Not sure about A &E

[Sfhmgusa]

Hi I have had an episode lasting nearly 48 hours now I have twice taken my pip dose of 150mg of flecainide after first episode I seemed to go from af to tachycardia cardiac but now I still show in kardia as in af. At a lower bpm 100 than usual but still af. My cardiologist Ben Brown told me some time ago not to worry as I’m on apixoban and can just ride these out , but I am at my wits end very depressed and anxious . I have no heart attack symptoms but still wonder if A and E is the right decision any thoughts appreciated

[CDreamer]

I know it can be very worrying and some people do go to A&E because they feel reassured about being in a place where they can be monitored.

The information I was given to go to A&E were:-

AF + high HR of 150+

Chest pain

Cold & Clammy

Feel very faint and dizzy - syncope or pre-syncompe

Otherwise sit it out &.

Is there someone with you who is calm? If you are on your own it can help to have someone sit with you - but someone who is going to panic is not helpful!

Have you tried slow breathing methods?

Be careful how much Flecainide you take - maximum dose is 300mg in any 24 hour period If you have exceeded this dose then yes you should go to A&E to be monitored.

Every A&E seems to have differing policies for AF but because it is not a life threatening emergency, though it may feel like that right now, the most that usually happens, unless you are very ill, may happen is that you are monitored until you convert and then sent home with instructions to see your specialist. A note will go to your GP with any findings - may be useful to have a copy of that sent to you.

You do have to think about the consequences of being in A&E both on yourself and others and having several experiences of going to A&E and sitting in the waiting room for hours to be seen, especially at this time of year, thinking that I would have been better off at home and a lot more comfortable.

The last time, a few years ago, 9 hours before I was even hooked up to a monitor - by which time I was back in NSR and that was simply A&E being swamped by people much more ill than I.

Your other option is to ring 111 and see what they say. They will sometimes ring & ask for Paramedics to attend and assess you. The decision to either go to hospital or stay at home is then taken out of your hands.

Remember it is also a week-end so there may not be a cardiologist available and A&E are unlikely to treat you as you are being seen by a cardiology outpatient clinic.

Staying calm is very important so - focus on your breath - breath in and out slowly.

Hope some of that helps - Best wishes CD.

[etheral in reply to CDreamer]

No cardiologists on weekends? Glad I was an Emergency doc on the states. Although I must admit I took a lot of flack if I insisted they came in to evaluate the patient at times.

[jeanjeannie50 in reply to etheral]

I'm in the UK and at my local hospital we do have cardiologists on duty at the weekends, though I will admit they're usually not the senior ones, they're usually on call. Once after being admitted to a cardiac ward in hospital I was given a TOE and cardioversion on a Saturday by two cardiologists and an anaesthetist, the second cardiologist although not on duty came in especially that day for the procedure. All on our lovely NHS.

This week I visited one of our smaller hospitals to have two suspect carcinomas removed. On arrival a nurse greeted us and showed us into a small sitting room, telling us it was ours for the time we were there and to watch the t.v. if we wanted, she showed us where the drinks were nearby and made us both a coffee. When the spots were removed I had four people dancing attendance on me, honestly I couldn't have received better service at a private hospital which I have had occasion to use several times in the past when I had private health insurance with my job.

I do get so tired of people (usually in the US) knocking our National Health Service.

Jean

[Hidden in reply to jeanjeannie50]

Re healthcare, I wish we had healthcare equal for all. Our 40 yr old son doesnt even have health insurance because he cannot afford it and he works as an insurance agent! He got it for the kids but when he gets sick, he rides it out. Very sad here.

[jeanjeannie50 in reply to Hidden]

You're lovely Hoski always so caring and polite.

My sister in Dallas, Texas, who has lived there for over 50 years tells me how much health care has changed in the US. So sorry to hear about your son. I'm afraid the whole world appears to be governed by greed now.

[Hidden in reply to jeanjeannie50]

Yes, you are correct. Im glad Im retired and no longer work in healthcare. When I graduated from nursing school in 1973, we took care of people. Now it is all about the $$

[Desanthony in reply to Hidden]

My son and his family live in the US. His partner is an intensive care nurse. Her sister-in-law is a hospital Doctor and got breast cancer 2 years ago. After one chemo session she got really sick and had to stay in hospital for nearly 2 months. Her family is no bankrupt from this stay and can no longer get insurance. It seems she may be likely to need further treatment but will either have to pay herself or go without. Her remaining parent has re-mortgaged her house to try and help them at the age of 82.

[Hidden in reply to Desanthony]

So sad

[Shcldavies in reply to jeanjeannie50]

Its really hard to convey just how good our NHS is to those not lucky enough to such a luxury (not sure if thats the right word). Its not perfect and can improve some but its as good as any other Health Service and I would say better than most if not all as its the least effected by where the money is coming from.

[Lilypocket in reply to jeanjeannie50]

Jean what is TOE? I' m in France and perhaps it's called something else x

[jeanjeannie50 in reply to Lilypocket]

TOE = Trans Oesophageal Echocardiogram. They put a camera down your throat to look at your heart with ultrasound,usually to check that no blood clots are lurking there.

[Lilypocket in reply to jeanjeannie50]

Yes I have heard of that! I can't even eat fondue without choking ( I swallow the elastic cheese - half goes down my throat while the other half stays in my mouth and my throat closes up) How did you cope with it? Sooner or later I'll probably need one. Thanks for replying.😊

[jeanjeannie50 in reply to Lilypocket]

I've only ever had one and that was before my very first heart cardioversion (that's when they're usually carried out). If your heart has been in AF and you haven't been taking anticoagulants for a good period of time, then it's necessary to check for the clots, but if you have then it's not generally needed.

I knew someone who had the condition you mention re having difficulty swallowing. What they did for her was stretch the throat area after putting her under a general anaesthetic. I think its not an uncommon complaint,

[CDreamer in reply to etheral]

Just to clarify - What I said was that a cardiologist was unlikely to be available in A&E - who are there to treat trauma and emergency patients, purely because they tend to so busy quite rightly, attending to life threatening conditions as a priority.

Of course there will be cardiologists in the hospital and consultants on call for emergencies.

Lone AF is not normally life threatening. Therefore A&E would monitor but would normally not treat AF with controlled heart rate IF the patient was already being seen by an outpatient clinic.

[etheral in reply to CDreamer]

Not meaning to disparage either system in the US or UK. There are obviously big differences between different hospitals in the states as far as the immediate availability of specialist including cardiologists and electrophysiologists. And my experience I always felt more comfortable knowing that I could attach an external pacemaker if needed and have the cardiologist float and internal pacemaker if needed. Unfortunately this does depend on where you are and the your credibility as far as payment goes which fortunately does not seem to be an issue with the national health service. By the way I am for a Medicare for all system which would be similar to your NHS system. Thank you for listening to my comments and I appreciate learning more about the system in the UK.

[Hidden in reply to etheral]

In neither the UK nor the US is the health system the best according to this assessment (see link below)-although for quite different reasons. The countries found to have the best healthcare systems were:

* Canada

* Qatar

* France

* Norway

* New Zealand

* Germany

* Hong Kong

* The Netherlands

* Switzerland

* Singapore

* Luxembourg

* Japan

* Sweden

See: worldpopulationreview.com/c...

[jeanjeannie50 in reply to Hidden]

Interesting, thank you for sharing.

[sotolol in reply to CDreamer]

Helped me. Again. So thank you.

[Sfhmgusa in reply to CDreamer]

This is a really helpful piece of advice thank you I have a very calm wife who tries to reassure me but your words and her presence work really well together

Sitting it out now trying to breath like a yoga teacher

Thank you

[jeanjeannie50 in reply to CDreamer]

Excellent post CD.

[Sfhmgusa in reply to CDreamer]

Hi there at last after 80 very long hours of worry nsr returned this morning at 2.30 am the advice and support of this group was really amazing and helped reduce my very high anxiety a lot seeing my cardiologist on Monday with long list of questions and will add an update but wanted to say a big thank you sorry this is posted a few times but I wanted to make sure several people knew how much their post helped

[CDreamer in reply to Sfhmgusa]

Oh that is good news - enjoy and long may it last. I always found it took me 3-4 days to truly recover from long episodes like that so please do take it easy now and listen to your body. My problem was always I felt I needed to ‘get things done’ when in NSR and often overdid it - ending up with another episode so matter of do as I say rather than what I do.

[CDreamer in reply to CDreamer]

PS - you don’t have to reply to us all individually, although that’s really nice of you. Either a new post or one at the end of the thread - we will all see it! Best wishes

[Sfhmgusa in reply to CDreamer]

thanks good tip !

[rosyG]

It’s good your heart rate is lower. I think it depends how you feel as to whether to go to A and E but main thing is to go if you have chest pain or other symptoms of generalised problem- breathing difficulties, feeling faint etc. How it stops soon. Mine stopped in hot shower once and perhaps it was because that helped me to relax

[Sfhmgusa in reply to rosyG]

Thank you rosy G hearing other people’s experiences really helps I will try the shower soon

[Sfhmgusa in reply to rosyG]

Hi there at last after 80 very long hours of worry nsr returned this morning at 2.30 am the advice and support of this group was really amazing and helped reduce my very high anxiety a lot seeing my cardiologist on Monday with long list of questions and will add an update but wanted to say a big thank you sorry this is posted a few times but I wanted to make sure several people knew how much their post helped

[jeanjeannie50]

I'm afraid your anxiety and stress is probably what's keeping you in AF. A rate of 100 is generally thought of as nothing to worry about 60-100 is considered normal. How is your BP! My current episode of AF has been going on non stop since last November, but I'm so used to them now I carry on as best I can. I'm not making out I'm a perfect person and your not, but I've had AF for 15 years and when you've had it that long you realise its not really the big deal we originally thought it to be.

You've been given some excellent advice from others on here.

Let us know how you get on please. Wishing you well.

Jean

[Sfhmgusa in reply to jeanjeannie50]

I agree it is anxiety feeling fear in a viscous circle. I know that but struggle to beat it. Your experience is super reassuring tho I’m really sorry you have it of course. Thanks

[Morzine in reply to jeanjeannie50]

I agree anxiety seems to make it so much worse....I found just taking myself off to bed early and trying to go to sleep was my best option so I didn’t think about it.....

[Lilypocket in reply to jeanjeannie50]

How do you usually stop it Jean? Or is it considered permanent now? X

[jeanjeannie50 in reply to Lilypocket]

I'm in constant AF, have been since November last year and I rarely think about my heart now, unless I walk up a hill. I've had a few health problems recently so they rather took over from AF. Will give my AF nurses a call once everything else has settled.

[Lilypocket in reply to jeanjeannie50]

Thank you for replying. It sounds as if you manage your Afib very well. I wish you all the best.

[Sfhmgusa in reply to jeanjeannie50]

Hi there at last after 80 very long hours of worry nsr returned this morning at 2.30 am the advice and support of this group was really amazing and helped reduce my very high anxiety a lot seeing my cardiologist on Monday with long list of questions and will add an update but wanted to say a big thank you sorry this is posted a few times but I wanted to make sure several people knew how much their post helped

[Jalia]

If after the advice you have been given you are really still worried I would suggest you phone 111 for advice and they will send out a paramedic to assess you. A rate around 100 is not normally any thing to worry about and not an emergency.

[Sfhmgusa in reply to Jalia]

The advice has helped hugely I’m sat breathing trying to be calm and reserving 111 for if anything goes worse thanks again

[CDreamer in reply to Sfhmgusa]

Do let us know how you go, it's always good to get feedback. Take care and sending positive wishes.

[Camelia23 in reply to Sfhmgusa]

I understand your anxiety. I hope you're ok. Glad you have someone with you and are breathing deeply.

[rosyG in reply to Sfhmgusa]

I find it helps me to stop panicking if I gave a plan. E g if my heart rate continues in 150 range ( which affects me a lot whereas 130 is not bad) then I’ll go in. Individual thing but having a plan stops panic!

[waveylines in reply to rosyG]

I agree rosyG. If you have your plan than in that mpment you can look at it and remind yourself what you had written. Brilliant! Thank you.

I know this post isnt meant for me but Ive found reading it really helpful & reassuring. Thank you everyone.

[Staceyhunter]

What about music that may seem a bit silly but music really helps shift the mood! Can only give it a bash I feel music makes everything better. 👍

[Rubymurray25 in reply to Staceyhunter]

100% agree with Music being a great all round medicine and so much to chose from.

[jedimasterlincoln]

My PAF was often very debilitating, I couldn't go up a flight of stairs without passing out. During the attacks my resting HR was 130-150 and I was often dizzy/clammy. However, my last two attacks (August 2019 and Janurary) reverted with a pill in the pocket after 24hours or so and rest. I didn't have the other symptoms I'd had in the years previous (thanks to 5 ablations) and I coudl go up stairs get dressed and look after the kids without feeling like I'd collapse.

[DevonHubby1]

I think CdDreamer has it right.

We also have (no good at weekends) the phone number of the AF nurse we had seen as an additional point of contact. I think her official title in our NHS hospital is 'arithymia coordinator'. She gave it to us when we were discharged from outpatients.

Good luck and hope AF reverts soon.

[Cavalierrubie]

Hi Sfhmgusa I had the same about three weeks ago. Phoned 111 for adivice, and they sent Paramedics to assess me. As it was a "slow" episode of AF and heart rate 90/100 bpm they told me to sit it out. They told me to contact them again in the future if I was worried. They were brilliant and really checked me over. One of the Paramedics said her father has AF and he had a 2 day " ding dong" of it. This never ceases to scare the wits out of you, and I have to give myself a good talking to when it happens. "It won't kill you" "You won't have heart attack" "It comes like a lion and goes like a lamb" etc. but what a storm! God Bless.

[Sfhmgusa in reply to Cavalierrubie]

Hi there at last after 80 very long hours of worry nsr returned this morning at 2.30 am the advice and support of this group was really amazing and helped reduce my very high anxiety a lot seeing my cardiologist on Monday with long list of questions and will add an update but wanted to say a big thank you sorry this is posted a few times but I wanted to make sure several people knew how much their post helped

[Cavalierrubie in reply to Sfhmgusa]

So pleased you are feeling better. Hope things go ok with Cardiologist and please let us know what he says. Take care - you are ok and will be fine.

[Patsy10]

Hi,

The longest af episode that I have had lasted eleven days, and whilst I was ok I found it very unsettling. Now they usually last from three to seventy hours!

I try the deep breathing exercises etc and then catch up on emails and letters that need replying to. Next I will find a good film that I will need to concentrate on. Sometimes without realising I slip back into NSR. If it persists I go to bed, snuggle right down into my pillow until I can not hear the fast beating and then really concentrate on my deep breathing. Often I wake a few hours later feeling 'normal' again.

I do hope you feel better soon, it really does impact on life more than we should let it but only af sufferers know what it's like.

Hopefully you are feeling more relaxed by the time this reaches you.

Fond thoughts.

[Sfhmgusa in reply to Patsy10]

thank you so much being like others who have had the same thing is really reassuring

[Hidden]

If it’s 100bpm or above and /or is unusual for you (e.g. more protracted) then the advice given to me by cardiologists and GPs was to go to A and E. I’m not , of course, medically qualified , but the advice that your cardiologist gave you ( that it’s ok to sit things out if you are on an anticoagulant) sounds rather suspect and conflicts with what I have been told. The anticoagulant will lower stroke risk but that doesn’t mean it’s still not significant.

[sandoval22]

I went to A&E last week with pulse of 148 and they said they weren't worried about me because I was on Apixaban. Never saw a Cardiologist, only a nurse who gave me Digoxin and my BP went to 175/121 so not taking that again. Hopefully an ablation in 3 weeks will put an end A&E.

[netie54]

Well reading this is such a coincidence. I am just back from picking my husband up from our hospital. His AF came in at 5am Friday morning. His HR was 130 do I thought by 4pm it was time to go to AE. They were brilliant and gave him some additional meds and kept him in to observe him. Best place really. He’s in Riveroxiban but it was still the best place for him. All normal (whatever normal is) now.

I think you should go.