When exactly am I in AF

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I am a 57yo male recently diagnosed with AF - I say recently although it started 4 months ago and I have been in Resus' 9 times since then with HB up to 193. I am still waiting to see a cardiologist and my GP just keeps saying it’s only AF and put me on Warfarin. I have done research and understand what AF is and the risks but although I understand it I am not sure when I am in it. Reading these forums many people say I had an episode last year or I have them every 3 months but like I say I have had 9 fast AF episodes in 4 months - is it fast AF people refer to when talking about AF. In addition to fast AF every day I have Palpitations and Flutters although my HB is low and seems steady - is this AF?  I also have episodes when my HB is low but clearly erratic and also episodes when the heartbeat is erratic and the HB seems to vary from 60-100 beats and is not constant. I have had 16 episodes like this in the last 4 months but is this just an irregular HB or is this also AF?  These episodes are always when I get up in the morning and for some reason all my fast AF episodes have been when getting into bed or within 5 minutes of getting into bed - it seems to be connected with lying down.  The biggest problem for me is dizziness regardless of what my heart rate is and this has led to some distressing incidents when out and about which now makes me anxious about going out and even led to a few panic attacks - of course all these feed the AF and the AF feeds the anxiety.  Apart from Warfarin on no medication at all - I always self-revert from Fast  AF as well - the longest in took was 2 hours and the quickest 20 minutes. Don’t drink, was very fit and have no known triggers and noidea where this came from – just wish it would go away but that seems very unlikely.  Sorry if my questions seem daft I am just a bit confused by what others actually mean by AF. Thanks.

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  • Posted

    I have read your post a few times and, though I probably cannot offer any useful advice, thought you might like to know that someone is reading this and sympathising!  I have symptoms a lot like yours and have been diagnosed with atrial flutter, possibly atrial fibrillation.  Like you, this all started about four months ago and I am feeling confused and unhappy about what is going on.  I have seen a cardiologist but it was not helpful, he was basing the diagnosis on the opinion of an A and E nurse with cardiac experience and I am not sure he had seen any ecg.  My GP has put me on a beta blocker, in fact four different ones have been tried, and all of them make me feel dreadful, very tired, waves of adrenaline, headaches, breathlessness.  Too ill to live a normal life.  They also fail to control the palpitations, in fact they seem to make them worse.  I am to start an anti coagulant on Monday but haven't a clue which one to choose (I was asked to choose Warfarin or one of the modern alternatives) and I am concerned the side effects of that will also be unbearable.  Perhaps an ablation will be the answer? I hope that you see your cardiologist soon and good luck!  Let us know how things progress.
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    • Posted

      Hi Pam143 - you are quite right it is comforting to know others are sympathising with your own suffering and share simlar problems, doubts and concerns and yet in many cases are coping very well with the condition - it gives hope that one day we may be in the same situation.  I am a way from that yet, still anxious about every flutter and chest pain, wanting to ignore it but the more you try the more you continue to self monitor and of course this feeds the anxiety further. I can cope with the physical aspects but need to get over the mental state of being frightened I guess to go very far or do the things I used to due everyday without any thought.  I cannot go on Beta blockers due to low resting heartbeat but I am on Warfarin - I went for this option because the newer drugs, whilst effective cannot be reversed quickly like Warfarin can in the event of an emergency, operation etc. I know many do not like warfarin but I have had no side effects at all with it - my gP tells me an ablation will not be offered until the drugs fail, not if they fail but when they fail. I am seeing a cardiologist next week after a 24 week wait. Lets see what that brings. I am determined not to take any drugs were the side effects are worse than the condition itself - what benefit are the beta blockers actually having for you? At least with the warfarin or whatever there is a real and essential benefit so may have to tolerate side effects, but like I say in my experience Warfarine is not problematic for me. I wish you all the best and anytime you want to talk, even if its just to let off steam get in touch. God bless. 
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    • Posted

      Hello again, Andy!

      Just reporting back and wishing you good luck with your cardiology appointment, I hope there is some reasurance offered and, perhaps, some as yet unidentified positive way forward.  

      I have chosen to take apixaban as an anticoagulant, after having talked to a friend who has had atrial fibrillation for 12 years.  He seems very happy with his medication and his lack of symptoms for the last six months.  He says he does not bleed more than usual if he cuts himself. He also says not to be worried by episodes of tachycardia unless you get chest pain and/or fainting or severe breathlessness.  Easy said!  Like you I find anxiety rising when tachycardia occurs, as it did yesterday when I was out walking.  HR 145 and anxiety sky high!  I ended up taking 20mg extra of the propranolol and, eventually after nearly two hours, the episode ended. That was a relief!  These episodes are getting more frequent, though.  I have found the vasovagal manoeuvres just don't work, have you tried them?  I am not really sure when to go to a and e with an episode that doesn't resolve quickly but am trying to avoid going as I haven't found a and e a pleasant or useful experience so far!

      You asked what benefits the beta blockers give me.  None, if we are referring to the newer, cardiac specific ones such as atenolol, bisoprolol or sotalol though, I must admit, I was not on them long enough to find out how they affected the heart rate long term. I was getting a HR of approx. 45 on all of them except for sotalol which increased the heart rate to around 72.  The only one I can tolerate is propranolol, and that in doses too low to have much effect of the tachycardia, though generally the heart rate is slower.  Are you able to take calcium channel blockers as an alternative to beta blockers?  I suspect not, as they slow the HR too.

      So, not a lot to report but just to say the impression I am getting from my friends with this condition, and the involved medics in my case, is that this is not something to be too frightened of, it is just a case of getting the medication right (it seems a personal recipe thing for each one of us) or having an ablation (and that is not guaranteed to work!).  

      Keep in touch, Andy.  I would like to hear how you go on.

       

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    • Posted

      HI Pam

      Was in Hospital again yesterday - very busy indeed so service was slow but always go into Resus so almost one to one attention - don't care much for 'majors'.  I was told to phone an ambulance if the HB goes above 120 and lasts for more than 10 minutes. I have always done that and always been told I did the right thing - but I just sit in Resus waiting to revert which normally can be anything from 20 minutes to 3 hours. They have never given drugs (thankfully). Yesterday I reverted in 75 minutes and the time before (18 days ago) in just 25 minutes whilst the the ambulance was still at the house but they still took me in. When I have the slow AF episodes - the heart is erractic but less than 100 bpm I sit them out at home. I always have mild chest pain with any episode - that is common I think purely from the excessive HB.  I have seen the cardiologist and he has given me Sotalol but the side effects seem horrendous and the common symptoms are the very things I already have and want to get rid of. Sotalol is also part beta-blocker. The cardiologist was arrogant to be honest - he kept saying 'its only AF'  which is perhaps all things considered no where as serious as the heart problems they see in others but I would have expected at least a degree of comfort or reassurance but none was given. I mentioned the anxiety side of the condition and he just said see your GP - then made me another appoinment for 8 weeks time - so tahts what I waited 22 weeks for!  Also said my both atrium were enlarged probably due to blood pressure - I don't have it, so then he said it was perhaps drink related - I don't drink so then he said I was probably born with it - so why I asked have I had no problems until now - well he said they will have enlarged over time - I just gave up. Hope you get on OK - I would query with your GP when to call an ambulance - 145HB seems high without exercise.

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    • Posted

      Sorry forgot to say I think the vasovagal manoeuvres only work with SVT not AF - I have tried them but they never worked. However, one time I went into Fast AF and after about 40 minutes the HB stuck at 165 and they said I had gone into SVT after 15 minutes they wanted to give me drugs (cardioversion) but I said no so they put my head into a bucket of ice and it all reverted within seconds. 
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    • Posted

      Well, the ice bucket treatment made me laugh!  Did anyone take a photo? Glad it worked!  The consultant sounds somewhat unsupportive.  Sotalol is a beta blocker, a full one not a part one.  I presume he took into account your low resting heart rate?  What sort of dose did he give you?  Have you taken any yet?  Might be worth double checking with your GP, if it causes worry or bad side effects.

      Sometimes I despair at the supposed professionals who are quite casual about prescribing strong heart meds. and often at pretty high doses.  However, you may be able to tolerate them well.  That friend I told you about is on sotalol and is perfectly happy with it!  

      By the way, for future reference cadioversion is an electric shock treatment to get the heart into a normal rhythmn (have I spelled that right?) and the drug alternative they usually give is, I am told, amiodorone which, I believe does the trick but gives some nasty immediate side effects.  I gather you haven't yet been offered an ablation?

      i am sorry you have had more episodes, Andy.  I wish you success with the sotalol and, if that doesn't work, something else that keeps you out  of resus!

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    • Posted

      NO ablation the cardiologist said until the drugs fail (not if but when) - I said they are only 50% effective at contolling the rhythm for more than 12 months and he agreed but still said no ablation until it all gets worse. l challanged again saying I'd be a couple of years older, the condition will have progressed and it surely makes sense to nip it in the bud now - but still a no!  Its all about cost - cheaper short term to pay out for drugs than costly surgery, longer term it makes financial sense but of course the financial burden comes out of someone else's future budget.  The sotalol is 40mg, I have a GP appointment tomorrow to discuss it. I had heard the bad reports on amiodorone thats why I refused. With regard to the ice it did work but it actually 'burnt' my face - no photo's I'm afraid more's the pity. 
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    • Posted

      Just one question, Andy.  In case I want to try the ice bucket game at home. How much ice and how long did you hold your face in there?  Still making me smile!
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    • Posted

      I'll make you laugh even more - technically it was not a bucket but a bed pan - the bottom of which was about covered in about 1" ice - enough to cover most of your face - its the shock factor that makes it work. If you try it I would put a thin cloth over the ice to protect your face to some extent. It took just seconds - no more than 20. I was told to hold my breath at the same time. Worth a try. 
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  • Posted

    Hi andy - have just read the blogs about the ice. its made my day laugh laugh laugh - its not funny though - i go to cardiologist today after having a cardioversion which didn't work and to see what they are to do next. i am 62 yr old female with af and also waiting to have decompression surgey on spine (in vicious circle - they won't do decompression whilst on warfarin and in af) - im just waiting to see if they offer me amiodrone (if they do i will not be very pleased as i also have glaucoma which means i think that this would be an absolute no no to take - i have read blogs where patients have had serious eye problems taking this drug)
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