This is my first post here and over the last few weeks I have found many of the post and responses really helpful in understanding my new new diagnoses of PAF and Type 2 diabetes.
Four weeks ago I got knocked off my push bike on my way to work - this turned out to be a blessing in disguise as I was having my heart palpitations whilst in hospital. I was quickly told that I was in AF and the hospital staff set about slowing my heart rate from 150bpm. I was put on 1.25mg of Bisoprolol. Following that hospital visit I organised for a complete health check with the GP where I have also been diagnosed with Type 2 diabetes - a tough couple of weeks!
I now know that what I have been experiencing for around 10 years and told was panic attacks was in fact Paroxysmal Atrial Fibrillation. I am not sure when the Type 2 Diabetes started but it wasn't there 5 years ago.
It is difficult to get doctors appointments at the moment and there is a lot to take in and go through but I am not sure what to actually do when I go in to AF. At 12am yesterday morning ! was woken by heart palpitation - I used the Kardia machine, supplied by the GP, which confirmed AF with a heart rate of 149bpm. I set about trying to relax and sleep (but this is near on impossible). By 4am I was in full swing of my usual symptoms - light headed, short of breath, heart pounding (now 163bpm), nauseous and endless trips to the toilet. My wife took me to A&E as I refused to call an ambulance - 4x my usual dose of Bisoprolol, being put on a drip and then finally 300mg of Flecainide I felt my heart go back into sinus rhythm and the heart monitors thankfully went quiet at 11am!
Sorry for the long way to my actual question - should I go to A&E when in AF or is it okay to wait it out at home? It is a couple of weeks before I can see the doctor again and I hate the idea of wasting NHS time when everything is so stretched.
Thank you for taking the time to read this and any responses would be greatly appreciated.
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Kingfisher44
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It should be accepted that AF is a chronic condition NOT and accident or emergency. I know it doesn't feel that way though!
What is important is that your stroke risks is assessed and anticoagulation started if appropriate as stroke is a much higher risk when you have AF. The diebetes also increases your stroke risk so depending on your age and any other co morbidities it is highly likely that you should be taking one of the anticoagulants.
As far as treatemtn is concerned you really need to get a plan under way so as a first step I woudl ring your GP adn discuss both antioagulants and what to do in the event of an AF attack.
Most people will ride these out at home but if you have any chest pain or dizzy spells or shortness of breath then go to A and E . In any case right now I would be tempted to go in such an event anywaay but make sure that you ask them about your CHADSVASC score(Stroke risk) and anticoagulation.
I do not agree that afib does not cause severe acute symptoms that would neccectate a+e in some cases. If your ejection fraction is already low, afib could reduce it to the point that you will literally drown from pulmonary oedema. This happened to me and an emergency DCCV literally saved my life. If your condition is not already worked up and diagnosed and you are on drugs to control it, a+e could be life saving. If you have chest pain and SOB call the ambulance.
There are a couple of ways to avoid the A&E (We call it the ER in the US) during an aifb episode and I have used both. That said, as has been previously pointed out, if you are in distress with shortness of breath, chest pain or feel you might pass out, then go to the A&E.
The two strategies to ride it out at home are variations of Pill in the Pocket (PIP) and will require a prescription and an OK from your doctor. If your GP shakes his or her head about this, then you will want to see a specialist, preferably an EP who understands these things better.
Just keep in mind we are not doctors here, so don't follow any advice blindly in these forums and always check with your doctor as well as other sources.
The first strategy is PIP rate control, similar to what is done in many ER's except in pill form. The concept is to lower your rate to a target range of around 90-110 resting and during light day to day activities. In my case I was advised to use fast release Diltiazem tablets. At the start of the episode I would take 60mg of Diltiazem and another 60mg an hour later if still in afib. This would usually bring my resting heart rate to the 90-110 target within 3-5 hours. Then I would take a very small amount of a beta blocker to bring my ambulatory (moving around) heart rate down to the target.
Once in target range, I would go about normal light activities such as doing my business around the house, going to the store, causual walks, etc. I would usually convert back to normal rhythm within 8-48 hours. If it was a longer episode, I would need more Diltiazem and Metoprolol at prescribed invervals to keep my HR in target. As soon as I converted I would stop both drugs.
Your doctor may use these same drugs or perhaps just a beta blocker, but the concept is the same. Control rate and then wait for normal sinus rhythm, or Control and Wait for short. This strategy served me well for over 30 years until my episodes became very frequent and longer in duration.
Now I'm on a rate and rhythm control strategy using Flecainide as my PIP. In my case and many others, I needed to have a stress test before I was prescribed Flecainide. Some will take their first dose in a supervised setting or at a hospital.
The way Flecainide PIP works is that at the onset of Afib you will generally take a beta blocker or Calcium Channel Blocker to control rate and therefore protect your AV Node. Half hour later you will then take the prescribed dose of Flecainde. Conversion to NSR can happen within 1-4 hours.
You should also talk to your doctor about taking an anti-coagulant which are often called "thinners" although they do not thin the blood per say. Whether or not you take it on a daily basis depends on your CHAD score, lifestyle and level of stroke risk you are comfortable with. A good cardiologist should be able to give you the numbers and you make the decision.
In my case, when my episodes were years apart, I only took thinners at the onset of an afib episode and stopped them 1-3 weeks after an episode. That is called "on demand" or "PIP" Anti-coagulation. I also participated in motor sports which influenced my decision not to take daily thinners. Now I take thinners daily as my episodes became longer and more frequent.
Some ep's like mine are supportive of the PIP thinner approach, others are not, as it is relatively new and therefore not as studied. From what I read here, most doctors prefer the thinners on a daily basis. Of course PIP thinners only work if you know that you are in afib which is obvious to some but not all. Devices like Kardia and the Apple Watch can be a big help here.
But back to avoiding the A&E. If your episodes are very infrequent and not too long, I think a good case cannbe made for PIP without Flecainide. And if your doctor supports it, something you can start with right away without further testing.
On the other hand, PIP with Flecainide has served many here well, but as mentioned, in many cases you will need further medical testing and/or medical supervision for the first dose and often when you increase the dose.
The best cure is to do your best to take your mind off of what your heart is doing. Anxiety almost feeds AF, it certainly used to keep mine going. It's taken me years to get where I am now and ignore my heart rate.
Many times we've had discussions on this forum about heart monitors, supplied by the NHS that stick to the chest. Why, we wondered does our heart always behave when we wear these? The answer is we feel secure when we wear one and don't become anxious. Another thing we noticed was that when we had an appointment with an EP (someone who specialises in heart rhythms) or a cardiac consultant. During the period leading up to it we were well, but a few days after the appointment, the AF would come back to scare us.
I used to go to A&E regularly when my AF first kicked off. However, mostly I'd sit in a cubicle for hours while they did lots of tests. It was so boring, but generally my heart would go back into normal sinus rhythm on it's own while there. A few times I was admitted to a ward and spent days in high rate AF. Take note I was once told off by a nurse, when my rate had been 160 all day and I eventually went to A&E. I was admitted to a ward that time
Once while sat in A&E I witnessed a little girl held in her dads arms, she kept passing out. I was furious that they were left sat in A&E, they needed help far more than others sat waiting - including me.
Now I wouldn't go to A&E unless it was making me feel faint, dizzy or nauseous.
I feel cross that you were dismissed for 10 years and told that you were having panic attacks! The times we hear that here.
Try changing your diet to a more healthy one that doesn't contain any artificial additives, avoid caffeine and alcohol. Artificial sweeteners were a sure trigger for my AF. Drink a little more water and also lose weight if you need to.
We're all here to help, whenever you need us, so feel free to fire off any more questions you may have.
Hi Kingfisher, you will have seen that AF is not the same for everyone, and yours is complicated by the type 2. As Bob writes, you need to be properly medically assessed. You'll also need to get mdical advice if you drive as AF plus low blood sugar may not be safe. combination for driving.
I can relate to your experiences and sympathise as I likely had a very similar history, not least being a teacher in a stressful job with occasional so-called "anxiety attacks". Nothing I was given helped calm them (SSRI drugs, diazepam, counselling, all sorts. The SSRI tablets made me very ill, but that was originally put down to the anxiety, not the tablets - my they were awful drugs!). In the end, insomnia became the dominant problem and I had to retire early because of ill health.
In fact, I had had the same or similar symptoms, sporadically, over much of my adult life, always labelled as an "anxious disposition", later blamed on a hiatus hernia I also have. The odd thing about that diagnosis was that I was always the one to cope perfectly well in any kind of of stressful situation or emergency at school or when family events happened.
It was many years later, after I had retired, during a visit to an art gallery in Oxford with my son, when another "attack" happened. I went to the museum's first aid room, and was sent to an Oxford GP where I was told that I had a pulse of 155bpm; the doctor told me not to worry but to go to A&E once I got home, which I did. It was there that the emergency doctors, one luckily being a cardiologist, finally diagnosed a heart arrhythmia, one called atrial flutter, which is similar to AF. Since then I have had an ablation which stopped the AFl, but has uncovered some AF and mild tachycardia, which continue to this day.
As for what to do when your heart races. I would ask your GP whether you can't take extra bisoprolol and see if that works. It did for me, and that what I do now when it won't slow down after an hour or two, or if I have something on that day. It's slow to act, so expect the racing to continue for about an hour or so. It lasts for about 36 hours, I find.
I now only very occasionally get AF with my racing heart, much more often it's mild tachycardia (up to 130bpm), sometimes with runs of ectopics. These easily fool the Kardia and Apple Watch into reporting AF. I seem to get fleeting episodes of AF also, which I can never "catch" on the Kardia, but which a 14 day Zio patch found.
It's worth saying that you most certainly won't die of AF, even though it can easily make you you feel like you will, so home therapy is safe if you are taking an anticoagulant (if deemed necessary). What does your GP say?
Have you had scans of your heart to check for any reason why the AF happens, with echocardiograms or stress cardiac MRI? They rarely show what the cause is, but will bring massive reassurance that all is well except conduction-wise. Many people with AF have either high blood sugar, high BP, high BMI or high levels of sleep apnoea, too, so check for these.
Thank you for you response - your experience does sound similar. Previously I had completed cognitive behaviour therapy and over the last few years thought that mentally I was coping - clearly my body is having other ideas!With the recent diagnoses of diabetes by Chad score has gone up - so I came out of hospital with blood thinners. I feel caught between a rock and a hard place with this as I am worried about a stroke but also worried about taking blood thinners.
At the moment everything feels reactionary and I am finding it difficult to get the appointments with doctors to make a plan.
I am sure I will get there as so many have done on here.
I was taken off rivaroxaban after my ablation for atrial flutter, but then put straight back on a week later when an attack of AF came my way. I’ll be on it for life now. The drug hasn’t proven to be problematic except that if any kind of surgery is ever needed, it will mean stopping it for a couple of days beforehand. I’m not sure how safe that is but that is a down side.
It was my cardiologist who suggested that I’d likely never suffered with anxiety attacks but, instead, had had a typical response to infrequent arrhythmias. If he’s right, it would certainly explain so much, but I’ll never know now.
It's really OK to stay at home. On my visits to A&E over my five years of AF, they have never helped in any way. However, chest pain or severe distress should always prompt such action.
The main problem when you feel that bad, is the fear and trepidation making it all worse. Try concentrating, as best you can, on something else. I enjoy watching the tennis during Wimbledon (I don't follow it at any other time), and a good match to get involved in has helped it to stop for me in the past. Similarly, maybe a good book, or a movie? Anything that engages your attention and does not involve too much stress.
Having said that, it doesn't always work, and I have had sessions lasting 70 hours or more which is very debilitating.
The experts in this field are EP's (Electrophysiologists) a specialist form of heart doctor. You should be getting referred to one by your GP. If not, ask for it.
I was told by doctors at the hospital to go to A&E if my pulse rate was above 120. I have ridden it out at home with a pulse rate of 180 plus. All they do in hospital is monitor you. The trouble is that having a very fast pulse for a long time can damage your heart, so if you don't go back into N.S.R. naturally or with a pip, l would go to A&E if l were you.
My experience of A&E has never been good as at our local hospital AF is SO common, unless you are thought to be in immediate danger nothing happens, not even monitoring these days. After the first few years I stopped going at all and if I was concerned about acute symptoms I rang 111, paramedics arrived and assessed, sent an ECG through to the hospital which went to a cardiologist who made the decision as to whether or not I required emergency treatment. I was MUCH more comfortable at home.
I also saw my EP who defined for ME exactly when I should not hesitate to call 999 or go to A&E they were:-
Syncope or near syncope
BP falling less than 90 systolic
Chest pain
Breathlessness when at rest
HR 150+ for more than 24 hours
He also said that as long as I was being treated, best plan would be to email him directly with ECG readings and that’s what I’ve always done.
I think that actually has happened 3 times in the last 10 years. My husband had low EF fraction and chose never to go to A&E.
Everyone’s tolerance level is very different so there may not be a definitive answer that applies to everyone.
I was always at A+E in the early days of my Afib unfortunately. It was out of fear and wondering what was happening to me.? But as time went on and I learnt about AFIB and was prescribed medication I started just sitting it out at home. Having said that if I’d have ever experienced chest discomfort, pains etc then I would have gone to A+E but fortunately for me I have never experienced any other symptoms apart from a fibrilating sensation in my chest. Best wishes kingfisher.Ron
Thank you for all the comments and sharing some of your personal experiences with this. Whilst I can see it is different for everyone it is comforting to know that I am not alone; not that I would wish this on anyone!
From my hospital visit on Thursday I came out with blood thinners as my risk of a stroke has increased with the diagnoses of diabetes. I am very anxious about taking blood thinners - I am worried about having a stroke but also worried about taking blood thinners and the impact they could have. I am struggling to make an informed decision with my current lack of knowledge. I assume many people on here are taking blood thinners and managing this?
I saw my GP just over a week ago. At that appointment her main concern was dealing with the diabetes. I think this was right as since being on Metformin I am feeling better in myself and for the first time in years actually have some energy. She also gave me a heart monitor to try and build up more of a picture of my PAF which could then go to a cardiologist. I am 50 this year and she felt that I am young enough to benefit from an ablation(?).
I have completely changed my diet - cutting all sugars, alcohol and cutting back on carbs. I am pleased to say it is working as I am losing weight! I have currently been signed of work which has reduced the stress and given me a bit of time to process everything. I will have to try and find a way to manage the pressure of work alongside my health as I will have to go back soon. There did seem to be a link between the number of AF attacks and the amount of stress I was under. Although there seemed to be no reason for my last attack.
I suppose this is all very new for me and it will take time to put the necessary plans in place and to be fully assessed.
Stress for sure so learning how to manage that is important. Worrying causes stress so adjusting to the new reality of hat AF may feel horrible but isn’t immediately life threatening on it’s own. Controlling any other conditions will also lower the risks.
Do you know your CHADSscore? Anticoagulants are all about managing & balancing risk of both stroke & bleeds. That’s what the doctors will have assessed. When your risk of stroke is greater then anticoagulants will be advised.
I’ve been taking Apixaban since 2016 & Pradaxa before that. I’ve had surgeries, dental work & just cut my arm badly enough to require stitches - no problems.
Knocks to the head may require screening but Apixaban has the best record regarding brain bleeds.
I think we have all had concerns about starting anticoagulants but adjust and become used to taking them. I’ve had no interactions with other meds or had side affects.
I can totally relate to your decision struggle about starting anticoagulants. I will share with you a few of the responses my Cardiologist and PCP said to me when I expressed my concern. I had a number of friends experience bleeding episodes while on blood thinners. My Cardiologist said that can happen on occasion however she didn't want the fear of the bleeding to stop me. She said they can always medicate to reverse a bleed, but once you have a stroke you have the life time residual effects. The PCP told me to think of it like seat belt, you don't expect to be in an accident everyday, but you still put the seat belt on as a safety precaution. That said I did have an excellent work up by the EP cardiologist from Echo, Stress Tests, 40 days home monitor and multiple EKG's. So that is all very important in helping you make an informed decision. I believe you mentioned knowing your CHAD/VASC score already.
As for staying at home or going to the ER during an AFib event, my EP cardio has allowed me to switch to the PIP (pill in the pocket) approach because my events are rare and told me if I don't convert in 1-2 hours after medicating AND I have symptoms ( chest pain , shortness of breath or lightheadedness ) I should go to ER otherwise, stay home and monitor. I think others have echoed this same advise. Hope this helps.
Thank you PleasantPink that is a really helpful way to look at it. I am not sure of my CHAD score - definitely 1 for diabetes. My blood pressure is on the higher side but seems to fluctuate from normal ranges so not sure if it does count. My PAF has become more frequent (every 3 -4 weeks) with the last two episodes stopping after 12 hours, I think helped with flecainide. The doctor in the hospital suggested blood thinners because of the number of episodes and the diabetes. Although it was difficult to have a proper discussion because at the same time the doctor was telling me that he was struggling to get my heart rate down, the heart monitor was beeping loudly and flashing red and I was feeling really rough! I have another GP appointment in two weeks time so hopefully I can make a plan with her.
An EP once told me that I didn't need to be prescribed anticoagulants, as my high heart rate during exercise was due to my cardio fitness. Eighteen months later I had a stroke. That was compounded by the ambulance paramedics not knowing that an absence of FAST indicators is not absence of a stroke. In fact a stroke that affects vision may not produce FAST indicators. That delayed the blue light journey by an hour, with millions of neurons dying each minute. That in turn meant part of my peripheral vision was affected, so the DVLA revoked my car driving licence: in effect a lifetime ban.
The purpose of the above is to show the consequences of not taking an anticoagulant. I take an anticoagulant everyday, and volunteer clearing scrub in a nature reserve using a bill hook, saw, and I'm certified to use commercial hedgecutters. I'm also a mystery patient for medical students to diagnose that I've had a stroke. Worryingly, some third year medical students had not heard of FAST.
Last year i had a 20mm flat polyp removed in my large intestine. A week later the scab gave way whilst I was back on an anticoagulant. I passed a lot of blood, A&E kept me under observation overnight but took no further action.
Your worries about anticoagulants may not be bourne out in reality. I can say that a stroke is something to avoid, as stroke aftercare is almost non-existant if you are ambulant with cognitive ability.
Thank you for your reply john-boy-92 - your experience sounds awful. On Sunday night, lasting all day Monday, I had another AF attack. As they seem to be more frequent and lasting longer at the moment I have started taking the anticoagulants. I think your point and the same made by others here is that the affect of anticoagulants can be reversed by a stroke can't.
If you are ever prescribed dronedarone or amiodarone for AF, make sure that you know the signs that you don't tolerate it. That said, it's rare - around 6 in 100,000. However, I had to argue robustly with a specialist consultant against being admitted to intensive care, sedated and put on a ventilator. They wanted to ring my wife at 1:15 am as I was hypoxic and, on a good day there's a 50% chance of surviving. If you do survive, the prognosis is not good. I'm still here, the consultant team wrote a paper that became case of the quarter on the Royal College of Physicians, Edinburgh.
There is much to learn about AF, medication, procedures and, you will become an expert. You will then pass on your experience to other people. That way we all learn. As others have replied, we are here and we've been through scary bits; we know there may be others to come. Write here when you need to.
We are all different, if I went to the A&E every 10 days when I have an episode of P-AF I might as well take up residence there..😟
I hate having P-AF but cope with it and the horrid symptoms by being calm and doing those things I have to do slowly as my body allows and leaving the rest for another day.
I tell myself there are worse conditions with which I could be afflicted.
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