How long should you leave it before going to A & E when you have an episode of atrial fibrillation? I've been having it for the last twenty hours,haven't slept at all and feel grim. The arrhythmia nurse at my local hospital told me not to go, but I've never had it for this long and don't know what to do. Could someone give me some advice please.
When to go to A & E: How long should... - Atrial Fibrillati...
When to go to A & E
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bugswhiskers
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BobDVolunteer
AF is a chronic condition not an accident or emergency and should be managed locally BUT if you have any chest pain or fainting then go to A and E. Otherwise discuss your situation with the arrhythmia nurse and do what most of us do and ride it out at home.
I agree. However, if you pass out and a paramedic is called - my stroke was without FAST indicators - if they diagnose atrial fibrillation or atrial flutter, it's likely that they will call an ambulance and take you to A&E. They will probably take a blood sample to check the troponin level, and if OK, discharge you in the early hours to find a taxi home.
My sympathies. Do you know what sort of rate you are in ? If you are feeling decidedly unwell and concerned I would go with how YOU feel and present at A&E.
Others may disagree with me but we all carry our burdens differently.
Do let us know how things progress.
Not an easy question to answer because the general thinking is that little is gained by visiting A&E unless you are experiencing chest pains. Others believe they have benefited from going so it’s very much a personal decision. Why not check out the “related posts” top right of this page and read what others have done in similar situations.
Agree with what already has been said. My shortest has been 6 hours and longest 57 hours. Only difference is I can usually sleep at night.
It was a nuisance and I felt tired but as no pain or shortness of breath I rode it out. Try to keep myself occupied and not think about it if I can. xxx
It may be better to call your doctor's surgery right now and see if they can do an ECG. With that, a GP would decide whether you need to go to A&E or not.
Good luck and hope you soon feel better.
Jean
Thank you for all the comments. I really don't want to go to A & E and never have done, because I know how busy they are, I'm just panicking a bit because I've only had two episodes of PAF since an ablation in 2012, and thought Flecanaide was my saviour! Maybe it's not working so well now.
Does anyone have experience of PAF being triggered by a chesty cold and a lot of coughing?
Please go A & E if you are still feeling uncomfortable, forget how busy they are please keep us updated are you on any beta blockers?
I'm taking 2.5mg Bisoprolol.
Maybe talk to your doctor about managing your medication if you are getting episodes
For instance mine has agreed that I can have an occasional extra tablet if needed. And if that isnt working there is scope to increase my dose permanently.
The cardiologist suggested that episodes are "annoying" but that I should seek medical advice if they last over 24 hours.
Yes, always! Earlier this year I had AF from Friday evening (awkward) to Monday morning. I didn't feel too bad until Monday, when I felt faint even sitting, couldn't get through to GP so went to A&E. They blamed the episode on a respiratory virus and seemed quite surprised I was still on my feet! It's not an exact science, if you feel very ill how are you to know how serious your condition is? That is what doctors are for 😊
I think my present AF episode was caused by a respiratory virus too, because I've just had a bad cold that has ended up with a wheezy chest and bubbling lungs. When I lie down I have to cough and my heart goes crazy. I phoned the arrhythmia nurse and she told me it would be a good idea to go to a GP to ask to be referred to cardiology again, perhaps for a second ablation, and she said I could take another Flecainide tablet during the day, which would even up the dose to 100g in the day and 100g at night. I wentout today and felt weak and a bit faint, but don't know if it's the cold or my heart. I,m really disappointed that the Flecainide doesn't seem to be effective now.
Once when I was admitted to hospital, I was told by a doctor that being ill can cause AF, even in someone who normally doesn't have AF. That's OK but they decided to put me on an amiodarone drip, something I now know that I do not tolerate.
Infections of any kind can exacerbate AF so yes it is likely your virus infection to blame. drink plenty of water and rest.
Hi, you asked if anyone has experienced PAF being triggered by a chesty cold and a lot of coughing?
One trigger that is very strong for me is taking Sudafed or cough medicines. It could be these over the counter medications that have set it off. Sudafed is almost guaranteed to set me off.
As Bob and others have said, it can be the infection itself. The easy one to resolve is if its the cough medicine/decongestant which you can avoid in future if thats a trigger for you.
If youre taking bisoprolol you shouldnt be taking sudafed!!! It contains ingredients that interact with bisoprolol and decrease its efficiency or stip it working.
Talk to your pharmacist
I think it is a matter of how you feel in yourself. My last two episodes went on for about 8 hours over a weekend. I felt absolutely awful; incredibly weak and washed out, so decided, albeit reluctantly, to go to A&E. On both occasions they arranged for me to have a DC cardioversion actually within the A&E department. I realise this is often not the norm, so I was incredibly fortunate and was back home the same day!
I have been given conflicting info in the past. Nurses on coronary care said always come. GP now retired said wait 40 mins then go to A and E. Cardiologist said if no chest pain and it's evening when it starts try to get some sleep. Starve from midnight in case need cardioversion and turn up next morning.
If you are concerned ring your GP. You feel better if it isn't your decision sometimes
There is really no one answer that will fit everyone and every bout of arrhythmia.
My rules of thumb are: go if in pain or dizzy/unable to stand from speed of heart in which case I would call an ambulance. Otherwise, peace and quiet at home resting compares favourably with a 40 minute drive to hospital to an overcrowded A&E - perhaps to be in NSR by the time I arrive.
Like Bagrat, I was given conflicting advice at the start of my AF journey and would have been camped out at A&E had I followed it!
I found that my dithering in my early days of AF - should I/shouldn’t I go - actually made me feel worse and stopped me from relaxing. Once I had decided on my own rules, things got much easier to cope with.
My rule of thumb, simply because it worked for me is ........... what is your blood pressure doing ? If you know your blood pressure and take readings at home, AND, if your BP is erratic BUT trending downwards then either go to your GP or to A & E and get it investigated.
AF is one thing - erratic and falling BP is something that needs investigating and should be treated as an emergency .... more so if you can produce a record showing how your blood pressure behaved in the previous - say - 6 to 8 hours.
Once my GP satisfied himself of what I was saying about how my BP behaved he rang hospital in front of me and got me seen straight away and so I was admitted on the grounds of erratic and falling BP .... it was during that initial investigation when I was diagnosed with Atrial flutter which then converted into Atrial fibrillation for which treatment was started.
So, it was while I was in A & E that they found the flutter and fibrillation and started treatment then and there - shoving me off to the cardiac unit a short time later where I was detained for a further 5 days while my issues were fully investigated.
So, within 9 hours of onset of feeling unwell I had a diagnosis and further investigations were started and I remain convinced that such a speedy response to my blood pressure was a big help in preventing my AF from being much more dramatic than it has been.
That said - that was 10 years ago and the NHS today is a totally different animal than 10 years earlier.
I doubt I'd get that treatment today, BUT HEY HO - I guess it depends on your hospital, the postcode lottery yet again.
John
I have multiple illnesses mainly genetic (thanks mum and dad) and also AF. As soon as anything starts hiccuping in my body I am off to A&E. I virtually get in straight away but then I guess I am a bit different to most folk. I am in NZ but I think the UK are the same...if you are genuinely concerned they will see you and willingly too.....it's all those folk turning up with flu symptoms or sore throats or alcoholic nuttery that pee them off.
How does one know of os afib
I was advised by both GPs and consultants that this depends on how fast the heart is going. If it is going at above 100bpm and does not respond after 20 mins to additional medication ( in my case an extra half tablet of Sotalol) )then I should go to A and E, preferably by calling an ambulance. If the heart rate is below 100 bpm (one GP said 90bpm) then there is no need to go. However, I was also advised that if there is anything unusual e.g. the PAF lasts longer than usual, there is marked breathlessness etc. I should also go even if the rate is less than 100bpm. If you have had AF for 20 hours you should definitely go imo.
Buffafly in reply to
I think that advice is exceptional, if we all did that the NHS would collapse overnight 😊 You should follow that advice as it is tailored to you but I don't think it is given generally. My cardiologist's words were 'You can come in if you don't feel well, we don't mind' which suggested to me that it was my choice, not a necessity.
in reply to Buffafly
It’s a difficult issue. Yes, if everyone followed the advice it would overwhelm the service; knowing this some cardiologists/GPs may temper their advice to something vague like “ go to A and E with AF if you feel significantly unwell”. If you ask them point blank “should I go to A and E of my heart is going above 100bpm for more than 20 mins?” then I don’t think many of them would say “no.” I certainly think that if an episode is more prolonged than usual (or is unusual for someone in any way) -as in he present case-they should go to A and E.
As with other replies I would go to A&E as you may need to be cardioverted. Best of luck
Like many have said go,if you are feeling unwell and the episode gone on for that long call an ambulance
I’ve very limited experience BUT even if I did I wouldn’t be advising you or anyone else not to seek medical attention when your symptoms are clearly and unusually (in your case) so severe and distressing.. It’s not like you’ve been running to A&E at the drop of a hat! You’ve been managing your condition with meds since 2012! You need to be seen by your doctor to get the advice you need - I’d suggest you get to your GP in the first instance or call them out for an urgent home visit. Failing that call A&E and explain your dilemma. These sites rightly carry a disclaimer that the advice given does not and should not substitute for medical advice. Best wishes.
I agree with valbun get a gp to see you today. After 2 days I got an emergency appointment with my gp who called an ambulance for me, I was then admitted through a&e for the af to be controlled by change of drugs. Had that not worked after 3 days I was scheduled to have an ablation next day. (Drugs worked, ablation a year later)
2nd ablation in the summer and have had a couple of episodes in past 6 weeks (first was atrial tachycardia, most recent AF). On both occasions admitted to hospital by GP following advice from cardiologists. Sat it out for around 40 hrs/ 28 hrs HR ranging between 135-155 and tablets having no effect. Both GPs said I'd left it long enough before seeking medical advice. Symptoms were more troublesome by time I was admitted and after monitoring I was cardioverted before being sent home.
Hi Bugs,
Having an "episode" of Afib is both frightening and chaotic.Unless you remain calm (which is VERY rare) your normal Fight and Flight responses (panic) takes over and this seems to make it worse.
As someone who went to A&E so many times in my early days of this monster,I can say I did it because it made me feel better,and therefore helped me to calm down.I was seen fairly quickly each time and usually put on a drip of amiadarone...sometimes it worked and sometimes it didnt,but usually after a few hours I had calmed down enough to go home.
I do feel for you because,as Bob D says,this is a chronic disorder,but thats certainly not what your body is telling you..............its not right,I dont feel right,Im frightened and I want it to stop....NOW!!!
Learning to ride it out is much easier said than done,but its very good advise,in fact the best advise you will get from anyone.Once you have mastered this you will certainly be taking the first positive steps of acceptance,.... give me your best shot you B&%$#@!
There is much you can do both medically and phyisically.Educate yourself...this site is a good start,learn as much as you can,then learn to smell the roses...Afib or not
Take Care
You're so right concup. I really appreciate the advice people give on this site, because only people who've had experience of this frightening condition truly know what it's like.
First of all I am so sorry you are going through this. I have been dealing with this for three years and I know it is so uncomfortable to say the least. I assume you know some of these
things to help you get out of A fib but I will mention them anyway.
The first thing I do is take Metoprolol Tartrate 25 MG prescribed by my cardiologist. Then I drink very cold water. Then I start a breathing technique that helps me. Deep breathes are key. I pretend they start at my toes and concentrate as my breath comes up my body to my chest and over my back and down to my ankles. It takes consentration. There are many types of techniques. coughing can help. Good luck!
I was told by the doctors at hospital and the paramedics that if my heart rate goes above 110 or 130 at the most to go to hospital. Unfortunately I have never had it that low mas when I go into tachycardia/afib/flutter it is never less than 180 or 240-250. Very uncomfortable (and scary) as hard to breath. Last time I had to have an emergency cardio version. I wouldn't take a chance, I think go to A & E or if you have chest pain , arm pain then don't take chances. Get well
How are you today? What did you do? I hope you are feeling better 💜
In my experience it varies. I have Fast PAF and as already said it depends how fast it is, and my BP rises too high so I have to go to A&E. However with experience a lot depends on how you feel. My GP once would not let me drive to the hospital from the surgery and phoned the A&E ahead, I felt okay but out of rhythm. The Cardiologist said unless I felt particulary unwell wait 24 hours. The most recent advice was to take an additional 100mg of Flecainide as well as the 200mg I already take daily and wait three days before getting help!
I hope you are feeling better today.
I had an episode last Friday heart rate 140 I have had it higher than that, I rang 111 after four hours, it felt like my heart was trying to burst out of my back! No chest pain or breathlessness just a bit dizzy, my blood pressure was very high. They advised me to go to A and E which I did, I am taking sotolol and apixaban they gave me Bisoprolol after a couple of hours and kept me in over night, my heart rate went back to normal about 1am.
I guess they have different rules in different hospitals, I asked what should I do if it happened again and they said seek medical attention. I have been fine since.
How fast has your rate been all of this time?
Hi, i am sitting here thinking same as you. My heart has went from my normal 65 bpm to 105 bpm and has been stuck there for 2 and a half hours. My longest episode has been 3 hours. I live in Scotland so am wondering should i phone 999 or jump in a taxi to hospital. These episodes come on for no reason. Can anyone help. Thanks
Here is a way that will reduce your afib episodes and make them less severe. Give it a try and let me know if it works for you. Does for me and lots of others:
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas or Thyroid - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
https//cardiab.biomedcentral.com/a...
GrannyE in reply to
I think there is a lot in what you say. I have had myself tested for which foods are OK for me and which not and sugar is a def no no as is dairy and gluten. Which foods are good and bad are different for each individual. I gather that sugar spikes are bad for everyone. I believe you need the minerals in sea salt and I always have Himalayan pink salt which contains umpteen minerals not just NaCl. I do eat fruit and have some real local honey and manuka honey when not well as it is anti bacterial and anti viral. That said I only eat bananas when they are still greenish before they develop all their sugars. I also use some essential oils.
Why is it that hospital canteens and cafes and vending machines all sell foods which are bad for everyone?
I hope you went anyway. How are you now?
Hallo Jt222. I did go because I was advised to by the arrhythmia nurse and NHS111.
They took bloods and did a heart trace and the doctor said he thinks the fast heart rate will slow down, but I don't feel optimistic. I saw a GP this morning and she said she will refer me to Cardiology again, so I'll just have to wait and distract myself watching dog rescue videos online and old episodes of Doc Martin!
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