Newly diagnosed

[Exhiker]

I have just been diagnosed with paroxysmal afib after having to go to hospital with fast afib with a top heart rate of 190.I was in for 2 nights and sent home on bisoprolol and rivaroxaban and I was already on enalapril. I have noticed my pulse rate is now in the 50s , lowest being 50 or 51. Are these pulse rates normal on betablockers or have they gone too low? Just wondered what other people's are.

[AAJJTt]

Hi, welcome to the forum. The presentation of Afib and response to medication varies widely between individuals.

I was diagnosed with PAF five years ago. Currently it is maintained with Flecainide (rhythm control) and my RHR is around 50-55bpm, dropping to high 40s in the late evening.

Initially I was prescribed Bisoprolol but this did drag my HR down into the 30s, leaving me tired and washed out. It was withdrawn as a daily meditation and now I use it only as a PIP.

It really depends on how you feel, I am perfectly fine with this HR and I’m very active.

[Exhiker in reply to AAJJTt]

Thankyou very much for your reply, that's very helpful. I do feel very tired at the moment but it's still early days yet so will see how I go, but at least I know not to worry too much about HR in 50s.

[mav7 in reply to Exhiker]

heartrhythmalliance.org/afa...

Welcome !

Check the above link for helpful info.

[Exhiker in reply to mav7]

Thankyou very much for the link.

[mav7 in reply to Exhiker]

Forgot to mention, if you have a question or thought but don't want to make a complete post, the search bar above is pretty good in my experience. Just type in the subject.

[Exhiker in reply to mav7]

Okay, thankyou very much.

[Buzby62]

The smallest dose of bisoprolol 1.25mg dropped me in to the 40s and later increased to 2.5mg (2x1.25) which lowered me again to low 40s at rest and one occasion to 39, that is while NSR and not in an AF episode. For some bisoprolol has more effect than you might think or be told, even at small doses. It’s also relative to your normal resting rate prior to taking the meds, I was mid 50s. You will be told to go on how you feel but if you feel unwell get in touch with the cardiologist or doctor.

There’s lots to get your head around when first diagnosed, here is a link to all the patient resources on the AFA website heartrhythmalliance.org/afa...

I would start with the AF fact file and the FAQ sheet. Once in that website you can also navigate using the Menu button at the top. Knowledge is the key to deciding your treatment path.

Best wishes

[Exhiker in reply to Buzby62]

Thankyou for your reply and info. Yes it does feel a bit overwhelming at the moment being newly diagnosed. I feel I've already found support from here which is great. I will see if the tiredness settles and see how I feel. I know I should give it a bit longer as only started last week, these replies have been very helpful .

[NewOne2023]

I was put on 1.25mg bisoprolol daily (+ propafenone) but I couldnt tolarate it well. My heart rate would go down to 40s, once it was 42 and also I would get frequently dizzy if I stand up suddenly. So in the end I stopped the bisoprolol (in agreement with cardiologist and EP). I had cryoablation almost three months aho I once more I tried to go back on bisoprolol but my side effects started all over again, so once more I stopped taking it. Seems I don't tolarate it at all. I could ask for an alternative blocker but I juat didn't bother since it didn't make any difference for me.But low 50s I would say is still in the normal range. That is, if you don't get other symptoms, like dizziness.

[Bramley01]

yes, my RHR was always in the low 50s on bisoprolol, also terrible fatigue, then changed to sotalol and feeling less tired

[AmandaLouise77]

My EP told me to take my Bisoprolol at night before bed to help to deal with the fatigue. It works for me.

[wilsond]

No that's quite normal. Mine always hovers around there.

[Drone01]

Same with me as with others. Bisoprolol took resting rate down into the upper 40s and low 50s. Carried on with the beta blocker after diagnosis until echocardiogram showed my heart to be in good shape. Then stopped bisoprolol altogether (in agreement with cardiologist), not least cos it was inhibiting my aerobic exercise.

[momist]

That seems normal to me. My heart rate on bisoprolol is often in the mid to upper 40's when resting. One thing I've found is that another effect of the drug is that the heart is slow to respond to increased demand. If, for instance, trying to walk up a hill, it will take quite a few minutes for my heart rate to increase sufficiently to stop me feeling tired, but it then _does_ rise and I can carry on climbing the hill. (I used to do a lot of hill walking, not so much now I'm even older). Similarly, my heart rate is low first thing in the morning, but never falls so low when sat relaxing in the evening. e.g. 47bpm when I get up, 56bpm when going to bed.

[Vonnegut]

Fine in the 50s - my problem was in the low 40s on the lowest dose of Bisoprolol! You’ll find this a very supportive group but we are all different and hope you find what works best for you.

[Paulbounce]

Hi Exhiker.

Worry not! I function best with my HR at that rate. I'll also let you in to a little secret - afib won't be half as bad as you think. New treatments are being investigated all the time. There's not one person on this forum who didn't worry when they were first told they had afib - me included.

Sure it will be nuisance at times but you'll deal with it - mark my words 😉

Paul

[Ppiman]

My rate on 1.25mg bisoprolol dropped to the low 50s, and now, on 2.5mg can drop occasionally to the mid to low 40s. I have been told that so long as the rate is comfortable for me, it is quite safe. Most of the day, the rate is higher, of course. Yesterday my Apple Watch (a godsend as it comforts me a lot!) measured 40-108bpm, for example. It seems to be early evening when my rate drops the most and at that time, too, is accompanied by runs not of AF but of ectopic beats such that the palpitations feel almost similar to when I do have AF, which is every 2-4 weeks at most.

I notice, too, that you are on a blood pressure medicine. The two often go together and high blood pressure seems to bring on AF over time (which can be many years). Some doctors believe that the generalised inflammation in the body that leads to hypertension also leads to AF. This inflammation might be caused by our genes, but more likely by a combination of these with a less than healthy lifestyle over the years. Whatever the cause, it seems well worthwhile to do things to reduce the high BP such as take tablets, lose weight and increase exercise since a slimmer, fitter body is extremely helpful for the heart and circulation. Doing this can also reduce the AF frequency and severity, as can reducing any sleep apnoea, if that is happening, as seems often the case, too.

You probably know what follows, but it's maybe worth saying. It's worth remembering that the heart illness in AF is confined to the upstairs apartment and so the heart is, essentially, safe. Even if a crazy party is going on upstairs, it can never cause similar chaos down below. Downstairs doesn't ignore the party, however (who could?!). It starts to dance the jive instead of the slow foxtrot and reach, perhaps 180-200bpm, but this is never a sustained rate, but a very irregular one, which allows the ventricles to pump blood sufficiently healthily and efficiently to the lungs and body.

The problem is that the volume and force of the blood leaving the heart is now, and this varies between sufferers, somewhere between what the body is demanding or a little less than this. When less, the body will show symptoms such as light-headedness, chest aching, a need to breathe more deeply, among others. On top of this, the nervous system goes into overdrive to boost the heart output, but this also can create feelings of stress and anxiety, which result in a panicky feeling, sometimes to the point of a feeling of "impending doom" and even with worrying tingling feelings in the upper left body and face. It can be frightening and the feeling that you need to be in hospital can be hard to overcome, but generally you don't unless your doctor has suggested otherwise. Most people sit it out and carry on as near to normal as the heart output will let them.

Steve

[Exhiker in reply to Ppiman]

I like your description of what's going on in the heart. Ha.

[Exhiker]

Thankyou for all your replies, I understand now that the pulse rate is OK at them levels but today I'm feeling breathless and fatigued.

[108cat in reply to Exhiker]

Yes as Buffafly implies the fatigue can be a resulte of the AF episode itself .. one cardiologist said to me during a hospital visit, if your heart goes out of rhythm and very fast for a sustained period, it's as if you've run a marathon and you will feel tired afterwards.

I find if AF episodes go on for hours I can be tired for several days - if it lasts 10 - 15 minutes I can be tired the following day.

It's very hard at first to figure out what's going on, lot of variables, and as everyone says we all seem to react differently to the meds and have different triggers etc. ...

sending best wishes ...

[Buffafly]

You do need to allow for your heart having been very stressed at 190bpm. I don’t know what your dose of bisoprolol is but it was probably prescribed on the basis of your high rate in AF. The trade off is that you feel sluggish in sinus rhythm. I used to take two meds which together made me feel as though I was physically and mentally wading through porridge but now just take one at a lower dose. It is very early days and as time goes on (rather slowly I’m afraid) you may be able to have the dose adjusted or different meds prescribed. Bisoprolol is a first line treatment and cardiologists love it, patients not so much. Best wishes ❤️‍🩹

[Exhiker in reply to Buffafly]

Thankyou very much, yes still early yet, hope to get there one day.

[TracyAdmin Partner]

Welcome to the Forum, I am positive all the members will welcome you and offer great advice about their own AF experiences.

Have you visited the AF Association webpage: heartrhythmalliance.org/afa/uk

You will find a wealth of support and information about AF, from informative videos, in- person and online events, patient stories and patient resources, but if you have any specific questions, please do not hesitate to contact the Patient Services Team: heartrhythmalliance.org/afa...

You may be interested in joining us for our AF Association Patients Day, taking place on Sunday 06 October, in central Birmingham, UK. For further details: heartrhythmalliance.org/afa...

May I recommend one of resources that may be of particular interest to you:

AF & You booklet: api.heartrhythmalliance.org...

Kind regards

TracyAdmin

booklet

[Exhiker in reply to TracyAdmin]

Thankyou very much, I already feel I've learnt a lot from just my first post.

[MWIC]

depends how you feel - my “normal” HR is low-mid 50’s and feel absolutely fine but when in Bisoprolol my HR would often drop into 40’s and at that rate I felt like a zombie - It can however take some time to adjust to taking Bisoprolol and many people are then fine on it - I wasn’t one of those and it was stopped so keep an eye on your HR and how you feel at the time - any doubts check with your doctors

[Exhiker in reply to MWIC]

OK thankyou, I will do that

[TopBiscuit]

Welcome! You'll find this forum very helpful and supportive.

As far as heart rate goes, in my experience doctors do not ask what your normal function is prior to prescribing medication. I personally have quite a low heart rate, resting HR in high 40s to low 50s going down to below 45 during the night....but I was still prescribed Bisoprolol when I was diagnosed with AFib. I halved the dose and still about fell over after my AFib episode had ended as it had also made my BP drop too low as well as my HR. I cannot tolerate the lowest dose at all.

All this to say, HR & BP are very individual and many people do fine with a lowered HR and many don't - it's all down to how you feel. If you're feeling very tired then it could well be that you need a lower dose, or a different medication even. I take Propranalol 10 mgs at the onset of an episode (knows as PiP - pill in the pocket) along with Flecainide and that works very well for me.

[Exhiker in reply to TopBiscuit]

Thankyou very much.

[Hallane]

average 45 - 60

[Exhiker in reply to Hallane]

Thankyou

[JOY2THEWORLD49]

Hi

BBs do nothing for my heart rate. Was 186 on Metoprolol and 24hr Heart monitor found pauses at night with average 47 at night.

When changed to Bisoprolol hert rate was 156. Same at night without pauses.

It was Diltiazen CCB which took me down to 51 but that was too much drop so I have been taking 120mg as against 180mg (1/2 dose).

During day 51 gave me lightheadness and couldn't drive on that.

I'd reduce your Beta Blocker. Also you work on stopping adrenaline from entering your heart and maybe the heart was stressed with a high heart rate but now you are more settled. Ask you specialist or Dr to reduce your dose. I did my CCB.

cheri JOY. 75. (NZ)

[Exhiker in reply to JOY2THEWORLD49]

Thankyou yes, I think I'll ask if I can try 2.5mgs instead of 5mgs like they put me on.

[Japaholic]

when first diagnosed I was given a very high dose of Bisoprolol, 10mg, that gave me bradycardia, and made me impotent. Since moving to Japan it’s reduced to 2.5mg, HR is average 65bpm and have some interest in nookie again.

Ask your doc to adjust if you can, not sure with the state of the NHS these days

[johnm66]

58-65

[Exhiker in reply to johnm66]

Thankyou