. I don’t have a machine to take my pulse rate but I guess it is something around 130. But of course it’s hard to guess.

[jeanjeannie50 in reply to Lewis1234]

Yes, I agree with oyster, it's time to dial the 111 number for advice.

Jean

[Lewis1234 in reply to jeanjeannie50]

Finally self-corrected! The journey continues. Thanks all.

[pottypete1 in reply to Lewis1234]

Now that is really good news.

So much better than laying on a trolley in A & E waiting for cardioversion.

Believe me, I have probably been in that situation about 20 times.

Pete

[Lewis1234 in reply to pottypete1]

Yes much better, after the first time in hospital when I was cardioverted I self corrected the next 3 times in hospital after a few hours and it was a generally a big drama, cannula's, saline drips, ecg's, x-rays, and then after I self-correct getting discharged takes hours and hours sometimes even staying overnight on a ward, which is very intense especially when you are back in NSR and completely well! Actually pointlessly taking up their time and a bed. That's why I don't go in anymore and sit it out at home. Of course I appreciate the care. but it's a big deal deciding to go in when you know the chances are you'll self-correct.

[jeanjeannie50 in reply to Lewis1234]

Phew, get the flags out!!

[Sleepyzz in reply to Lewis1234]

For another time if you are using mobile to post there is a free app called Instant Heart Rate which is good for getting an idea of your rate. When in AF it struggles sometimes but does give a fairly good indication of highest rate. I’ve found it useful when deciding whether to self manage or call 111

[Hidden]

Your light-headedness suggests your rate may be higher than you report. Given the bank holiday tomorrow, I would ring NHS 111 now for advice. With luck they may be able to send out paramedics who can assess you and do an ECG

[Oldiemoldy]

SO glad heart went back in rhythm. Just curious - why no anti coagulants/blood thinners?

My understanding is that it is safe although very uncomfortable to wait out AFib for quite awhile AS LONG AS there is anticoagulant in your system to ward off stroke.

[Lewis1234 in reply to Oldiemoldy]

Hi Oldiemoldy, Thanks, yes its a relief...til next time. I am not on anticoagulants as my ChadVasc score is zero. Male, 55, no heart disease, no history of strokes.

[Lewis1234 in reply to Lewis1234]

I assume that may be reassessed if I keep getting more frequent and longer episodes?

[Melleray]

Hi Lewis - pleased to hear that you have reverted. Do wonder though if it is time for some anticoagulants as your episodes are likely to get more frequent.

[Lewis1234 in reply to Melleray]

Thanks, will discuss with GP

[Tapanac]

I was told by the hospital that if I had persistent AF/tachycardia of over 110 I should go along to A & E. If it went over 200 (mine most of the time was 240-250 before I had a cardioversion and then an ablation) then I should call an ambulance.

I hope you are seeing a cardiologist or EP as these are so frequent as really you should be on anti-coagulants, beta blockers.

I've just seen other posts and would add to mine that I had been taken into A & E eleven times by ambulance with the above rates and when they decided to do a cardioversion I wasn't then on anti-coagulants so they did that scan (can't remember the name) behind the heart checking no blood clots and when none there, then cardioverted - such a relief. Luckily for me it was a success. Unfortunately the hospital discharged me with the same amount of pills that they were giving me before the cardioversion which sent me into bradycardia. Anyway long story although I was better the EP decided to do an ablation as he wanted me to come off Flecainide which I thought was a miracle drug as felt so well on it. However he said that sometimes it can cause atrial flutter...???!!!

Best wishes and hope you feel better soon

[007talullah]

This is the advice from my cardio: if you are in AF and experiencing breathlessness, chest pain or dizziness go straight to hospital. Something worse might be brewing. If you know when your AF started count forward 48 hours. If you haven’t CV by that time they will start you on anticoagulant therapy and it could be a month before they can CV you (if you don’t CV spontaneously beforehand). While you are within the 48 hour window, do whatever helps you to CV. Rest? Climbing stairs? Valsalva? Or take PiP if you have it. If you get to 40 hours or so it’s time to get to A&E so they can hopefully DC CV you before the 48 hours is up.

[KMRobbo]

My hospital says over 130 for siignificant period go to a&e

[allserene]

First thing they did with me here in Wisconsin was get me on anti-coagulation (Eliquis), and that was immediately on arriving at emergency on the first episode..."They say" the biggest risk of all this Afib/flutter business is stroke, and heart attack is a long way second... I had been fluttering for about a week/10 days at 150 pulse, and yes that's like running a marathon 24/7 for 7 days without sitting down, and that wears your ticker out, but the stroke risk is number one. Can't imagine why they didn't get you on warfarin coz its really cheap.. Eliquis is $640 or £500 quid a month here before insurance co-pay, and 280 a month after insurance, but warfarin in $4 a month ! As a Doc Martin/Cornwall fan, I know he would have you on warfarin immediately if that didn't mess up any other conditions/medications you have...I have converted once on my own. I take a 25mg beta blocker twice a day, and when I saw 150 pulse, I took a 50mg 3 hours after my 7am 25mg, and then the 25 at 7pm.... Converted by bed time... I am worried that you aren't on anti-coags... I want to drop mine seeing as I am not having an episode now for 2 months since the first one, but I am too scared of stroke...

[Lewis1234 in reply to allserene]

Hi, They seem to base it all on the ChadVasc score here and I am zero so no anticoagulants. But will discuss with the doc. Thanks

[allserene in reply to Lewis1234]

I score one on that scale by virtue of being an old git of 71, but otherwise healthy (Kawasaki 1000 owner and I get on the roof to sweep my own chimney), and one of the few Wisconsinites (ex-Otley), who isn't gravitationally disadvantaged. The Doc must be confident that your persistent afib isn't dangerous for stroke coz the cost of anti-coag is tiny and can't be a factor... I am anti-pills and want to get off these soon, but if I had that much persistent afib, then personally I would hang back on that plan.... The warfarin poppers on this forum swear by em, and have used em 20 years with no probs... If I get sick of shelling out big bucks for Eliquis, I would do warfarin with no worries. As I may decide to have an ablation in August, it will be bye-bye all pills after that...

[WendyWu20 in reply to allserene]

Is that Otley, the place in West Yorkshire?

[allserene in reply to WendyWu20]

Yes that's the one... 12 years permanently in the US now, so I have seen the pros and cons of both systems and they both do have pros and cons... A feature of the UK NHS is that if you go to a 'posh' area like Harrogate, (you can), you get superb service, and if you go in the inner city, then its awful.... Saturday night in the emergency room in the inner city is same in both countries with blood and guts and stomach pumping and very long waits... My wife often pays $12,000 premium plus $7k annual max= $19,000 or £15,000..a year ! When you have had many decades paying nothing (nowt), it's a culture shock.. Petrol is for nothing though lol !

[WendyWu20 in reply to allserene]

I have very fond memories of Otley, I lived near Ilkley for many years in my youth and had a boyfriend who was raised in Otley, we used to go to walking up the Chevin then have a pint in the Junction pub. Happy days...glad you like the USA, I now live in Spain.

[allserene in reply to WendyWu20]

I was in the Junky last month.. Stone floor, dogs and crisps and Timmy Taylor's. I get there 3 times a year without fail. I didn't so much emigrate, as I expanded my territory lol .....I was secretary of Ilkley Rifle Club for many years. One of my wives was from Addingham; her dad was Police Sergeant there... He died at 55 of heart problems and we are lucky we have ablation techniques etc nowadays....

[WendyWu20 in reply to allserene]

I lived in Addingham from 1981 until 1987. Love the area round there, still have very good friends and visit when I can. I'm surprised you've emigrated, not many Yorkshire men would leave Yorkshire!

[allserene in reply to WendyWu20]

Kidnapped by a ruthless redhead with ace chubbies. Can you imagine the fireworks twixt a big-mouth typical yorky and red haired easily offended yank ? I haven't really left, I am just 'out of town' ... lol

[Lewis1234]

Hi there, trouble is if I went every time I'd be in hospital every week, and then only to self correct!

[Lewis1234]

"Staff at the Royal Cornwall Hospitals have welcomed today’s report from the Care Quality Commission which has seen the Trust move its rating from ‘Inadequate’ to ‘Requires Improvement’. Dec 2018. Lovely people working hard and doing their best, but that's how it is here in Cornwall. I am on the list for a more detailed scan and then an ablation (if I feel brave enough) but that is many months away at least....

[Bob002]

Go to the hospital or emergency room and be evaluated to be safe, don't take the chance if your not on a blood thinner or your afib isn't being controlled. I know it cost money but your life is more important, Don't be scared of blood thinners or the meds. Life is better when your afib is controlled and the blood thinner prevent blood clots. I can remember when I had my first attack I was in denial and it almost killed me. now I take medication and blood thinner and live a pretty normal life. Uncontrolled afib is serious. LOL

[jedimasterlincoln]

I'm 36 with a 5 year history.

In all my 30-odd episodes of acute fast PAF, I've never once been told "You don't need to be here" when presenting at ED. Yes there have been some skeptic attitudes (usually further on from ED in MAU and so on which I soon countered) but no one in ED has ever made me feel like I was wasting anyones time.

In their view, hearts are something you don't screw around in and just because it was fast AF the previous 29 times does not mean it is still fast AF on the 30th/31st times.

My own personal "regime" - at the moment following 5th ablation in Jan - is that if I am unable to climb a flight of stairs or am unable put my shoes and socks on without feeling short of breath, dizzy and on the point of collapse, then I need to go to ED. Since Jan I have had one fast PAF episode which had a resting HR of 110-20, and it could well have been my flutter settling down. I was able to do the activities above - so I didn't go and I reverted after 30-odd hours. Those activities are my personal benchmarks because they are fairly basic daily living activities everyone does and a good way of explaining to someone how debilitated I am.

Previously, (prior to Jan( I could not perform these basic activities without feeling very very unwell, and the resting HR when in fast AF was much higher at 130-160 - rising to 190 when going up stairs.

[Lewis1234 in reply to jedimasterlincoln]

Thanks Jedi, Yes of course, no one at hospital has ever made me feel bad about coming in, that's just me thinking that after cardioverting spontaneously once again. A few people on here think I should be on anticoagulants, are you? and what is your ChadVasc score if you don't mind me asking?

[jedimasterlincoln in reply to Lewis1234]

It's 0. Long discussions with my EP..... I only really need anticoagulation if I'm having PVI ablation on the left hand side. It wasn't required for flutter ablations on the right or any other time. In the words of the EP its a low score and couldn't possibly get any lower than it is.

[allserene in reply to jedimasterlincoln]

My score is 1 and that's because I am 71...ie no other stroke risk factors... but I am scared coz I see my neighbor who got a stroke at 41 years of age (10 years ago), and he trundles around in his electric scooter and he is a real mess..... I want to get off this Eliquis coz I am a tighto and I resent paying hundreds a month; but if I had any doubt, and if I had another flutter/fib activity, I would be on $4 a month warfarin in a flash.