When Bisoprolol doesnt work?

My mother had a bad AF attack a few weeks ago, ended up in hospital where they increased the bisoprolol from 2.5 to 10 a day. 4 weeks later she is back in. They tried adding digoxin but HR plumeted from 130 to 42, so she is now off both for 48 hours and HR creeping up very slowly. They have mentioned a pacemaker, but i am fairly sure that would involve a waiting list?

She IS 82, has all her mental faculties, so what might i be fighting for. I dont think cardioversion, ablation nor amiodorine have ever been mentioned, and unfortunately i still ahvent managed to see a dr myself to ask. She is still in an "assessment unit" being monitored as cardiac beds are all full - there are at least 3 patients with her waiting for a cardio bed. This will be her 5th night in this temporary unit :(

What might the next step be?

Many thanks

A very concerned daughter

7 Replies

  • Oh dear I do feel for you and your mum. Are you At a hospital large enough to have the full facilities she needs. Do they have an electrophysiology team as you really need to speak to someone with that level of expertise. I assume she is in a monitored bed and having interaction with the cardiology team ongoing,

    Hard as it is you really need to insist on seeing or at the very least speak with a cardiac specialist. Her needs assessing as a priority by an EP. Then a full and proper treatment plan can be initiated. It is so concerning and frightening for you both and ever more so with the lack of a plan of action.

    Now is the time to be insistent. If the hospitsl does not have the specialist facilities she needs then she needs to be considered for a transfer to a hospital that does. If the current hospital has the correct facilities but you aren't reaching the right people then they are going to have to be pushed to speak with you both and move this situation along. Now is not the time to sit quiet on this. I know it is hard but we have to be the authors of our own destiny and right now you are both in need of some answers and reassurance.

    Where are you based is mum in a teaching hospital if so they should have the expertise required. If you are in a small local hospitsl then they should have a connection with a larger hospital for support in such matters.

    Wishing you and your mum well, it may well be time to be very assertive. I am doing the same thing with mother in law currently and she has signed a letter to say she wants us to speak with medics alongside her as in our case they would not speak with us in detail. It was madness and we insisted they transfer her from a district hospital to the teaching hodpital in the next city, things have improved rapidly from then on.

    Take care both of you it's an awful and very vulnerable time but being assertive is the best option. Thinking of you both.


  • Thank you Dee that is very supportive device.

    She is in a hospital (Prince Charles, Merthyr Tydfil) that has a good reputation for cardio, but does not, i believe, have an EP there. For that i think she would need to be moved to The Heath, Cardiff.

    It is very difficult for me as visiting hours are long after doctor visiting rounds. Yes she is being monitored by cardio via a heart rate monitor and it is reassuring that they phoned the nurses yesterday to get them to check her, turned out the batteries were flat!!

    i will phone in morning (thank goodness Monday is here again!!) and ask (demand?) to speak to a doctor

    Many Thanks

  • That's exactly what happened with mother in law we were at work and docs went home before we arrived at 6pm. My husband rang to speak with a doctor and he refused to speak with him even though we had prearranged it. My husband has a high level role nationally in the nhs and was not taking that for an answer.

    We asked for a second opinion from teaching hospital which we were given and they had her transferred to them things moved on swimmingly thereafter.

    good luck I hope you get the answers you deserve it is such a worry and even worse at weekends when everyone goes into the woodwork it seems. Let us all know his you get on. Hope you and mum get a good nights sleep.


  • You need to get your mam referred to Dr Peter O'Callaghan and his team at the Heath hospital in Cardiff ...Dr O'Callaghan is an electrophysiologist who specialises in heart rhythm disorders

  • Remember just because there are visiting hours inside the ward doesn't stop you demanding to see the doctors after round visits. The nurses will say it doesn't work like that so you do have to shout and demand to see someone high up. Now is not the time to play by silly rules though.

  • Good advice above.

    My husband had a similar scenario to your Mum's 2013-2014. We saw a cardiologist who recommended a pacemaker as his HR also dropped - to below 40 after AF & tachycardia so cardiologist could not prescribe Biso. He had a pacemaker inserted at our local hospital Royal Devon & Exeter, which is a teaching hospital but did not see an EP. Pacemaker did not require GA, all done under a local as a day case. Hubby was 80 when he had it done and after recovering from the soreness and adjusting to the implant which caused some muscle stiffness, he did (still does) incredibly well, recovering a lot of his old energy.

    Since then he has had only 3 known episodes of AF & arrythmia which happened in June this year which slowed him down for about 4-5 days but nothing more. We were in Spain at the time so he just rested whilst he recovered, he had been having quite a few regular episodes before the implant. Apart from anti coagulants and BP meds he does not take any other meds, is fit and active and very mentally aware!

    Hope you find this encouraging.

    I agree that one needs to be assertive about talking to the Doctors, it seems that unless you are nothing very much happens unless you are an emergency or very lucky.

    Best wishes, it is always more worrying when it is a family member than when yourself I always think.

  • Thank you all for your comments, i have spoken to the cardio doctors secretary who has arranged a meeting with an SHO to explain things to us. We are now much better informed, reading here, and the NICE guidelines!!

    Thanks all

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