Last Sunday I had a dreadful accident. I either slipped or tripped in the kitchen. I had a kettle full of boiling water in my hand at the time. The result was that I badly scalded my leg and was taken by ambulance to my nearest A&E hospital which is 20 plus miles away. Whilst enroute the paramedics did an ECG. Once at the hospital the A&E doctor ordered another ECG. After that he decided that I had AFib bearing in mind I had just had the worst shock I had ever had. He prescribed Apixaban and Bisoprolol. I told him I had Acalabrutinib and asked if it would be ok, he said he wasn’t up to speed with Acalabrutinib. I was reluctant to take medication without speaking to my Haematology Consultant. I was discharged from hospital after my leg was dressed. I tried for two days to get some answers before starting the medication. My consultant said that if my GP prescribed the heart medication then she was happy for me to take it. She requested another ECG which was done on Thursday last week. This was totally normal! Later on Thursday I spoke to a locum GP and voiced my concern, again I was told that he wasn’t up to speed with Acalabrutinib. He was losing patience with me, when I said that the ECG done in that morning was normal, he said, it meant nothing that it was normal on that occasion, if they were to do more that same day, then it was possible that they would find one that wasn’t normal. He said I should start taking the heart medication otherwise I could have a stroke or blood clot. It was obvious that I was getting nowhere so I agree that I would take them until my next hematology consultation in August. I have said that I want every bit of my concerns to be logged and I have told my husband, family and friends that if (God forbid) anything goes wrong, they have to create a real stink.
My blood pressure always good has been erratic since I started the medication.
Can I ask your advice on what I should be doing.
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If I can find details of the contra indication in couple of minutes on the web then your doctor(s) should. I checked all anticoagulants and it stressed the risks. It did also say that for people with high thromboembolic risks (AF for example) an alternatve to acalabrutinib should be considered. Don't be confused by the ECGs as AF can be paroxysmal.
It might of course be that the shock caused the unusual ECG so you need to ask for a wearable monitor for a short period (maybe 72 hours) to find out if you do in fact have AF.
First, I have no medical training and this is just patient to patient forum where we share our experiences and thoughts. Advice here should not be acted on unless you get the OK from your doctor.
Afib is the most common arrhythmia in the world. You are in a very big club. Just about everyone here in this forum has it. In general, people with afib live as long as everyone else and many lead a perfectly normal life. It can seem scary, but very often its bark is far worse than its bite. And if the bite gets to a certain point there are treatments.
So I put your three medications into Medscape's online drug checker and there is a interaction between Acalabrutinib and Aphixaban where Acalabrutinib increases the anti-coagulant properties of Aphixaban which is an anti-coagulant (blood thinner).
The advice from the drug checker is "Monitor Closely". Nothing to be alarmed about and I assume your doctors are aware, but take nothing for granted, especially since they told you they are unfamiliar with Acalabrutinib.
So first step would be to bring this to the attention of your doctors, maybe the one who prescribed the Acalabrutinib? You should also know that not everyone with afib needs to be on an anti-coagulant like Aphixaban. It depends on your CHADS2 score. Something to file away until you see a specialist.
Bisoprolol has a place but it's sometimes handed out like candy to afib patients. Something again to file away until you see a specialist.
So my advice then is to see a specialist. This could be a cardiologist well versed in afib or a electrophyisologist (ep) who is even more specialized. Because as I think you are finding out, sometimes GP's don't have a clue about afib.
You might also want to invest in a home monitoring device called the Kardia 6L. It will tell you whether you're in afib or not and give you a read out that you can share with the specialist.
Meanwhile, the good news is that you are no longer in afib and like you surmised, the shock of that boiling water could have put anyone into afib! Good luck moving forward!
Good advice here and you're right I think to be concerned. I agree Bisoprolol is handed out willy nilly. Even if you do start to get AF occasionally it doesn't mean you need something like Bisoprolol all the time although the stroke risk is always a concern. Lack of joined up thinking in the NHS is problematic- you need to do the job for them. Write to whoever prescribed the Acalabritinub and also call the medical secretary. Copy in the cardiology department at your A and E - call them to get the correct names etc abd explain why - copy in your GP. Also contact patient liason at your local A and E. Stress you feel at risk.
Hi and welcome - AF is an added burden you really don’t need but can be a complication of the other meds you are taking so you need close monitoring as MrJames said.
You’ve had good information above, especially from Bob and Singwell so I won’t repeat except to stress that you need to seriously consider whether or not you need anticoagulants because of the risk of stroke if you have paroxysmal AF ie: it comes and goes. So first establish that by asking to have a 72 hours monitor. You could be asymptomatic so not know whether or not you are in AF. To be honest - if I were you I would be investing in a wearable which tracked my heart rate and gave an alert for arrythmias - many such on the market but with the iWatch you can also take your own ECG which recognises AF. Doctors are taught that patients lie - they often do or at least distort the truth - so only rely on evidence. If you are self monitoring - you can provide evidence.
The risks of taking anticoagulants do need to be assessed and you can do this for yourself by using the CHADS scoring system and balancing that against the HASBLED and your doctors should help you to do this, if they haven’t already so ask them - what is my CHADS score?
When you have other conditions medications can become very complex, as I know only too well and I certainly cannot take any heart meds - but I do take anticoagulants. Personally I would ditch the Bisoprolol, I just refused to take it and then eventually my cardiologist put a Red Alert on my file, on my neurologist’s insistence! I would ask why I need Bisoprolol? Was your heart rate high in AF? What were the numbers?
I wouldn’t be surprised if your HASBLED score cancels out your CHADS score making the decision as to whether or not to take them far more difficult - but your choice. Make that an informed choice based on knowledge so I would suggest you read up on AF and the treatments and the risks and perhaps ring the AFA for advice.
There are many people on this forum with complex health conditions as well as those with lone AF but their needs and assessments need to be very different so persist and keep asking your doctors searching questions, it’s your body and your life.
The Merck site advises extreme caution if used with an anticoagulant as the drug can cause increased bleeding tendencies as well as afib. The risks/benefits should be discussed by your EP and Haematoligist and hopefully they can come to the best conclusion. etheral
Ask a pharmacist in the meanwhile - they are the real experts and you should be safer taking their advice until the cavalry arrives (if it ever does 🙄)
I'm so sorry to hear about your accident with the kettle. I think any normal persons heart rate would have gone up after that! I really feel for you and hope that the scald on your leg isn't too painful, did the hot water hit a large area?
Hope your leg will heal quickly. Do you have to go back to the hospital, or your doctors surgery, to have the dressing changed?
You've had good advice from others here and there's nothing more I can add, but just wanted you to know that I care. I'd be cautious re taking the heart tablets like you. You need more evidence that you do indeed have AF, but then the doctor in A&E would probably know that people who have suffered a dreadful trauma don't usually present with an irregular heart rate.
Hello Jean, thank you for your reply. I threw the kettle as I fell and think that saved more injuries. I had thick jogging pants on which again helped but pulling them off, also pulled skin off. The nurses say that although sore it is superficial and will heal. The area is my hip and upper thigh. After a week of daily dressing changes, I can now go every two days. I go to the wound clinic at my local hospital and have weekend visits at home.
That sounds like an a very unpleasant accident, and scalds are so painful! I hope you're feeling better.
AFib is indeed a big topic and I would second the advice to think about getting either a Kardia 6L or an Apple watch. If you have indeed started experiencing paroxysmal AFib (occasional episodes that end spontaneously) you could not have another episode for weeks/months or longer) so it may well be not picked up by another ECG or even a 24 hr or longer ECG. I just got a new Kardia 6L on eBay for £101 delivered as a back up to my Apple watch. The Apple watch will be more expensive but I believe a model 4 or later carry the ECG function. The Apple watch is brilliant and you can wear it all the time but the Kardia (I believe) does a more detailed ECG that also picks up other arrhythmias and you can email ECGs to your doctor.
You've already had a lot of good advice, so I would just echo Singwell's advice to email your haematologist via their medical secretary, copy in your GP etc. The lack of 'joined up thinking' is indeed a problem that only you can combat, and do express your concerns in writing, about your blood pressure fluctuations and concerns about mixing meds, which are very valid concerns.
Good luck with all that! It might seem a bit overwhelming at first but you can find a lot of information and support on here.
Well, I looked up your question & this is the answer from Macworld:"When you first get an Apple Watch, it requires an iPhone to set it up. There’s no getting round that. The Watch app on the iPhone does most of the heavy lifting, and without it you just have a pretty bracelet that cost far too much."
Trust to your doctors. They have online systems that alert them to any issues.
The doctor told you correctly about the ECG. Once heart cells can go into fibrillation, then, sadly, that is that - they remain "arrhythmogenic" as it's called. Given the right conditions, they will do so again. Also, as most AF seems to be asymptomatic and of short duration (i.e. not really felt), you might not know you have it. The stroke risk comes from tiny blood clots that form in a part of the atrium called the atrial appendage and the anti-coagulant deals with this really well. Many people don't find out they have AF till they get a small stroke so do follow the advice of your doctors. They are especially stressed these days owing to covid, and also, they don't treat AF as seriously as the AF sufferer might think they ought, but they do treat it well in my experience.
I have been taking Apixaban for over a year after being diagnosed with A Fib and pleased to report that to date I have had no problems with this medication
What an awful experience for you. In the circumstances I would push for a 48 hour tape. That would give a broader picture of what is going on rather than a vey short ECG. I have paroxysmal AF which comes and goes so an ECG rarely picks up an episode but the longer 24/48 hour tapes are more thorough. I think there may be 7 day tapes too but I haven't had one of those. As for Bisoprolol. It is a beta-blocker whose job is to reduce your heart rate. In my case it was so effective it reduced my heart rate to 33bpm so I was taken off it, thank goodness. It didn't suit me but there are others who swear by it. Ignore stroppy doctors, it's your health not theirs. Push for a longer tape to get a clearer picture. I would continue with the meds until then. Good luck.
Thank you, the GP's just don't seem to understand my concerns. I have said that I fully agree with them if there is a problem, I am happy to take medication. However, I just want further tests. OK, I understand that once the heart has gone into AF then it can do it again. Yesterday after taking my blood pressure 7 day diary into GP's, I was told to stop the Bisoprolol immediately. I asked for a referral to a cardiologist but was refused so I have messaged my Leukaemia nurse to see if she will ask my consultant. I do realise that the NHS is busy but all I am asking for is to have things checked before simply giving me a packet of tablets.
I completely understand how you feel. Why the refusal for a cardiologist? It would be helpful to see one and get a thorough examination and tests done and correct treatment for you going forward. Good luck.
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