BP 233/114

Last Saturday morning my BP had been its usual morning level 168/85. As the morning went on my chest felt tight and bloated but no wind coming up and my head felt tight as well.

When I checked my BP at 5pm it was 196/95 heart rate 44. After a small for me dinner I checked it again at 8pm as my chest and head felt even tighter with a slight pain behind my breast bone and a numbness in my left arm and tingling fingers. It was 232/114, heart rate showing as irregular and 66. I took the 50mg Losartan I now take at night.

I phoned the out of hours 111 service and they said to get to A&E within the hour. Ambulance? No chance but if you feel worse on the way dial 999. Eight in waiting room and screen said 2 hour wait to be seen. Saw triage nurse after about half an hour and she got reading of 220/80 and did an ECG. She compared it to an earlier one that I pointed out was from November 2011 the last time that I had gone to A&E with chest pain prior to my aortic valve replacement. They only have records for A&E visits and cannot access other records.

She asked if I had been very fit when younger. I asked why and he replied because of my low heart rate. I denied ever having been fit. 

Then seen by a mature student nurse in her late 40's who took BP again and fitted me up to heart monitor. BP still over 200 but heart rate fluctuating from 70's dropping into my usual high 40's. Heart trace showing various irregularities. They then took bloods and sent them to lab with an hours wait to get them back.

Then seen by a middle aged Asian doctor who I could hardly understand and who could not pronounce words like bicuspid or prosthetic.

He said that I was in AF and said Losartan will not lower your BP you need amlodipine and gave me a tablet. I went through my reasons for not taking Warfarin, Statins and Amlodipine.

Blood results eventually came back and he was concerned that troponin level (sign of having had a heart attack)was a bit high and said that they would keep me overnight to check it again and wanted me to have a chest X-Ray. Ended up in five bed MAU (medical assessment unit) ward after 1am. Another doctor came to see me. Go through history and BP now around 180/85 and he wants me to take a 100mg Losartan and says that I should be on warfarin. I tell him of joint pain with it and he suggests Rivaroxaban that I tell him is contra indicated with a replaced heart valves. He looks it up in BNF on his iPad and says that they can still prescribe it if they think it is necessary although it has not been tested on heart valve patients. I go through my usual refusal routine. He wants a urine test done in case my high BP has caused bleeding from the kidneys. I tell him that the nurse downstairs had already checked my urine. He says that she might not have checked it for that.... no notes made down in A&E? He says that his boss will see me in the morning. It is now 2.45 and my sleepy wife gets a taxi home.

No chance of sleep there as ward bright for me and others in the ward getting attention most of the night and another patient brought in after one sent elsewhere. All the time it sounds from the constant chatter and laughter at the nurses station that they are having a cocktail party with other staff joining in. A couple more times they come and take my BP and then put a cannula in and take more blood for testing.

The boss doctor comes in to see me around 7am. Go through all the usual stuff warfarin etc. He is also told that rivaroxaban is not for me. He notes that the blood tests show iron/ferritin level is low. I tell him that I had to have a ferritin infusion before my operation and iron tablets sometime after but since been told that level is borderline. He assumes that I am losing blood from somewhere and should have another colonoscopy... you want me back in AF I ask. Well you should have an endoscopy in case it is from your stomach. No way I tell him, I gag just cleaning my teeth and my uncle and a doctor at the practice I used to go to both like Joan Rivers went into cardiac arrest and died during one. I did actually have one in 1983 but never again. He says that they will fit me with a 24 hour ECG monitor. And off he goes. Soon a very junior pasty faced young feminist doctor comes to see me and we argue about rivaroxaban and other drugs and I tell her as the others that the three makers of the new anti-coagulants had all confirmed to me that I should not take them. Losing the argument she then turns her head away from for the rest of the time asking if I want to have a stroke. I ask if she wants me to have a bleeding brain or stomach instead and she stomps off. No one ever asked for that urine sample.

All in the ward are in a pretty bad way. One is from a specialist facility for permanently disabled people. He has his own carers with him who do twelve hour shifts.

They have decided to move me to a cardiology ward just as my dinner is arriving. I'm taken up there with my dinner. I ask if they can heat it up for me and am told that nurses are not allowed to use the microwave:-) Eventually they find someone from catering who is authorised and I get to eat. This ward is even worse than the last one with five old guys continually coughing their guts up with chest infections. I protest but am told that they are not infectious. One is comatose all the time the others most of the time. Two have dementia and at least two have had a stroke. None are capable of conversation.  I say that after a sleepless night that I hope that this ward is dark and quiet. I'm assured that it is. When the main lights are turned off the ward is like a disco with flashing lights from various equipment. I get up and pull my curtains round my bed but green lights still flash through and the five others cough and choke. Three of them keep trying to get out of bed. A nurse decides to sit in the middle of the ward to keep an eye on them. I manage about an hours sleep before more noise wakens me up. By now I am seriously considering checking out. I get back to sleep for a little while before getting wakened to have my BP taken at 2am. Another restless hour awake and doze off to be wakened to have the battery in my ECG monitor changed as it is not transmitting. Doze off again and then nurse back as one of the leads has detached. At 6am they come round doing blood pressures etc (now 164/78).

Another young doctor and his even younger learner come round and say that I can go home. I'm no longer in AF but have my usual ectopic beats that I seldom notice but show on my BP monitor and my troponin reading is within range so I have not had a minor heart attack. Stay on the same BP medication. If they had tried to change it I would have said no as the Hypertension Centre I attend are now supposed to be doing that. Have the Rivaroxaban conversation yet again with him saying that they can override the makers and the BNF if they think fit although even if it has not been tested on patients with prosthetic valves.  He says that I will get an appointment to have a seven day ECG monitor fitted and an appointment in three months with a cardiologist. I tell him that my GP had asked for me to be referred back to cardiology out of concern about my slow heart rate and that I have been waiting for an appointment since January. Then have to wait for him doing my discharge letter. He goes over my ECG readings and explains them to me. He said that an ablation would stop the ectopic beats and future AF. I said that they would not consider it for me as many are much worse than me and can't get it done. He said to wait until after the 7 day monitor depending on the R test I might be able to argue for it. 

I get a taxi home and  have something to eat and we go out for an hour and do some shopping. When I get back I check my BP it is 96/66 heart rate 47. Go figure.

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