Should you see a Cardiologist Specialist?

[Treschere]

After a few visits to A&E last year, commencing in June, I was diagnosed with PAF, started on Bisoprolol and Rivaroxaban, I eventually had an Echocardiogram in June this year with a report that all was okay.

I have just returned to the gym and swimming this week. This morning I managed 6 lengths with a short rest, but I realised that my heart had gone into what I believe is a Trigeminy rhythm with two beats then one missed. I did some "stair climbing" in the gym too and found an hour later that I had gone into arrhythmia. This has now subsided.

My question to those of you who live in the UK do you think I should have been referred to a Cardiologist at all? and what should I do about exercising if this brings on an episode.

[BobD Volunteer]

I guess that your GP is currently the ony medic treating you?

NICE guidelines are that if your GP is unable to succesfully control your arrhythima (AF) in a month then you have the right to request an appointment with a rhythm specialist.

It must be noted that GPs have only limited permssion to prescribe certain rhythm control drugs such as flecainide without primary prescription by a consultant cardiologist so options are limited.

Regarding exercise the recommendation is that you must be able to do whatever you do and carry out normal conversation at the same time. Listen to your body is another oft stated comment.

[Treschere in reply to BobD]

Hi BobD,

My prescription was given by the Respiratory Registrar on duty while I was an inpatient overnight, last August. My GP has upped my Bisoprolol from 2.5 to 3.75 as I was having quite a few episodes this year which steadied it, with episodes that I am aware of in between, but also, dealing with breathlessness as and when it kicks in. I don't take too much notice and get on with life however, I went into AF last week at the gym and then as said again today. It just seems that if I had an exercise tolerance issue noone, including me would know, because my heart hasn't been tested while excercising.

[Paulbounce]

Hi Tres.

The simple answer from me is yes. Ask for a referral - you have every right to do this.

Don't worry and don't panic - it sounds like it can be dealt with. However best play safe. Get on the phone first thing in the morning and start the ball rolling.

That's my take anyway.

Paul

[Treschere in reply to Paulbounce]

Thank you I will ask for a referral now.

[secondtry]

Yes, go for a cardiologist referral and if the appointment date is not within a month, arrange a private consultation if affordable (estimate £250). Re exercise stop completely and build back slowly to identify the trigger and provide info for the cardio.

[Treschere in reply to secondtry]

Thank you secondtry I know what the trigger was yesterday, it was the swimming, as for cutting back, I have only just restarted so not doing very much.😀

[Buffafly in reply to Treschere]

How long before you went back to the gym?

[Treschere in reply to Buffafly]

I haven't been since 2020 at the outbreak of Covid, all this began last year during the lockdown period. I used to go to the gym early in the morning on my own but didn't feel safe doing that anymore, so stopped going. Our new gym has a pool and staffed all the time so I know there are ours around if I needed help for anything.

[Buffafly in reply to Treschere]

So basically you are a couch potato with AF ‘not doing very much’. Seems your heart doesn’t agree with you 😀

[Treschere in reply to Buffafly]

Hi Buffafly, I am anything but a couch potato

[Hidden]

Yes, and ask for an EP! AF is so variable and worth seeking expert opinion

[Treschere]

Thank you FaberM

[irene75359]

Some people are adversely affected by Bisoprolol on even a low dose and as it is a rate control drug it isn't going to be much good at getting you back into rhythm. I would agree with the others; see an EP if you can, privately if there is a long wait. I saw one when first diagnosed and his advice was worth every penny.

[momist]

Two beats followed by a pause is good description of Bigeminy. Trigeminy would be three beats. The pause is because the second beat came too early and the following beat gets missed out.

My experience of cardiologists has not been good, although I don't want to taint the whole profession with the few that I have seen. You need to ask specifically to see an EP - Electrophysiologist - who is the expert on the electrical side of the heart's function. The cardiologists that I have seen have only been interested in the plumbing and valves, which is not the problem you have, as shown by the all clear from the Echocardiogram.

Edited for spelling errors - what's wrong with my fingers today?

[Treschere in reply to momist]

Thank you, you are quite right it was Bigeminy.

[Desanthony]

Sounds like you should see a cardio or better still an Electrophysiologist (EP)

[C66t]

I would push for appointment with EP. As BobD said GP s are limited in what they are allowed prescribe.