AF Association
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Anxiety with heart rate

Hi. I had an episode of a.f when I was on holiday in Wales I was on 5mg bisoprolol at the time. My heart rate was 217bpm. After 12 hours my heart went back to normal rhythm. And I haven’t had a problem until now. I’ve recently lost nearly 4 stone. And now my heart rate is going as low as 48bpm just before I sleep which scares the crap out of me as I feel I can’t breathe. I went to see the doctor yesterday as I’ve been getting bad panic attacks and anxiety because of this. My usual resting rate is in the 60’s during the day. She thinks the 10mg is too much and has dropped it to 7.5mg. Now I’m scared to take that incase I get another a.fib. I feel I can’t win. Has anybody else experienced this?

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Hello Keira

Welcome to the forum. Could you tell us more about your situation, your history of heart problems and your medication. Also biographical details which can help us to get the full picture.

I have no experience of Bisoprolol, but I believe it is used in AF to reduce the heart rate. It does not cause AF.

It does slow the heart rate to really quite low levels sometimes and I wonder if your recent weight loss has made the Biso as we call it more potent. Dose reduction usually solves this problem.

You must have a strong heart if you tolerated such a high heart rate for so long, apparently without problems. Or did you go to hospital?

You will be in safe hands, once the cavalry arrives. While you wait, have a look at the information and search the archives, both tabs top right.

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I’m 38. No history of heart problems. 1bad a.f attack in 2016 it lasted 12 hours they were going to shock my heart but meds kicked in. No heart damage and was let home next day. Put on rivaroxiban as a precaution. I’m on a lot of meds but for blood pressure I’m on bisopolol 10mg, amplodipine 5mg and losartan 50mg.

I already have panic and anxiety but now I’m constantly watching my fitbits pulse rate. If it drops I panic 48 was the lowest and felt like it was struggling. Doc says I have a very strong heart beat so that’s why I feel it more. And when it rises to over 110 I panic too. I’m constantly worried I’m gonna get a bad attack again.

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OK thanks for that Keibra

I can imagine just how you feel, your story will resonate with many of us.

A low heart rate is not in itself indicative of a heart problem particularly if it causes you no physical symptoms, like faintness or dizziness. In your case your GP clearly thinks your low heart rate is due to the Biso.

What do you worry might happen when your heart rate is low?

I think one thing likely to trigger another episode of AF is your anxiety. You have to get a handle on that. Have you tried anything to calm yourself like breathing exercises, meditation etc. ?

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Yes I’m on tablets for anxiety/depression.

When it goes low and thumps hard I worry it will stop completely when I’m sleeping as it mainly only does it in bed.

I start my 7.5mg tomorrow morning so hopefully that will fix it.

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This is one of my problems and manyou others I expect. We get anxious and up goes the heart rate. I am doing Thai chi and find it very helpful. I tend to use it to calm myself when I feel anxious. It's worth a try. Good luck this af is so unpredictable that it's trial and error trying find coping mechanisms

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Yes my resting rate went to 95 when I was in full on anxiety mode. It's back down to the 60s today. It was like chasing my tail there for a while anxiety heart rate anxiety heart rate lol round and round...

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Throw away your fitbit! If you are an anxious person these things can only make thing worse by focussing you on your heart. Go on how you feel not what the machine tells you. A rate of 48 is normal for many athletes (some even lower) and you won't die from a low rate.

You are anticoagulated so your main worry of stroke is covered so go with the flow and see what happens. AF won't kill you either although I know it is scary so as Badger has suggested you need to sort out your head first and I'm sure you heart will follow.

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Up until now I had sorted my panic attacks and anxiety out. I hadn’t had an attack in years. The low heart rate has triggered it back up. So I’m kinda chasing my tail if you get me. I did try turning the Fitbit hr off but then found when heart did it’s thing I wanted to know why. Now I’ve seen lots of posts saying it’s possibly most likely the biso i feel a lot more calmer. My heart beat is pretty hefty so I can feel it go weird if you get me. But just before sleeping is scary lol

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Hi

My resting rest is often in the 40s and an EP said as long as it increases when you exercise that's ok.

I would go to A and E if the rate is in the 200s when you have AF They may convert you or just monitor you.

You are young to be on meds for life- have you seen an EP for all the options.

No need to be scared- if you know you will g to A and E if the rate is very high again, you can relax, trying deep breathing to slow the rate down, and get help if it stays high

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Thank you. Sorry but what is an EP? My GP has me booked in on Friday for an ECG

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Hi

It’s a cardiologist who deals with the electrical channels in the heart and offers ablation if appropriate.

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I have only ever seen one when I had the a.f attack that took me to hospital.

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When I went to doctor yesterday my blood pressure was fine... my hr was 75 and she said it was a steady beat. She wanted an ecg to make sure anyway

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Hello again Keibra

What is the dose of your SSRI?

What a fantastic achievement to lose 4 stone in weight! You must feel so much better. What is your BMI now?

I imagine that cardiac output is inversely related to heart rate, given the longer period for the ventricles to fill. Could that be why your heartbeat seems more forceful at slow rates? I find I am more aware of my heart beating at night when I lie on my left side.

Would it be wide of the mark to suggest that from a symptomatic physical point of view, you are in pretty good shape now. Do you get plenty of healthy, moderate exercise?

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I was nearly 25 stone I am battling a few things like diabetes and polycystic ovarian syndrome and fibromyalgia. Now I’m down to 21st, my health has improved although I am still in my weight loss journey. (I weighed in today after xmas and I’d only put on 2lb) I’m definitely eating a lot more “good food” and I am definitely doing a lot more than I could before. It is when I lay on my left that I notice it more too. The weird thing was when I was bigger I didn’t feel it as much. But 4 stone ish in less than 8 months I suppose is a big deal to the body. I don’t know my bmi sorry

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Oh my Ssri is setraline 100mg I’m also on amitriptyline 25mg to help the fibromyalgia

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BMI relates weight to height and is more useful than simple weight, so it is hard to envisage your heft without knowing your height.

I also take Sertraline 100mgs. I'm surprised that it is no longer effective. Are you compliant or do you need to up the dose?

I missed that you panic that your heart might stop when it goes slowly. Biso will not on it's own stop your heart.

Do you actually need to take Biso regularly? When was your last episode of AF.

If you do come off regular Biso, your low nocturnal HR should settle. If not, a cardiac rhythm monitor may be useful.

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Ok I looked my bmi Is 46. As far as I know I’ve only had 1 a.f attack in 2016. But if my heart feels fluttery laying down is that 1 too or just the drug?

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I asked to up the dose but the go said she’d rather change the bisoprolol n see how I am in 2 weeks. Well I tried to get an appointment and I have to wait for a month

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On reflection, excellent advice from GP.

? try for telephone appt. or email.

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Fluttery?

Rate, rhythm as in regular or not, duration

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I get like a strong heartbeat/flutter in my throat.. feels odd. As I’m laying here now it feels steady when I hold my fingers to my neck though

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And it last for about 2 or 3 seconds

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This could be ectopic beats. Have you considered getting a Kardia?

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A what? I had a monitor on for 24 hours after the a.fib corrected itself and they said it was all ok. Would that not have picked it up?

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May be it did. Ectopics are so common and generally benign that their presence is not really noteworthy, unless troublesome

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Watch Sanjay Gupta videos, helped me so much when dealing with the heart flutters and palpitations, if the doc says your heart is structurally sound, the flutters and the like are perfectly normal. :) i fell them too someties but now know im normal and i released a lot of stress.

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Hi , interested to read you have fibromyalgia as l have too.

Ended up in A&E last year when on Amitriptyline for pain relief as it had an adverse effect on my heart rate as do all other pain reliefs ending with ine.

That's just my take on it obviously may not be same for you.

Carol.

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Just a word of warning, fitbits are notoriously unreliable a) for measuring heart rate and b) particularly bad for measuring AF related HR!

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Yes the doctor said the same

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I was going to say the same thing I have a Garmin vivosmart HR watch and it not reliable at all get a kardia alivecor

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Hi Keibra. You are young and have that to your advantage! Please push with your GP to see an electrophysiologist. They are heart specialists with additional expertise in the electrical working of the heart which is what largely causes AF. As one of the wise and experienced members on here says, you wouldn’t call out a plumber to fix an electrical problem in your home. Be well. Hugs, Nicki

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Are you sure it was Atrial Fib and not Supraventricular tachycardia? Yes, beta blockers like Bisoprolol can slow your heart too much and that can be dangerous. Do you know what triggered you arrhythmia?

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The a&e doctors said paroxysmal? A.fib

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Hi Keira .This horrible AF affects us all differently,myself I have been on 10 mg of Bisoprol for the past two years ,yes my heart rate averages between 47 bm to 70 .Touch wood I have had no trouble for the past9 months with AF,I do think with myself worrying to much with what my heart rate is doing.

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Welcome, Keibra!

Im so sorry to hear how you’ve been feeling, and the health stuff you’re coping with overall. Fantastic achievement to lose 4 stone - good on you! Keep going steadily on the healthy eating and keeping active as possible (with the fibro I know how hard it is) and it’ll keep helping your heart and other health. (I’m encouraging myself here too!)

Agree with others that you don’t need to worry about the slow heart rate at bed at night - it’s nothing that would flag up warning signs to medics, and it’s very likely just you need a lower dose of bisoprolol. Especially after the weight loss. You do take bisoprolol in the morning, don’t you? Obviously if you take any at night it would make sense to shift it to daytime when it’s needed more (checking with the dr first of course).

Short flutters like you describe are common too- and thuds and thumps. Especially lying down. It is possible it’s simply because the bisoprolol is just suppressing your heartbeat too much when you’re lying down ready to sleep, so getting the right dose could help there too. However I’d still push for a referral to an EP (specialist cardiologist) as others have said. It’s always good to be looked after by an expert :)

Please try not to worry about the sensations or about the rate... Or going back into AF. Though I know that’s easier said than done, as it’s such a horrible experience. But remember you got through it fine last time - and you’re anticoagukated now, so you’re even safer. But anxiety just makes everything worse, so getting on top of that is always good :) When you feel like it, the AFA website is full of useful info (if you haven’t read it already!).

Do keep us posted with how you’re doing :)

Take care xx

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Hi, just to reiterate others in that the Bisoprolol will drop H/rate. Like you my resting is around the 60bpm mark. With me just 1.25mg will drop it to 50ish and 2.5mg to 40ish which is too low for me, bringing on dizziness and lightheaded feeling, similar to AF with me. You will get used to your best dosage.

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I have taken my lower dose today. I must say my anxiety about heart rate is dropping because so many of you have had same problem with bisoprolol. So thanks so much for the reassurance x

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AF gave me huge anxiety and similar side effects.lt got to the stage where I was taking BP & heart rates readings every hour or more! Agree with others about discarding the Fitbit but maybe a simple pulse oxometer would give you your heart rate if you felt it was starting to gallop. To have left you for 12 hrs at over 200 bpm was imo not the best treatment and will have left you with the anxiety which I am sure will decrease in time. Hope all improves with the reduced dose of bisoprolo but do insist on seeing an EP.

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Hi Keibra! I'm an elderly lady whos has had AF since 1998. First not so long episodes and not too long, but with time they have increased. My first advise to you is don't get anxiety because of this. This is such a common nuisance that many of us have. When in episode, just take it easy, I usually have to lay down, head high and be relaxed. Try deep breathing. The slow heart rate is because of Bisoprolol, it's doing it's job, slowing the heart. After my ablation procedure I could not tolerate my heart drugs, Biso and Propafenone. The rate went very low in upper thirties, ofcourse I felt like passing out, especially when the heart was pausing. So now I have a Pacemaker, which does not let my heart go too slow with the meds. This is recent for me, so still "playing around" adjusting the PM and the dose of pills. So, just try to relax and accept that you have this "friend" that comes and visits you out of the blue. The anxiety is a very good trigger! With me also if I'm in constant pain. Alcohol is a no-no, sometimes I get away with one drink, but it's not worth it. Great that you are loosing weight!! Also walking is beneficial. Good luck ❣️

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Thank you. I already feel alot better that it is just the drug. I started my lower dose today and I have an ecg tomorrow. My mood/anxiety has decreased lots seeing all these replies. So thank you. I wish you well also x

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I have a question. I’ve just had the odd feeling again, I’m having a ecg tomorrow. If I go and it doesn’t happen while on ecg will they still be able to tell that it does happen now and again?

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Not unless they run the trace for a few minutes and it pops up.

A prolonged recording with Holter should if it happens every night.

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No! But they will be able to see if everything is normal at the time or not. They can give you a holter monitor to wear for 24 hours or a week, which should pick up more.

This is where the Kardia is useful (it works with an app on a smartphone), as you can take readings yourself when you are concerned, print them out and take them to show your doctor to discuss.

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Ok so tonight I’m sitting here and getting what I think are a.fib/odd beats but when I feel the pulse in my neck it’s a steady beat. Could this just be anxiety I am so confused. It’s scaring me. Sorry for so many questions I feel like an idiot.

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Had ecg today. It’s all normal. I broke down in there and they said they think it’s my anxiety playing tricks. So now if it happens I will try to ignore it. They want me to see a counsellor too. So I will try and sort that out soon.

Keibra x

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Keibra

Not sure what you are saying. Counselling may help your anxiety but it won't treat your PAF.

I wonder if it is a little soon to say your present symptoms are all in your mind. Many patients labelled as being anxious have a delayed diagnosis of an underlying physical problem.

You may need a 30 day event recorder.

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