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Hi everyone, I have had diagnosed afib for about 5 years now and am on Bisoprolol and Apixaban. Lately my symptoms have got much worse and I have had five attacks since the end of Jan, with my Heart Rate sometimes reaching 140bpm. The attacks last about four hours and then for the next couple of days my Heart Rate plummets to about 52bpm.I asked the Doctor about seeing a Cardiologist but she said you don't need to see one with afib. I wonder if this is the case.
Thankyou, Jenny
Change your GP! You have the right to be treated by whoever you wish if your GP is unable to contrl, your symptoms. Drugs like flecainide are not permitted for GPs to prescribe for example and must be initiated by consultant level.
Hi Jenny,
Yes, you do need to see a cardiologist! It was only after seeing a good cardiologist that my AF was cured. Untreated AF seems to increase other risk factors, apart from the bother.
Please research your condition. Learn as much as possible. Do not take a 'no' for an answer.
Kind wishes J (-:
Given the change in frequency and swings of severity of your episodes, it's best to get a referral to a cardiologist. This can ensure you're on the best treatment plan and need clarity on your changing condition now. Making sure you're getting the right care is a key part of managing AF long term.
In the US, you would be sent straight to an electrophysiologist (ep) not just a general cardiologist. I understand your system is different, but a number of members here in your system have gone private, at least for an initial consultation, to expedite their treatment. if that is not something you're interested in then definitely change your GP.
Have you ever gone to the A&E during an epidode? It might be another way to get the attention of a cardiologist and some treatment direction.
Good luck.
Jim
This is how it should go:
First your GP does full blood tests to check for changes in results, infections and thyroid issues. Then if none found, you see a cardiologist who will check heart structure, maybe order holter monitor (actually your GP could do that I think). They can then prescribe as necessary, probably an antiarrhythmic if the heart structure is ok. If that doesn’t help/doesn’t suit you, you should be referred to an EP with a view to possible ablation or maybe tweak meds.
Maybe you don’t need to see a cardiologist for AF as long as your AF is well controlled and you are happy. If not you should definitely see a cardiologist or EP, in fact I think you should see a cardiologist regularly anyway because heart damage could be occurring without being noticed as has happened to a few people here.
Best wishes ❤️🩹
Afib is a progressive condition and you yourself report more episodes with longer duration. It seems that your current burden is a little over 2%. Over the last6 months my burden has increased from less than 1% to a recent 5%. I have found the GP service to be less than helpful. I paid to see a cardiologist and for various scans. I am told that the scans indicate that I have had 2 recent heart attacks. I then saw an EP who has said that I cannot have flecanaide but that I am a good candidate for a pulse field ablation, I am now on the NHS waiting list for this procedure. My experience has been that you have to advocate for yourself and politely push for your own treatment. Regards and good luck.
What? Are you sure your GP is properly qualified?Never heard such bilge in my life.
1. Please seek a second opinion within your GP practice ( surely there must be better options than this ....trying not to be too rude...'confused ' ' ignorant ' ' cretin'......ah you see I can't help it.
2 . Demand,not request,a referral to an EP or failing that ,a Cardiologist. Your right under NICE rules.
3. Let us know how you get on.
Not good enough 😕
That is not correct, you do need to see a cardiologist to have it diagnosed and correctly treated, and if it was me I would insist upon it.
I think everyone else has covered it. I would add that this is enough of a red flag that for me it would undermine their credibility in general and I'd want to change GPs fir everything going forward.
TBF, I haven't needed to test the GP -> cardiologist referral route as I went post HA Cardiologist-> EP referral.
But even then, the hospital tried to cancel my cardiologist post HA f/up because it "wasn't needed" (my ejection function had returned to normal).
You really need to see an electrophysiologist as they specialise in the electrical side of things. They are usually qualified cardiologists too. If you feel the need and can afford it a private consultation costs around £200
I have a wonderful GP, who freely admits he knows virtually nothing about Afib, it's not even given more than a couple of hours, if that, in medical school. He knows that, due to this forum, and my own reading, I know more than he will ever know.
Of course you need to be seen by an expert. In my experience, the cardiologist I saw after my first episode did the 'plumbing' bit, ie Holter monitor, ecg etc, which showed my heart was structurally sound. Then I was discharged. It took a few years of episodes, and this forum, to discover the 'electrician' was the expert we need.
In the UK, you do not need a referral from a GP to see a specialist privately. I paid to see an EP I had researched online, made an appointment online. I brought with me a list of my history with Afib, how long episodes last, heart rate etc, also a list of (many) questions I had that no one in the NHS has got the time to answer. That hour was the best money I have ever spent in my life. I was listened to, and treated like an intelligent adult. We discussed my options, and came to a joint decision on how to proceed. He wrote a letter to my GP right there and then, gave it to me to hand in to commence medications. I can email him, go back to see him, whatever, any time. He will also add me to his NHS list if in future I require more than medication, or I can pay for that if I can.
I think the going rate for an initial consultation is £220-£300, but very much depends on where you live, which of the private health care organisations they're attached to, etc. Everything is online, their bios show their particular field of interest, you just select the one you like the look of, or has the earliest appointment, date they have availability that suits you, click on it, and it's booked. You will find recomnendations/reviews/where they practice/nearby etc etc in a 2 minute Google search. Next to choosing my husband, it is the absolute truth to say that doing it is the best decision I ever made in my life.
And, I'd do the same research both online, and asking around, to change your GP. You obviously have one of the know-it-alls who think they're the Almighty. Again, you don't need any authorisation to do so, you find a better one, no permission, no justification, no explanation required from you.
I believe that in medicine, increasingly you need to be your own advocate to get the treatment /reassurance/time/be listened to. And especially with this condition, you need all that in bucket loads. Alongside as much research you can do to help yourself. Good luck, Jenny, there's nothing like beating that feeling of helplessness /nowhere to turn to, to taking charge of what you need, and getting it. Diane.
You need to see an electrophysiologist, who is a specialist cardiologist
Hi Jenny
I remember vividly the early days of my AF. My GP was wonderful but the cardiologist was an arrogant banana who told me to stop being hysterical about AF. Fortunately, a good friend's anaesthetist husband transferred from Aberdeen where I was living, down to Papworth and strongly recommended I see Mr Frank Wells. I didn't wait for a referral, I made the appointment myself and flew down 2 weeks later. That saved my life - the tests showed that I had damage to 2 valves that may be a cause of AF but Mr Wells told me that if I had waited any longer I would need a heart transplant, rather than the valve repairs that he did. It didn't cure my paroxysmal AF but I am still forever grateful. This was 25 years ago but it was all done on the NHS. Sorry to be long winded but my point is don't put up with your GPs nonsense. Good luck!
Best regards Penny
Bisoprolol reduces the heart rate and does nothing for the irregularity. After my paroxysmal AF was finally diagnosed about 6 years ago, the lowest dose of Bisoprolol (1.25mg) proved too much for me to take daily after just three days! As my surgery didn’t come up with anything else, as I have recorded here before, we found a private EP ( the cardiologists who specialise in electrical problems in the heart which ours is) through the AFA, and having introduced me to having a smartphone and Kardia, sent a prescription for Flecainide to my surgery for me to take as a PIP after I had sent a recording of my heart in AF to him. I had already had an echocardiogram which showed there was nothing structurally wrong with my heart. The EP told me that unless an episode of AF continued for a long time with a heart rate over 140 twenty minutes after taking the Flecainide, I was not “at risk of stroke”, and mine never did. I was able to stop taking anticoagulants as they all had dreadful side effects on my digestion. Now that I take Flecainide regularly, I have been AF free for several years and my heart even continued in normal sinus rhythm without the morning dose of 50mg for a few days when I missed it. We have found that we are all different and I hope you find out what works for you, with the advice of an EP.
Ask your doctor to give you that statement that 'In my opinion he does not need a cardiologist' in writing. And tell her you will place it on record in the event of your death or a stroke.
She will soon change her mind. Or if she refuses to do this, then report her and get a new doctor.
Mine is similar, but I have seen a cardiologist, initially paying privately.
It would take a lot for me to change my GP, so that would not be my advice or preferred route, unless you have other reasons to do so, of course. In the very unlikely event that your symptoms were in any way dangerous to your future health, it would be unprofessional for your GP to have given such advice. If you feel you have been poorly treated, then you must let him or her know how you feel, in writing if necessary, ask for an explanation and have that put onto your health record permanently.
Your GP is unique in knowing both you and your medical history like no other person is likely to do; he or she will have a good deal of training and experience in treating AF. It is an electrical issue occurring in the safer top region ("the atrium") of the heart. Its effect on the much more important bottom section, the ventricles, is variable and, luckily, often limited to sporadic speeding up (i.e. tachycardia, often it seems to 130bpm, but in some unfortunate sufferers much more, maybe 180-200bpm); added to this is pulse irregularity and a feeling of bumpy palpitations. It is a common enough condition, and in the vast majority of cases, is not overly symptomatic, disabling or dangerous to your future health.
The problem with AF is that it creates in all sufferers varying levels of fear and anxiety. Sometimes these symptoms, which are not imaginary and can be a natural "shock" reaction of the mind and body to any kind of heart disturbance, can add to the other symptoms the AF is causing. Despite being under a hospital specialist and awaiting treatment, mine yesterday evening did frighten me and took me the closest I have been to visiting A&E since 2019, when it all began. I will be phoning my GP this morning and likely emailing my cardiologist / EP's secretary, too.
In your case, I would, if you are able, pay £200 or so to see a cardiologist at a nearby Spire, Nuffield or other private hospital. Make sure you see a doctor who is practising at your nearest NHS hospital and, preferably, one who also carries out cardiac ablations (i.e. a cardiologist EP (electrophysiologist).
I would also want to have a test called an echocardiogram performed along with a 12-lead ECG. These two tests will give the specialist very useful information and, if done before your private appointment, would save time and money.
Overall, though, given your GP's response, I suspect you will join the many thousands of others who cope as best they can with this frightening "but not as bad as it feels" condition.
Steve
🤔 Can’t agree with you there - ‘he or she will have a good deal of training g and experience in dealing with AF’ - I don’t think so! My GP told me frankly she knows nothing about cardiology (yes I know af is an electrical problem but I guess she doesn’t).
I don’t think your post is very helpful overall, particularly the implication that the poster has health anxiety. A change in symptoms warrants investigation. Only when that has been done and no issue found can you talk about ‘coping as best you can’.
That's interesting. My son trained to be a doctor and cardiology was a major part of the course that I spent a long time testing him on.
I know what you mean, though, but my comment was more to do with the GP having such a wide experience of seeing other patients with arrhythmias and how they cope and so on.
I most certainly did not mean to imply the OP had health anxiety, and I wonder if that is not the way you read the post. My point was that cardiac issues like AF and ectopic beats naturally cause anxiety since the body reacts to such events in a "shock" like way increasing the heart rate and output as a protective mechanism. Some people have a stronger reaction than others, and some get used to the effect more quickly than others - but the "shock" reaction is a physiological fact of life, so far as I know, and will surely add to and worsen the effects of the AF. I have had direct experience of just this.
As for my post being unhelpful, I do hope not. I put a lot of time and thought into what I write and receive so much good comment in general. On this occasion, I apologise if that seems to be the case. I try always to be positive, open, straightforward, and helpful.
Steve
I myself do appreciate your posts. They are always temperate well considered and interlaced with a fair amount of common decency. Hopefully you will continue in this manner for many years to come.
"Your GP is unique in knowing both you and your medical history like no other person is likely to do;"
You are lucky if you see the same GP, more than once nowadays.
I guess you are right. We are lucky to have such good family GPs but I have known quite a few and have worked with many, and hold them in high regard in general. Human, of course, like the rest of us and not always treated with respect. The NHS has become a disaster for many having, I suppose, been spectacularly badly managed and funded over the years.
Steve
I had the same scenario, I was diagnosed last June with persistent afib and was put on bisoprolol and digoxin as had mild heart failure due to the afib my HR could not be brought under 100 and I asked twice to see a cardiologist who specializes in afib and was willing to pay but gp said I don't need to see one, bisoprolol pushed up to 10mg and I had a severe allergic reaction taken off cold turkey which was hell put on dilitazem and hr still not bringing her down so insisted on seeing cardiologist who I saw 3 weeks ago, booked right in for cardioversion and another medication and he told me he would do his best to get my quality of life back wish I had insisted before.
As what Bob says below. Without knowing your full history and I'm not medically trained, some kind of intervention is required and this can only be decided by a cardiologist. I once asked a GP who I trusted if my AF could be vagal and he said 'What's that? Cardiologist is the way forward.
If you're GP is difficult, just pay to see a Cardiologist who can put you on drugs such flecainide that will help your quality of life.
Moreoverthe cardiologist could recommend an ablation .
Things may be different here in South Africa, but as soon as I was diagnosed by my GP, I was immediately referred to a Cardiologist (we are short of EPs in this Province). He kept me in hospital for 2 nights under observation, and on one check up six months later, I was in AF and he did a cardioversion the afternoon of the appointment. I now have an annual appointment where he does an Echo, Dobler, ECG and a manual exam and checks my medication (I see my GP 6 monthly for a new prescription), but the Cardio changes anything he feels appropriate. He is a delightful person and I'm happy to see him. I can also see him if I have any concerns.
You absolutely do need to see a cardiologist! My cardiologist has offered me an ablation. Its now recommended in early stages of AF whilst still paroxysmal.If no joy with your GP vote with your feet and register with a more clued up GP.
Hope all goes well.
Sigh - why is it that GPs can so often be so flippant about AF, with no concept of how it can impinge on normal life for so many people. Of course you need to see a cardiologist!
I hope this does not sound patronising, but are you sure you saw a doctor rather than a physician assistant? They can be useful for sprains, sore throats, etc. but they have no business advising on anything potentially serious. Having said that, some doctors are better than others; I have had a few outrageous remarks from two different GPs at my practice (both of whom were male doctors commenting on gynaecological issues, not cardiology).
Also, if you have any heart problem you should get regular check-ups, although chance would be a fine thing nowadays; I used to have a routine appointment every six months, but not since the pandemic.
After my ablation my AF almost disappeared but gradually over the next 2-3 years the number of AF episodes increased to 3 or 4 a week. Telephoning the cardiac nurses I was told I had been taken off the Cardiac patient list and would have to go to the bottom of the waiting list. My GP made the referral but would not alter my medications. I waited 6 months and no NHS appointment so I booked to see the EP who had performed my ablation privately. He was fantastic offered three levels of intervention a stronger beta blocker, another ablation or a new procedure which was not undertaken in Bristol where I live. I opted to change medication and if that didn’t work then I could have another ablation. New meds have been a great success. I finally got my NHS cardiology appointment through after 14 months and was so glad I had taken the private appointment and saved myself 8 months of AF misery. Seize the day!
if you are symptomatic with bouts of AF then you can ask your GP for a referral to an electrophysiologist. I saw one privately for the first appointment he then wrote to my GP to be referred on NHS , best £200 I ever spent
👍
Definitely change your GP!
of course you can see one, if you have difficulties you can have a private consultation usually about £200… I did that in Sheffield. Happy I did. Good luck
I saw a private EP and the cost was considerable. £250 for initial 30 minute consult. He recommended an Echo cost £450, plus another £140 for follow-up to discuss said Echo, so £840 in total. Shocking, but he was very nice and reassuring. He said as I was female and of low body weight an ablation could be risky so to just medicate my persistent af and not to stress about it. Difficult sometimes as I am never in NSR. I was 79 last month.
Do you drink alcohol or use marijuana?
What???????
I have had two Cardiologists explain that drinking alcoholic beverages is a definite trigger for Afib. Anyone with Afib should give up alcohol beverages for a few months and see if there is a definite improvement.
My original GP balked at my request to be referred to a cardiologist when I first experienced a-fib, so when my health insurance changed and I was able to self-refer (I live in the US), I got one on my own. And from the cardiologist, was eventually referred to an electrophysiologist.
You need to see an Electrophysiologist. If your lovely doctor was living with afib she wouldn't be long changing her mind. AFib is progressive and an EP is the cardiologist with additional training to deal with it. Just demand a referral.
see a consultant cardiologist electrophysiologist. The days of “oh it’s ok we handle AF in primary care” are over. Insist. Good luck!
I would definitely get a new GP and also find a reliable cardiologist....
You need to think about finding a good Arrhythmia Specialist. When my cardiologist discover I had AFIB that’s the first thing he did was refer me to a specialist. For your peace of mind find a good Dr.
hi Attic, see another doctor? . I’m on a 6 monthly phone call appointment with a cardiologist for the simple reason I have AFIB.👍
in sussex i was sent to a cardiologist within a year/. after some loss of files and various hiccups i was referred to a cardiophysiologist who did an ablation about a year later. you have to tell the nhs what you want , dont wait for them , nothing happens. you might no be suitable for an ablation but i wouldnt take anything from a GP speak to a cardiologist and if you want a 2nd opinion ask for it. ps how many of the delightful boosters have you had., have you read the up to date literature, try Dr Peter McCullough, dr aseem Malhotra for a start if you havent.
you definitely need to se someone from the cardiology team especially as your AF is not well controlled at the moment
any referral to a cardiologist in the uk will take a while. If you have £250 to spare, book a private appointment with a cardiologist who specialises in AF and arrhythmias. (an EP).
Many years ago my GP told me his surgery did not deal with heart matters & I was to go straight to A&E, so that's what I've done over the years. My HR has often been 140, or more, & I've not hesitated. A couple of times I've dialled 111 to discuss & they've said the same, they've even sent an ambulance on two occasions. Also, through attending A&E, I have been referred to a hospital arrhythmia cardiologist for my heart care.
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