Adventures of a Racing Heart Afib number 7 (SEPT 2021)

Adventures of A Racing Heart Afib #7 (SEPT 2021)

Four and a half months after my second cardiac ablation I went for my annual flu jab, probably the seventh time I’ve had this. I had some slight trepidation since the Covid jab had set off Afib after my first ablation, but since then I had survived the Covid second jab so I wasn’t properly worried.

So, you can imagine my mood when I was awoken at 0455 the next morning with a racing heartbeat.  I took 100 mg of flecainide as a PIP and it settled down at 0532 before starting up again at 0538!  0545 I took the second PIP as instructed.  At 0640 the heart suddenly went berserk and was beating at over 150 bpm and I was feeling very breathless so we had to call an ambulance.  The paramedics were great as usual but had to take me to my arch-nemesis, the DREADED local hospital (see previous posts regarding AFib 2 and 3 for my stormy relationship there!).

As expected, they refused to read my nice long typed history of my Afib, but did at least listen to me when I said that (pre-ablation number two) a quick dose of flecainide had converted me back to NSR.  They gave me 100 mg of flecainide intravenously (but only after I had refused to take a tablet and insisted that it needed to be given intravenously!) but the new modern pump drip was hopeless, ever time I moved my arm and the pipe kinked the pump stopped but then rather than restarting when I straightened my arm, like the old-fashioned gravity drips, it would need to be reset by a medic. So, what was meant to be a small, sudden dose of flec to shock the heart back into the rhythm turned into a slow drawn-out administration which did absolutely nothing. 

Next, they tried amiodarone which also did nothing.  At lunchtime they decided to move me to the cardiac unit and I began planning for either a long stay or self-discharge and get myself over to the big teaching hospital for a cardioversion.  However, while preparing to move me my HR suddenly shot up from between 90-120 to 173.  I was very breathless with chest pain.  Once on the cardiac ward they gave me 5 mg of bisoprolol which then suddenly dropped my BP down to about 90/60 and I was passing out.  So, I ended up with my legs in the air and the bed tilted to about 45 degrees!  However, the doctor did say she was pleased with how much it had lowered my HR and for a few awful minutes I seriously thought they would excel themselves and discharge me like that!

Luckily, even they are not that bad and they arranged an emergency DCCV. It’s a huge big deal when they do it at this local hospital.  They use the operating theatre and an anaesthetist and a whole load of theatre staff and knock you out and keep you in the recovery room for ages afterwards.  At the big teaching hospital, it is done in the resus department with the emergency doctors and nurses and takes about five minutes!  Finally at 1800 they did the shock but apparently, I had 7 seconds of asystole afterwards which sounds a bit scary!  I expect the poor little heart was so stunned by all those drugs and then being expected to start working again was a bit much for it.

 

I had a very low heart rate afterwards – down in the upper thirties if I recall correctly so I was kept in overnight.  They were also concerns over my Q wave whatever that might be.  The next day I saw another of my nemeses, Dr H, who is just the rudest doctor ever.  He barely grunted hello at me before discussing me with the junior doctor as if I wasn’t even there.  They had all the facts wrong (including the doses, plus the flecainide showing as an oral not IV dose!) and he was rudely insistent that I had had amiodarone before flecainide.  Then he added up how much flec they had given me and angrily accused me of having taken too much!  I pointed out that at all times I had been lucid and had constantly told the paramedics and A&E doctors that I had taken 50 mg flec at night and two lots of 100 mg flec as PIP.  They had then given me the IV flec which made a total of 350 mg within about 13 hours which is over the maximum dose of 300 mg!  And, apparently this was my fault! Now you know why I avoid this hospital like the plague.

Eventually I was discharged even more determined than ever that the next time I had AFib I would endeavour to keep as far away from that hospital as possible!  I felt rough for about two weeks after this performance too.

 

Abbreviations

PIP                  Pill in Pocket (emergency dose to restore NSR)

NSR                Natural Sinus rhythm (i.e., normal heart beat)

Afib                Atrial fibrillation – an arrythmia of the upper heart chamber/s

Bpm               beats per minute

Flec                Flecainide, an anti-arrythmia drug

IV                    intravenous, via the blood stream

HR                  Heart rate

DCCV             Electrical cardioversion (electric shock to stop and restart the heart! Used to correct Afib etc)

Asystole       No heart rate (i.e., flat-lining)

 

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