AF Association
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Breathlessness and Bisoprolol

I take only 1.25mg of Bisoprolol which my EP says is essential to keep down the heartrate of my short bursts of Flecainide-induced AFlutter.

After four years of being constantly short of breath, I would like to discuss a change from Bisoprolol (which is the drug of choice of my cardiologist). For such a discussion I need to know more about any alternatives.

Has anyone taking Flecainide changed to a calcium channel blocker or other drug to relieve breathlessness?

Does anyone know if these alternatives to Bisoprolol keep heart rate down? I assume they do.

I suspect my cardiologist may be resistant to making any changes but I am fed up with the shortness of breath, so pointers to alternatives would be useful for me to research and make me able to present a sensible case to him.🙂

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I came right off Bisoprolol last year.

The reason was that I have bad conductivity and was getting Bradycardia.

I cannot really do much that is too physical as I feel my heart pounding and still get breathless.

I am happy to be off Bisoprolol.

Pete

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Horrible, isn’t it? My heart rate never goes below the low sixties but on certain days I feel like someone is sitting on my chest and the only candidate for blame is Bisoprolol which EP said I couldn’t stop, even to use as a PIP. Hoping for an alternative.

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I was prescribed Diltiazem for my Flutter (already taking Propafenone for PAF) because I am asthmatic. I was happy with it but even on the lowest slow release dose it was keeping my HR too low. If you have an ok HR with Bisoprolol then maybe Diltiazem would be suitable.

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Thank you Buffafly - my heart rate is normally in the low seventies at rest with Bisoprolol but my BP is low normal and when it dips the breathlessness gets worse. Will research Diltiazem. xx

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Not actually answering your question, but I’m on 12.5 mg Bisoprolol and was constantly breathless until I was put on Entresto, although the latter is specifically for heart failure which I don’t think affects you?

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Goodness, that’s a hefty dose of Bisoprolol! I’m glad the Entresto is a better option for you and, no HF doesn’t affect me.

Strangely enough, we’ve had an inversion layer today ‘up here’ and the breathlessness was very bad until about 4pm, so the weather also affects it. Sunshine made up for it tho’. 😀

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Didn’t explain that very well; I’m on both Bisoprolol and Entresto, but the latter seems to have reduced my breathlessness.

Wasn’t the weather glorious today? We are so, so lucky to live here. (That’s just to make the rest of you jealous) 🤗

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I have permanent AF and am on 5 mg Biso, which was making me a bit breathless. I had to come off Digoxin and this was replaced with Diltiazam and it did seem to help reduce the breathlessness. Still take the 5 Biso. Meds are going to have to be reviewed again as I have also have mild COPD which is causing more breathlessness now. I did the other day ask to go on Nevididol(thats not the right spelling, as this is for people with astmas and other chest problems. Got refused but will have a go again when I next see the chest clinic, It was cardiac who said no.

Cassie

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I wonder why your cardio said no to the change Cassie. I expect mine will say that Bisoprolol is the best option - which may well be the case in spite of its tendency to cause breathlessness.

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He was a young cardiac registrar and had to look up the drugs book for an alternative - he was not very clued up on AF. He did prescribe me something else Cardevidol (wrong spelling I know) but when I got the tabs printed on the outside of the packet was a warning - Do not take if you have asthma or breathing problems. So I did not take them !!!

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Oh my - at least I don't have that problem. I do hope you get it sorted out.

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Hi Finvola, I have persistent AF and Asthma. All was fine until I had appendicitis and was in hospital to have the appendix removed. A hospital doctor asked me why I wasn't on a beta blocker. I said because I am asthmatic, and the tone of his voice was as if he'd said "piffle", and he put me on Bisoprolol 2.5mg. Everything was wonderful until 7 weeks later, the Friday evening before Christmas Day when I started getting very painful rashes all over my body, mainly torso and limbs, but also my scalp. They were intermittent rashes, they'd stay for a few hours then go for a few hours and pop up somewhere else. I went to a pharmacist who suggested anti-histamines and to see a doctor after Christmas. I did, and when I saw him there was no sign of the rashes, so no change in treatment. I then hit upon the idea of taking photographs on my mobile 'phone, and went back when I had an itchy back, asking for an appointment to see another GP who is a skin specialist. I showed the receptionists my back, whereupon they said I could see another doctor straight away, but I waited a couple of days to see the skin specialist. She declared it an allergy to Bisoprolol, took me off it, prescribed anti-histamines, and told me to stay off it for 3 weeks. I stayed off for a month, but now take 1.25mg Bisoprolol.

Two other side effects were a runny nose and shortness of breath. On 1.25mg I have the odd rash, not itchy because of the anti-histamines, and a runny nose. In the month when I was off Bisoprolol I had a "dry" asthma attack, by "dry" I mean it wasn't caused by infection as all previous attacks have. It happned to be in the pharmacy, which is attached to the medical centre so saw a GP and subsequently I spent 2 nights in hospital getting over that. It was the first "dry" attack in the 44 years I've suffered from asthma. I put the dry attack down to Bisoprolol.

Yes there are other beta-blockers but many have the same side-effects. I am not medically qualified, and we are all different. Currently I have no rashes but am on 40mg prednisolone a day because of asthma, this time caused by a viral infection. Other people get 24-48 hour colds: I get a cold followed by a respiratory infection.

I should add that I was on 150mg x 2 of Flecainide daily for about ten years before my AF became persistent. For me it was a superb drug. I hardly had any episodes of AF.

I have never tried calcium channel blockers.

Bisoprolol is cheaper than other beta-blockers. Some people think nebivolol is better for asthmatics .

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Hello Thomas - thank you for sharing your experiences. You’ve certainly had a time of it with Bisoprolol - even I know it can cause problems for people with asthma, so the hospital doctor had a strange reaction.

It’s interesting about the runny nose - mine runs constantly and I assumed it was part of my wider problem with nosebleeds and sensitivities - it could be Bisoprolol doing that too. ☹️

I assumed that other beta blockers may be as bad but I know nothing about calcium channel blockers and reading up just made me more confused! The difference in price between various beta blockers is also interesting . . . Drug of choice or drug of price I wonder? I too am happy on my Flecainide at 2 x 100mg and have had no AF in four years - would be very happy to reach the ten year mark too.

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I changes to Nebivolol which had the same effect n reducing my heart rate but much less side effects - it is more expensive though which is why i keep being asked to justify why not Bisoprolol

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Thank you songbird - price is something that didn’t occur to me when I was told Bisoprolol is the drug of choice. I will research Nebivolol.

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Hi,

I have just reported back to my ep that even my minute dose 1.5 bisoprolo does exactly what you describe and sometimes worse

We seem to have given up on medication now , it had become ridiculous I have taken about 14 variants and combinations landed in hospital twice, they were reluctant to admit that bottom line none work on me, and produce nasty dangerous side effects

Hope your people find a sensible remedy for you

Thinking of you

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Thank you Jacqlihe - it’s awful that your drug therapy cannot be stabilised and that so many variations have not worked and I hope you can be offered an ablation or better targetted drug therapy.

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I wish they would realise that we are all different and that the drugs can make us worse. The lowest dose of 1.5 bisoprolol taken daily brought my heart beat down very low and it is the same if I take it as a pill in a pocket though the cardiologist I saw said it was fine to just keep taking them for that! They are obviously cheap! Since my initial diagnosis after an extremes of hot and cold experience in a spa which I would not have undertaken had I been diagnosed earlier, I have never had a high heart beat when I have fibrillations so the beta blocker is not right for me then! I am impressed that you got to see an EP. I had an echocardiogram which showed my heart was fine and ECGs since have also been fine. So now they want to do a most unpleasant sounding stress test and I was going to ask to see an EP first but it would appear from your experience that they might be much the same.

Good luck with your quest. We really should all record our experiences on a spreadsheet and present it to some medical authority in the hopes of some better help for us all. I'm just taking the anticoagulants now!

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Hi Sandi. I was referred to an EP because of my hospital’s protocol of referring after two drugs had failed to control the AF. The wait on the NHS turned out to be 16 months so after 3 horrible months, I saw the EP privately (£200) and continued on his NHS waiting list. The EP prescribed Flecainide and reduced the Bisoprolol to the lowest dose so it was definitely worth while seeing him. He has now referred me back to the local cardiologist with the arrangement for ablation, should I wish to pursue that option.

I had a long and useful talk with my cardiologist last week and he felt dehydration was an issue. He advised me that for my body weight of 70Kg I needed 2.8 litres of liquid daily. I complained also about low BP - this morning it was 81/54 - this seemed to confirm his idea of dehydration.

My GP is very cardiac aware, so my plan is to try aggressive hydration for six weeks or so and if I’m still having problems, I’ll start with seeing my GP to get advice.

Don’t worry about the stress test - a treadmill on which they increase speed and slope. But, you are well monitored and supervised and you can ask to abort it if you wish to during the test.

Like the idea of the spreadsheet!! Can you imagine the size of it?

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One of the GPs at my surgery did give me a prescription for the calcium channel blocker (which, like bisoprolol, is really for high blood pressure) and as all it achieved was slightly increasing my blood pressure which was hardly a problem previously, I've stopped that, though I might give it another try. Sadly, they don't have a treadmill at the hospital and instead give a drug to make the heart behave"as if you were exercising" and as I seem to be oversensitive to drugs, I really don't want to chance it! I've been doing Pilates for years and always carry water with me and drink lots of it and herbal teas and weigh 62kgs. Also, it seems that having a low heartbeat when I get fibrillations means it's no use to take a pill that will make it even lower. I tried to get in touch with an EP who is listed on this site and though he said he would see me privately, he has failed to be in touch since I let him have my contact details! It is so sad the way the NHS has been starved of funds.

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ps I have never been offered Flecainide though others I know are on it and I've mentioned it. Perhaps it costs too much (or there has been a scare).

Thanks for your reply.

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Hello,Flecanaide is a powerful drug which is not suitable for everyone,which is why GPs are not able to prescribe for us.It is given under careful consideration of how your heart structure is,etc.So n e people here have described it as the drug of last resort (!) So perhaps you are being given other meds for now?

best wishes x

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I have updated the situation in this post:

healthunlocked.com/afassoci...

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I was told to stop taking 1.25 daily after only a few days as it was bringing my heart rate down too low. There are breathing exercises you can do to help with breathlessness. Do look into that. I only take flecanide when/if I get an episode of AF.

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