What are the first steps medically for AF

[JMF1]

BACK AGAIN TO HOSPITAL AFTER EXPERIENCING ANOTHER AF EPISODE. HAD TWO ECGS NOTHING SHOWED UP AND ON THIRD THEY CAPTURED AN IRREGULAR RATE AND ONLY ONE BEFORE GOING BACK TO NORMAL RATE. GIVEN SCRIPT FOR THREE DAY COURSE OF MEDS NOT SURE WHAT THE NAME IS AS HUSBAND DROPPED IT IN PHARMACY AND THEY HAVE TO ORDER IT IN, COULD NOT TAKE MUCH IN HAVING BEEN IN THE HOSPITAL NEARLY EIGHT HOURS AND TOTALLY EXHAUSTED. JUST HOPE THIS HELPS - DIAGNOSIS INTERMITTENT AF, THANK YOU ALL FOR YOUR SUPPORT.

[Buzby62]

Hi intermittent AF is called Paroxysmal AF, often abbreviated to PAF on here. It can be really difficult to capture for some. I only had one episode captured officially at my GP surgery but recorded more than 40 episodes in that time on my Apple Watch. There’s lots to take in and learn when first diagnosed, I suggest reading the AF fact file to start with here api.heartrhythmalliance.org...

Further reading on the following link.

heartrhythmalliance.org/afa...

Knowledge is power as we say on here.

Best wishes

[SamAdmin Administrator Arrhythmia Alliance AF Association]

Good morning JMF1

Thank you for your post on the Atrial Fibrillation support forum.

We hope the medication starts to help soon and you start to feel better, if you would like any information on AF please use the link below.

heartrhythmalliance.org/afa...

Kind regards

SamAdmin

[Teresa156]

Hi JMF1,

Now you have been diagnosed with paroxysmal AF, it should be in your medical records as such. This means, as Busby says, that your AF will come and go. It might be worth looking to see if anything specific that you are eating, or doing may be triggering it, but we can drive ourselves mad, trying to find triggers.

It’s strange that you’ve been given medication for just three days. Would be interesting to know what they have prescribed. Not sure how old you are, but once you are 65 ( and being female) anticoagulants are also recommended.

What should happen now is that you should be referred to a cardiology unit, who in time will probably give you a monitor to wear for a few days to see what your heart is doing. You should also get to have an echo cardiogram, which is a scan of your heart ( painless and doesn’t take long) and then a cardiologist ‘should’ discuss next steps with you and how best to manage this condition.

If you don’t hear anything, or struggle to control any further episodes, it would be worth seeing your GP, for further guidance, especially with rate control, or what best to do during an episode. You seem to be very panicky when in Afib. You really don’t need to go to A&E if you think you are in Afib again, unless in pain, or HR extremely high or if you are excessively worried or you don’t go back to a normal rythm after a while. Your GP should be able to advise on what best to do.

You say that your HR has been very high, do you know what it gets to? It’s not unusual in Afib and is not life threatening.

[mav7]

JMF1 Good advice by Teresa. A heart monitor worn for an extended period will provide detailed evaluation.

referred to a cardiology unit, who in time will probably give you a monitor to wear for a few days to see what your heart is doing

[JOY2THEWORLD49]

Hi

I had a heart eate of 185avg (no stress) gor 1 year 3 mths persistent AF and diagnosed with Rapid Af abd Thyroid Cancer discovered and I never went to ED.

May be I should have but with a little dog at home and didn't know anything but that I did not want the Metoprlol and said,I finally asked for a Heart Specialist. Monitoring proved 186bpm Day and 47bpm Night with pauses.

But that H/Spec changed me and did another Heart Monitor and left me @ 156 uncontrolled.

They haven't got it right.

I was discharged after Thyroidectomy 4 months later from Stroke with H/Rate 134.

No one followed it up.

Surely a Stroke requires a followup and more so with rapid and persistent AF. I could do no exertion. Breathless.

I don't accept the long delay in controlling my heart rate day.

Damage of my heart was caused ultimately by leaving me.

But A&E aren't the best Drs to control you and Heart Specialists should. That's their role.

It was a private H/Specialist who was interested in me who introduced CCB Diltiazem and 120mg (less than 1/2 full dose was enough).

For 2.1/2 years I've been on the same meds regime. CCB am and BB Bisoprolol 2.5mg PM.

cheri JOY. 75. (NZ)

[GoodHearty]

Hi. As part of the investigation by the cardiologist you will have a echo scan done to check the structure of the heart and as long as that is positive with a good EF (ejection fraction, the amount of blood being forced out by the ventricle) then it’s a case of getting to know your new friend Af and living with it - plenty of information as cited by Buzby and others above.

My personal experience- ensure you have adequate levels of magnesium and other minerals like potassium, iron, zinc etc that are all good for normal function of the heart. Lookup videos on YT from Dr Sanjay Gupta, best source of information about Af and other heart conditions who will explain it in a sympathetic manner that district hospital cardio’s don’t have time to do sadly.

Best.

[Mismerswe in reply to GoodHearty]

I have other issues (kidney transplant) apart from Afib but I find both magnesium and potassium supplements do help with Afib but again I have regular renal blood tests which includes magnesium and potassium testing so I don't overdo the levels.

[Vonnegut]

We have all been through similar experiences but have found that we are all different and have found help through different drugs and procedures. The best advice I received was from an EP I saw privately, found through the AFA website after the lowest dose of a beta blocker proved too much for me to take daily, was to get a Kardia (and a smart phone so I could use it and the app) so that I could track my episodes of AF and then take Flecainide, which he prescribed, as a pip ( pill in pocket) when needed, to stop them. Now that I take it regularly, it has virtually put an end to my AF episodes (and my smart phone has become a fun companion!)

And I had an ecg a month or so after I finally got a diagnosis, which showed my heart was structurally fine.

[Ppiman]

Hi and welcome. Can you remember what feelings or symptoms made you feel the need to go to hospital? It's unusual to need this with atrial fibrillation unless:

- you collapsed or felt that you might

- the episode lasted for many hours

- your heart rate was uncomfortably fast (people vary, but I find 150-180bpm too much)

- your blood pressure went too low and you felt breathless

I have only been twice to hospital and that was the first time I had this when I was told by a GP to go; and the second was after a procedure called an ablation when I had a bad relapse and felt too ill (looking back this was likely anxiety and fear) as, once I was reassured by a specialist, and given a dose of a beta blocker called bisoprolol (5mg), my heart calmed down and I went home.

Finally, what you have developed is an illness in the top part of your heart (i.e. the part called the atrium, split into two atria, left and right). The electrical pathways here can now suddenly, and usually temporarily, change from beating regularly to beating with a chaotic shivering called "fibrillation". This stops them sending the normal signal to the bottom of the heart, the important pumping chambers called the ventricles. These, instead are forced to beat differently, but almost always (unless diseased themselves) still well enough until the fibrillation stops, or. if this is permanent, they become used to it happening. They usually respond by beating irregularly and too quickly.

The effect varies by individual, and is often made much worse - sometimes very much so - by feelings of fear and anxiety. Most people soon find they can live with the condition and sit it out (as I do), or even live normally (as a 90-year-old friend does).

Treatment is usually aimed at stopping the racing using a beta-blocker tablet. Tests include an echo-cardiogram to be sure the bottom chambers are healthy, among other things.

The chances are you will have repeat episodes, and sometime these merge to become permanent (as with my fiend). people search for "triggers" but the evidence seems to be against these.

People with this are more likely to have other conditions:

- obesity (which stretches and enlarges the heart a little, making it prone to arrhythmias like AF)

- high blood pressure (which does the same as well as causing other important changes)

- sleep disturbance called obstructive sleep apnoea

- thyroid issues

- insulin issues (e.g. diabetes)

Steve

[lizzieloo2]

Hi. I will be 70 this year and was diagnosed with paroxysmal AF about 10 or so years ago. The first time it happened, it woke me about 1.00am with my heart jumping all over the place and I felt lightheaded and sick. After several hours, I managed to go back to sleep and when I woke up I was back to normal. I went to see my GP that day and she said it sounds like AF but was not life-threatening but to go straight to A&E or call an ambulance if it happened again. She referred me to a GP with a cardiology specialism and he carried out an echogram, ultrasound and put me on warfarin. I went to A&E several times to begin with with a heart rate of 150 or more and they increased my Diltiazem (which I took for BP at the time) from 240mg to 300mg per day. I was then referred to an EP (electrophysicist) cardiology consultant who carried out all sorts of tests, echo, ecg, nuclear medicine test and finally an angiogram which told him that the AF was not caused by anything physical so he put it down to stress. I was working in oncology in the NHS at the time and I was stressed and overworked so was not surprised at this. I also found that overdoing the wine, overdoing it per se and being overtired brought on an episode but everyone has different triggers. I didn't bother with A&E after the first few episodes and was given a PIP (pill in the pocket) tablet called Flecainide 100mg to take when an episode came on. This worked fine for years but as the condition is progressive, the episodes became more frequent from every 9 months to a year at the start to eventually every week. At this point I asked to go on the waiting list for an ablation (I was offered this quite early on but didn't fancy it) and I had this procedure last August. I have had episodes since but minor and short-lived and they go on their own as I no longer take Flecainide. I don't worry about AF now and you will learn to live with it after a while. Take care

[manabouttown]

The best way to capture an episode of PAF is to use a Kardia Mobile device that connects to the Kardis app on your phone. The Kardia device does an ECG for 30 seconds.The 6 lead Kardia is much better than the single.

You can then print out your scan and/or send it to your Cardiologist . The Kardia app save all your ECGs as well.

Just google Kardia Mobile and is explained.