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.

Oh right, dh has been told it’s all last resort stuff for when your older.

It does make more sense to do it when their young doesn’t it?. Like most procedures. It’s really hard to see the wood from the trees when things like this happen so thank you for pointing that out Toddler.

Dh has had 7.5mg bisoprolol today and can feel his heart twitching.

I am not a medic but was married to a DH with cardiac issues for a long time. The way beta blockers were described to us was this: when the body needs extra circulation, it sends a message to the heart to ask it to work harder. Beta blockers interrupt that message and slow down the heart's response - this is to protect the heart from over-exertion that sends it into irregular rhythms. They are not the only option, the right dose is important, and sometimes you might need a combination of other things too.

While you're adjusting to the beta blocker, it can feel awful, because those slowed down messages can make you feel exhausted and really unwell.

From what you describe, your DH's heart has been over-working while in the irregular rhythms, and now you also know about the valve issues etc. All those things could be causing breathlessness that is cardiac-related, so I would guess they are concentrating on treating the heart issues. If he is still short of breath after they get his treatment right for the heart, then they should explore whether there is an asthma issue.

A final word on ablation - essentially the burning away of the route that the electrical current is mis-directing down, so that the electrical impulse goes down the right path instead for a regular rhythm. There are lots of things that make someone a good candidate or not; my DH was not, because his heart was so damaged and enlarged that whenever they tried an ablation, the irregular electrical impulse just found another "wrong" route to go. He was young, so there's no hard and fast correlation to the age of the patient.

I hope that the hospital takes this opportunity to get his medication right under close supervision, and that he soon feels an improvement. Regardless, if you can find a friendly nurse, do ask about a nurse specialist for heart failure (horrible term, it doesn't mean the end is nigh, just that it's not working perfectly). They would be able to take the time to go through all the diagnoses and options with you, and answer your questions. Ideally the doctor would have done this, but he doesn't sound like he does "people" unfortunately.

When he talks about surgery - is the Consultant talking about ablation or replacing the leaky valves? Whichever, your husband isn't being controlled at the moment, so the Consultant needs to explain his approach, especially as his current treatment appears to be exacerbating the asthma. also, being in AF long term is exhausting and debilitating.
I think you are right to ask for a re-referral, you have obviously lost confidence in your local hospital.

DH went back out of rythmn in May, so is back on 7.5mg bisoprolol, which he is currently taking in divided doses - 5mg in the morning and 2.5mg at 1pm. Seems to get better control and fewer side effects, although its mostly given as a single dose. He's waiting to discuss the next move for him, but is managing at the moment ( more or less) but he can ring the Cardiac Nurses at his hospital at any time.
Over the years he has been on 3 different beta blockers, some are more effective than others, and a couple of other drugs to treat his AF.

I think there’s two separate issues with his heart.

1. Arrhythmia from radiotherapy. If he has a can of Coke or tea with caffeine that’s enough to excite the heart muscle.

2. Damaged heart valves. Calcification on it and regurgitation. He had a heart murmur at birth so possibly when various gp listened to his heart over the years and found a murmer it was actually his valve slowly failing.

3. Infection in lower lobe of lung, we didn’t know about that & he's on doxycycline as he is allergic to penicillin. Same area as a previous fungal infection from what I can tell. It’s always that one side.

So, overnight his heart was in a normal rhythm. His blood glucose was 6.8 so they gave him biscuits to raise it. Which seems odd to raise glucose levels in a diet controlled diabetic with active infection.

He wants out.

@Fluffycloudland77

Wow you have a lot on.

Glenfield is a great hospital for cardiology.

What has probably happened over the years is that his heart has enlarged, the top chambers, the atria are almost like a balloon in that high pressures cause them to expand.

The leaky valves (depending on which one) allow blood to flow the wrong way when the ventricle (lower chambers) contract.

Pressure on the lower changes cause the heat muscle too thicken rather than expand.

When the top chambers expand the 'electrical circuit' in them stretches and often some stops working.

This means the top chamber isn't contracting in the way it should and this is when you get blood 'pooling' in the atria, that's when it can cause other problems as clots can build up and be transported around the body.

I'm trying to explain things so you know what's going on, if you'd rather no then tell me to shut up, I won't be offended.

I think you need to be asking for a second opinion NOW.

I'm glad he was in normal sinus rhythm overnight, and I hope you are taking care of yourself.

Best wishes.

I’d rather know tbh. Podiatry degrees don’t do a lot of heart pathology as you can imagine. Give me a non compliant diabetic foot ulcer patient & Im ok.

I’ve told him if he wants to come home I’ll get him because he’s on a ward that hasn’t been cleaned yet, no wiping down & drs not wearing masks. I’m in today and I’m wearing a mask all day until I leave.

Glad I'm not upsetting you OP

It does sound bad where your dh is, have you contacted PALS?

Yes I complained on Tuesday which dh thinks is why the consultants not happy with him and says other people cope just fine with af and two leaky valves.

The back way of getting to Glenfield is to present at the A&E at Leicester Royal and they transfer you to Glenfield. Well that's what happened when my dad had AF. I couldn't fault the care he received from them. It was all done and dusted in about 6 months.

That's terrible, consultants should not be like that, as professionals (as you know) HCP should teat people fairly.

I'm shocked that he's expected just to cope. You've clearly said that he's unwell. My dad had it nowhere near as bad. And it had a significant impact on his life.

I'm really angry on your behalf and that's really unlike me!

This has been going on since July 2019. He’s nearly in tears today & the consultants on his way round.

I don’t like being lied to, chest pain unit & consultants secretary both swore blind any abnormalities on his gel scan would have been flagged up.

If it’s a valve in the top chamber & bottom chamber it’s a mitral valve plus either the aortic valve or vein to his lungs (vena cava??) isn’t it.

Anyway, he wants a copy of the times & a sandwich. Might get the Telegraph, he’ll be out quicksmart if they think he’s a Tory voter.

This is awful.
I too was going to suggest going to a different A&E to see if he could be admitted to a better hospital.

He was slurring his words first thing so they’ve split his dose 5mg then 2.5mg.

I think he’s had some sort of panic attack and they’ve given diazepam. One of the nurses has apologised for the way her colleague has spoken to him & seems to have established a rapport with him.

Pulse is 80 which is better as it can be 100 when he’s watching television.

Fluffy what is a gel scan? Do you mean an echo?

I think so.

Maybe he should see Magic & Maia's cardiologist. She's fab!

She’s probably got a better bedside manner.

The motral valve is between the atria and ventricle on the left of the heart, some 'leakyness' is very common but this is obviously beyond that.

The aortic valve leads to the aorta so basically all the blood pumped in one contraction goes through this to the body (the blood from the right side goes to the lungs).

There is some good news with the aortic valve in that these can be replaced without open heart surgery, it can be done in a similar way to an angioplasty feeding a valve through the vascular system and in to the heart.

Note not everyone is suitable for this AND the valve still leaks, it is better than nothing but not as good as surgical replacement. The reason for it though is that it doesn't need a GA so is better for patients who are not suitable to surgery.

OP

Get him the telegraph and ask the staff if they are happy to be quoted in an article.

fluffy just seen this while mumsnetting as I can't sleep! So sorry to hear about dh, it must be really stressful. Sending you frugal hugs. You know where we are

Hi North how are you? £14 in smiths for two magazines. Paid on his card for that little lot, men’s magazines are so pricey the publishers should watch Harry Enfields “I saw you coming sketch’s” or maybe I they already have.

Bought the times as it was smaller.

He wasn’t answering his phone so I had to ring the ward. Still with us. They woke him up to say your wife’s worried.

@sashh
His dad had a TAVI a few years back and he’s really well. He had quite bad pneumonia when we got him in there. Apparently two uncles died of heart attacks on that side way back, fil is the youngest so when dh was very young.

All these years I’ve worried he’d get cancer again I never thought he’d get heart failure.

I'm good thanks. It has been a hard year with A levels, covid etc but surviving! Love that you reported spends, once a frugaleer...... How is DH today?

I still get nervous around exam result time and I’m 43. It’s a bad enough time as it is and exam results seem so final like your whole life depends on that one day .

Feels grotty but who wouldn’t?. Thank you for asking.

@Fluffycloudland77 north grassed on you. Big supa frugal, or not, hugs..
Nice to see a sense of humour still.