its 6am and I'm still in an afib episode with average heart rate 175 on my kardia since 4.30am. Feel terrible. How long should I wait before a trip to hospital? I'm on bisoprolol and flacinide. Due to take it at 9am should I take it now? Any adevice greatly received.
when to go to hospital with an afib ... - Atrial Fibrillati...
when to go to hospital with an afib episode
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Youngest
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Hi Youngest
I am so sorry to hear you’ve got an episode going on at the moment. I know how scary it is as I have I high heart rate with mine, too.
Firstly, you say you feel terrible which is understandable. Do you have any chest pain or breathlessness? If you do then I would suggest calling an ambulance. I have done that a couple of times in the past but am on Bisoprolol 1.25mg now , so, as advised by my cardiologist, I just take an extra Bisoprolol if I get an episode. That helps to bring my heart rate down from the 180s to around 100 which is much more manageable. So, if you don’t have chest pain, then, speaking for myself, I would take the meds now and focus on trying to reduce my anxiety- that goes through the roof when I’m in AF even though I’ve been having episodes for a couple of years now and have survived every one! Try to practice slowing your breathing with the pursed lip technique- breathe in for 2 counts through your nose and out for 4 through pursed lips and try to distract yourself with something you enjoy doing. I think Jeanjeanie put up a post a while back with all the techniques people use to try and terminate episodes. I’ll see if I can find it for you.
I do hope you get back in NSR very soon.
All the best TC
The video below might be useful too. I’d forgotten to mention electrolytes- if you have anything like coconut water or tomato juice on hand , or a fluid replacement powder like Dioralyte- something high in potassium, that may be helpful too.
healthunlocked.com/afassoci...
Hi,
I understand Youngest has received excellent help from yourself others on the Forum.
I also liked the link you gave for the Dr Day video which I hadn't seen before. Regarding this however, I could not fail to notice that his 1. recommendation was having a first aid kit of medications ready to be used as PIPs.
But besides sanctioning the expected Flecainide and beta blocker as PIPs, he also very significantly recommends the "blood thinner" Eliquis (Apixaban) to be taken as a PIP during these AF events.
So, if I understood the video properly, Dr Day is recommending the PIP use of anticoagulants? It would be good if he had given a fuller explanation of this approach because in UK this approach is not yet approved.
Do you know of any other Dr Day videos where he talks about using anticoagulants as a PIP?
What do you think of this part of the video? or is it too risky to comment?
Others welcome to comment as well on this aspect of Dr Day's video, and which is of ongoing interest to me.
bob
Hi Bob
I don’t want to hijack Youngest’s post but appreciate the relevance of this to your situation. Below is a link to a blog post Dr Day wrote on the subject, containing links to the studies to which he refers. Hope it helps! TC
drjohnday.com/afib-blood-th...
TC, or CL as I once called you,
Thanks for link. Quite right about not "hijacking" Youngest's important Post.
But it's important for all here to quickly note that from the Dr Day article you mentioned, Dr Day says the PIP anticoagulation approach should only ever be a consideration for those AF sufferers with low stroke risk scores and no comorbidities.
bob
after my diagnosis of PAF my cardiologist put me on flecainide 50mg twice day but if I have an AF episode to take two straight away snd wait for an hour, if not settled then off to A&E. I’m sure a lot of us have had similar instruction, discuss with your cardiologist as you are suffering there. You write this post a few hours ago now snd I really hope you’re feeling better by now. Ring 111 if you’re not going to A&E. you’ll be exhausted. Take care and keep us posted 🦊
thank you everyone. I'm in A&E waiting hopefully to come home if blood tests are clear. Felt so bad with the face tingling etc my partner took me in just after I posted. Rate went up to 200, but down now to 112. Thanks for the tip about deep breathing and your article Jean. Due to see my cardiologist after I have an echocardiogram, but there's a 3 month waiting list for that. Might just call him and ask about meds. Just been changed to flecinide last 2 weeks as couldn't carry on with double dose of bisoprolol as it gave me cluster migraines. But looks like flecinide isn't keeping AF at bay! I hate this condition..
Excellent decision in going to A&E with that high of a heart rate.
Best to you !
Me again, Flecainide didn't suit ma and caused more episodes which it can do. You may want to discuss alternative meds. My EP took me off it and bisoprolol and put me on sotalol, much
thank you John6. The doc has suggested I take 1 flecinide at point my symptoms start and if not gone within 45 mins take another and if after 2 hrs in afib go to hospital. But I need to speak to my cardiologist. No chance of that so I'll have to leave message with his secretary! I've had a headache every day since taking flecinide and I've noticed my heart rate can be very low but high in morning. Such a struggle to get it right. Took nearly 2 years to catch afib on a monitor in hospital and 18 months since diagnosis and feel so unsettled with it.
Hi Youngest, I'm another person who uses flec, but I have a slightly different story on the timing. My cardiologist says take one (150 mg) at the start, then wait at least a few hours, because he said "flec can take as long as 4-6 hours to act." I think that depends on one's biochemistry, blood pressure, history of the type of AF you have, co-morbidities, and so on. But I can take another 100 mg at any point if I want to move things along quicker. I did in fact just convert last night with flec and it took 5 hrs. I have 2 sizes of flec on hand--the 100 mg and the 150 mg. Usually the first 150 mg does the trick. What dosage does your cardio prescribe that he expects it to work in 45 minutes (or even 2 hrs)? I think my drs. are not too fond of have AF treated in the ER! Cheers, Diane
Hi Youngest,
I’m a bit late to your thread but see you’ve had some excellent advice. I’m sure your doctor has advised you, but you haven’t mentioned how much fleconaide you are on daily - or the amount per pill the doc says to take if you have an episode ( as they come in 100mg and 50 mg) just to be aware that the max amount you can take in 24 hours is 300 mg ( I’m sure he mentioned it, but just in case and to be on the safe side).
Also I noticed you were on a double dose of bisop and you aren’t now, please can I ask, what were you on and what did you reduce to and how quickly did you do it? I only ask, as if you reduced very recently and went from a double dose to a single, in one day, that could be the reason for your increased heart rate in the morning especially. Bisoprolol is a strong beta blocker and reductions are best done slowly ( I speak from experience 😳).
I hope you’re feeling better by now though.
Hi Teresa156, thank you for your response. I am on 50mg flecinide 2xdaily. I was on 1.25mg Bisoporol, as I couldn't cope with 250mg a day. So my Cardiologist advised 1.25mg 2 x daily one in morning one at night. However when I increased this after 3 weeks I got cluster migraines. Advised to stop evening one. Migraines stopped. This was 4 weeks ago. I started Flecinide 2 weeks ago. Feeling much better today thank you.
Hi Youngest,
Ah, I think I follow now then…so you were taking 2x1.25 mg daily ( morning and evening) for 3 weeks, but then stopped the evening dose 4 weeks ago? This could still have had an effect on the fact your HR is higher in the mornings, as even in those 3 weeks your body got used to having two doses of bisop and you stopped the evening one. I took 2.5 mg for initially 8 weeks, then halved it last year (after discussion with docs etc) and noticed my HR increased significantly, especially in the morning. They may hopefully ease off but it can take a while, if it’s that, that may have caused it. Some people aren’t affected at all by reducing bisop and some are…it is just a thought. I just picked up on the fact you said your HR was quite high in the mornings. Sorry….I latch onto these things, like a detective 😳 particularly where bisop is concerned! I take 1.25 a day now and although I’m not it’s biggest fan, it helps.
All the best to you and glad you’re feeling better,
Teresa
HI Teresa, nearly right lol. I've been on Bisoporol for 18 months 1.25mg a day. Increased to 1.25mg (morning and evening) 4 weeks ago as AF episodes every day, but got cluster migraines. Stopped the evening dose and took Flecinide 50mg as well as my bisoporol in morning, and 1 flecinide in evening. My heart rate in mornings is around 88 - 100. I know what you mean, got to have all facts, I'm same lol. Just wish I could sit and talk to my cardiologist properly.
ah, I see now😊
To be honest, I think people’s HR can be a bit higher in the morning as we wake etc and mine is definitely higher as well straight away, than it is during the day when it settles after my dose. The level of 88-100 is still within the limits of normality as I’m sure you know, so perhaps don’t worry too much about it. I think we get more ‘tuned in’ to our hearts and their every move, as afibbers unfortunately. Not always s good thing as it increases our worries.
Yes, speaking to a cardiologist is a bit of a lottery it seems. Some of us end up going for a private consultation to get seen quicker (about £200) if you can push to that, might be an option for you to think about if need be ( and you can refer yourself).
Good luck,
Teresa
Hi Youngest,
Do hope you are feeling better now. You have had some excellent advice on here and I hope it all helps. As regards your headeaches I take one soluble aspirin every couple of days and this stops me having a migraine while on blood thinners. My consultant says this is fine for me but you may need to check for yourself. Hope this helps. Good luck.
Hi Lovefrance, I was told not to take aspirin with AF, I'm glad it works for you and thank you for taking the time to answer. Feeling much better today thank you
Hope you're feeling better by now. As always, medical advice seems to depend on who you talk to. My cardiologist told me to call an ambulance if my heart rate went above 100 and stayed there for more than 30 mins.
Hi BrotherThomas, It obviously does depend where you are. I have never been told when to contact etc. But the hospital were so good, could not fault the care I had. Just need to try and contact my cardiologist now!
Indeed, it is different everywhere. My doc says 120s! And I was higher than that one day that I was in afib while at his office. He calmly remarked, "We should probably get that down a bit...I'll put on some metoprolol at the pharmacy." I do have low BP, no diabetes, and my episodes are mostly lower rate and no symptoms except irregularity. My GP does not favor going to the ER for my usual afib attacks. Others may disagree but his attitude has helped me stay calm and not be so afraid of afib.
Hi
You mean 120h/r at REST.Too high as should be under 100.
Youngest does not say BP. 1.25 is negiigent
Bisoprolol or Metroprolol did not control H/R but CCB Diltiazem brought me down 105 H/R per minute within 2 hours!
Youngest needs to be controlled along with BP.
I am now after seeing a PRIVATE HEART SPECIALIST. I lived with sweating, no energy for 2 years 3 months no oe cared.
Public DHB did not pay attention even though I wrote NO QUALITY OF LFE.
9 months after the change in drugs for H/R and BP I havent looked back.
diltiazem 120mg am 2.5 Bisoprolol pm.
BP 123/72. Day Avge H/R 77-88. Night stays at 47.
Hooray.
cheri JOY. 73. (NZ)
No, I didn't mean 120's "at rest". I meant "in afib." My dr said not to go to the ER for an afib episode unless HR is in the 120's for some hours. They know that the 80-100 "normal" HR is flexible, & the same for afib rates because people have so many different factors, ie., fitness level, blood pressure, co-morbidities like diabetes, drugs they're on, etc. I was once in afib in the 120's all day (before I got onto metoprolol and flec) and when I finally went to the hospital, the dr. said, "Well, think of it this way: you just passed the stress test without running on the treadmill!" I've been with that doctor for 30 years. It's good when our personal doctor knows us well enough to make good judgments about what is more normal or permissible for us.
Hi
Confusing statistics because 3 24-monitors were showing
My Avge Day on Metroprolol 186. and 47 at night
My Avge Day on Bisoprolol 156 and 47 at night Priv Spec said 120s at rest.
My Avg Day on CCB Diltiazem 82 and Bisoprolol 2.5 at night
Now controlled and mine was rapid and persistent
But be careful and you know best when to seek Medical Treatment. Sweating comes with the heart under stress.
I had a stroke (mild embolic left frontal lobe), with AF first diagnosed, carotid arteries were clear but a shadow ion thyroid was diagnosed as Papillary cancer which was in both lobes and 2 of the removed right lymph nodes.
So the thyroid problem caused the AF which caused the stroke.
It hasnt reverted. I was diagnosed of having a soft systollic heart murmur 4 weeks ago. Stroke Sept 2019, Thyroidectomy Feb 2020. CCB Diltiazem controlled the H/R.
cheri. JOY. 73. (NZ)
Brother Thomas, flippin hec I would be there all the time,,! My EP who is a top professor tells me to sit out the episodes no matter how long unless I feel very unwell or get breathless, chest pains. If you go to A & E they often just link you to machines and monitor you which caused more anxiety which increases heart rate, vicious circle
Hi Karendeena, I neglected to mention that I was told the same by a GP. However, I've only ever been to hospital once with cardiac symptoms, after calling 111, and I am absolutely convinced that hat was down to being put on two different calcium channel blockers. Whilst I was in there, I was told by the duty cardiologist that, if it happened again, I should call an ambulance rather than go through 111. I had to do that about 2 weeks later, but the symptoms abated whilst the ambulance crew were with me, so I didn't actually go to A&E. Although it's been about 5 years since I was diagnosed with AF, apart from these two incidents, I've always had no significant symptoms, but I have some slender evidence that my resting heart rate goes from its normal 55-65 to 75-85 heart during an attack. Apart from that and I'm not convinced it's correct, I have no symptoms when in AF.
Hi again Brother Thomas, you are so lucky not to be too symptomatic, it scares the life out of me as my heart rate climbs to over 150 bpm and can stay that way for over 24 hours often longer. At the moment I'm getting attacks like this about 3 times a year, in fact I think my heart as a clock because they do come almost to the date every 4 months! I am told that like.''jackin the box" the more episodes I get the more I will get them, they make me feel
yes, I do consider myself lucky not to suffer some of the extreme symptoms that many people write about on this forum. However, it is something of a double-edged sword in that it appears that I must have had the condition for several years before diagnosis. The diagnosis was made completely by accident when, on a routine check with my GP, I asked for my blood pressure to be measure the "old fashioned way" as I'd previously had problems with the automatic device. The Dr. felt the irregular pulse and from there on in it was tests to confirm AF. The reason I say that being asymptomatic is a double-edged sword is that the result of having the condition undiagnosed for some time has left me with an enlarged Left Atrium and ischemic changes to my heart elsewhere. There was also some indication of blood leaking from my heart, although this seems to have stopped. There's also the increased risk of a stroke that we're all aware of, which in my case, I was unaware of until diagnosis. Bottom line is though that I'd rather be asymptomatic despite the damage to my heart.
Hope everything resolves soon and you feel better. Best wishes.
hi
so you are taking flecanide without a betablocker ( such as bisoprolol)?
Flecanide on its own can trigger another arrthymia,Atrial Flutter,as it did for me. This is always a very fast rate.
Flecanide will have no real effect on that. If it is Flutter it is easy to spot on an ecg,and the best option is ablation,with 95/99 % success.
best wishes
Hi Wilsond, I am taking 1.25mg Bisoporal 1 a day, Flecinide 2 x day 1 morning and 1 evening. I also take Apixaban twice a day. I definitely have Atrial Fibrillation. My cardiologist has mentioned ablation, but waiting for echocardiogram which has a 3 month wait and then wait again for a face to face consultation. But I am going to try and contact him. As this episode was really awful. and tbh it frightened me. Thank you for responding
Hi there
Ironically, I am currently sitting in A&E having had the same predicament as you - to go or not to go? I went into AF at 1am. Took Flecainide 100mg at 1.30am. This is the first time I have needed to take Flec since having it prescribed as PIP in July (PAF diagnosed 2019 and I'm also on 7.5mg Bisoprolol and Rivaroxaban). Like many others, I decided to sit it out at home because I felt OK. No nasty symptoms. HR was around the 150-160 mark. After 6 hours, and no change, I called 111 and they wanted me to go to A&E to get checked out. Once at hospital I was triaged within the hour and hooked up to ECG - you guessed it - back in NSR with no medical intervention required. However, the lovely doctor who dealt with me said that, going forward, if I am still in AF one hour after taking Flec, get myself to A&E. I'm waiting on bloods before they will discharge me but I won't hesitate to get here in future as per their advice. I hate the thought of taking up a bed but I also think that, psychologically, the fact I was here might have reduced the stress and anxiety and had an effect on my HR. I won't know until next time, and we can guarantee there will be a next time unfortunately. Hope you are feeling better. All the best.
Hi Sputnik56, I do hope your blood tests are clear and you can get home soon. Yes it is an awful predicament to be in, and tbh it is worrying, which then affects the rate etc. like you I didn't want to take up a bed, but at the same time thought what if it doesn't go back into NSR. It's so typical that it goes NSR in hospital, took 2 years for them to catch mine before they officially diagnosed me with AF. I haven't taken Felcinide as a PIP yet but will try on the next one, as you say we both know there will be a next one, unfortunately 
6 hours seems a long time to sit and wait, not sure I would wait that long. I had awful symptons, couldn't talk properly, sweating, dizzy, had tingling and tightness up my neck into my mouth and tongue, on the right side, but on way to hospital went for the first time to my left side, which honestly frightened me. But all clear thank goodness. Hope you are home soon, and can sit and relax to get over this awful episode. best wishes
My heart rate can stay racing at that rate for up to 48 hours, horrible, but still sit it out!
Hi. My experience is that I was put on Flec to control my Flutter, both as a 2 x daily and PIP. This first prescribed by locus cardiologist seen following A&E diagnosis. Subsequently by consultant cardiologist expressed his dislike for Flec but kept me on it as seemed to be working without -ve impact. Post 2nd Ablation I developed PAF though episodes reducing and now every 3 months. Still on Flec 50mg 2 x daily, no Beta Blocker.
I agree John. Flecanaide gave me other arrhythmias. I couldn’t take it except it worked like a charm as a PIP.
Hi
You are not controlled yet.
What is your BP?
How much Bisoprolol? You can have up to 10mg.
I wasnt controlled on Metroprolol or Bisoprolol.
Went to PRIVATE SPECIALIST who introduced CCB a Calcium Channel Blocker.
Now take 120mg Diltiazem am and 2.5mg Bisoprolol at night.
Although I have a day avge HR of 77-88 my night rate remains at 47.
If your BP is over 155/95 I'd ring your emmergency number.
I have a St John's alarm at home.
I guess you are sweating profusely with no energy?
What is your AF caused by? Are you anxieus?
We need more info before we can suggest anything. But BP is raised in early morning.
Cheers Joye 73. (NZ)
Go immediately to your emergency room … don’t play games with this condition … deep breathing techniques on the way to emergency if you like. Feel better. Jan
Hi janith, my EP would disagree, in his words "This is not life threatening" sit it out as you are medicated (with an anticoagulant as well) so the real risk of a stroke is dramatically reduced He really is a top EP in the UK and pioneers robotic ablation)
lrregardless of what your EP thinks … when l go into afib … l pack my bag and off l go to our emergency room … l am highly symptomatic and l could never ever sit there and wait it out … ever. I go into the emergency room. They immediately medicate me and it goes away in a matter of one to two hours. It’s comforting that it isn’t a life threatening condition … however, when in the middle of an attack, l feel as thought my life is being threatened and it terrifies me. Thank you. (Nor would l ever have an ablation … ever!) l appreciate being in a hospital setting, being monitored with their sophisticated equipment and the safety of their doctors and nurses. Cheers.
why never an Ablation?
l don’t trust the process … my afib condition, although terrifying … isn’t bad enough to warrant an ablation … cardio version yes … ablation no.
Have the episodes been regular or is there any sign of them getting more frequent? If consistent, that’s good and supports continuing as is, however if getting more frequent, you may have to increase / change medication or consider alternative. It took 2 ablations to sort my flutter. I found it quite straightforward and with the comfort of hindsight, the right thing to do. No guarantee though. Hope all continues good with you.
Hi Janith, I know how you feel as I am highly symptomatic too. Having said that being hooked up to bleeping machines sends my anxiety into overdrive! Waiting in A & E is too long and often makes me worse. My partner was taken to hospital today with a dangerously low BP having been released a couple of weeks ago after a severe infection, he has also had 2 heart attacks and he waited on the ambulance for 5 hours before being admitted!
Well, l’m in the US … Things may be quite different here … when l went to a doctor when l was in Europe … it felt very different than what l am accustomed to here … we get IMMEDIATE attention … and it is more of an adventure rather than torture … l love being hooked up because l want to know precisely what my heart is doing at all times … l don’t like mysteries … Best, Jan
according to what I’ve been told you should already be at the ER. I just had a cardioversion on Friday I have been running in the 150s since the end of April and wasn’t addressed because of a problem with my doctor. Anyway wow did I get lectured. Before I left the hospital Friday they went over the list of anything that I feel that I am to call my doctor if he’s not available go right to the ER. They are things that I have lived with since the end of April. I was a ticking time bomb evidently and obviously God protect me I certainly wasn’t helping myself. They all say the same thing don’t wait it’s better for them to send you home than you waiting before you go. I wonder how many of us are ignoring the signs and symptoms that should put us at the hospital? As I said I ignored them I think most of us get so used to feeling awful that this is what we do. Please if you can’t get your doctor go to the hospital ASAP
Were you medicated and have paroxysmal afib? If so I would sit it out unless breathless or chest pains, inevitably you will revert to NSR eventually if your afib is paroxysmal
Get to the hospital ASAP. My heart rate in afib is usually 130s-150s, and I don't wait more than an hour or two to call paramedics to be taken to hospital.
were you advised to do this? Are you in the UK?
Yes, I have been advised to do this by my cardilogist, and, no, I live in the US.
You would struggle to be seen herein the UK it's appalling. Waiting times in the nearest hospital to me was 23 hours yesterday and my partner was taken by ambulance today and was still in the ambulance waiting to be admitted for 5 hours and he has had 2 heart attacks previously
Hi youngest, I would contact my EP or cardiologist. I get episodes like this and mine go on for over 30 hours sometimes 48 hours. I am on sotalol (Flecainide caused me to have more arrythmias). I have been told unless you are breathless, extreme dizziness, pains in the chest or feel very unwell then sit it out, which is what I do even though,like you, I feel terrible and exhausted afterwards. I eventually slow down and heart goes back to NSR
UPDATE
Hi Guys thank you for all your input and messages. It's interesting to see how it affects everyone in a different way, and how it is treated, and what each of us has been told.
I chased my cardiologist and managed to get through to his secretary, who emailed him. He said I was to stop Flecinide immediately (although I will probably try it when i get my next AF episode as a PIP). I have an echocardiogram on Monday and have been put as urgent for a face to face consultation, but they said it still may be Dec or Jan. I have stopped the flecinide and already I can feel such a difference in my breathlessness and tightness across my chest and throat, and I'm not coughing as much and it's only been a day! Again thank you all so much for replying to my post, I really appreciate it.
If you have been told to stop flecainide you should STOP IT.
Your EP/ cardiologist may say in the future that you can use it as a PIP , but await his/her advice. Dosage is also different when used as PIP as opposed to daily.
Flecainide can be a very dangerous drug for some people.
Best wishes
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