To be shocked a hospital did this?

[Honeyroar]

My 77 yr old mother went for a pre op today. When they took her heart rate it was 150, so very high. She has had a history of ridiculously high heart rates in the last year, and has been admitted twice. The nurse doing the pre op had her taken to A&E in a wheelchair to be checked over. A&E was at the opposite end of the hospital and down a huge hill. She sat in A&E for two hours and by the time she was seen her heart rate had calmed again. They said they would write to her doctor and that she could go home. They then left her to walk back up the huge hill on her own. She was at a hospital that she didn't know, she didn't know where the car park she'd left her car in was, and was breathless and stressed when she rang me. Am I unreasonable to think that they ought to have wheeled her back up again rather than risk her heart rate going crazy again? They also told her they'd tried to ring me (next of kin) but I'd not answered, however I have no missed calls on my phone.

Thankfully she drove home safely and is fine.

If she became ill in the first place simply from walking around looking for the right place why wasn’t she taken to the appointment by whoever in the family looks after her in a wheelchair?

CherryPavlova I'd love to know what over 80s you speak of. My mother and sf are relatively fit people in their 80s who still drive and cruise and remain independent. However in the last six years one has had septicaemia, tinnitus and three cataract ops, the other has had two new knees and prostate cancer albeit the latter was caught v quickly.

Apart from the fact that no way would they have the stamina to look after grandchildren they still do a lot but very much have to pace themselves and I always have half a tank of petrol - just in case.

Atrial Fibrillation is common. Very common. Most don’t need to rush to hospital when they have an episode. Most are given beta blockers by their GP once diagnosis is confirmed. Most AF settles itself. I suspect your mother has been told this. A pulse of 150 really isn’t that high - most people want to get to that rate when exercising.

A heeart rate in sinus rhythm (sinus tachycardia) on exercise is fine (and not the same as a pulse, you can have a normal heart rate and no pulse, rare but it happens), an AF of 150 is a different matter.

If you want to see what is going on with your Mums heart, dont buy a fitbit, buy a Kardia (on amazon). It connects to an ap on your phone and can do an ECG. You can then email the tracing to your doctor, or show it shen you go for an appointment. Its a fabulous bit of kit because heart rythmn problems are never helpful enough to happen when you are at the hospital hooked up to the machine.

At the most this could give a rhythm strip, which can be helpful but if it's not of good quality then it can be difficult to see fine fibrilation. And you need to know what fibrilation looks like.

OP

If you and your DM want to monitor then just taking a pulse and noting if it is regular is all you need to do. If you find that difficult and you do want to monitor it you can get a pulse oximiter for about £15, you can see if the HR is regular easily enough.

The very old school way to see if your pulse is regular though is to get a drawing pin (an old style one wiht a conves edge), find the pulse and put the pin upside down on it, you will see the pin part 'twitch'.

Cherry who are you trying to convince Us or yourself

Is there an elderly relative in your family saving you money on childcare?

HelenaDove - no my children are long past child are stage and we never used grandparents. We fund our parents rather than the other way around.
I just find it somewhat patronising to think a 77 year old is incapable and needs protecting. Our neighbours in their 80s will be out clearing the pond next weekend. My MIL and husband still climb mountains at mid 80s and looked after my SILs child into their seventies.
It’s not good to infantalise perfectly competent adults.
It’s also not good to repeatedly use an emergency department for a chronic problem that should be managed by a GP.

My dad is 75yo & has health issues. He would have called a taxi to deal with the hill. A&E stabilise people, not fix all their other health issues. A&E usually don't know about all their issues. NHS arms don't share info with other NHS arms (British people protested very strongly against this ever happening).

Are you sure there wasn't some miscommunication between your mother and the hospital wrt where she was going once released from A&E? I only ask because I know the one time I was in hospital, in Bristol, I had to be transfered from the bri to St Michael's and I know they have an ambulance specifically for this purpose, because of the huge hill. They also ask NOK details and how you got to the hospital etc. I just assumed this was standard practise.

OP, has your mother had her ferritin level checked recently? I had racing heart episodes, weak muscles, lethargy etc years ago. Had echo, 24hr tape saw the cardiologist and everything was fine. I still had the symptoms though. Roll on 7 years and my symptoms were worsening. Had bloods checked and a MW requested ferritin levels. Turns out it was absolutely in my boots, despite my haemaglobin being fine. Took iron tablets and it really helped. The symptoms return occasionally still, so I get back on the iron.
It might not be this at all, but it’s an easier to treat (and often overlooked) possibility.

This will.sound harsh but the NHS, particularly ED Is struggling. It's not their responsibility to arrange transport. People expect far too much from the service that's already at breaking point. They see all kinds of people, not all elderly are unable to look after themselves. If she can drive then she should have known to ask for assistance. Due to staffing needs and shortages there is not always a possibility for staff to even leave the department.

I agree it is not the responsibility of A&E to organise transport; but it is their responsibility to make sure that someone leaving their care is asked whether they are OK to get wherever they have to go, and to facilitate contacting a relative, friend or taxi. They should not just turf folk out.

I spent a day in A&E the other week and no-one checked that I could access a drink - never mind eat!! By the time I cajoled a cup of water from someone I had not drunk for about 17 hours.

Hydration is pretty basic.

Slightly off topic, and assuming that her planned operation is going to involve an anaesthetic, has your Mum checked that she's been discussed with her anaesthetist? If her AF is that badly controlled she may need better drug management before embarking on an operation.

Also I see a couple of comments re HR monitoring. Don't bother with a peripheral fitbit or pulse oximeter type thing. Part of the problem with uncontrolled AF is that not every 'electrical' heart beat becomes a 'palpable' heart beat and each heart beat may generate a different pressure so, as these monitors depend on there being a measurable pulsatile change, they may not reflect the HR accurately and may provide either false reassurance or unnecessary panic. They also average the recordings over a period of time so don't record the peaks and troughs terribly well. This is a problem even with hospital equipment and is why we often use a combination of different modalities of monitoring in people with dysrhythmias.

Thanks walking, I'm actually wondering whether they will do the procedure altogether now - they had concerns about it due to the anaesthetic and her COPD and heart issues prior to this episode. I guess we will be going back to her GP (and A&E said they'd refer her back to the cardiologist again).

For the record my mum was cycling 50 miles regularly five years ago, now she can't walk 100 yards uphill without her heart racing and all her energy slumping. She's the last person to give up and become a couch potato- she's actually quite depressed that she can't do anything at the moment.

And contrary to what somebody said on another thread they started, I wasn't expecting a taxi or ambulance home, just a porter or someone (we have charity helpers at our local hospital) to make sure she got safely back to her car, or someone to tell her to ring me to collect her.

Just an update for this - (hopefully people will notice it's not a new thread!)
She went back for another pre op a fortnight later and had another resting heart rate of 160. They decided not to do the procedure and referred her back to the heart consultant. We went this week. It was a different consultant. He did an ECG and her heart rate was 150 at rest. He said her AF was clearly out of control and her heart would be damaged if it carried on at these rates, so he has referred her for a pace maker. Thanks to everyone that had sensible suggestions and recognised the dangers.

Pleased to hear you are a bit further forward.