Evening in a &e

[Tilly1957]

So, had six episodes now since end of March. GP glossed over my concerns because he was more focused on treating and referring me for possibly fibromyalgia (which, apparently, has af shown as one of the possible symptoms!) so the 6th episide started about 2 yesterday afternoon, was peaking a lot higher than usual and I was feeling rough. After I cooked my self a good dinner, off we went to a &e (6.30 by now - I wasn’t going to sit in a&e for hours without a full belly 🥰) of course, by the time the ecg was done there was nothing to show. Just had a slightly brachycardic pulse. Outcome: new plan of action as things had changed with the af behaviour. I now have Verapamil as a pip to take up to 3 for an episode and if doesn’t resolve, to go back. I was going to discuss use if a pip if I could get a GP to listen, but this turned out faster! Fingers crossed xx

[mjames1]

I was on a similar PIP strategy for many years. In my case, I used the calcium channel blocker diltiazem, instead of verapamil. It always lowered my heart rate and kept me out of the A&E, It allowed me go about my daily business until I converted, which was usually between 12 and 36 hours.

In your case, you might want to get your instructions clarified as to how long to wait until you go back to the A&E and under what circumstances. In my case I was told to wait three before taking any other action as long as I was relatively comfortable.

Lately, I use a different strategy to convert with the drug Flecainide. Flecainide is a rhythm control drug as opposed to verpamil which is primarily rate control. In most cases, it will be a faster and more reliable conversion and even can be taken daily to help keep you out of afib. To qualify for flecainide you need a structurally sound heart and it is usually taken with a beta blocker.

Given the current frequency of your episodes, your case seems well beyond the hands of a GP and especially in your case based on what your GP is doing, or let's say what they are not doing. A consult with a good cardiologist and/or ep would be in order now.

Jim

[Tilly1957 in reply to mjames1]

A & E doctor said to take one as soon as I am aware afib starts, then I can take up to two more 3/4 hours apart, he said if that’s not working to get to a&e. I can’t tolerate beta blockers, unfortunately, otherwise I think it would have been them and flecainide they would have prescribed! At least I have been given a plan. My gp was completely uninterested in what I was saying about the afib.

[mjames1 in reply to Tilly1957]

When you say "if that's not working" are you meaning it's not working to control your rate, or not working in terms of restoring your sinus rhythm? I ask because Verapamil is primarily a rate control drug and would not necessarily restore sinus rhythm that quickly.

So, in my case, Diltiazem "worked" in the sense that it controlled my rate in afib and then I simply waited 12-36 hours until I naturally converted and therefore never had to go to the A&E. If my instructions were to go to the A&E if the Diltiazem did not restore sinus rhythm, I would have been on a first name basis with everyone at the A&E Keep in mind, I'm not telling you what to do if it contradicts what you were told, just relaying information you might want to discuss with your doctor.

As to Flecainide, it does not have to be administered with a beta blocker. I take my Flecainde with a calcium channel blocker Diltiazem which is similar to Verapamil.

The reason you may not have been given it is because they often want to do some testing first and you were in the A&E where expediency is the name of the game and as you said, your GP isn't interested.

The A&E doctor was a start, but you really need to see a cardiologist and/or ep to get a more complete plan moving forward.

Jim

[Buffafly]

Hi Tilly, your remark about not wanting to sit in A&E without a full belly made me smile but it also tells me something. I couldn’t cook dinner at all if in AF bad enough to go to A&E, nor could I eat one. So it’s good that you made some progress with your treatment by going to A&E but hopefully you won’t need to go again. Certainly that is a lot of episodes in a short time and the concern is that the more AF you have the worse it gets, so your GP is wrong to ignore it while searching for a cause. Unfortunately GPs don’t seem to know much about AF treatment. Maybe the A&E bill will shake his ideas up! Best wishes ❤️‍🩹

[Tilly1957 in reply to Buffafly]

By the time I did myself some food, it had calmed down to its ‘normal’ level. But I was aware of my paramedic friend’s string instructions after I sent her my Kardia ecg to go to a & e asap. Missing a meal is one of my triggers. Thank your reply xxx

[Buffafly in reply to Tilly1957]

Very handy having a paramedic friend 🙂 Maybe cooking is a good distraction from symptoms - you could recommend it next time someone asks how to cope with episodes 😀

[Tilly1957 in reply to Buffafly]

Was just an m & s pie in the oven and some veg all cooked in the same pan 🤣 yummy. Oooohhhh now I am thinking I am getting hungry 🤣🤣🤣🤣 Had a nice soak in an Epsom salts bath. Am surprised at the results, despite being told about it lots of times . Helping with aches & pains, and so relaxing ..,, also been watching Lucifer on Netflix .. am chilled, so if I add the distraction of cooking …. Alls well 🥰🤣🤣🤣 Enjoy the jubilee weekend x

[Buffafly in reply to Tilly1957]

Thanks, you too 😀

[Singwell]

I agree with James that you should request consult with cardiologist or preferably EP. You're getting quite frequent episodes. Most A and E Doctors are troubleshooters- they know very little about electrical issues so they'll only offer a temporary fix. I'm sure you can get better advice than this that will offer you more stability.

[Tilly1957 in reply to Singwell]

I agree. I will see how long before next episode rears it’s head, and try this med, because I will get asked how I got on. In our practice, one of the Nurse Practitioners is the arrhythmia ‘specialist’……….. In the mean time I am exploring the possibility of going privately, depending on cost. Thank you for your support and advice….. it is appreciated, from everyone 🥰

[Lucymoo]

Hi, before my ablations year ago I had episodes of AF most days lasting from minutes to a couple of hours. My heart rate was up to 180 at times occasionally sometimes above that. Basically my cardiologist suggested only going to A&E if I felt really ill and following his advice (plus bisoprolol 10 mgs a day) managed to keep out of A&E for a year except for one occasion when after sat in the waiting area for an hour it resolved so I went home after my initial triage contact. Worked well for me and I found my triggers to avoid which are different for everyone.

[Tilly1957 in reply to Lucymoo]

I know most of my triggers. Think I just got too hot and over tired at the same time x