A few years ago i had Mitral Valve Repair i was on Bisoprolol for a few months, Post-Op ,for Sinus Tachycardia and My Cardiologist agreed as all was well
i could taper off Betablockers .As there is no evidence that they are needed long term after Mitral Valve Repair.
I have had since a young age Sinus Tachycardia at night a few times a year but recently had it once a month
and couple of days in a row while off of betablockers.
Cardiologist has said these symptoms should be treated with 2.5mg of Bisoprolol a day which i take in the evening.I really didn't want to be on medication but it is working .I would like to find evidence
or links that are associted with taking Betablockers long term but not really about the side effects but if it's safe
being on Betablockers long term
and any health implications that i should be aware of Diabetes for example.I would be most grateful to any members
for any advice.
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I see that no one has replied, so I will have a go. I enjoy researching questions like this. Your major concern is safety, and that needs defining. Safety is also something that is often hidden by drug companies. The other side is that sometimes a perfectly good drug is taken off the market for trivial safety reasons.
Follow my thinking. I am writing how I set about looking. My problem first is the search term. After several attempts I hit on "long term safety of bisoprolol". At first I tried the generic, betablockers, but that did not work. I tried it in google scholar. This got me: Safety and tolerability of beta-blockers: prejudices and reality
From that, you may notice the 'cited by' and 'similar articles' which I may explore and post later. The cited by in particular can be useful, because the links are to newer publications, so you can start with an old publication then move towards newer ones.
For safety, I think you need to break it down into more precise areas:
1. Drug interactions
2. Effect on the kidney and liver
3. Other problems such as lung, COPD, asthma, diabetes etc.
4. Look at specific effects eg reducing the heart rate, and how it reduces the rate and the long term effect of this. eg it reduces blood pressure, but look at it from reducing the lowest pressure as separate from reducing the highest pressure.
In general, safety long term is assessed by the use of case studies, long term, and these are expensive etc. If you tried adding 'case study' to your search that might help.
thank you very much for taking the time with my questions which is very much appreciated and thank you for the kind links too.
I have been struggling to find the answer to these important questions .I even contacted a Professor in Cardiology .
who raised issues about the older types of non-cardioselective betablockers in which he had wrote articles and made publications but who now says i should speak to a chemist ,although he is
way more experienced has come over rather less helpful than a couple of years ago on the whole subject.He explained he is focusing on other things in Cardiology which is fair enough.But i did think he might have some answers to my questions especially in his field.
I am glad you enjoying rerearching things which is helpful to others, i am like minded ,and have contacted by email some of the Top Heart Surgeons in the world and all have replied to my emails which has been quite amazing and incredibley kind as they are very busy professionals.I will work through the links and i'm most grateful for your time on answering my post.
You say you have contacted other professionals. Do come back here to post the main comments and papers they refer to. Many people on this forum use betablockers, some for years, so the question is very interesting. Also, long term studies are difficult and costly so research tends to be more on short term use of meds.
Interesting. Now we see some disagreements. Your reference says:
"Compelling contraindications are asthma, chronic obstructive pulmonary disease with significant reversibility and heart block. " But the first reference I provided, by Erdmann said:
"Although asthma is a clear contraindication to beta-blockade, COPD, in which airway obstruction is irreversible, is not.". Also, asthma is a big topic, there are types and degrees. My consultant said, that in times when I had asthma I should stop the bisoprolol (only 2.5mg daily, so can stop and start) then restart two weeks later. She preferred me on bisoprolol for life, as a precaution against AF. Even though I tolerate bisoprolol quite well, I decided NOT to follow her advice. I take it when I need to -- for the times when I overdo things physically, and my heart will not return to normal resting rate. Usually, if I suspect trouble, I just take Flecainide, alone, not with bisoprolol. Off subject, sorry, this is the nuances of PIP.
So, asthma is NOT always every time contra-indicated. There are loads of people with mild asthma who cope.
you mention in your case taking PIP and similar to me took the opposite route with Betablockers that the Cardiologist wanted me to take for life.
Although i am full circle contamplating, whether to, in fact take them long term because of the Tachyarryhthmia .
I have mild Asthma even could call it seasonal .
But have been on Propranolol 40mg twice a day which after a year i did eventually get some sensitivity and tapered off .A year before i was on Calvedilol .Like you say there are degrees of Asthma and that's where the Cardiologist or GP will look at to make that call. .But i am taking
2.5mg of Bisoprolol.
I have a found another link which mentions Panic Attacks or Tachyarryhthmia or both which is interesting which i can post.As i don't have permission to provide the link it can be searched at
escardio.org by searching
"panic attacks and arryhthmia" which could be interesting for members to read.
Tachyarrythmia is the wording i found on an American website.
From the Snap shot ECG and fast Heart rate while having my Echo Test every 2 years [which was a good result] the GP and Cardiologist both seem to agree on Sinus Tachycardia and told me Betablockers will treat these symptoms .As i orignally wanted to be off of them which was fine for 2 yrs.
I have this had since i was young
am now in my 50's.It normaly happens in the early hours which lasts about 10-15mins each time with a normal steady [but obviously very fast strong] and gradually slows back to normal when i do the Valsalva maneuver or focus away by listening to music on my headphones.
I did see the room becoming foggy which i never had before
but GP said lay down next time as it could of been Syncope due to the fast rate and BP dropped a bit, but i didn't faint.
I have it a few times a year for many years now, but recently 6 times over 4 months which is a bit unusall for me.But i did explain as i have had Mitral Valve Repair
a few years ago which the Echo showed is fine i was concerned that
although had this for many years it could also be another issue as i was getting quite a few Ectopic beats and also these strange bursts of 6-8 clusters of extremely fast beats in normal rythym recently that my
GP didn't really explain what they were and can get the occasional even on betablockers.
I have had a 24Holter few years ago but only picked up a few Supraventicular Ectopic Beats and no AF.
But a professional that recently answered a question i had said
after Heart Surgery you are more susceptible to this type of thing.
I have always since i was young had fast heart its always in the 88-90's in daytime,which GP's have always commented on.
64-68 at night[not that i focus on it that much!] now 60-64 at night on Bisoprolol.
Had an episode last night in early hours, heart rate was up but not
too fast and feet were sweating which is a symptom i get but the Betablocker do seem to do the trick.Although i did have a bad dream though.
The Sciencedirect website article from the Journal of the American College of Cardiology 28th October 2008 link i posted i think
I came to the same conclusion as yourself when i read in the article
"increasing central aortic pressure"
but did use Propranolol atenolol oxprenolol pindolol all Non Cardio-selective,
and they did use metopolol atenolol Cardio-selective BB's in the study.
Although it doesn't appear the study used Bisoprolol Cardio-Selective.
I couldn't find the amount of Betablockade taken by people in the study.
So all this can go on my list of Pro's and Cons so far on Beatblockers.
Ok. I have similar problems. I have had my mitral valve replaced with something metallic, which I am told means I am more likely to get AF. In the past, for a few years, I was getting incidents of tachycardia: the kind that start suddenly and stop suddenly. They never lasted more than an hour. I was told to come and see the doctor if I ever had three in a week. I was put on flecainide, and that did the job. That, after over a year, increased irregularities, so i was told to stop flecainide.
Now, when I get tachycardia, I act, fast, since it was an unstoppable tachycardia that led into AF. Since I cannot wait to see how it ends, I have to try to remember how it started. If it started suddenly, then I take Flecainide, because the sudden start indicates a normal reaction of the body to dampen excess irregularity, therefore taking bisoprolol would be working against the body. If it started over a minute or two, that indicates bisoprolol + rest. That is my reasoning. if in doubt I take both, have a drink of cold water, valsalva breathing, lie down.
Hi again thanks for sharing your story and details and i'm glad you are doing well after Surgery and also being treated for the tachycardia and glad you got your mitral valve replaced.You probably know this already but its a good idea to check if you need antibiotics for any dental work where for example you get any slight bleeding. I take 3mg ammoxicillin 1hour prior to Tooth clean and scale as i have prosthetic material an annuloplasty ring in the Mitral Valve Repair and many Dentist always go against my Surgeons and my choice...sorry a bit off topic!
I was wondering if you can explain when you mean starts straight away you mean immediately?
As i find i wake up with a bit of a jolt and then gradually the heart starts to pick up speed while laying still, feat sweat and a cycle of anxiety maybe in subconciuos kicks in and heart starts tachycardia.
Also you mention Bisoprolol working against the body which i didn't quite understand?
It's funny where we have gone through this Heart Surgery
once you move on you tend to be asking many more questions and research a lot of things dealing with your Heart Surgery as your not really given a great deal of info at the time just a couple of leaflets but like yourself i found it my challenge to get all the answers to alot of the important questions but also there is the pissibility of over annalysing everything which isn't always a great thing.This is a good website in the USA although i'm from the UK which shares others stories and the owner is Adam Pick heart-valve-surgery.com/abo...
It is interesting getting your views and feedback too.
Concerning antibiotics for dental surgery. Yes, that used to be the advice. Check the British National Formulary – the one everyone uses in UK – onsite access is free in UK I think, and the latest advice is it is not needed unless you have an infection eg chronic bronchitis that you do not usually bother to treat.
On topic. Sometimes Tachycardia catches me, out of the blue. One moment I am normal, then it kicks in. It can even happen when resting. This is the rapid start version. Other times, I can sense a tension, the normal rate is heavy thuds, slightly faster, then it ups a gear – never quite as high as the sudden start. The two types need distinguishing, and need different treatment.
A few weeks ago, I woke up, and suspected fast HR, so, if in doubt, valsa breaths etc. I might even risk disturbing my wife by reaching for the torch and counting. I have wondered if these were happening regularly without me knowing, and stopping before I woke up, in which case, no problem. But, if not, then I need to do something.
This usually happened though when I had been anxious the night before – some upsetting news, an email (serves me right for checking late at night, but sometimes it is crucial) or thoughts of the next day. Certainly, anxiety is a major contributor to the start of tachycardia.
Also you mention Bisoprolol working against the body which i didn't quite understand?
It's funny where we have gone through this Heart Surgery.
Clarification: bisoprolol working against the heart. Since the heart muscle is stiffened, I take that as working against the heart, just like stiffened arteries are also bad.
Yes, I know the tension well – trust and relax, and analysing carefully. My balance on that has changed over the years. One of the biggest strain factors when I had AF was coming up to speed on the literature, and coming to an informed choice myself on several issues, and then having the courage to face a doctor who did not take kindly to that kind of discussion and saw this as one more problem in his patient. In the end, I set out a summary (I find writing easy) and submitted it all to a consultant in UK whom I trusted. On page 1 I put my questions, in order of priority. When I saw her she answered them, so well. She was not afraid of my questions, and I respected her grasp of the medicine etc. All good experts can explain and justify their reasons, and can relate to patients, particularly because, in my case, I would then be on my own for making many decisions.
Thank your for BNF info i will get a reply to you later but wanted to give you a link to ponder over which is a reason i don't follow all of NICE advice i think your will find it interesting
Wow. What a convincing important article! Thanks. I am going to print it and put it in a file I have with me when seeing doctors etc. I have had endocarditis -- it was the probable cause of the strings breaking in the mitral valve. Given the high mortality in those with artificial heart valves, then it makes sense to take all reasonable precautions. I think you should repost this article as a separate thread. It is important.
Yes organisation NICE, i find, are not always the best to follow ,after all, it is only guidance.So i decided to eer on the side of caution, although the Dentist will not give Amoxicillin they will let you get the 3mg sachet from your GP's as the dentist follows NICE guidelines,even if the Dentist may not be a probable cause place to get endocarditis.
When NICE lowered the bar and Dentist's stopped giving Antibiotics to some patients that had been taking it for years for treatment the amount of Endocarditis cases did actually rise hence the changes recently to their Guidelines.
I will post the article as a separate thread thanks.
I think the custom on forums is that whenever you go off subject, significantly, or whenever you find something big, then you start a new thread, just like you started this one, with a new topic. This forum is for AF, and many people who have AF also have had valves changed etc so this subject of endocarditis is relevant.
a question i asked on Betablockers below and not meant as medical advice just an opinion.
Q .Bisoprolol and other Betablockers long term can cause type 2 diabetes in people without it seen in trials since 2006 ,what is the risk?
Reply from a Cardiologist
A. Although drug-induced diabetes has been a concern for several years, not enough information is available to influence prescribing for the majority of patients. The number one priority should be controlling blood pressure in a timely manner. The effects on cardiovascular risk are also unproven. Beta blockers have so many short and long term proven cardiovascular advantages that risk of DM is less pertinent.
There are plenty of other ways of controlling blood pressure. I heard that the best and safest is a diuretic! Your adviser said there were "short and long term proven cardiovascular advantages" to which I say, have I missed something? What? Maybe in my focus on risks + real reluctance to take meds unless absolutely necessary has made me miss out on the benefits. Or is this another vague and general statement to be challenged?
i think Betablocker have become 4th line treatment in blood pressure if i'm not mistaken.
So it looks to me there just is not enough information out there accept for a few short term case studies on betablockers for people with hypertension and with diabetes.
Some of the replies i have had on Betablockers Bisoprolol on treatment for Sinus Tachycardia without high blood pressure have said this is the wrong one to use but it is working in my case possibly because like a doctor on that website replied it could be a different Supraventicular tachycardia that i actually have.And that is why it working .He said inderel would be a better choice but like i'm thinking don't really want the risk of type 2 diabetes from any type of Betablocker taken long term as a healthy person without hypertention
Yes i have had similar problems with Doctors firstly some don't like patients that have insight or knowing too much.I don't mean i know a lot but it does go against the grain and sometimes they don't have an answer to your important question .But you've done well being persistant in the right places as some GP's have a limited scope and are not always up to speed with the changes of things drugs etc.I remember
asking for an Intrisic factor test recently and the GP asked me what is that!
I was quite taken back.And also it is easy for someGP's to stay in the comfort circle.Sometimes the Doctors just don't have an answer they just don't know.I think you have done amazingly well if i may say so as getting a consultant involved is the best thing to do and one that cares and listens if great makes a big difference.
My Consultant Cardiologist is just an email away and a very thoughtful person too.The more advice you can get from professionals the better as most really do want to help i have noticed.And as for some of the case studies i looked at it appears some professionals disagree with those too and mention Heart rate lowering betablockers
and There are opposing views that Aortic pressure is increased but actually is decreased in taking betablockers
Some of the best doctors in my view treat me as a junior colleague/partner. I have met some who check on the internet in front of me, or who postpone the discussion till next time and we both do our homework. Given the choice, I would even choose this kind of doctor even if they are not yet experts.
There is another side. It is well known that patient compliance increases when they fully agree with the course of action.
is for educational type answers and not medical advice.You can join and Consultants in Cardiology and Doctors will answer questions
for free from there knowledge you can join up
and register and then put all you medical history
which they can see access when they answer you questions, the questions go straight to their phones.I found it very useful and good to get
other opinions from another country ,even.
healthtap.com
my Q :What's the long term effects of the heart rate lowering Bisoprolol 2.5mg in healthy people for Sinus Tachycardia.Can they increase Aortic pressure?
Q: Can Cardio-selective Betablockers lead to dyssynchrony between outgoing and reflected pulse wave & increase central aortic pressure & cause stenosis?
Q:The physical effect of Betablockers on the heart is they decrease the cardiac contractility can this lead to stiffened Heart Valves in long term use?
from the case study by the Journal of the American College of Cardiology :
Relation of Beta-Blocker–Induced Heart Rate Lowering and Cardioprotection in Hypertension .
with the study conclusion:
Conclusions
In contrast to patients with MI and heart failure, beta-blocker–associated reduction in heart rate increased the risk of cardiovascular events and death for hypertensive patients. Pharmacologically-induced bradycardia may lead to dyssynchrony between outgoing and reflected pulse wave, thereby increasing central aortic pressure and the hemodynamic burden to the target organs.
What would be interesting now, would be to take each of these answers, then ask them about the research that says the contrary, and get their reaction. This is not a trap, though it could be. It could well be that we have missed something, and their expertise enables them to point this out, and we learn. I would be fascinated to find out.
But, it is well known that experts miss things, just as all of us do. I have found that approaching experts cautiously -- please explain this inconsistency -- makes it easier to challenge them, and sometimes they have effectively said, oops, missed that, thanks.
My Doctor explained that Beta blockers in my case for Mitral Valve Repair taken lifelong will benefit very little overall risk reduction and it would be extremely hard go over statistically significant reduction in mortality.
My GP a few years ago mentioned on Betablockers there are very small risks (with the long term risks of betablockade ) by reading the possibilities leads to extra anxiety levels . But you should be able to make personal choices, but we can possibly become too cautious.
Also this was an interesting article from sciencedirect on the effects on slowing the heart rate Conclusions:
In contrast to patients with MI and heart failure, beta-blocker–associated reduction in heart rate increased the risk of cardiovascular events and death for hypertensive patients. Pharmacologically-induced bradycardia may lead to dyssynchrony between outgoing and reflected pulse wave, thereby increasing central aortic pressure and the hemodynamic burden to the target organs
This article is serious. It seems to be saying that people with normal heart rate and high blood pressure who take betablockers have higher mortality.
Highly relevant conclusion especially for AF prophylaxis. It is one thing to take a betablocker for fast heart rate that will not go down, and another to take one when your HR is normal. Especially so when it seems to be used as a first resort, before other neutral steps have been taken eg taking magnesium, exercise, keeping warm, etc
We need to look at the physical effect of blockers on a heart. They decrease cardiac contractility. That reminds me of stiffened arteries. Does not sound good for long term use.
So, why are bblockers so routinely prescribed, and for so many conditions? Probably several reasons:
** They are cheap
** The pressure to do something, to prescribe
** The medical profession has been slow to monitor drugs use beyond 2 years. Even the study you refer to above is less than 4 years long! True, longitudinal studies are expensive to do, but good reporting back would be cheaper, and this is known to be poor.
** Lack of active looking
** Need to focus better on HOW they work, not just, black box, collecting figures from deaths.
** And, lack of listening to patients. There are few if any active ways of channeling patient experience and patient data into the mainline medical publications. On another subject -- self dosing of Warfarin, for instance, the patient voice and patient experience has not been heard, and there are few mechanisms for hearing it. The result is continued bad official advice for dosing, and several unanswered crucial questions.
The lack of listening reminds me of when i was being referred to a Heart Surgeon
by a very good Consultant Cardiologist and being referred to a very good Surgeon but not a specialist Mitral Valve Surgeon with a High Volume practice.The one i was originally referred to was probably doing an average of 1 Mitral Op a month, so i decided to change to a High Volume Surgeon that was nearer 90 Mitral Procedures a year and the Consultant Cardiologist
agreed to this.
I do realise as i was urgent and he wanted me to be seen sooner,but i only waited a few weeks longer.
And after i chose my Heart Surgeon for the whole operation i had a young Registrar come an
mention that he would in fact be doing my Mitral Valve Operation while my Heart Surgeon over saw the whole thing! So ,to counter that i put pen to paper in writing on the top of my consent form, before the operation i wrote the name of the Specialist Mitral Valve Heart Surgeon that i expected to perform the Operation and it was him that i wanted to do the whole operation and Mitral Valve procedure from start to finish and that it be the named Heart Surgeon that i was assigned to all of the time and signed the form .So you have to make it plain and simple sometimes but i nearly overlooked this as it would of defeated the whole exercise ,using someone different.The registrar was not put out by this on this occasion either. You have the choice.
I never knew i would be getting a Annuloplasty Ring either,so that was one that got past me,cant be perfect!
You can get the best treatment ,but you have to challenge others opinions and ideas even professionals ,never be worried to ask or question top professionals and researching things helps too.
The threading on this forum is not great. So, here is a wider question. Given that there are long term dangers of bblockers, especially related to diabetes, and given this is an AF forum (+ related issues) and given that rate control is the most favoured route of handling most types of AF, you now have something else in the picture. The benefits, if any, of rate reduction, must be weighed against things like diabetes risk.
On studying AF, for my kind of AF, I concluded that most often, my problems were caused by rhythm getting out of control therefore the rate increased in order to dampen the rhythm. I treat myself (PIP and sometimes a week or so of prophylaxis) accordingly.
But, my Cardiologist wanted to put me on a bblocker, just in case, because most people who have had AF are on it! She saw it as having general advantages as well.
Consultant wanted me to take a low dose, 2.5mg bisoprolol as daily prophylaxis, then use Flecainide as PIP. I sometimes have mild asthma leading to bronchitis. She told me loads of patients in my case still take betablockers, and maybe stop for a few weeks sometimes to allow the infection to clear (usually naturally, without antibiotics). In the times when I was not taking betablockers, the PIP was BOTH flecainide + bisoprolol.
Since then, I have worked it out as to the times when I need bisoprolol as PIP and the times when I need flecainide as a PIP. This is not in the medical literature as far as I can see. I plan to write it up, and send it to her before my next appointment in July.
Forgot to add. In life seasons of stress when I feel the need for AF prophylaxis, I usually take Flecainide for a few weeks. I have reasons which are either not in the textbook or against the prevailing winds. I have also found the advice of the Dr at York Cardiology to take Magnesium to be helpful: it really has calmed down the irregularities, without totally eliminating them, which is what I want, because, as I found out in another thread I started, a small amount of irregularity is normal healthy and desirable.
.I also take magnesium bisglycinate at 150 mg twice a day as i had
migraine aura without headache 7 a month now on magnesium average of 1 a month frequency.I explained this to my GP as he gets this too ,but he won't take it as he said theres no clinical evidence it helps i thought that was quite funny.
The doctor popular here, York Cardiology, consultant, would disagree with your GP. Hearing him made me try the experiment. I think he even says that if he can, he tries Magnesium first, and this often deals with the problem or reduces the severity. He also convinced me that it was safe. I was surprised how quickly the effects kicked in, though, if I am deficient, it is not much. I work must of the year in Tunisia, and most of my food is unprocessed, straight from the fields to market.
In Tunisia probably close to the Mediterranean diet very healthy.
what I have heard is when you get a blood test for magnesium it's not particularly accurate in the blood and doesn't give a true picture of stored magnesium in the body so you could get a normal result but be in deficit of the mineral and as you get to your middle age your stores like everything else can dwindle so that was my other main reasons to top up with this essential supplement .We ,in the UK don't get a high rich magnesium diet ,particularly .I would definitely recommend it if your GP says there is no interaction with anyone's medication.
Yes, I read that the normal Magnesium test does not measure the intracellular level. Therefore I took seriously Dr Sanjay Gupta who basically said, give it a try, since the risks were almost non existent (in otherwise healthy people) and the potential benefits were high. He warned if there is a deficiency it might take months of steady daily Magnesium supplement to correct it and to get the benefits. I was surprised when I felt something after only 3 weeks. I am now trying to halve the dosage, and see if the effect continues. I do not have much contact with a GP -- I function mostly on my own, which suits me. Out here, the main use of a GP is in recommending specialists, and for that I can do my own asking around.
Thanks for sharing the information on Magnesium and good to have a good GP on board too.
I started with Magnesium Citrate which was harsh on the stomach that's the reason i changed to Magnesium Bisglycinate which is just as well
absorbed than the very low grade cheap synthetic Magnesium Oxide found in the High Street Brands ,which you probably would Know about,and which are pretty useless amount to use which i originally started using!
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