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)

There’s a difference between “you did not need to be there” and “you should have known you did not need to be there”.

After investigation, OP was found to be fine and sent home. Therefore yes you could say she didn’t need to go. But she didn’t know that in advance and I don’t think that, with her history and feeling unwell, she was unreasonable to be concerned enough to go to A&E.

in isolation a slow heart rate and feeling a little poorly is not an emergency

Thank you so much! I never actually go to a&e for anything apart from my heart. I would never go for something that I didn’t think genuinely needed to be seen. I’ve been that person who was rushed straight through and have been shocked back to normal rhythm so many times so I know first hand how important a&e’s work is and I would never waste their time for something if I didn’t feel really unwell with it

But it’s not in isolation. It’s in combination with her heart history.

Also you’ve changed OP’s description of feeling unwell to “a little poorly”, which seems like an unfair attempt to minimise it.

I remember your previous thread, OP, and (speaking as a GP) I was one of several people who advised you to go to A&E; one of the others was a Cardiology Specialist Nurse, if I remember correctly. With a heart rate as low as that, symptoms, and a history of cardiac abnormalities requiring an ablation, I would certainly have expected the A&E doc to have at least consulted with Cardiology while you were there - it would be a ‘brave’ doctor who would discharge you off their own bat in those circumstances. Do you know if they got Cardiology involved at all?

It wasn't in isolation though was it,,op has a cardiac history of arrythmia

I completely agree with this.
Even without the history of ablation, I'd tell anyone with a heart rate of 29 feeling unwell to go to A and E ( would do a manual pulse check too though as smart watches can be a bit iffy).

Ah thank you so much! Really grateful again for all the advice, thanks again

honestly, I’m not sure. They monitored for a while, I saw some different doctors and nurses but no cardiologists as far as I know and I got asked a lot of questions about if I’ve ever been paced etc, I said no, they said had I ever been told I’d need a pacemaker, I said as far as I was aware no, then they gave a few things as IV but I think it was fluids not medication, and because I felt generally ok and only a little unwell they were happy for me to go and said it’s probably nothing to worry about because I’m young and sometimes it can be normal. They said to mention it next time I go to cardiology but told me not to worry about it. It just sort of went back to normal and hasn’t gone low like that since

I didn’t want to stay so I was just so glad to get out, I’ve stayed on the coronary care ward so many times I wouldn’t be surprised if I was invited to their Christmas party this year (joking of course but you get my point haha)

but realistically I think I was probably just so on edge from being fobbed off that it made me hyper worried about it happening again if that makes sense and I guess it can be normal and maybe I was just tired or something and that’s maybe why it was so low. I’ll ask cardiology next time I see them x

gonna just put it out there that this is not necessarily true. Just every so often it will be something that could go horribly wrong quite quickly.

Honestly don't worry just get into your GP and so pleased you are seeing cardiology...hope you have a restful night and relaxing Sunday but please any concerns get to a&e

@StarvingCaterpillar essentially you needed to have acute causes ruled out. The ECG checked the electrical system in your heart - is the signal starting at the right point, getting through the conduction pathway effectively, and triggering the beat?

Then you needed a blood test to check the chemical composition of your blood, such as your sodium, potassium, calcium, and magnesium, your thyroid, and your infection markers.

If all of that was ok, and you weren't feeling unwell anymore, they will have been reassured.

Are you under any care with cardiology with your issues, or were you signed off?
That's the dept you need to be under and ideally A&E should've recommended you or even themselves to be referred you, so please make an apt to your GP to stick you on a waiting list.

Sadly though, up and down the country there is a waiting list of over a year to see anyone in cardiology, for some reason it's one of the worst hit in our broken NHS at the moment so please get yourself referred asap..

That said, if you feel crook again, go back to A&E. My neighbour, who has heart failure and a racing heart (with occasionally bouts of approx 180bpm), was told by her GP after waiting last time for 14hrs in A&E to phone 999 in future so you don't sit and wait all over again. Make sure all of them know your history if go back to A&E again. Her 'emergency' cardio apt has been made - and it's not til end of Feb. Yeah, I know.

Wish you well and you get some help soon. x

I’ve had fast AF before and an ablation. I’m also a nurse. If my heart rate was as low as yours I’d have gone to A&E too. Failing anything acute picked up, I’d be asking my GP for a 24 holter monitor. In fact I’ve just had one done as still having palpitations three years later. I waited five months for it. My heart rate is regularly in the 40s but I am on bisoprolol although only a tiny dose.

Low heart rate would NEVER be seen as a waste of time.

She absolutely should have gone. Why so dismissive?

Yes it is. You must be a troll.

DH has got AF, and had a catheter ablation 3 years ago. But around 3 months ago, he started getting regular episodes again and went to A & E on 3 consecutive weekends when his heart rate went over 160 and stayed there. They were wholly unconcerned, did a few basic tests and then sent him home with a slightly higher dose of bisoprolol. It was quite frightening to be honest, as on each occasion it took a good 24 hours for his heart rate to drop below 90 again. He was exhausted each time. In desperation, we rang the Cardiologist's secretary and he saw him within 48 hours. He's now on a higher dose that appears to be keeping his AF more stable, and he's booked in for further ablation in the coming months.

A & E really is just there for treating life threatening emergencies these days, but someone needs to tell 111 operators as that's where they send you.

No, it’s not.

The voice of reason!

@StarvingCaterpillar if A&E did not consult with cardiology then I would suggest at your next review to ask your consultant what his expectations are if and when you need to attend a&e again to get checked out. There may be an SDEC service you can use instead of “true” a&e

if their expectation is they are consulted by a&e please ask them to write that in your clinic letter and next time you attend a&e take that with you to self advocate xx

Are you aware op has had ablation in the past for arrythmia

My dad has had an ablation.

still doesn’t make it an emergency.

I'd love to know your credentials for giving such dangerous advice to others. I'll tell you mine, I'm a nurse.

Even without OP's update about previous heart issues. Low heart rate and feeling unwell is good enough reason for A&E.

A heart rate of low 30's as well as feeling unwell is most certainly an emergency.

Op had symptomatic vradycardia with z history of ablation and cardioversions, that warrants a trip to a&e and back for a cardiology review. Op may have needed urgent treatment, a pacemaker or a icd.