This may sound a silly question but here goes. I have parox Af and am on all the usual tablets. I'm just wondering, when my heart isn't beating too fast, so at a normal rate, wont the daily doses of Bisprolol make it too slow? I'm usually on 62/65 (that's when Ive checked) Could this be why I have the odd days when fatigue hits? I have been taking 1 tablet in the morning and half at night. Thankyou.

33 Replies

  • I think that rather than slowing the heart down the drug reduces the heart's ability to speed up hence the inability to exercise.

  • Ahh! I see, it makes sense now you put it that way. Ive been a fitness fiend for 40 yrs and now have a loss of strength when climbing stairs , plus a bit breathless when walking up hill. Quite difficult to break the habit of a lifetime, because these two things were a sign for me to put more effort in to stay fit. I'm very sad my fitness has suffered and I no longer go on uphill walks just for the hell of it to get myself fit. I miss my aerobics classes like crazy. Yes life changing and very sad. Thanks for your answer BobD.

  • Has someone told you not to exercise? Because I was told to work through it. I also hillwalk and do get breathless but I just keep going albeit at a slower pace and have found that I gradually get used to it. I am on 10 mg Bisoprolol too and have been for a couple of years.

  • No no, Ive been told nothing really, I'm just picking stuff up as I go along from this site and on each visit to the docs I have more questions. I'm assuming because my legs are weaker due to the meds and my breath is short, the best thing I could do was just stop really as my bodys telling me it cant do it. I do yoga now and that's about it. Thanks for your answer, obviously I need to ask about exercise on my next GP visit...Thankyou.

  • I get breathless just walking but was told as soon as I get breathless to sit down !

  • I do sympathise. That feeling of just trying to get upstairs but the legs are just not doing it ...awful. It's like driving with the brakes on. I really find it helps to take the beta blocker at night (for me). The worst symptoms are about 2-4 hours after taking it. If I'm asleep or resting then I don't notice.

  • I asked similar things when I was first prescribed it. It's my understanding, as bob says, is to put a cap on the heart rate to stop it rising not knock it down consistently to a low rate.

  • I do wish the doctors would explain these things at diagnosis or at least tell the GP to educate us about it all. At first I thought I needed to keep climbing the stairs etc to stay fit, but my legs just wouldn't get up them. Ive found the doctors are very complacent about AF. It seems as if its not important at all. Thanks for your reply.

  • They that is Cardiologists and Gp's more then likely don't know. There is much time, money and effort spent into post heart attack care and prevention that disrupted heart rhythms do not get a look in. Plus the Cardiologists and Gp's are so over worked if you are alive and functioning that is good.

    I suspect this is where being self informed and educated comes into play. This will give confidence to assert yourself. Alternatly ask the British Heart Foundation for information.

    I've reduced my Bisoprolol dose and the depression, low mood and heaviness of limbs have been lifted. I decided I'd rather be breathless at a manageable state then experience the medication side effects.

  • Ive got to be fair, Ive not had depression. low mood etc. But my muscles jus kind of wont take the pace. There are 18 steps up to my office and some days the last four are really hard to get up. Its not so much as heavy limbs, its muscle fatigue. Thanks for the info, I will contact British Heart Foundation. Cheers.

  • Amendment to text. Don't forget this site and the A Fib Association as a source of information. Apologies.

  • My doctor seems to learning on me , I'm sure he just didn't have a clue when I asked him questions , Iv got more advise on this site than in the four months iv had it from any medical people xx

  • Bob's explanation is interesting.

    However I found more recently that if I took Bisoprolol daily my heart rate dropped as low as 35bpm. I am on Flecainide as well.

    I spoke to my Cardiologist last week and he advised me to take it as a PIP to counteract my occasional Atrial Tachycardia.


  • Yes, that's too low. I'm on 62/65 rate so ok, but I do miss my old lifestyle including the social life that came with it. Thanks for your answer.

  • The cardio told me my hr would not be able to get to the 200bpm but during my last af it got to 160 even with the 10 mg of bisoprolo

  • I think that's rubbish from the cardio, when AF kicks in a lot of us on here will suffer much higher, I have recorded instances of 245 lasting 30 minutes with all the medication I was on.

    My expectation is that the medication would discourage it getting too high in general but if it's going to go it's going to go

  • I think so too

  • That must be terrible. I cant begin to imagine. I mostly notice mine when I'm nodding off at night, this then stops me from nodding off because its always in the back of my mind I might not wake up. The only thing I can say is that we are lucky its been diagnosed. My sister in law died in the Feb as I was diagnosed in the Sept. She had no idea she had this problem, same as me, no idea until a massive attack, the trouble was she didn't make it. Age 61. Think that's why I'm over cautious, or am I... ? Thanks for your answer and I wish you some peace of mind.

  • Thankfully I haven't had an attack like that since I had an ablation in January and so far (touching all the wood I can find) I've been doing really well. Still on Metroplolol but a reduced dose until my EP is happy

  • I am on 10 mg of Bisoprolol and I have a pacemaker fitted. I sometimes think the two are fighting one another, the pacemaker increasing the HR when trying to exercise but the Bisoprolol saying Whoa slow down! The end result is legs not wanting to work and breathless.

  • And heres me thinking a pacemaker was the ultimate cure and end of the p[roblems. Sorry to hear that.. thanks for your answer.

  • I feel same bisoprolol and flecainide and pacemaker but can exercise just stairs and hills

  • Don't get me wrong, I am grateful for the pacemaker because without it I probably wouldn't be here. It's just a question of getting used a new way of life.

  • My pacemaker working 99% of time so def need it it keeps us going

  • Dr Sanjay Gupta convinced me that I should take 'even a tiny dose' of betablocker. How I love it when doctors give reasons! Then we put all the facts on the table (my own case history including blood pressure figures, facts from my medical past, and my preference which is to live with a condition if I can and avoid medicines) and we can make a reasonable decision. Betablockers:

    1. Slow down the heart. They seem to work at all speeds

    2. Lower the blood pressure

    3. Potentiate the anti-arrhythmic effect of Flecainide. This means smaller doses.

    4. Reduce the tendency of Flecaininde to promote irregularities and to promote tachycardia

    5. Reduce the inflammation of the heart. I would like to know more about this point.

    6. Particularly in high energy people who live on nervous energy, help to soften the effect of unwanted adrenaline.

    I have good reasons to keep the blood pressure above 130/80 at all times. The development of Glaucoma is minimised when blood pressure is higher.

    Dr Gupta was clear: even a little bit, say 1.25mg, gives you some basic protection, especially when taken long term.

  • Thanks for that its good to know these things. I do wish the NHS would be more helpful with this.

  • ILowe, your comment about Glaucoma being minimised when blood pressure is higher is interesting because my ophthalmologist told me the reverse. He said that atrial fibrillation would not affect glaucoma but high blood pressure would. I am a candidate for glaucoma.

  • Information on the Web seems contradictory, which makes it difficult to assess. There are criteria -- that needs a separate thread. In addition, since there are different kinds of glaucoma, there is always room for more than one answer. But, if I have understood correctly, the main treatment for glaucoma prevention is to reduce the internal eye pressure. They do this even if you have normal or low eye pressure. And because of a sophisticated version of osmosis, the higher the outside pressure the lower the internal eye pressure.

    Here is a quote from

    Blood pressure and eye pressure vary independently. Controlling blood pressure does not mean IOP [Intra ocular Pressure] is controlled. But studies have shown that patients with high blood pressure have an increased risk for glaucoma.

    The relationship of low blood pressure to glaucoma has been better established. Chronic low blood pressure is a risk factor for developing progressive glaucoma damage. We now understand that in some forms of glaucoma, there is a strong link between glaucoma and poor (reduced) blood flow to the optic nerve. Low blood pressure is strongly associated with normal-tension glaucoma—a type of glaucoma that occurs even though the pressure inside the eye is not elevated.

    Patients who are taking medication for high blood pressure may actually have their blood pressures dropping to very low levels during the hours they are sleeping. This reduces the amount of blood flow to the eye and optic nerve and may compromise the optic nerve. The role of blood flow in optic nerve damage is the subject of ongoing study.

    Patients with any progressive glaucoma need to make sure their blood pressure is not dropping to very low levels while they sleep. Your ophthalmologist needs to know about all your medical conditions and the medications you are taking and needs to work with your other doctors to make sure everything is in synch.

  • Additional point. That is why I am always curious to measure the lowest possible blood pressure, usually immediately on waking before I hardly move and before I think about the day which shoots up the Systolic. Another, easier time, is just after a looong siesta of an hour or more. I have done this consistently over many years, and use this reading to assess any blood pressure treatment, as well as the standard doctor measure, sitting calm. I also like to see the highest I can get. A question I will be asking my British Consultant in July is which BP medicine takes the edge off the high BP, and leaves alone the low BP.

  • An empty bladder and/or bowels have a positive effect on the BP.

  • Do you mean an empty bladder *increases* blood pressure (a positive effect?). If so, how large is this effect? Will it not be drowned by other effects such as movement, and adrenaline? When I wake up and want the lowest possible BP, similar to what you get when you do the 24 hour BP Holter, then it is quite noticeable -- the slightest movement, and the slightest thinking about the day, shoot up the BP

  • I don't know what your history is, but my question is why are you on a beta blocker when you have been a fitness fiend for 40 years? Also, was it your GP or cardiologist who put you on a beta blocker? I had the same complaint about metoprolol when I had atrial flutter. So, when I developed AF, my GP put me on a calcium channel blocker since I told him I would not take the beta blocker due to the side effects.

  • It was the cardiologist that put me on b.blockers and my GP has agreed. As far as I know, its because my heart rate goes from normal to fast haphazardly. It wasn't like this until I had a massive attack in Sept. I do know that I can be stood with say a mug of water and my heart will start pumping so much that I can see the mug and my whole arm moving, then it will go back to normal. I'm just assuming thats what the b.blockers are for. To be honest I'm confused so doing as I'm told.

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