A&E or stay home?

[Crumble2]

I have paroxysmal AF. I’ve usually gone to A&E when my heart goes out of rhythm but decided I would stay at home this time. I took an extra beta blocker - which is the only treatment I am given in A&E plus blood test and X-ray- and rested. After a shower, I went back into rhythm 21 hours later. So no difference in how long it lasted but I was more relaxed and not guilty of using an ambulance and medic time . What do others do?

[BobD Volunteer]

Spot on Crumble. AF is never an accident or emergency it is a chronic condition. Generally speaking only if you have chest pain are passsing out should you go to A and E but we ar all different.

[Cos56 in reply to BobD]

I didn’t know that I should stay home until this last time when the doctor told me I don’t have to go to the ER. I thought it was an emergency! I was afraid of a stroke. Thanks again for the information. It’s such a horrible experience when it’s happening I felt safe there. I hope it never happens again but if it does, now that I’m anticoagulated, I’ll ride it out and pop an extra metropolol. 😊

[dunestar in reply to BobD]

And breathlessness. When I got to A&E I was in respiratory failure but then I've got microvascular angina as well as AF.

[CDreamer]

Exactly right. Much more comfortable at home. Ditto to what BobD said.

[Cos56 in reply to CDreamer]

I rode out my first at home episode last night. Quietly relaxed and ready to fall asleep and BAM! Out of the blue it came. I took a metoprolol succinate(only type I have) and rode out the storm now that I’m anticoagulated. Yeah for me! But it’s such a nerve racking episode. Lasted one hour and twenty minutes. I kept reading all the posts and that helped me through it, knowing it wouldn’t kill me. And it didn’t!! Yay!But it was awful. Gotta come up with another way to avoid this .I see my doctor on the 30th. We’ll see!

[CDreamer in reply to Cos56]

Well done. It can feel very scary can’t it, especially if on your own and at night. Do monitor your HR and if you feel at all unwell call for help. Take care and take it easy today, I have been going full blast the last few weeks and my heart is very sensitive at the moment and I know rest and lots of it is the only way to recovery.

[Cos56 in reply to CDreamer]

I’m back at work today. Exhausted physically and mentally. Will try to chill a little. Thank you for your support.

[Hidden]

I agree Crumble2. I went to A&E once, over four years ago, on doctor's orders, to try to get a heart trace showing my arrhythmia. It wasn't worth the guilt of using up valuable resources on something which wasn't an emergency, and I've never been back since. (It didn't work either. I went back into sinus rhythm shortly after arrival.). I would use A&E if there was an extraordinary event which left me truly worried, but I think that, once you thoroughly understand what AF is, the best thing to do is to learn to manage it yourself with the help of primary care.

[Jalia]

You are quite right !As the default treatment at A&E is normally Bisoprolol I start titration up to 10 mg at-home first to save time ! For me this doesn't work unfortunately but I try to sit it out as long as possible, whether thats overnight, next day or whatever . If still persisting at fast rate I'm advised to go to A&E where I'm normally dc cardioverted. We all have different experiences and learn to cope in our own way, bearing in mind that chest pain, undue breathlessness and fainting do warrant an A&E visit.

[minchern]

Hello Crumble What Beta Blocker do you take ? I had PAF for several years taking Flecainide as PIP. After bout of pneumonia now in AF and have cardioversion on 25th to sort out hopefully. I was put on Bisoprolol 10mg by Hospital after a visit to A&E

[Crumble2 in reply to minchern]

I’m on 2.5mg bisopropol daily. I can have up to 10mg if necessary. Hope your cv works for you x

[minchern in reply to Crumble2]

Hi Crumble

Back after my CV and I have to say how wonderful New Cross Hospital Wolverhampton were especially Caroline and the team. They sorted the AF out and reduced my Bisoprolol to 5mg from 10mg. Not sure that will be the final medication out as seeing my cardiologist next few weeks. HR around 50BPM so far

[Crumble2 in reply to minchern]

Mine is usually around 58 at rest. Good luck with your cardiology visit x

[Jajarunner]

A and.e.everytime as.italways requires.dccv

[Suesouth]

I am always told by 111 and paramedics, go to A&E for anything to do with heart!

[KMRobbo in reply to Suesouth]

I was told hr over 130 consistently then go to A&E

[Suesouth in reply to KMRobbo]

Mine is always 180-200, so perhaps that is why?

[Lbeat796 in reply to Suesouth]

I was told to go to A and E if heart rate goes to 180. I honestly do not think this condition taken seriously so they just tell us anything. As Bob says it's not a condition that requires hospital treatment t u nless you are experiencing dizziness or pain but for the person having the attack it can be very scary

[Cos56 in reply to Lbeat796]

I have no idea of the rate. It won’t register on my phone app. It’s completely irregular, bouncing all over the place. Can’t count it on my wrist. The irregularity of it is so frightening. Will I ever get used to it? How do people stay in that state for hours and hours?

[Cally53]

I have only been to A&E once, about 5 years ago, before I was formally diagnosed with af. I had seen a cardiologist a few months earlier who advised me to purchase a Kardia to capture my episodes, which I did. Because of course, without proper evidence I couldn't be diagnosed and halter monitors were capturing nothing. One morning I began feeling quite unwell, I could feel my heart beating uncontrollably and my Kardia was reading 190 so off we went to A&E, I was moved into resus where I was eventually medically cardioverted. I left the hospital with beta blockers and anticoagulants and was told that I had done exactly the right thing by going there.

I have never felt the need for a return visit as after a further appointment with my cardiologist I was prescribed flecainide, which thankfully does work for me.

Unfortunately I have episodes of af approximately every 10 days so I'm having my 2nd ablation today. I'm hoping that will do the trick.

🤞🤞

[Rubymurray25]

We are receive different advice by our doctors , my doctor was livid that I initially weathered an AF episode at home as he said had no trace of what the real problem was without an ECG ( before the Kardia device was readily available). I see no value with risking anything you don't feel comfortable with ,an 111 call I always find reassuring. If my 300mg Flecainide PIP doesn't work after 4/6 hours I am told by 111 to go to A & E and am normally intravenously given something stronger and my track record is that after 12/24 hours I'm back in normal rhythm.

[DevonHubby1]

Wife has PAF, doesn't respond to cardioversion by pill or shock so usually waits epidodes out at home. However, once she got chest pains after an episode lasting 7 days and went to A&E having spoken to arithymia nurse on phone first. She got a telling off from doctor in A&E for leaving it so long. She ended up on the cardio ward for 7 days.

[Jalia in reply to DevonHubby1]

We really have to listen and get to know our own bodies. Some years ago I was left in AF, only about 120 ish bpm , for almost 3 weeks and went into heart failure. It was a very frightening experience as I didn't know what was happening and could barely walk. I presented at A&E and was admitted fir several days and told this was a result of AF

[kivihaka1]

Well done and i hope you feel more comfortable , I tend to get AF every 4 weeks and i just stay home and rest.Heart goes back to sinus rythem after 24 -28 hours. I can almost set my watch by it..👍

[Ppiman]

I’ve been told that it is tachycardia that is the enemy rather than AF itself (that is, once the clotting risk has been dealt with). That can be controlled with a beta blocker, and that’s what I do, take 1.25 or 2.5mg bisoprolol tablet if needed.

My cardiologist felt that often my tachycardia / AF was reducing on its own within an hour, so in those cases he said a “PIP” beta blocker wasn’t much use as it takes too long to exert its effect.

The real issue, so far as I have been told, is what effect the AF or tachycardia is having long term on the left ventricle (and to some degree also on the valves). It is that which needs protecting long term to prevent heart failure.

Steve

[Auriculaire]

I sit it out at home. My episodes are about 7 a year and last around 12 hours. I take extra beta blocker , 200mg of magnesium and eat a banana. I check with my Kardia every so often to see if heart rate is going down a bit. If episodes lasted longer or I felt ill I would consider going to hospital but would be very reluctant as I am pretty sure they would keep me in like the first time.

[doodle68]

How hospitals and advice differs..

5 years ago when my episodes became frequent I was given a letter of permission to take to my local hospital when I thought I was in AF requesting an ECG to try to capture the event and to get a diagnosis.

When the next episode started I telephoned my son to take me to hospital , he dropped me off then went back to work .

Breathless and sweating I presented my letter to the hospital and waited for the ECG which confirmed fast AF with a HR in the 160 and a fluctuating BP. The nurse then said I could go home no mention of any help or treatment. I managed to make my way to a seat by the door phoned my son to collect me and struggled to stay in an upright position on the seat because I felt so ill.

Weeks later I got a letter stating I had P-AF and to see my GP to get a prescription.

The GP I saw asked if I knew what AF was and when I said I knew very little about it I was told to go and look it up on my PC also CHADS and HASBLED and to go back and say if I wanted the recommended medication.

At no time did anyone give me the impression that I had a condition that needed hospital treatment although during episodes I felt so ill I was convinced I could die any moment or at the least have a heart attack.

I opted for the medication and learnt to manage my frequent symptomatic episodes myself with the help of the internet and only got to discuss my condition in detail 6 months later with a nurse in the first clinic I attended.

My fist contact with an EP in person was was 4 years later and I paid for that myself. The clinic suggested I go to hospital if I have severe chest pain or an episode 'lasts too long' maybe over 24 hours but the only thing they can offer is cardioversion.

So no I don't go to hospital when I have an episode , I have no desire to spend hours on a trolley in A&E I have my own regime at home...

[Dodie117]

Only went once and never after that. But do go if any chest pain.

[seasicksurf]

Get on anticoagulant if you’re not and see if doc will set you up with PIP. I was on that self medicating routine for about 5 years until episodes progressed to nearly weekly, at which time I had a successful ablation.

[momist]

I went to A&E the very first time, when I didn't know what was going on. I was scared and panicked, and thought I was going to die. After the treatment I got there, (an aspirin!) and learning all about AF, I vowed never to go there again.

However, on the last occasion when I'd been alternately in AF and tachycardia for nearly 70 hours I called for help and ended up in A&E once again. They failed to do anything that helped, and I eventually reverted to NSR after they left me on a trolley for sixteen hours in the resus. section. ☹️

I still say "never again"!!

[Karendeena]

Hi Crumble 2, I do exactly as you have done. My EP (who is a top Professor) told me that as I am medicated to sit if out and not go to A & E unless I feel unwell or have pain. I take an extra sotalol and although it wipes me out I return to NSR a few hours later. Sometimes I am in af for up to 48 hours. A & E will only monitor you and make matters worse by linking you up to bleeping machines

[Hidden]

Back in the day I just didn't know what was going on .... actually felt as if it were the onset of flu. Nothing to indicate cardiac at all. UNTIL THAT IS ........ my BP dropped from around 136/80 ish to 76/50 in about 6 hours or so. spoke to my GP, he arranged an urgent consultation ( and I mean in 10 minutes or so) did his own checks and told me to get to A & E urgently. He rang A & E and told them I was coming. He then wanted to phone an ambulance and I told him due to weather conditions I'd be hours and I'll drive myself. Which I did. On admission my HR was clocked at a constant 156 bpm.

Then came the diagnosis of AF. They kept me in for 6 days doing all manner of tests including blood tests, scans heart ultrasound and god knows what else. Then discharged me with the diagnosis of paroxysmal AF. If it hadn't been for the confirmed drop in BP I would never have gone to A & E.