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Emergency Department Discharge Instructions

Atrial fibrillation



Emergency Care Discharge Instructions

Instruction summary

Atrial fibrillation is a common disease, characterized by an irregular heartbeat. While the irregular heart beat itself is not usually harmful, in many people it can increase the risk of having a stroke by interfering with normal blood flow. Not everyone with atrial fibrillation is at risk of having a stroke; your physician will assess this for you.

If you are at risk of developing a stroke, you may have been started on a blood thinner medication in the ER, which is used to prevent a stroke. If you were started on a blood thinner called warfarin (which is the same thing as Coumadin), it is important that you follow-up with your family physician (ideally within a week) to have a blood test called an “INR”. People who are not on warfarin have an INR of “1” but individuals with atrial fibrillation on warfarin should have an INR level between 2.0 and 3.0. The dose of warfarin may need to be adjusted, based on the INR test results.

Other blood thinners such as dabigatran (same thing as Pradaxa), rivaroxaban (same thing as Xarelto), or apixaban (same thing as Eliquis) do notrequire a blood test, but you should still schedule an appointment with your family doctor as soon as possible, in order to avoid running out of the prescription. If you were not started on a blood thinner in the ER, make sure you see your family doctor (ideally within a week) to discuss whether you need to start one. Depending on your age and other medical problems, this may prevent you from having a stroke in the future.

Another medication that your family physician may need to check on is an anti-hypertensive medication (i.e. a blood pressure pill). These medications can be used to prevent your heartbeat from going too fast. Your family physician will check your heartbeat to assess whether the medication and the dose is working well for you.

If you are starting new medications, it is important that you take all of your medications to your regular pharmacy so that the pharmacist can determine whether the new medications have any interactions with your usual medications.

Reasons to return to the ER
  1. Chest pain or feeling of tightness in the chest
  2. Shortness of breath upon physical exertion, such as when exercising or climbing stairs
  3. Feeling light-headed or dizzy