I had an appointment yesterday to discuss results of recent echo. Was seen by a specialist (can’t remember official title) who is a level below cardiologist - apparently does all the ground work and liases with cardiologist. He advised that as well as afib, I now have 2 slightly leaky valves and also a part of the heart that isn’t “squeezing” properly. He says he is not concerned at all and no treatment is required.
Heart still racing despite trying Diltiazem and then Bisoprolol, which I don’t tolerate very well. Bisoprolol now reduced from 5ml to 2.5ml, and added Digoxin 125ml. I had the loading doze of digoxin (4 x 250ml tablets) yesterday and it does seem to have brought heart rate down, so fingers crossed.
My concern is that I have now been signed off by cardiology- don’t need to be seen again. I feel that I have just been left to get on with things and would have thought at least an annual check would be in order. One way of getting the lists down I suppose !
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Puzzled8
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Hi Buffafly, only been a couple of days on digoxin. So far hr isn’t going above 100 very often, mostly mid 80s, which is a massive improvement already.
That all sounds most unsatisfactory. Could your GP interpret the findings for you. They will get a letter from the hospital in time and may be able to advise. A second opinion from a different hospital may be wise, ask your GP. Best wishes.
Thank you meadfoot. I’m hoping GP or pharmacist will contact me once they have hospital letter, but I’m not too hopeful on that score either ! It just means I won’t feel guilty in the future if I have to go to A&E, as Cardiology have created this situation. In one breath I was told they would need to get heart rate down otherwise damage to heart could get worse, then in next breath that they weren’t concerned and didn’t need to see me again !!!
As you have a number of things going on you can try telling them you would prefer to stay on their list and have an annual review rather than being signed off. I did this and my cardiologist was absolutely fine with that.
The problem with being signed off is if you do have a problem and your GP refers you again it’s back to the bottom of the waiting list which isn’t ideal.
Yes, you’re right bantam12. Just didn’t think at the time as I was a bit taken aback . I was told in one breath that they need to get the heart rate down to stop heart damage getting any worse, then in next breath that they are not concerned and don’t need to see me again. Definitely a list cutting measure. I might take it up with PALS.
This is happening a lot, reducing lists I am guessing, as I am the same, however if you continue with 'problems' your GP can refer you again to the Cardiologist and his team.
Yes opal11uk, I am learning now that it is happening a lot. Definitely to reduce lists in my opinion. No wonder so many people end up in A&E. Being re-referred can involve a lengthy wait.
Last year I had a very bad summer with persistent AF so when I had a phone consult with a cardiologist well after the event and he proposed discharging me I pushed back and said that as this is a yearly problem I didn’t want to be discharged so he agreed that he would phone me in summer and if I had concerns before that I could phone cardiology direct. I recently had an ‘event’ which landed me in A&E with a new heart condition and my GP formally referred me - my ftf appt is on 30 October! But the covering letter gave a ‘standard waiting time’ which might be varied either way at their discretion. So waiting times not set in stone and I am reassured that they don’t think my case is urgent …..
Exactly, then you don't become another statistic on their waiting lists however this must never deter you from seeking further treatment and investigations, we have to be pro-active in order to maintain our health, so return to the GP and ask for a referral as and when you feel there is a need, admittedly you will then join a waiting list but with persistence you can move things along yourself. Positive thinking in all things, don't let the blighters grind you down......you matter!
Update: I had a call this morning from Cardiology, ‘You have an appointment for October but our doctors would like to see you sooner. Can you come tomorrow morning?’
Wow, that was quick lol, well don't read anything into it, they probably had a cancellation and phoned many before you, its for their convenience. Good luck with your consultation x
Sorry to hear that you’ve been discharged. Would have thought with leaking valves you would require regular ECHOs to review.
It’s okay getting GP to re refer but in our area it’s a 52 week wait for cardiology!
Push for a letter re this consultation, find out your echo results and get GP to interpret all of it for you. You can then decide if you’re okay being discharged (which obviously can be good news) or not.
Great advice, Hosta-Lover. Will try to get copy of letter(that in itself will be a battle 😄) I’m in Scotland and we don’t have online access to any of our test results.
It was only in hindsight that I started to question what had been said at the appointment- I.e. that they need to get HR down to avoid any further damage to heart, but they weren’t concerned and didn’t need to see me again !! Maybe could have been worded better.
I will be more than happy if it is the correct decision but still feel it is a list cutting excercise.
Me too. I have been discharged as a outpatient. I said what happened if there are better meds, research for changes etc. Well we are happy with your progress and you are now on controlled wel for both rapid heart rate amd hyper tension especially in the systolic BO level. Yu have recently been diagnosed with a soft systolic heart murmur.
He emphasied that there were folks with new diagnosis who need to be seen too. So some drop off due to work load. Your Dr can also refer you back to us.
The state of the Health Services are as bad in New Zealand.
Its the state of the nation.
They untreated me from the stroke, with AF and thyroid Cancer actually the cancer is somehow kept a careful eye on rather than the heart.
Hi cheriJOY, thanks for your reply. Sorry that you’re going through so much at the moment. Your situation with your heart does sound very similar to my experience. It’s ok saying you can always be referred back, but that can involve a lengthy wait. It’s no wonder so many people end up at A&E.
I didn’t realise things were as bad in NZ (I have relatives in Auckland). Here in the UK we tend to think we are in a worse state than anywhere else, but it seems to be the way of the world now.
Hi Puzzled, seems strange to be signed off. I started with AF about 10 yrs ago and was seen every year by cardiology. To combat AF I've had 3 cardioversions and 3 ablations., all needed cardiology's say so. By having regular checks, scans etc my leaking valves were monitored and in 2021, aged 71, I was told I needed valves repaired, had open heart surgery in Dec 21. One of the triggers for being seen seemed to be when my GP knew I'd gone back into persistent AF he'd let cardiology know. I think once you get your letter you may need to make a fuss. Leaky heart valves generally get worse as we age and so these need to be watched. Good luck
You can be reassured that if anything changes, your GP will look after you well. If you feel otherwise, then a private appointment (£200) might later be worthwhile but I’d be surprised.
The NHS is far and away from how good it was a decade or so ago, but I would say your treatment has been safe and satisfactory. GPs have a lot of training and experience in arrhythmia treatment. I suspect some here will disagree with me but I have good reasons to feel confident about this.
Try not to add extra worry to your situation. Your AF will settle and the small changes the senior registrar you saw told you about are not welcome to hear but are not that unusual as we age.
I beg to differ. GPS rely on med setting by Heart Specialists and only if necessary GPs will put the Med given by specialists up and down only.
They do not add new meds or remove them.
For a start after my stroke with aF I had an Endoencrinlogist prescribing me meds. I said NO to Metoprolol re histry breathless but she over rode and prescribed 3 x 24.75mg and stated in my report that I could reduce the total dose. I got to choose PRADAXA x twice day.
But with no followup by transferring minor hospital, I struggled for 1 year 4 months until I asked for a heart Specialist. For those months the 24hr monitor put me at186 and I was unable to exert myself. I collapsed into bed and slept. Also shoed pauses with avg 47 bpm Night.
Damage is surely done for all those months without care of me.
So now I advocate for myself to get attention.
Control f Heart Rate and BP should be at the foremost importance.
By putting me into the hard basket was not being responsible
A Locum referred me to a wellknown private heart specialist
who tried me on CCB Calcium ChannelBlockers which solved the rapid Heart Rate - thank goodness.
cheri JOY. 75. (NZ)
I will not know if my slightly leaky value gets any worse. I will demand an ECHO every 2-3 years. My excuse for the 2023 ECHO was that my Orthopaedic surgeon wants an uptodate report on my heart.
My reply was intended to give the general case for most people in the UK, and to be confusing. I still believe it to be generally the case. Special cases do get special treatment (or can slip through the net).
Hi Ppiman, thanks for your response. I admire your faith in my GP, but unfortunately I can’t share it. I am not panicking or unduly worrying over my situation, but it would be nice to know that at some point down the line, someone would check on the efficacy of the Digoxin. When the registrar states that they need to get the heart rate down to prevent further damage to the heart, then tells you that no further appointments are necessary, it just strikes me as a bit odd.
My GP practice ranked 10th from the bottom for patient satisfaction last year, out of approximately 320 practices. The partners decided to resign and the only other Drs that could be found to take over, ranked 4th from the bottom !!
Sorry if I missed reading that about your GP practice before I replied. That was new to me.
In general, my response was to reassure you and to say what I thought might have been the thinking process of the senior registrar you saw. He seems to have prescribed drugs following a standard NICE protocol and these should help (insofar as drugs can. Ablation is another possible treatment).
Digoxin requires vigilance but, at a low dose, I gather it is unusual to be problematic. It worked well for me when my atrial flutter caused persistent fast tachycardia in 2019.
In terms of "further damage" then the doctor means weakening of the left ventricle and valves that prolonged tachycardia can cause. The digoxin should stop this in its tracks. .
Hi again, Thanks for clarifying and for the further helpful information. It is appreciated. Bit early to tell how well digoxin will work, but the numbers are going in the right direction so far. No side effects that I’m aware of so far either. Hopefully I’m on the right track now.
I have been discharged twice by Cardio, This happens when you are usually stable.
But, AF is a bit unpredictable, so I have been under another new Cardio who referred me to an EP in Oct 2022 with ablation last year as the AF became daily, and was put on Flecainide. My rate couldn't be controlled when in AF.
If you get admitted to A&E again you may get to see another Cardiologist.
GP's seem to be doing alot more monitoring nowadays and it was my GP's who put me on Apixaban after a NICE push to get people on them, as I was borderline for them
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Follow up appointment...
EP Appointment tomorrow
AF again and long wait for appointment. 
Outpatient Appointments 
AF or flutter? Stress test and more.
