AF for 4 days

[GardenLover2]

I had my first episode of AF several years ago. I had another cope of episodes over a three or four year period. In January this year 2023 I was started on Apixaban but changed to Edoxaban a week ago because my blood pressure was low and I thought it was the reason for feeling tired. 4 days ago I went into AF and been in AF ever since. My blood pressure is very 74/57 one day and I feel extremely tired most of the time. I am a 66 year female.

[CDreamer]

Have you spoken to your GP? What is your HR? BP can be variable in AF so it’s difficult to get an accurate reading but if it stays at those numbers that wouldn’t be good. Apart from tiredness, any other symptoms?

Don’t hesitate to ring 111 if you feel ill or 999 if you feel faint or have chest pain. Meantime sip electrolyte drink, keep up the fluids & keep feet higher than heart.

Have you seen a specialist? Any drugs to control Heart rate?

Hope you revert to NSR very soon.

Best wishes

[GardenLover2 in reply to CDreamer]

Thank you for responding, and for the advice on hydration. My HR is between 60-80 on my blood pressure monitor, and between 40-140 on my Fitbit and Kardia ECG monitor. My GP says the blood pressure monitor would be the most accurate. The GP talked about a Atrial Pulse which would be fast and a Ventricular Rate which would be slower. I am on Bisoprolol 1.25mg twice a day, and Fludrocortisone to raise my blood pressure.

[mjames1 in reply to GardenLover2]

Sorry what's going on, but the way you are feeling can be quite normal as you're in afib.

Your GP is incorrect about computing HR and may not be that familiar with Kardia.

The most accurate way to compute your HR is by ekg, which the Kardia will generate. If you manually count the QRS complexes on Kardia's 30 second tracing and multiple by 2, that will be your HR. Kardia will also compute it automatically for you and I find it to be quite accurate, but a good idea to double check by manual counting.

If possible, you will want to see either a cardiologist or electrophysiologist (ep). The latter specialize in arrhythmia's like afib. Maybe you can ask your GP for a referral. The goal ideally is to get you back into normal rhythm as soon as possible and come up with a plan to keep you there.

But in the meantime, you want your rate controlled. 140 bpm is not a controlled rate. So maybe email your GP the Kardia ekg to show them what your actual rate is so they will be working off of correct information.

Feel better.

Jim

[GardenLover2 in reply to mjames1]

Thanks Jim for responding, that is very helpful and good advice. I will speak to my GP on Monday and ask for a review. This morning OMRON X7 reading 88/65 HR78, Kardia HR 81, Fitbit HR range 41-137. All three devices say Possible AF.

[CDreamer in reply to GardenLover2]

I agree with that you need a referral not only to an EP but one with specialist knowledge of dealing with low BP. I am really surprised that your GP prescribed Fludrocortisone unless you have a confirmed diagnosis of Addisons’ Disease?

May I suggest that you look at the STARS website and contact an EP on their list or find an EP who has specialist knowledge of dealing with people with very low BP

heartrhythmalliance.org/sta...

I went to the Patients’ Day in 2020 and I have to say learned so much about this condition, many people attending were really struggling and not able to stay upright without fainting. That happened to me only once for about 3 days. Not a pleasant syndrome. I now have a very steady BP at 115/75 since pacemaker implant.

Hope that helps.

[GardenLover2 in reply to CDreamer]

Thank you for responding, and for the very helpful information you have shared. I felt faint while in AF too, and it is not pleasant. I thankfully came out of AF on Sunday evening, and have been feeling well since. My BP is 96/63 HR 65. I am pleased to hear you BP is normal.

[Hidden]

I’m not medically trained but as I understand it, anticoagulants do not tend to affect blood pressure. I also understand that some surgeries are encouraging their AF patients to swop Apixaban for Edoxaban using a variety of different reasons to justify the change, which is most likely due cost reasons and I guess there is nothing wrong with that. However, although it’s probably coincidental, it’s a bit surprising that your burden of AF has changed, so if I were you, I would be talking to my surgery and seeking a return to Apixaban which I believe you have a right to pursue. As has been said, it’s virtually impossible to obtain accurate blood pressure readings on a home monitor but if your readings are consistently low or you feel faint or have chest pains, then as CD says, you really should seek proper medical advice asap.

It’s normally Beta Blockers or Calcium Channel Blockers which impact on blood pressure but we cannot advise on medication. If you taking this medication and you call 111 or speak to any medic unaware of you medication, please make sure you tell them what you are taking and how much….

[GardenLover2 in reply to Hidden]

Thank you for responding. I had heard that Edoxaban is a cheaper drug than Apixaban.

[Jalia]

You should seek proper medical advice with the figures you have given. The Kardia device is known to be accurate and indeed is used by the medical profession.

[GardenLover2 in reply to Jalia]

Thank you for responding Jalia, I agree I need specialist advice.

[BenHall1]

Hiya GardenLover,

I was diagnosed with paroxysmal AF along with the tendency to be asymptomatic in Jan. 2010. Back in the day my daytime BP was 136/80 ish. The day AF mugged me I had No!, None, Zilch cardiac symptoms at all .... just felt I was going down with flu ! Then I started to feel real crap and my BP dropped suddenly to 76/50 ish. My GP sent me to A & E where I was diagnosed with AF and kept in for 5 days for tests and to get a medication plan sorted,

I would not agree with your GP, a Kardia device would be the thing I'd take notice of, for sure. Your BP readings ? what device are you using to record your blood pressure readings ..... The only thing that would give an accurate BP reading would be one in GP's surgery or one you buy yourself, an Omron or another reputable brand recommended by NICE. My personal view is that the anticoagulants you mention, Apixaban and Edoxaban would not likely cause your BP issues. However, a good old hit of AF would and I feel if you can get to A & E pronto or at least get someone medically trained to get an proper ECG done, a paramedic crew should be able to sort that in your home of you give them a call.

hope all goes well for you.

John

[GardenLover2 in reply to BenHall1]

Thanks for your reply John. The BP I have is an OMRON X7. My BP this morning is 88/65 HR78, Kardia HR 81, Fitbit range 41-137. I will ask my GP for a cardiology review I think, or get emergency treatment if I feel faint. It’s very scary as you know. Thank you for your good wishes.

[Ppiman]

You might, naturally enough, be connecting things that aren't related. That's what I do. The anticoagulant would not, to my knowledge, affect blood pressure. Edoxaban is currently the NHS preferred drug for AF.

Your blood pressure is low as 90/60 is considered the lowest normal pressure; I guess it likely would make you tired and perhaps dizzy on standing? Do you find drinking plenty of fluid helps? My daughter-in-law also has low blood pressure, which runs in her family, and that's her secret to helping, although at times, it doesn't and she just copes (as a nurse), sometimes warning her colleagues and sitting down and wait things out. I recall reading once when I worked in the pharmaceutical industry dealing with blood pressure, that in the UK doctors generally don't treat hypotension, whereas in Germany, they do. I'm not sure how, though!

What does your doctor say about it?

Steve

[GardenLover2 in reply to Ppiman]

Hi Steve, thank you for responding. y GP said that having low blood pressure is not a problem and in fact would mean I would live longer. However, because I was having symptoms of dizziness, weakness, lightheadedness and fatigue he prescribed Fludrocortazone. I am feeling much better today. Blood pressure 88/65 this morning. I’m still in AF.

[Ppiman in reply to GardenLover2]

I think there's something in that remark but low blood pressure can lead to more falls, and they are the number one cause of problems as old age comes on. I think hypertension is the biggest killer overall in the way it contributes to so much else (including AF, of course).

The steroid you've been given seems to work by increasing sodium levels, which is similar to taking in more salt.

Steve

[GardenLover2 in reply to Ppiman]

Thank you for your reply. I am now in normal rhythm, after being in AF for 5 days. BP 96/63 HR65. I am feeling much better. I stopped taking the steroids.

[Ppiman in reply to GardenLover2]

That’s good to read. If your heart is anything like mine it can go months in a calmer state with no AF but plenty of palpitations, then… wham. Bisoprolol daily (1.25mg) this past few months has seemed to help keep the AF at bay, although it might just be a calmer period.

Steve

[GardenLover2 in reply to Ppiman]

I am on Bisoprolol 1.25mg twice a day. I was Bisoprolol just when I needed it when I went into AF. Not sure what the doctor will suggest now after this 5 day episode of AF. My blood pressure is 92/63 HR62. I hope it doesn’t keep dropping further as I don’t want to take the steroids that the doctor prescribed.

[Ppiman in reply to GardenLover2]

So many tablets. I’m amazed what I take, 4 a day for my AF, 1 for cholesterol, 2 for enlarged prostate,

Steve

[Singwell]

In case this is of use. Ppman has mentioned that the steroids you're taking for hypotension increase your sodium levels. But according to my understanding this would be bad news for the AF. This is why I think CDreamer gives good advice -an EP who is experienced in working with those who get syncope (fainting) and/or who have low blood pressure. Both factors need to be taken into account.

[GardenLover2 in reply to Singwell]

I was not keen on taking the steroids and have stopped them. Bp 96/63 HR 65. I came out of AF after 5 days. Feeling much better. Thank you for responding.