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Dr. Mark
Dr. Mark, Board Certified Physician
Category: Medical
Satisfied Customers: 5558
Experience:  board certified internal medicine
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I am experiencing atrial fibrillation and am not sure at

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I am experiencing atrial fibrillation and am not sure at what point I should go to the ER. That is my only option since it's Sunday
JA: The Cardiologist can help. Just a couple quick questions before I transfer you. Can you tell me about all the symptoms you've experienced (e.g. shortness of breath, heart palpitations, minor physical effort making you feel tired)?
Customer: The symptoms started sometime during the night, I woke up in afib shortly after 6 this morning. I have gotten a head rush, like I stood up too fast, a few times today but only when I did, in fact, just stand up. I have been diagnosed with lone afib in the past, and had to be electrically cardioverted once several years ago due to an elevated heart rate. Since then I have gone into afib only a few times, once I went to the hospital and since my heart rate was normal they discharged me, and I happened to cardioverted naturally while waiting on the discharge papers.
JA: Do you know if your family has a history of heart disease? In general, how would you describe your health lately?
Customer: My maternal grandfather has afib, he has a pacemaker. My health is improving lately, I have started trying to lose weight and am down about 20 pounds so far.
JA: Anything else in your medical history you think the Doctor should know?
Customer: I take metiprolol daily to keep my resting heart rate down, my cardiologist took me off the 81mg aspirin he had me taking after thaw t first severe episode.
I suggest you go to the ER now for evaluation. I don’t know all of your cardiac details but the possibility of an embolus is always there with a fib.
Customer: replied 11 days ago.
OK I wanted to make sure, I know a lot of people live in afib most of the time so I'm never sure how long to wait since this is only the 4th time I've had it last more than a few seconds.
Customer: replied 11 days ago.
Is there more information I can give you about myself or my case that would change that recommendation, or would you advise me to be seen regardless?
The latest criteria uses the ACC chads2Vasc risk calculator.
Customer: replied 11 days ago.
My chads score is 0, I have none of the history items mentioned and I am only 36 years old.
Think I misspelled that. What we need to know is your risk for emboli stroke. Criteria include age, sex, hypertension, congestive heart failure, diabetes, and history of diabetes.
A score of zero only needs aspirin. No other blood thinners.
Let me send you the calculator so you can double check. If indeed your score is zero, the take aspirin and see your doctor tomorrow. I’ll brb.
https://www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk
Customer: replied 11 days ago.
I was taking "baby aspirin" 81mg a day after my first episode, when I had to be cardioverted electrically because my heart rate was very high, 165+, and they were worried about the risk of stroke. My cardiologist has since taken me off the aspirin because all my other factors looked good. We had talked about ablation later as an option, but this happens so rarely that he was hesitant to recommend the surgical option.
Calculate your score and let me know.
Customer: replied 11 days ago.
My score is 0.
What is your pulse rate? Extremely fast rate along with shortness of breath or chest pain or lightheadedness are other reasons to be evaluated today.
If you have none of the above symptoms with a zero score then just start a baby aspirin.
Are you still there? Having any symptoms from the a fib?
Customer: replied 11 days ago.
My pulse rate has been varying between standard resting rate in the 60s and up as high as 130 or so. Measured from my smart watch, which has struggled with accuracy during afib in the past. Feeling my pulse and counting it out its about 100 right now, give or take.
Customer: replied 11 days ago.
The only symptom I'm having other than the afib is feeling a little light headed when I stand up quickly, and I woke up with a mild headache this morning but don't know if it is related. I have not had headaches with afib in the past.
Then there’s no need to go to the ER. Just start aspirin and see your doc tomorrow
Headache isn’t related to a fib.
Customer: replied 11 days ago.
Should I be trying to see my cardiologist or my gp?
Cardiologist
Customer: replied 11 days ago.
I'll see if I can get in with him tomorrow, normally takes a while but it should be doable especially if I'm still in afib tomorrow. The past couple times it's happened it hasn't lasted more than about 12 hours.
Call your gp tomorrow though for a referral. I’m sure your gp will want you to see the cardiologist. On second thought, call your cardiologist yourself.
The cardiologist should see you tomorrow. He or she can try medication to try to convert you.
Customer: replied 11 days ago.
OK I'll make that call first thing tomorrow when they open. I'll see what they advise and make an appointment as early as possible. If I'm still in afib tomorrow or if the symptoms change or my pulse goes up I'll go to the ER
Customer: replied 11 days ago.
Is there a mark as fsr as how long I could be in afib before I should go to the ER to be evaluated regardless of additional symptoms?
There’s no time frame for how long to be in a fib.
Customer: replied 11 days ago.
OK that's what I had read but wanted to be sure.
With a zero score and you basically are stable, there’s no need to go to the ER. What you should do,is call the cardiologist now. They have your records. The on call cardiologist will call you back . It might even be the one you saw. Anyway, they can access your complete records from their home and better advise you.
Customer: replied 11 days ago.
OK, I will do that. Thank you for your help!
Glad to help. I’m very familiar with a fib but treating you online is a bit difficult for me without access to all of your history and tests.
Good luck.
I’d appreciate you rating my answers with the stars on your screen so I receive feedback and credit. Thanks
Dr. Mark and 5 other Medical Specialists are ready to help you
Customer: replied 11 days ago.
I will do that, and thank you.