Too slow?

Since my dose of Sotalol has been upped from 2x40 to 2x60 mg per day my heart has slowed down to about 50-55 during the day but has been as low as 47 in the late evening after taking a dose of Sotalol and about 49 when I wake up (so it may be very slow when I am asleep). My GP thinks below 50 is too slow and has asked me to keep a diary and records of heart rate etc. What are the risks of such a slow heartbeat? The GP didn’t give a reason.

[Hidden]

Unless I was symptomatic with that level of minor bradycardia, I wouldn’t be recording anything. Most fit young chaps like you should tolerate a rate of 47 just fine, If you were feeling faint or dizzy or had chest pain, that would be a different matter, but otherwise stop counting your pulse rate.

[Hidden in reply to Hidden]

Well, I’m 63 and so hardly “young”. However, in the mad world of AF three separate doctors have referred to me as being “young”, which I have interpreted as “unlucky enough to get AF at an age when most people have not yet acquired it.”

[Hidden]

Hi there,

A normal heart rate is between 60 and 100 bpm and many health care professionals regard an optimum heart rate of 72 to 75 bpm as ideal. Its all very much a personal thing though, our bodies all being different.

When I was diagnosed with AF I was put on Bisoprolol, 5 mg a day taken at night. I was 65 at the time and with no other heart/cardiac condition other than Arrythmia. I had been treated and medicated for hypertension for some 5 years before that. I'm 74 now.

Bisoprolol and Sotalol are both in the family of beta blockers and are usually prescribed for heart rate control but some health care professionals prescribe them for lowering blood pressure too.

Over the 9 years I've been on Bisoprolol I have had occasional bouts ( 6 or 8 times a year at the max) of coldness, mostly hands and feet ..... the ice man cometh springs to mind. When this happens my heart rate drops significantly from its normal rate of 65 (held at this level by Bisoprolol) down as low as 46 bpm and I feel totally crap. This drop usually occurs during the day, mostly late morning.

I am a 15 stone, 6 foot tall guy and this for me is far too low. Oddly enough this always happens when I'm at home resting or pottering around. Never when I'm active and or at work.

Because I'm at home I usually make a cup of hot sweet coffee, take a hot water bottle to bed and hug it and sleep for anything between 2 and 4 hours. I wake up and everything is normal and I feel fine with my heart rate back to the 65 mark again.

If this changed to any significant degree, like to 6 or 8 times a week instead of 6 to 8 times a year then I'd go back to my GP or Cardiologist for a review of the medication.

Anyway, that's what happens to me and how I deal with the drop in heart rate. It's my patent technique for dealing with the low heart rate - probably isn't approved by NICE or my GP :-). You don't say who prescribed the increase. Personally, if the 2 x 40 a day worked for you originally and did the job I'd ask to return to that level unless there is any underlying issue which you may have overlooked in your post. I certainly cannot function at all at 46.

John

[Paulmillwa11 in reply to Hidden]

Hi. Had my ablation on the 20/12 and apart from palpitations on and off no af. No more flecanide but still taking Diltiazem. I've had the same problem for a couple of years. Aged 46 and do a manual job. Average HR during my working day is around 60. Resting at home 52. Wake up every morning with a headache so could be too low at sleep. Hoping the ablation cures the AF and can then come off all my tablets.

[Hidden in reply to Paulmillwa11]

Sounds like your prospects are fairly good. If you are only getting paltpitations after a month things are going in the right direction.

[Hidden in reply to Hidden]

It was a consultant who upped the dose when I was in hospital last week. I mentioned I had a slow heart rate at times but he didn’t seem concerned; a doctor, however, thought below 50 is too slow. I don’t feel bad at below 50bpm- maybe a bit chilly, but that, of course, could just be the weather. Heart rate usually goes up to the mid 50s if I walk about. It’s now about 52, 30 mins after waking up.

[Hidden]

My resting heart rate is often in the forties. I don't find it a problem but when I complained about cold feet to my GP some years ago and had a pulse of 40, he halved my betablocker and doubled something else.

[Hidden in reply to Hidden]

I don’t feel bad at 47bpm, I’m just wondering if it’s good for you.

[Hidden in reply to Hidden]

47 is fine with me. I've not noticed any problems other than the cold feet.

Dizziness or lack of oomph would not be good.

[BobD Volunteer in reply to Hidden]

Whilst doing some random ECGs for a project a few years ago I came across an old chap with a HR of 36 who was perfectly happy and healthy. He laughed when I queried it . Ex LIfeboat Man and super fit. Try not to worry so much. How you feel is more important.

[Pabba]

Hi Sam.

Please stop checking your pulse, you're making things worse.

I'm a 72 year old male. I was 30 when all of a sudden completely out of the blue a switch flipped in my chest and I was in Atrial Tachycardia. Over the years this morphed into Paroxysmal AF. The heart docs told me not to dial 999 when I get AF unless I get chest pains or shortness of breath. In July 2018 I got an AF episode and Angina along with it (got CAD too) I was on 40mg Sotalol twice daily at the time and the heart Doc doubled it to 40mg four times daily. My heart rate plummeted and I felt generally all over horrible (Sotalol is quite nasty for side effects, if you read the horrendous list on the leaflet I suffer from ALL of them) My GP checked my pulse at 50 bpm and dropped my dose to 40mg three times daily. I was a bit better but brain fog still dogged me. I experimented with dosage myself. I have found a sort of middle ground with 40mg twice daily, 8am and 8pm. My pulse now is what they call 'Regularly Irregular' (skips every other beat regularly) but fingers crossed I haven't had a PAF episode since last July. As others have already said, we are all different and there is no fixed 'fix' for us all, to a large extent trial and error can help. Realise that none of what is effecting us is an exact science and although they might be reluctant to admit it, even the consultants do not have all the answers. All my heart problems are genetic, from my Mums side, I have never had any of the known risk factors, the fickle finger of fate and all that. I did go through a phase of reading up on everything and constantly checking my BPM but now I think I have come to terms with it. Besides, I have something else to worry about now, my wife of 54 years has been diagnosed with COPD and she has never smoked a cigarette in her life, go figure! 'And the moving finger writes. . . .' Wish I was 63 again.

[Hidden]

It’s reassuring to know that you have had these symptoms or similar for around 42 years.

I have been checking my pulse recently a lot as they doctor asked me to keep a diary of blood pressure, bpm etc., also I wanted information to give to St Barts on Wednesday.

Hope your wife gets the best medical care and feels better soon.

[Bobobe]

If you're in good health (good shape) i would say it's normal. I'm 46 and have a low hearth rate also.i don't keep any log but i do keep an eye on it from time to time. I go swimming 4 times a week and do a few classes of boxing with no side effects from sotalol at all. Since i've started on this drug ,3 years ago,no more afibe. The only thing that bothered me at first was being tired for a couple weeks bit after that,i've been feeling awsome.. hope it works out for you..cheers

[Hidden]

Boxing-I assume you are not on an anticoagulant?