Should I go to ER???

I started my latest AF at 6 pm on Monday night. This morning, after what is now 36 hours, I'm still in it. My cardiologist never mentioned going to ER after so many hours. I'm getting a bit nervous here since I'm now at 36 hours and have always converted by hour number 36 at the latest. My episodes are frequent. Every 3 to 5 days. I am anxiously awaiting my first EP appointment on Dec. 5th.

I am not on Coumadin. I'm taking Toprol XL 150 mg. daily,and 325 mg. of aspirin daily.

What do you think??? The 48 hours time frame is fast approaching!!!

Thanks for any input.

Cathy

Carol:
You must be miserable. Just go to the ER and let them convert it! That's too long. My opinion.

Pam

Cathy - go to the ER. Your risk of clots and stroke increases as your episode lengthens. Good luck!

Cathy,

I agree with Pam.

Richard

hope all is O.K. by now.
either way, I wouldn't rely on this board for this type of decision.
You will get great insights but clearly your doctor should be intimately involved with this type of intervention.

I have an arrangement with my EP- my episodes always occur at night.
If I haven't converted by the afternoon of the next day, I call their office
and they at least make sure that a conversion can be done the next
morning. that would usually be about 36 hours. Fortunately, this has
only happened once in the year that I have had Afib but the point is that
a good EP will prepare you for this.

You also might consider asking your EP about flecainide on demand.
This works great for many, including me. If the EP you choose fights you on this and wants to put you on a daily anti-arrhythmic you might consider finding a doctor who will agree to this regimen. It works great.

Cathy,

I agree as well, especially since you are so nervous about this. Take some aspirin as well as Vitamin E (no more than 400 iu) if it is a far trip to help prevent the clotting

We will keep you in prayer!

Joe

Cathy,

Kerry makes good points, and if you see just about everyone on this board would agree that you should go to the ER anytime you believe there is a serious problem with yourself at whatever time it might be....and MDs, DOs are the only people legally qualified to give you these type of directives. It would be folly and libelous for anyone on the board to point you in any direction other. When you feel threatened you should do what is in your best interest.

Kerry also makes a good point when talking about the on-demand use of drugs for situations just like this. On-Demand is the only time I take Rhythmol and I won't take it until after 10 hours have passed and I haven't converted.

Best Wishes.
Joe

Well here's what happened. I had myself all prepared to go to the E.R. by ten am if I hadn't converted. That would have been 40 hours. At about 8:30, after showering, I self converted. Total time is 38.5 hours. Although I must say that I'm not sure my rural hospital would even know how to convert somebody anyway.

My episodes are frequent and long. Duration is usually about 30 to 36 hours and every 3 to 4 days.

The reason I was asking what others thought is this. My cardiologist is in another city (I'm in rural PA and he's in Maryland). He diagnosed me in August, put me on Digoxin in addition to my 50 mg. of Atenolol I had been taking for years, and a daily aspirin, and sent me on my merry way to come back in six months. No real discussion or anything. Just a quick "any questions" as he was heading out the door from my 10 minutes of allotted time.

I had a terrible time with the Digoxin in that my episodes were almost daily. Meanwhile my family MD called me and wanted me to come in and discuss the a-fib with her. She changed me from the Dig and Atenolol to the Toprol XL, now increased to 200 mg. daily. Meanwhile scheduled me to see an EP in Baltimore but can't get in til Dec. 8. However, neither the cardiologist or my family MD seems to think ER trips are necessary. So...that was/is my dilemma. In between doctors, and very confused.

I'm sorry if it seemed like I was soliciting medical advice. That was never my intention. I just feel like I am really floundering right now. Bring on Dec. 8th!!!

Cathy

You are a brave lady............I would have already been in ER!

Good luck with your cardio.

Cathy

What is your resting heart rate in afib? I was told by my cardio that because my resting heart rate is of the slower variety that there is a lower risk of clot formation.

Adrian v49

Cathy:

Have you considered the "on demand" approach? I would be in AF for anywhere from 10 - 20 hrs., I was given Rythmol to take within the first 10 min. of going into AF (I take 225 Mg. which works for me), my episodes end in 2 1/2 to 3 hrs., since they always occurr during the night, I am fine in the morning. This has helped me a great deal.

I go to a EP and he said if I go longer than 24 hrs. that I should go to ER, I too am not on coumadin, I take asprin every day. I have tried coumadin and for some reason cannot take it, even at a low INR I have a reaction, I will get a lot of bruises on my legs, fingers swell with broken blood vessels and hemotoma in my eye, so with the on demand approach I am not in AF long, hopefully I won't throw a clot.

Liz

Cathy, clearly only a doctor can you medical advice. However, many of us have found that doctors are not current on afib issues. I live in South Florida and, supposedly, the heart doctors in Palm Beach County are good--they should be, with all the old folks here. BUT, I have never found one who will sit down and really discuss these issues nor have I found one who seems to be up to date on vagal afib. The protocol here is that they give you an IV drug (Corvert or something like that), and if you don't immediately convert, they stick you in the hospital with montior, IV and the infamous belly shots. Belly shots are a blood thinner. You are not allowed to get out of bed. My personal experience has been that moving around helps me convert back to NSR, but that isn't allowed in the hospital. My episodes last longer in the hospital and the whole experience is extremely unpleasant. I wouldn't even consider going in until 36 hours passed; fortunately, except when I have gone to the ER, the episodes have never lasted very long.

It is a troubling, perplexing issue. Depending on the type of afib you have, you need to educate yourself and figure out how to make the doctor discuss it with you. Good luck, as I haven't had much luck with the doctors, but at least I could somewhat intelligently suggest things like digoxin being bad and coumadin being unnecessary (for me). Read everything you can and try to come to some better understanding with the doctor. Good luck! John.

Cathy

If it makes you feel any better I have never been to ER or casualty as we call it here, once in the 20 years I had AF. It was never mentioned to me as an option, never mind a necessity. When I discovered they could cardiodivert I asked my Dr's why they had never put me forward or told me. They said my AF was too long standing for it to be an option. I was never on anticoagulents either. I think different Dr's, different health areas etc all have different ways of dealing with AF. To be quite honest I think I am quite releived that the 'neccesity' of going to ER was never put to me. I think at the time it would have made me think I was seriously ill - and to be quite honest I don't think this is the case. Frightening, annoying, debilitating and a pain in the ass yes, but not life threatening.

Fran

Joe.

Why will you not take Rythmol until 10 hours have past? And also how much do you take? I myself have found out that I convert faster if I wait several hours and need not take additional doses as when I don't convert after 5 or 6 hours. This runs contrary to board opinion, that suggest an immediate dosage.

Thanks, Don R.

Don,

A good Question. This is a personal choice for me. I struggle to be drug free. I have found that I will usually convert on my own at about the 8-10 hour mark. If it get's past this I will take the Rhythmol. I use it as my second line of defense.

Currently, Here is my protocal for Afib. Usually I can tell it is coming on, I get ectopics, pacs, pvcs. At this point I will usually take 400mg of Mg Glycinate, 200mg Gamma Tocopherol and 1000mg of EPA. Many times that is enough to start the subsiding of the ectopics. If I proceed into afib, I typically slow down what I am doing. Take 200mg more Mg Glycinate and 200mg more Gamma Tocophero ltake some type of antacid, and perhaps an aspirin (If my mind is playing games with me that day!). This works for me 90% of the time. When I get past this point then I take the Ryhthmol. 2 Tablets for 300mg total.

Sometimes I take Calcium and Pottasium in addition. Although, not all the time.


Joe

Cathy,

Can you tell me why you were put on atenolol in the first place, and was this before you had AF. It is my opinion that this can cause one to go into AF. How are you doing and feeling on Toprol now? Toprol is cardiac specific, whereas atenolol is not.

Richard