My AF has taken a turn for the worse lately - very twitchy heart and some long episodes. I woke up on Saturday and felt my heart ‘go’ as I sat up. I took my PIP (60mg diltiazem - big deal) and spent a very quiet day. My HR on my shiny new Kardia was mostly under 100 (that’s been a new thing) so no panic. Still going this morning so I decided enough was enough and I wanted an ECG and a referral back to cardiology, preferably the cardiologist of my choice. I didn’t take the PIP in case my GP suggested A&E. I asked to speak to a GP ‘for advice’ and was very sweetly told to phone 111, who would decide if I needed to be seen and send a full report to the HC if so. I was pretty sure 111 would send me to A&E where I didn’t want to go especially as I had an upset stomach which wasn’t helping. While I was thinking my heart rate rose too high so I took the PIP to top up my usual dose of 120mg and that helped so I decided to give it until tomorrow morning and then be brave if necessary. A&E is bad but AMU is like the first circle of Hell as far as I’m concerned (no criticism of the lovely nurses).
I really have to get this ‘when to go’ question sorted out because I’ve had so much conflicting advice 😕 I wasn’t impressed with the cardiologist I asked who gave the impression it didn’t matter either way! If it doesn’t I want to know why not....
I am really hoping when I get to see a cardiologist I can have a pacemaker or another medication (ugh!) suggestion but if not at least solve the ‘Go /stay’ problem.
Sorry, this is just a bit of a rant but if anyone has any comments I’d love to hear them 💔
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Buffafly
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Oh Buffafly I’m so sorry 😕 Ugh I feel for you. I wish I had some helpful advice, but I don’t think I can add anything you haven’t already thought of... It’s all such a nightmare when you’ve had conflicting advice about if you need to be seen/treated or not - and when the last thing you want is to go to hospital unnecessarily. 😕
I’ve been in exactly that position while in rapid (180bpm) AF. Once I eventually went into A&E, was admitted and had a cardioversion; the last time I sat it out at home and it did self convert (for which I was very thankful). I still don’t know what I actually SHOULD do another time! So I sympathise 😕
Any chance it could have been triggered by your upset stomach? I’m wondering if when that’s better you might return to NSR. (But I’m clutching at straws maybe.)
How are you feeling now? Sending love, hugs, prayers that you self convert and that you get to see or talk to a really helpful Cardiologist/EP about your treatment ❤️
Hi Buffafly, So sorry you are struggling with this. I was given clear instructions as to when to go to A&E and when it was OK to sit it out at home but I usually plumped for home as I was more comfortable there and spent too many hours in waiting rooms and without treatment of any sort.
In the absence of clear advice for you personally from your doctor, I don’t think there is any definitive answer to your question - other than what you want to do. What information or reassurance would help you do you think?
In normal times I would have said if you are concerned and your episodes have lasted more than 48 hours and if your HR exceeded 150 (those were my parameters) maybe think about going to A&E - the response in A&E seems to vary and I have never had a good experience so I tended to contact my EP who in those days, would usually reply within 48 hours.
Have you got an Arrythmia Nurse/Clinic you could ring? Have you thought about phoning the AFA?
These times are extraordinary times and my own view is that I would not want to be in A&E unless there was real need as in my experience, they rarely do anything other than monitor you.
If your HR isn’t high and you aren’t in any pain or distress I think the choice is yours, however, I really would push for a consultation with an EP for sooner rather than later because if you are having more frequent and longer lasting episodes it sounds as though you do need a review.
The old saying - she who shouts loudest comes to mind - sad but true.
Last time in A&E I was given a loading dose of Digoxin but then I did go in with a HR of 168.... I have to say they were excellent, and always have been on the few occasions I have been in. But they did say the longer you waited the harder it was to convert - see what I mean about confusing?
Good thought of Jane’s that the AF was triggered by the stomach problem in which case try sipping warm water constantly for the next few hours. If your stomach settles more than likely the AF will also.
Thank you both for thoughts re the stomach upset but the trigger was either very bad heartburn or deciding to dig up some hefty irises or both 🙄 I also think I may have a slight throat infection/virus so who knows? I suspect the upset stomach is caused by the AF because it always happens! Problem is my heart is getting increasingly twitchy 💓
Hi Buffafly, So sorry to hear about what you have to go through. We totally get you. Hope you are feeling better now. I agree with CD, I don’t have a definite answer for you but personally I would go to A&E if my AF continues for more than 48 hours without self converting or my HR is constantly above 150 bpm during the episode. Of course i am sure you know that if you have other symptoms like difficulty breathing, dizziness, chest pain etc you should go to A&E pronto. All the best.
Thank you, yes I certainly would! I do ignore slight chest pain because I have been diagnosed with coronary artery spasm (twice) after clear angiograms 💜
So sorry to hear this Buffafly its a very tough decision but the advice of CDreamer JaneFinn is spot on, personally i would go to A&E suppose my Anxiety takes over and i just want to get it sorted, please tell us if you do decide to go and things settle down, but if i had to guess i think your heart is playing up because of your stomach
Hi Buffafly 😊 I am really sorry to hear of your latest experience and as someone who is an 'old hand ' at AF I think you must have been feeling really rough to have considered A&E.
I can't suggest to anyone if they should 'go or stay' except as the others have said take into consideration the usual things like duration of the episode. heart rate, difficulty breathing, chest pain etc.
I would also ask myself the question what can they do in hospital that I can't do at home and what do I want them to do if I go in . So if I had been in AF with a high HR for much longer than usual as I am anti-coagulated I would be thinking of cardio version so I wouldn't eat or drink anything for 8 hours in preparation before getting myself to A&E .
Just a thought Buff, I agree with Jane about the tummy upset which as well as increasing the burden for your misbehaving heart it could also have change the way you metabolise your medication adding to the intensity of your episode .
I hope you are feeling a bit better now,take care 😊
Thank you, I agree with you that I avoid A&E if at all possible, hence my worry that 111 would advise me to go, and report that to my GP, so I would have no choice 😬
Forgot to say, my problem is that I have no effective medication for AF at home - not allowed - so to stop the episode it would have to be A&E. Last time I got the impression that cardioversion would be the last resort as it is a very painful experience for me (my spine is fused).
It makes it difficult without any backup meds at home. Personally if while I was sitting it out the episode was really making me feel terribly unwell after say 8hrs I would probably go. My experience prior to diagnosis was just being wired up, ECG and rest and it slowed on its own. My cardio advised to sit it out unless I couldn’t cope as he said they probably would do the same as me at home. I think we know instinctively when it’s ‘time to go’. Do hope you return to normal very soon. It’s a horrible thing when it happens and scary. The only consolation is we aren’t alone which is borne out by this amazing forum.
How odd that your GP's surgery could't help you! I think I've read somewhere recently that we are all going to have to dial the 111 no. before we can get to see a GP.
To be honest it makes me cross, ok I can understand that there's a limited amount of people going to the surgery for attention because of social distancing, but what are those doctors and nurses doing if not at work? Couldn't they at the very least be answering calls and giving out advice.
Supermarket staff are all turning up for work and we're not hearing that lots of them have the virus. Nor are they complaining.
Honest is it just me that feels this way?
I wouldn't go to A&E with a pulse under 100, may go if it was over 120, but I would wait 24hrs to see if it reverted back on its own.
How are you feeling that's the main thing? Sorry you have this worry.
I thought it was weird, I thought it was because it was a heart thing but maybe not. The receptionist said something about it meaning I wouldn’t have to wait to see the GP so maybe it would get me to jump the Monday queue? I even think I heard the words ‘come out’, that would be amazing!
I am feeling ‘up and down’, just have to remember to take it slow 💜
My heart rate went like yours towards the end of last November, but I'd only had a cardioversion early October and also had one at the start of the year. I rang my AF nurse and was told I wouldn't be offered any more and said I'd see how I got on. Around May I rang and spoke to her as my heart was still going up to 110 at rest (normal pulse rate is 62). She had me in to see her weekly for the next two weeks, then was on holiday, but soon as she was back had me in again. Upped my meds a bit and when my rate kept below 100 she said I was ok and to contact her if it went up again.
To be honest I find it so much better to be in constant AF than paroxysmal and my heart is happy at that rate now. The longer I've been in it the better I feel, I'm almost as well as my normal pre AF days. I just take things a little slower if I need to.
Jean 😊 I know if I ring my GP when in AF and when I eventually get through the numerous dial options/triage and ask a GP what I should do I will be told to call an ambulance. When I have asked before 'what should I do' I have been told 'if the episode is too bad to cope with call an ambulance' and I would have to be really bad for me to do that.
I think the stress of having to go in an ambulance and face the dreadful local A&E would probably cause me to have extreme anxiety 😒 I dread to think what would happen then.
Jean Jeannie I am shocked because I am a great admirer of yours. But your suggestion that GP surgeries are doing nothing really upset me.
I went to my surgery today, for my flu injection, so I asked my lovely GP how they were finding things.
She told me she has never worked so hard in her life, not getting home till half past eight at night. She was utterly exhausted working three days a week and if she was full time had no idea how she would cope. Phone and video consultations are much more difficult to manage than the usual appointments and a waiting room and added to that is the stress of being constantly worried sick that they might miss a diagnosis.
When I missed a morning call because I was in the shower it was about seven in the evening before the doctor was able to slot me in again.
I’m assuming you have an old fashioned phone with no portable handset and no mobile phone? Or couldn’t delay the shower until you had had the call? I take your point about the difficulties GPs face and I have no complaints about our Health Centre, quite the opposite, but people who don’t take care to be available for a call can’t be helping the situation ☺️
Cannot really add anything to what has already been said Buffafly, just hope that things settle for you soon and that you get the help you need to get through to a better time soon.......
This is so difficult because as you say the advice is often conflicting. In the end I would say go if you feel really compromised. I am lucky in that my A&E is not far away and am seen pretty promptly . I would go if my rate was over 130 and unable to get it down overnight say.
Hi I absolutely sympathise with you on the go no g to A and E dilemma. I have been truly tormented by this . I think the conflicting advice mainly comes from the advice given to different individuals ...is “personal”, not uniform and to do with other conditions and the “state” of your heart.
So I think asking the doctor you trust most what YOU should do is really important. And going through a few scenarios with them and writing their advice down( and carrying it with you)
I did this and it has really helped so for instance for me my cardiologist ( having done a recent CT scan of my heart) is not a great fan of A and E and prefers I sit it out with the , as long as there is no chest pain or breathlessness proviso
I think generally if your cardiologist were sat next to you they would be less keen for you to go to a and e than 111 or similar but it is well worth asking.
My heart is in unpredictable/ unfamiliar mode 8 weeks past ablation#1 so I have had unfamiliar episodes fast eg. Recently afib 160-180bpm but only lasting 12 or so hours so my scenario list answer (sit calm eat small ) has been really helpful.
Good luck and I hope things settle ( heavy plants in the garden have a lot to answer for!)
Thank you, completely agree with what you say, though this conflicting advice has all been given to me personally! I have chosen the cardiologist I want to see next, looked up his website and discovered he isn’t taking private work at the
moment - hooray for him - so I may have to take my chances.
Still in AF and feeling rubbish so I am going to phone 111 soon.
The ‘sit calm’ advice is fine for a man (sorry if this is sexist, just the scenario in my house) but I’d be sitting watching the laundry etc pile up which doesn’t help the calmness, also totally frustrated that I can’t garden in the lovely weather.
Anyway hope your heart settles soon, best wishes 💜
Maybe you could 'sit calm' in the garden admiring your plants and relaxing to the sound of birdsong and buzzing bees. After my last episode of afib nearly a fortnight ago I felt so wiped out the next day after going back into NSR in the early hours I relaxed in the garden and had a day off from actually doing any gardening. It was nice just enjoying it and not thinking about things that needed doing that I did not have the energy for. Hope you are feeling better soon and don't feel driven to go to A&E. I am lucky - I've always reverted within 12 hours so I don't know what I'd do if it went on but it is something that bothers me the "what ifs" . The first time it happened and I sent for an ambulance I ended up spending 4 days in a cardiac ward . They would not let me home till my INR was in range and I was really fed up! Best wishes Madge.
Hi, it is a dilemma, but having been to A&E yesterday I was told I should always attend with AF. I have had a chest infection and it pushed me into AF. I don't ring my GP as they don't seem to know what to do!
Oh, gosh, Buffafly, this is the very same question I have, with no real answer from anyone in the medical field including my EP. I can't tell if I'm in AF or SVT or whatever, although my EP errs on the side of caution (IF I can get hold of him or someone in his office!) and tells me to go to Emergency if I have certain symptoms....and the interventions for AF or SVT are different. The last time I was in the Emergency Room, the ER doctors there couldn't determine from the 12-lead ECG that I was in SVT--something about p-waves that my EP caught after the fact. I feel for you!!!!
Hi. When I went back into AF in June (after 3 years of NSR) I first rang my GP as they have an ECG. My GP wasn't in but another one from the practice was and told me to go to hospital. I told him that he should be the first port of call and with the virus situation I would rather have an ECG in a quiet GP surgery than going to A&E at that time. He then said that he thought that the nurse might be to busy to do it so I should contact my cardiologist. After a few choice words on patient care (or lack, thereof) I bid him farewell, contacted my cardiologists secretary who arranged for an ECG in the hospital cardio clinic next day. I have since been back for a cardioversion and an xray as I had a chest infection and although it's a bit surreal with new procedures in place, it was quiet and controlled and not the usual queues and being left hours on end so if you feel uncomfortable, then I wouldn't worry about going to hospital. I was always told HR over 100bpm meant going to hospital but having just ridden it out with no intervention many times in hospital, I have ridden out the recent episodes, prior to my cardioversion 2 weeks ago, in the comfort of my own home, even at 150-160bpm but thankfully, they didn't last too long. Hope you get sorted soon.
I was hoping for an ECG at my Health Centre to show ‘my cardiologist’ when I get to see one but didn’t get further than the receptionist, probably should have argued but reading your experience it probably wouldn’t have done any good 😐
Have to say, I probably would have had more luck with receptionist at our surgery, as they are very helpful. This particular Dr I have only seen once, last year when my pulse had dropped into the 40s. He told me there was nothing he could do and not to worry unless it was in the 30s and then go to hospital. Methinks he gets a mighty fine salary to provide a hospital referral service!!! My own GP, thankfully, is very thorough.
Sorry to hear about your recent af problem but I understand your dilemma.
My brother has been suffering from af for two years now and kept putting it down to his type 2 diabetes. Just before Christmas 2019 last year I told him he was having af and to go and see the doctor. He made the mistake of telling the doctor he was having af and the doctor told him he was not, until he checked him out and said his heart was irregular. He put him down for a heart monitor to be fitted, NEXT JANUARY!!!!
He has been having quite a few very bad episodes of af since and I have been telling him to send for an ambulance, but it took quite a bit of nagging from me before he did. He was then hospitalized 4 times in less than 2 weeks and both the ambulance crew and the nurses told him to get an ambulance whenever he was very bad and that would get him to the front of the queue and get himself seen to. It has worked and he is now on medication and has had a telephone consultation with a cardiologist who is going to fast track him. So the short answer is YES get an ambulance or go to A&E if you are bad enough. It will be the only way you will be fast tracked to get something done. My brother has now realised that my advice was right and is glad he did it. Just to let you know that I was having af for just short of 3 years before I had an ablation last year in November, and it has worked. That is why I knew my brother was having af also. It's hereditary, my father had it also.
I recently attended A@E after a bad bout of AF, they kept me in overnight and put me on a list for an ablation, so always best to go to hospital as they thoroughly check you out. Good luck 👍
If a could not get my heart rate close to or below 100 after a few hours, I would go. My rate was always 190 or higher and made me terribly ill. I was also concerned that frequent episodes with my heart rate so high would cause an enlarged heart.
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Usual dilemma: Rate or Rhythm
Should I go to A and E?
A&E or stay home? 
When to go to A & E
Should I go A&E or am I panicking 
