Was this a&e treatment normal?

[StarvingCaterpillar]

just wondered if anyone works in a&e, what is the normal typical treatment for bradycardia?

I know it’s hard to give an exact answer because it’s dependent on a lot of factors, but if someone could answer roughly it would be really appreciated

i posted a while ago with a question about having a suddenly very slow heart rate for a few days and was advised to go to a&e. I can’t actually find the post for some reason and I’ve since namechanged 😩

But regardless, I went to hospital, overall it was quite pointless and I basically felt a bit fobbed off. My heart was sitting at about 34, going between 29-43 but generally sitting about 34/35. Just been kind of told it’s not an issue since I’m young and the symptoms are mild. Basically said not to worry about it. Just not sure if that’s the expected treatment and I was just stressing over nothing or if it’s worth getting a 2nd opinion if another episode like that happens again? (Hopefully it doesn’t of course)

That heart rate is pretty low! Was that shown on their monitors as well. Loads of people come in with "I feel fine but my watch says X and now I'm worried". I believe generally most staff are distrustful of heath info from a watch.

Typically A&E is only looking for things which need to be corrected immediately, they often won't go too in depth. I hear this phrase "fobbed off" quite a bit and I think it stems from a mismatch in expectations - if you weren't having severe symptoms requiring treatment then it's not an emergency so not much to do in A&E - it's not a short cut to see the specialist/get to the bottom of every concern. People often rock up with "they told me it was X months to see the specialist but I can't wait that long so I had to come to A&E to have it today" - then frustrated because they waited half a day for nothing much. Agree the wait times are horrific, a&e doesn't jump you in the queue though.

In terms of what normally happens: typically id expect them to have taken a history of any symptoms, physical/cardiovascular examination including a 12 lead ECG and some routine bloods. This would be to consider whether there's an obvious cause of the badycardia. If nothing found, no major symptoms - you present well/not symptomatic then often people are directed to their GP who can arrange a referral for a 24 or 72hr ECG tape and onwards specialist referral if required.

You should also have been given some safety netting advice - sudden persisting shortness of breath, feeling dizzy/near collapse at rest or on standing, severe lethargy - return to A&E or call 111 for advice if unsure.

You need to go to the doctors and get referred to cardiology. A&E just basically make sure you aren't going to drop dead there and then. That's all they really do. But it sounds like you need to get to the bottom of why this occurred. So you need to go via the GP and get properly investigated by the relevant departments.

ED is busy and overwhelmed . If you present as ambulalant, alert,no chest pain,stable obs no other worrying signs yes you’ll be dc to GP follow up
People are literally receiving corridor care and are v unwell awaiting admission. Your care can be adequately and safely managed in primary care.

I’d expect an ECG 12 lead and O2Sats
Routine blood test
Take a history eg Ask if any Chest pain, Short of breath, confusion, history of Eating disorder
Write to GP suggest cardiology follow up. 24hr trace tape
Discuss what To do on event of feeling unwell. Signpost to appropriate services

I agree that their main purpose is to stop you dying now. Assuming they went through the type of processes listed by previous posters and you were otherwise well, this is something that can be followed up through the gp with an appropriate referral. If they didn’t examine you at all or ask any history/questions and check you were otherwise well then it’s a problem. Hopefully they gave you a list of symptoms to be on the look out for that would mean you should return to emergency.

I will also say ED role is to establish who needs to be there. After triage Who can be signposted or treated else where. Who needs to go home
Fobbed off often arises from examination & assessment and safe to go home, from a staff pov you’re safe,ambulance,alert and have no barrier to discharge. The patient view can be feeling rushed or not given answers to the what ifs and queries.

it will be viewed as a waste of A&E time if your only presenting symptom was a low heart rate.

my Dad is 60 and his resting heart rate is under 40. And he is no workout dude. in fact he is relatively sedentary and stocky, heart beats per minute isn’t a job for A&E. call you GP

Sudden low heart rate is worth a visit to A&E
If its ‘normal’ for you then go to the GP and get a referral

Are you getting these readings from an Apple Watch?

It’s just I had the same thing happen. I’d get alerts about sudden drops. Mine turn out to be because my watch wasn’t fitting snuggly (I’d intentionally lost around 7 pounds) so it was giving false readings.

That’s all they do? I’m sure you didn’t mean that as dismissive as it sounds? I think you mean,the clinical priority is treat who needs to be in ED, divert & signpost non-urgent cases to appropriate service

@StarvingCaterpillar are you okay now?how you feeling?
Btw this thread has brilliant user names

12 lead ecg to check for conduction issues, but if it is sinus bradycardia and you are asymptomatic, and as they say young, fit and healthy, 34 at rest is not outside the realms of normal for some people.
My heart would go to that when i was sleeping when i was younger, I'd love to claim supreme fitness but it was just hereditary, my dad was the same as was his dad.

Was it your GP that advised to go to A&E? I had the same thing a few months ago, low heart rate but no other symptoms. I contacted my GP and got an appointment fairly quickly, they confirmed bracycardia with an ECG and took a blood test to check thyroid, but as there were no symptoms and all was well they've put it down to a good state of health. They didn't send me to A&E at any point.

i noticed it on my Apple Watch but I only checked that because I felt unwell in the first place. But in hospital it was on the moniters too. On one of the ECGs it was 33. I’ve got a history of problems with my heart, had it shocked multiple times, had part of it burned off to try and make it beat normally, but never really had issues with it going low and feeling unwell with it so that was unusual for me (I’ve had it sitting in 40s and felt fine but this felt different)

maybe I’m just slightly biased because of my previous experiences with my heart and I’m maybe slightly on edge because I spent a long time being fobbed off as young and anxious before until I was taken seriously and the problem was found, so it makes it harder to know if you’re being fobbed off again or if actually it truly is just nothing to worry about IYSWIM! It definitely makes you more on edge which isn’t always a good thing

I feel fine now and not had any issues since, so hopefully it won’t happen again!

Just realised I had forgotten to put in my OP about my history with my heart, I was sure I had included it but re read my OP and I had forgotten oops, was half asleep when I posted yesterday

I think the poster who put above about a mismatch of expectations was probably right- perhaps I was just a bit on edge because of my history and with being fobbed off and it makes it hard to realise if it’s happening or not again! Definitely a relief to read from the comments that it doesn’t sound like I was fobbed off this time :)

A&e is pretty much checking you not going to drop down dead. You need to see your GP Monday to be referred asap. Keep eye on this op as it's the weekend and don't hesitate to return to a&e if you are worried but this is a gp urgent referral...you need to get on the phone at 8.30am on Monday and get a gp appointment...keep all your records. Hope they get to the bottom of this. Please please return to a&e if things don't improve. Hope you feeling better soon x

My resting heart rate at 26 and relatively unfit is 43.

i Wouldn’t even think of going to a&e with that.

The clue is in the name accident & emergency…. You were suffering from neither….

Did you read my comment literally 2 above? Have you had issues with your heart rhythm before? Because when you have you’re always advised it’s best to get it checked if something changes :)

See my comment above :)

It’s not an accident or emergency. You did not need to be there.

Thank you! I feel fine now, it was literally just because it had suddenly dropped down and wasn’t going back up and I felt unwell with it. I should be seeing cardiology soon anyway so I’ll bring it up with them. Thanks for the advice again x

That’s a pretty rude reply to a helpful post.

Omg ah that was to the wrong comment! Ive literally just commented to this person (the post above) and this comment was NOT meant to be sent to them. So sorry!

It’s literally in my cardiology discharge advice to attend a&e if I have any sudden changes to my heart rate and have symptoms 🤷🏼‍♀️

@Londonrach1
im SO sorry, that initial reply wasn’t meant for you, a few comments came in at once and I had quoted the wrong one. I’m so sorry! I only realised after another poster pointed it out but can’t seem to edit it! Sorry again