Should I just take dh to A+E every time he gets atrial fib & tachy?

[Fluffycloudland77]

Cardio put him on 2.5mg bisoprolol, it’s made it much worse, his asthma now requires two ventolin a month not one & he gets out of breath walking up stairs now.

He’s had a gel scan late July, no results sent to gp.

He’s been arrhythmic from 12:30 last night till 13:30 today. Heart rate 160. Dr is ringing us back about upping his meds which is what’s made him worse to begin with.

What do we have to do to get treatment because we keep getting fobbed off.

Right, I’ve arranged for pharmacy manager to ring him later today. I could tell the assistant knew what the problem was when I said bisoprolol & ventolin in the same sentence.

Dh convinced you can’t ring cardiac nurses so I’ll have to do that when I’ve googled the number.

Turns out they don’t have a cardiac nurse to talk to him but the secretary’s going to email the consultant.

He said twice last night he woke up short of breath laying down and he had to sit up to get his breath back & I explained that to the secretary.

Trouble is that he gets stressed thinking about it and that doesn’t help at all because it does make his heart play up. But you can’t ignore it can you.

Having to sit up to get his breath back is a very strong indicator of fluid on his lungs. I really wouldn't delay OP, I'd get him to A&E.

Well pals got back to dh, consultant aware of his condition apparently& pharmacist was very helpful.

I wish this had happened last week when I was off work.

So, pharmacy say take 2.5mg bisoprolol am & pm. He is ringing dh on Sunday to see if it’s still affecting his breathing.

PALS have fast tracked the 24hr trace and the consultant will be able to review it with the gel scan in two working days and will then decide what to do with dh.

I don’t know exactly what dh told PALS, he said she was a bit useless.

The AF is happening roughly weekly so next Tuesday is when he’s next due.

He has at least come to the decision he doesn’t care about having an op on it he just wants it fixed & if that means an op then so be it.

The cardio secretary is still insistent there’s a 2-3 week wait for ecg tapes to be read.

Does dhs mirtazapine affect his af meds?.

The heart issues are what cause his anxiety, he was ok before his af ramped up last year.

Ablation is not a cure all. Dh has had 4 and reverted before he got to the follow up appointment after the last one. Waiting for follow up. Lost count of the cardioversions he had before the first one and between the first and second.
There are alternatives to beta blockers for AF, and some cardiologists start with them.
Anti coagulation seems to be a debatable point. DH was taken off after 2nd ablation by the Prof at one specialist unit, but the following year GP surgery had all their patients with active or previous AF reviewed by another Teaching unit and was recommended to go back on them. Last time we looked his Chadd score was 1 but he has always been left on the anti coagulation.
Think your DH needs cardiology and asthma review. Sad to say PALS is probably your best bet, one the one occasion we used them the result was miraculous.
To answer you question, take him to A&E if you are worried.
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Well he just briefly had it but it’s stopped. He bent over to get his t shirt out of a drawer.

I think his asthma needs better management because sometimes his sats are 88-90% but he feels ok and he looks well even when he’s poorly. I think he’s just used to feeling unwell.

It started up again so he’s in a+e. Af & 150bpm.

111 said go in if no one rings up in 20 mins.

Is he a candidate for surgery. I think it's called Ablation. My dad had it done for AF as he couldn't tolerate the medication. He had it 18 months ago and is completely cured.

@Fluffycloudland77 is he under Glenfield? I'd have his care transferred fully to there. If possible. My parents live in Leicester. I don't recall that they tried many drugs with him. They went fairly quickly for ablation.

I don’t know is the honest answer. He’s in with a dr now which means his heart will go back to normal.

He’s under derby & burton for heart. This is the trouble of living on the borders.

I can ask if we can transfer over if needs be.

Their giving him drugs & trying to get a line in. Best of luck to them because his veins have damage from all his cancer treatment so that’ll be interesting.

No idea which drugs though. 🤨

They’ve given more beta blockers & ordered re-sus.

He’s had a chest x ray now.

Apparently he might need a different drug. There’s me thinking beta blockers are the only drug in the bnf for af 🙄.

fluffy giving you a gentle hug. You must be exhausted with all this.

Hopefully some action will be taken

More betas apparently.

@Fluffycloudland77

How are YOU?

Has anyone asked you yet. I know you are worried about your dh but you need to look after yourself as well.

With the ECG / 24 recording they are usually reported by a physiologist. What happens next depends on the hospital and the team, cardiologists are usually happy with that but non specialists usually want a cardiologist or at least a registrar to double check.

There can be delays, the more complected the recording the harder it is to report on.

There is also another possibility, if you are at a smaller hospital they might be out sourcing the 24 hour recordings to a third party, this can take a week or more for 'turnaround'.

Re ablation.

Ablation literally destroys some cells in the heart. Imagine an electric circuit with an extra wire or two, the cardiologist will try to 'burn' the extra wiring away.

Ideally there is a small amount of tissue destroyed and the AF completely stops.

BUT it can take more.

One option is 'ablate and pace' this is where the heart's natural 'wiring' is destroyed completely and a pacemaker is fitted to take over.

I'm doing a second post so you don't have an essay to read.

Pacemakers are very sophisticated these days, when I was working in cardiology pacemakers could be programmed to slow down when asleep and speed up when active up to a maximum.

There are pacemakers that have a different program to stop certain rhythms.

I've been out of cardiology 20 years so what they can do now, well it's going to be more @Elsiebear90 will be able to update you.

Having said that there are options and the cardiologist should be discussing them with you.

Drugs are good if they control the AF as they can be stopped or changed as necessary.

Ablation is a cure for many people but it cannot be reversed and some people require a pacemaker.

If a pacemaker is implanted then it will need to be checked and sometimes reprogrammed. This sounds complicated but from the patient's point of view it is simple, you lie on a couch and the physiologist will place something that looks similar to a computer mouse but bigger over the site of the PM.

It takes a few minutes and needs to be done every 6 or 12 months (depending on the hospital and the cardiologist)

No one in the family knows so no but I’m tired and scared. Thank you.

I don’t want to leave incase they discharge him. Apparently their on the phone now. Probably ringing his cardiologist to ask if he knows anything about hearts.

I’m a doctor. If not anticoagulated ( as someone above said this depends on his Chadvasc Score) he would benefit from aspirin 75mg per day.
I would have thought that poorly controlled PAF with runs of tachycardia like his would benefit from Anticoagulation.
Hope that things are better today OP. So worrying for you x

Before you take him home please ask if they have reassessed his need for anticoagulation.