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AF Association
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Heart Rate

I measured my heart rate before I got up this morning and it was 44 bpm. I then got up and put clean sheets on the bed, put the washing in the machine and generally tidied up. I then remeasured my heart rate and it is now 46 bpm. I am on 5 mg bisoprolol fumarate and am now wondering if I should be on it at all. I get AF every now and then and it lasts about 2 or 3 hours. I am getting quite good at recognising warning signs and go through some relaxation techniques to try and avoid AF. I am wondering whether I should ask my GP if I can be weaned off bisoprolol to see what my normal heart rate is without a beta blocker or at least reduce the dose. I am on warfarin which I would continue. I believe bisoprolol doesn't prevent AF but just slows the heart rate but I might be wrong. I would be interested in hearing other opinions or any advice.

UPDATE: I decided to monitor and blood pressure for a month and went to see the GP with my evidence of low pulse rate. He agreed to drop the bisoprolol dose to 3.75 mg per day. My heart rate sticks in the 50's, usually 57 bpm which I can cope with. So all is well. I also discovered I had a Vitamin D deficiency and low Vitamin B12 and folate. Having sorted this out with loaded Vitamin D dose and Vitamin B complex and magnesium glycinate supplements, I am feeling very much better. So my advice is to get your Vitamin D, Vitamin B12, folate and ferratin levels checked if you are feeling very tired and weak. A deficiency in any of these can make you feel awful.

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I think I'd ask your GP if you can reduce the dose, but I'm sure when you say what's happening he will probably suggest that anyway. Please let us know how you get on. Is there any chance of seeing him today, or even talking to him on the phone?

Jean

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I won't get near my GP today. I am not too worried as my heart rate has been low since being put on bisoprolol in A & E the first time I had an AF episode. That time it lasted for about 9 hours. I actually have never had my heart rate checked at the GP surgery. I suppose they think all is well as I don't complain. However I don't like the side effects of bisoprolol so will definitely ask the GP to reduce the dose. Thanks for your advice.

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You're correct that bisoprolol slows the heart rate rather than preventing AF per se. If I were in your situation I'd certainly ask your GP about the possibility of reducing (halving?) the dose since (by my standards at any rate) yours sounds quite low to me - even after some exertion. However I suspect that what's most important is how you feel with a heart rate of 44/46 bpm.

I know that 'normal' is considered to be anything between 50 and 100 bpm, but then there's 'what's normal for you'. My 'normal' is at the upper end of that scale, yours could well be at the bottom end.

Talk to your GP is, I think, the best advice as we are all so different.

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Good advice. Thank you. I have learnt so much from the posts in this website and I am much less anxious. I managed to ride out my last episode of AF without panicking so thank you all.

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I am on the same doseage of Bisoprolol and it holds my heart rate at around 63 to 65. HOWEVER, just occasionally it drops my HR to 46!

TBH, Bisoprolol is something of a 'dirty drug' and you should only tamper it under medical supervision, and then only by small amounts.

I tried reducing it by 1.25mg some years ago and my heart rate took off to around 90 BPM, which is what it was prior to AF.

Yep, not a cure for AF definitely for rate control. You don't say what your normal HR is/was.

John

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Yes I agree. I have been nervous to ask my GP to change the dose but I may ask to go down to 3.75 mg. I shall monitor my heart rate every day for a couple of weeks before I see the GP to get a better picture of the situation. Thanks for your input. It is much appreciated.

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I wouldn't want to be on Bisoprolol with heart rate that low. See your GP in my opinion.

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I was taken off Bisoprolol as my heart rate was falling below 40bpm regularly and I had been diagnosed with heart block. I was only on 1.25Mg.

Pete

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What is heart block Pete? Is that through having a low heart rate? Since my ablation mine varies between 39-44-45. My systolic BP is fine at roughly 130 but again the diastolic is low..about 45-46. I am on 1.25 bisoprolol but no one has suggested coming off of it.

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It is complicated but in essence it is bad conductivity through the right ventricle I think.

As there is bad conductivity then the electrical impulse takes longer to travel.

As Bisoprolol is a rate control drug it can exacerbate the Bradycardia (slow heart rate).

However if you have concerns you must talk to your EP.

Pete

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Thank you Pete. I have an appointment on Monday and I'm hoping to sort out a few issues.. Not least is I'm on Rivaroxaban and I used to have such thick hair and it is getting soooo thin. I did keep asking the forum, as its such a helpful site, which would be the best one to be on, ie Rivaroxaban, apixaban, edoxaban, and the other one beginning with Dani something, as my GP says they are all the same (?!?!?), but...... The bet all rounder...??

Thank you and best wishes

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I was taken off it with a heart rate as low as yours and put on rhythm control instead (Flecainide)

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...and are you feeling much better on the flecainide Archie??? After my ablation I was taken off the flecainide and just told to carry on with my bisoprolol 1.25 in the morning with the furosemide (plus my thyroid tablets) and then the rivaroxaban with evening meal then losartan before bed. Since stopping the flecainide all the palpitations and missed beats have returned and I definitely don't feel good. I had to have the cardio version and ablation because my heart beat kept going up as 240-250 and irregular. Now it seems to be the other way. Best wishes

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Sorry to hear this Tapanac. I am so much better on the Flecainide 50mg twice daily. I’ve been on it since mid - August and did have some side effects, headaches, palpitations and dizziness, though I had been having the last two since my A&E visit & diagnosis of Fast AF in July.

It took a couple of weeks for the headaches to go and a month for my dizzy spells to disappear. I still have occasional palpitations and rare slight raised resting HR (100-120). AF has not broken through but I can take an extra Flecainide if it does.

I would say I am feeling 90% better on the Flecainide and for me, Bisoprolol was not a good drug as I was sensitive to the lowest dose of 1.25 mg which made me so dizzy and tired I could barely stand up. It also dropped my HR to 44 and when the nurse at my surgery checked my BP he did one reading sitting and one standing (postural BP check) and the change to standing dropped my BP thus explaining the dizziness.

Cardiologist has told me never to take Bisoprolol again, but we all react differently to meds and need professional advice.

I’m also quite new to the AF saga and hope I’m one of the lucky ones who manage on meds and no procedures - who knows? ( I’m also on Apixaban 5mg x 2).

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Thank you Archie. I don’t know why the EP took me off Flecainide as I was brilliant from last Christmas on diagnosis of atrial fibrillation until July when he stopped it. A nurse said that after an ablation that Flecainide could cause atrial flutter but no one has said specifically. There are do many people on here taking Flecainide that I find it hard to figure out why I had to stop unless it was to do with the ablation.

I hope you carry on feeling better. Someone on this forum has been on it for over 20 years and hasn’t had to have anything else done donkeep up the good work and stay well. Best wishes

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Hello Happy Walker, I too have A-Fib and I also take Coumadin because I have an artificial mitral heart valve. I'm not on any meds for my A-Fib, but in April, 2018, I did have to have surgery to shock my heart back into it's normal rhythm. You mentioned you take bisoprolol, which can be used for treatment of A-Fib, but it's also used for high blood pressure (my husband takes it for his blood pressure). I would ask your Dr if it's safe to stop the bisoprolol; it could be they are keeping you on it because they are trying to keep you from going into A-Fib that requires the surgery of shocking your heart. I developed A-Fib because I went through 22 surgeries from Oct 2017 to July 2018, due to a severe infected knee replacement. The constant use of anesthesia caused my heart to become somewhat "confused", so the only answer was to shock it, to pull it out of A-Fib. It's been fine ever since April, when I received the shock surgery. My cardiologist did say if I wind up developing A-Fib again, they might have to use a beta-blocker such as metoprolol along with the Coumadin I'll be taking the rest of my life for the artificial heart valve I have, to keep blood clots from forming on the valve. But please speak with your Dr before doing anything, I hope this helps and I wish you happy health!

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Thank you.

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Hi Happy walker. I was PAF then it turned to just AF so the cardiologist took me off bisoprolol as my heart rate went down as far as yours and felt very dizzy and almost fainting. Just on Warfarin now and I am managing quite well.

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That is good to know. I shall see if my GP agrees with a gradual reduction with monitoring to see if I can do with a lower dose.

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It's a seriously toxic medication and I'd get off it if at all possible. Similarly Warfarin. I had been on it for several years but the surgeon said to stop 12 weeks after the ablation. That was 4+ years ago, which I've spent eating sensibly and getting plenty exercise. The body's marvellously responsive to being treated well. 69 and medication-free. Heaven forfend I ever depend on it.

Do try to get off that Bisoprolol n Warfarin!

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I'm a bit concerned that you are suggesting that people should "get off" any medication prescribed by a medical practitioner especially warfarin which is a life saver for so many people. Anti coagulants are prescribed to reduce the risk of a life changing stroke. BobD will I'm sure be willing to attest to this and many others.

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I agree with you 100%. That's quite dangerous to advise someone to "get off" of a medically prescribed drug. There really aren't any side effects from Warfarin (Coumadin) as I have been on it 11 years, and will have to stay on it the rest of my life due to my artificial heart valve. If someone like me, were to "get off" Warfarin, there's a huge risk of having a stroke or heart attack from a blood clot. And to me, that's very scary☹️

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Don't be concerned Bagrat. I understand that Americans aged 50-64 have been/are chowing down an average of 19.2 prescriptions per person. This is a narrative that reflects a generally sick society, whether from genuine illness and/or from this kind of excessive intake of chemicals. It surely cannot be a heresy to urge people to be less dependent. As for the life-saving qualities of Warfarin (and in my case Diltiazem to slow the heart), I know them well, but I was extremely glad to be free of it, which after my ablation, on the recommendation of the surgeon, I achieved without a hiccup. In fact my energy surged.

I don't urge people to 'get off' all medically prescribed medicines. I urge people to minimise them where and when genuinely safe to do so, and we can help facilitate that by eating much better than well, and getting plenty of proper exercise. The heart muscle needs to beat fast sometimes to keep it fit.

God bless us all to have and enjoy our health.

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I am surprised the moderators let your post stay.

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Thanks. I shall discuss the matter with the GP and see what he advises. It would be great not having to pop pills all the time.

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I was told that the target rate was

between 55 and 85, so there might be a case for reducing the dose. However, a slow heart beat is not consisered problematic unless it is making you dizzy etc..

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The most annoying thing with bisoprolol is the general fatigue. I have to force myself to take a daily walk and don't enjoy it. Before AF, I used to go out for an hour and a half everyday but now can only manage 30 minutes and am relieved to get home.

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HI Happywalker. Yes, my understanding is that Bisoprolol is used to slow down the natural response to increase heart rate as the demand rises. In this way it can limit the maximum rate your AF could drive it up to. It also generally lowers the rate overall, which is annoying. Also, everyone seems to respond differently to the drug, and some get very used to it, so there is no standard dose. It's all trial and error.

I've also learned from this forum that you can't just stop taking it - that's dangerous, and even warned against in the leaflet with the pills. You need to be weaned off by a very very gradual reduction of the dosage.

I'm on 1.25 mg daily, the minimum dose, I understand. I did try 2.5 mg, but found that sent me into very low rates (similar to yours) and also meant I was struggling to climb the stairs without feeling faint and dizzy. I was cut back to the 1.25 again. Your dose sounds very high, so there is certainly room for it to be adjusted. I suggest you see your doctor.

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Will do that. Thanks.

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Stopping medication without medical advice/supervision, particularly anticoagulants is never a good idea. Fatal heart attacks and strokes can occur even if your heart rate appears well controlled.

Assuming you feel well with a relatively low heart rate as in you don't feel faint or dizzy, you're not short of breath, you don't have chest pain or tightness and your exercise tolerance is good then as you say there is no immediate cause for concern.

We'd all like to be medication free but please discuss this with a gp or cardiologist

Take care

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HiHappywalker,

Bisoprolol is one of the best "New Beta Adrenergic Blockers".It is Beta 1 specific and is use to decrease the force of contraction of the ventricles, there by giving your ventricles a rest and allowing them to contract more efficiently.

Yes ,it will also lower your HR due to the alpha 1 effect.

The combination of a beta blocker and an Anti coagulant is the appropriate Rx for AF or VT.

My concern is "When do you take your BB?

If you are taking it at night ,then I would ask the Cardiologist to switch it to AM.

In fact it works better in the AM as this is when you are most active and your heart can use the support.

I would not mess with the dosage too much.

Lastly ALL drugs and supplements have untoward side effects.

How well we can cope with them depends on the individual.

I wish you all the very best.

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Many thanks. I take the bisoprolol in the morning an hour after the levothyroxine and the warfarin in the late afternoon.

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That's the most beneficial way to go.

If your HR still drops below 45BPM then I would recommend that you discuss this with your GP or cardiologist to decrease the dosage.

Keep well.

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