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)

So your cardiology discharge says to get checked in A&E if any sudden changes, and you posted here for advice and got the same answer.

Then you went to A&E and got pretty thoroughly checked and you were fine. (This is a good thing, not a bad thing.)

Next step is to see your GP and ask if you should be referred back to cardiology, and in the mean time if you have the same symptoms again go back to A&E because that remains the treatment plan unless cardiology changes it.

What some people may be missing is that heart rates generally drop in our sleep by 20-30%. If the OP had a new, awake, resting heart rate of 34bpm then that could drop to 24bpm in her sleep. The heart needs to shift blood around the body to oxygenate it. If it doesn't beat enough times, then the person doesn't get enough oxygen.

She’s not going to get a pacemaker from the ED 😂

am guessing that you've never had to externally pace anyone? Have done it in ED, on the wards and in ICU. It's much much less common to insert a temporary wire for pacing now, but juuuuuust every so often if you're in a hospital without a cathlab and someone can't be transferred then that might be a possibility. And just occasionally you do go hairing round the country in an ambulance if you're in a hospital that doesn't have one and you need to get someone to a lab quickly. A HR that's genuinely in the 20s absolutely is an emergency until proven otherwise.

Really pleased for you that your experience is of a benign sounding bradycardia, but that doesn't mean they all are. If it's a first presentation/change in normal pattern then it is worth at least finding out what rhythm it is. Just occasionally a high escape rhythm will give a good enough rate to not cause symptoms but that can deteriorate really quickly. Personally as a mere anaesth/ICU doc I worry much more about abnormally slow pulses than fast ones. You do not seem to know enough of what you're talking about to be giving advice.

My mom has an irregular rhythm, and carries around a laminated EKG on a wallet sized card - it has come in useful for the times she has visited, and had to visit A & E so the doctors can have a look at what's normal for her.

Going forward, would it be helpful to have a summary of your condition?

I know that electronic medical notes are in theory supposed to be accessible to all NHS, I think, but having something to initially show to doctor/triage nurses, is an idea?

"Personally as a mere anaesth/ICU doc I worry much more about abnormally slow pulses than fast ones"

Mere anaesthetic/ICU doctors are the best. They catch the pieces as they fall.

If you weren't symptomatic then it would be a GP job

How is this comment relevant?

OP was symptomatic and was following previous cardiology advice.

That sounds ok to me. You clearly did not require emergency intervention or you’d not be posting. Your gp needs to take this forward.

It wasn’t an accident and it wasn’t an emergency - what did you expect them to do?

I honestly think it depends who you get on shift. I've been to a&e a few times for tachycardia. Like you with a cardiac history. And every time the treatment has been completely different iv been put in resus, I've been put in majors, I've been put in minors and I've been left to sit in the waiting room all for the exact same thing.

A sustained heart rate of 30 all of a sudden absolutely can be an emergency. You're giving out extremely dangerous advice

Are you the person that also posted the rhythm strip? After looking at it for several minutes I thought it looked like a heart block. I noticed that after several beats there was no longer a “P” wave. It’s been many years since I’ve worked but I still remember a bit of those things. Hope they did a 12 lead and plan on a two week Holter monitor. I had been having quite a few “PVC’s” and had one but of course the pvc’s stopped once it was placed. Wishing you very good health and hoping doctors find out what’s going on.

OP, that heart rate is not normal under any circumstances really. It could be duggesive of something like heart block, which can result in cardiac arrest. Please see your GP and insist on a cardiology referral.

Also just to say, I unfortunately had a friend who had a pulse in 40’s, advised them as I have you, they did so but before they could be seen they had a cardiac arrest, thank god were about 10m from a defib and was able to be shocked back into a normal rhythm ( now has an implantable cardioversion device)

bradycardia can be nothing to worry about or can be a symptom of other things including minor illness. If they did an ecg on you and a blood test, and aren’t concerned, then they haven’t found anything major wrong with your circulation system, nor any conduction disorders. It would be for you to then gave a chat with your gp regarding further referral. They would get a cardiology referral for you in A&E if necessary- my Trust would anyway, but I would want reassurance from someone regarding conduction disorders and heart rhythm disorders.

Sorry that should say 'acutely symptomatic', if they didn't have red flag symptoms A&E wouldn't have investigated and would have sent back to GP to manage. GPs should be able to offer urgent treatments and referrals, within days usually. Her previous cardiologist gave appropriate safety net advice, she went to A&E who triaged her and assessed her as safe to be at home. The cardiologist was not wrong, neither was the OP to go to A&E. I am just trying to answer the OPs question, good grief. I assume OP didn't have a heart attack on the way home and is hopefully awaiting appropriate investigation from the comfort of her own home instead of spending 72 hours in a corridor, having been reassured that after following previous medical advice she is not in it imminent danger.

Ohhh I do apologise! I misunderstood you as dismissing the OP as so many others on this thread have done.

OK but that’s very unusual so Op isn’t wrong to go. When my HR goes that low I pass out unconscious which is the normal reaction to a sudden drop in pressure.

Appologies ive quoted a random message by accident and cant figure out how to delete! Will repost🙈🙈

Op, I think you did the right thing going to A&E, speaking as a person who waited 17 hours before seeking help for vauge chest pain becaue I was worried it wasnt anything serious and I was taking precious A&E services up , and it turned out i was having a massive, high risk heart attack and very nearly died. I dont think you can be too careful with heart problems, always best to be on the safe side. The treatment you received sounds reasonable though. If they deemed you not in a emergency situation that was likely to be life threatening, esp if a cardiology appointment is in the pipeline soon. Even while having a heart attack, there was very little A&E could do other than meds and keeping a very close eye until they could send me off to a Cath Lab in another hospital.
I hope you get some answered from your Cardio appointment, I have found them to be some of the most helpful, patient and informative medical professionals ive met along my very long complex medical journey (and ive been seen by a large variety of depts over the years!).