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What`s a high heart rate in your opinion ?

Hi everyone.

I saw my cardiologist two days ago. I was taking bisoprolol 2.5mg and flecainide 100mg daily. He just stopped my bisoprolol and doubled the flecainide to 200mg a day.

All well and good ? Not really. I expressed my concern about just stopping bisoprolol as my HR might go up - it has !

Before I saw him it ranged between 72 - 85 (ish) in the day. Now it`s around 97 - 100 during the day and up in the evening to 100 - 105 going as high as 119 (at rest).

It`s higher than I`m happy with.

So my question is this - what HR is to high in your opinion ? Is there a cut off point when you go to A@E ? Would you accept a regular HR of 100 - 110 or do you think it`s to high ? What is your average HR ?

Thanks for any replies ;-)

Best,

Paul

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On 10mg Bisoprolol, my resting HR is 50-70 - usually sitting at 65 most of the time but can be as high/low as the range I stated.

When I'm not on bisoprolol, which has been rare the last few years, it's been 80-90 resting. This could well be because my BMI is a shade over 30 as well, so everything has to work harder.

I remember checking regularly, when stable, in 2015/16 and it was usually around 100 resting. At the time I didn't think anything of it, though now I'd probably think that was a bit high for me. But maybe thats because I'm used to it being so low on the medications.

At what point would I go to ED? Well, as my last AF episode showed.... after 5 ablations and 20+ cardioversions I was able to function with the resting HR at 120. In all previous instances that would be the point I would go to ED because I was symptomatic - dizzy light headed short of breath clammy and sweaty.

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Thanks for your reply. So a constant resting HR of 100 would be OK for you - you wouldn`t worry to much ?

Best,

Paul

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Hi Paul, personally I would not be happy with a resting HR as you indicate and I would go to the doctor for advice - I would not take the word of a non medically trained adviser, such as here. People are all different and responses to or without medication can vary greatly so please do go see your doctor.

What I am even more concerned about is your acceptance of a BMI of 30 knowing how it affects your heart rate - now that is an even greater concern since weight affects every facet of ones life and is a genuine threat to life on a daily basis. I sincerely do hope you will be addressing this as a matter of urgency and do hope you will also discuss this with your doctor at the same time and your high heart rate.

Good luck and please remember that can't is not a word I accept - can't just means won't and if you want something badly enough, you will succeed .

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Thanks TT for your reply. I agree with you that 100 is to high IMO. Just with reference to BMI - mine is just a tab under 25. I`m sort of happy with it although if I could reduce it by a points I would be delighted ;-)

Best,

Paul

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It's me with the BMI of over 30 risking my health, not Paul.

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I wouldn't say 100 would be "ok" for me, if it persisted I'd get it checked. I've been discharged from ED and cardiology with a HR of around 100-120 in normal sinus rhythm and they haven't been concerned. Equally, when we score people's observations, they actually flag up as a trigger and score 1 when the HR hits 3 figures.

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Thanks Jed. I think 100 is borderline but not quite enough to visit A@E. I`m going to give it another 24 hours - maybe the higher dose of flec will kick in and help a little.

Best,

Paul

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Well the flecanaide is more about the rhythm than the rate, so if your heart is regular, just fast, that may not help. But it's hard to tell without a trace. One thing that helps me is a lot of fluid intake, good hydration lowers HR. Of course increased fluid intake + AF = pee more.

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Good point Jed - drinking a lot of water is VERY important.

Best,

Paul

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Having been to A&E - a lot - anything over 120, anything less they don’t seem concerned about. Having said that, I wouldn’t be too happy with those sorts of rates constantly so would be asking my doctor for options. As it happens I am unable to tolerate any Beta-blockers so my resting HR is often 85-100 but sometimes as low as 55.

I would say no emergency but if you are uncomfortable then go back to your doctor.

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Thanks CD.

Best,

Paul

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How long since you stopped the bisoprolol? Your HR does sound a little high but I remember it took several weeks for mine to normalise after stopping

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That's a very good point. Now you mention it I seem to remember an upwards trend in the weeks following my stopping it.....

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Very useful reply Mike. I think after stopping bisoprolol it can go up a bit. This is why you normally wean yourself off it over 2 or 3 weeks. I was told to just stop completely and increase the flec.

Best,

Paul

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Medically, normal heart rate is defined as between 60 and 100 . so you are not far off normal. A rate of 120 may be treated and 140 + must be. I find it odd that you were told to just stop bisoprolol as a rebound reaction is quite expected. Since the flecainide does not affect rate, only rhythm this should have been expected I think .Why not ring your cardiologist for advice or his arrhythmia nurse if you are worried? I have never gone cold turkey on any drugs I have been prescribed.

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Thanks Bob. I questioned my cardiologist about just stopping bisoprolol when I saw him on Tuesday - I also told him I would like to cut down over a few weeks. He said to just stop as the flec was being doubled. TBH honest I found it a little strange too.

Trying to call him is not an easy process. He`s normally on holiday - that`s if I can get past his secretary ;-)

Best,

Paul

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Bisoprolol or Diltiazem are usually prescribed in tandem with Flecainide because of the danger of Flecainide alone inducing flutter. So if your HR goes up or you feel unwell you should seek urgent advice - from a medic! Hopefully it is a withdrawal reaction and will wear off.

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Thanks Buff.

Best,

Paul

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Hi P

A somewhat cryptic answer - possibly. Please peruse the link pasted below (Harvard Medical School).

Best wishes

Sydney J (-:

health.harvard.edu/blog/res...

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Brilliant link. Ty for sharing.

Best,

Paul

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Best wishes, keep up the good fight

J (-:

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Thanks Globe ;-)

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Without any drugs my HR is 200-260. If the Flecainide stops working, the Diltiazem keeps it down to 120-180. My RHR is 45-50.

In 2014 my GP told me to call an ambulance at 120, but A&E sent me home untreated. They measured my HR at 120 but that was supine, so they didn't see it going up to 180 standing. Anything over 150 is an admission on the red telephone.

I've had mixed messages about going to A&E from the outset, which can best be summed up as the patient's place is in the wrong.

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So true!

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For sure - different medic`s seem to give mixed messages. Over time a high rate will take it`s toll and could lead to heart disease. The link above given by Globe is worth a look.

Regarding mixed messages. I work abroad much of the year and saw a cardiologist in Bulgaria for second opinion (at the time I was waiting for my first cardioversion in the UK as recommended by the cardiologist here.) The Bulgarian doctors exact words were 'what the hell do you want that for' ? He put me on a course of med`s (5 different types) and said come back in two weeks. I returned to the UK a few days after and the doc here took me off them - he said either be treated on the NHS or Bulgaria, you can`t do both.

Rock and a hard place !

Best,

Paul

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Brief summary:

2010: First episode. Crawled around on all fours 10 hrs until I reverted for fear of calling 999 and being labelled a timewaster.

2012: Same again, but it didn't go away. Called NHS direct, they were indecisive so I called GP. He called ambulance. Consultant in resus ticked me off for not calling sooner.

2013: Call ambulances promptly on several occasions until I get sniped at for being 'frequent flyer'.

June 2014: I call GP who tells me to call 999. Sent home from A&E untreated by Dr who thinks I'm just anxious. Told to stop calling ambulances. Call another ambulance later in day after HR reaches 180. Put in a side room to 'calm down' by Dr who still thinks I'm anxious. Diagnosis following day, nearly too late for DCCV.

Aug 2014: Wait for 2 days before calling 999. Now too late for DCCV, so I end up in hospital for a week which could have been avoided If I had felt confident enough to call sooner.

June 2015: EP stopped my meds altogether. Back in A&E a few days later. Drs clearly think I'm stupid/difficult for stopping meds and put me back on them again. I wrote to the hospital, they told me no doctor would ever have stopped my meds. I sent them a copy of EP letter telling me to stop meds. They didn't reply.

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This is what I think ectopic. There`s a saying 'being nice doesn`t always work'. If my HR was 180 I would call a red light on the spot - regardless of being told not to. It`s your health - if your worried either get a cab to A@E or call for an ambulance. Don`t be palmed off.

The health service do a fantastic job, don`t get me wrong, but sometimes the left hand doesn`t know what the right hand is doing.

You wrote.......they told me no doctor would ever have stopped my meds. I sent them a copy of EP letter telling me to stop meds.......

I can well believe it. When I saw my cardiologist a few days ago, he asked me what med`s I was on. When I told him I was on flecainide he said 'who put you that' ?

Errrrr you did. You couldn`t make it up ;-)

Best,

Paul

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On one occasion the crash team disconnected me from the bedside monitor, and used one on a trolley instead. The leads were draped over the bedside monitor, and it was bleeping gently with an annunciator across the screen: "Leads Disconnected".

An hour or so later a nurse walked into the room:

"Why is it bleeping?"

"Oh, it's OK, I'm connected to this one on the trolley"

"Why does it keep bleeping?"

"It's just because the leads are disconnected"

She took no notice, and just kept muttering "Why does it keep bleeping?". After a few minutes of pressing every button on the screen at random she announced triumphantly "Aah, I know why, it's because the leads are disconnected".

It's not very encouraging to see staff who don't know how to use the tools they've been provided with.

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I have a heart rate of about 95 to 105 bpm. I am in permanent AF. I find it a perfectly acceptable rate. Yes sometimes I tire easily, so I have a rest. I don't check my heart rate or BP very often, perhaps a couple of times a year.

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Hello Thomas. If your happy with the rate then that`s OK. However personally I would want it a little lower. Although your rate is not excessively high, surely a lower HR would be less likely to cause problems over time ? To put it bluntly - a HR of 100 is going to wear the heart out more quickly than a HR of 70 ?

Sorry to hear you are in permanent a-fib. It sounds like I might be joining you soon ;-)

Best,

Paul

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My doctors and hospital considered anything under 100 to be ok long term.

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Thanks Hambo - the juries still out though in my opinion. A recent article said over 77 can have a long term affect. If I can find it again I`ll post the link.

Best,

Paul

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Mine beats at 65. At anything much over 100 I get breathless. I try to go for a walk every other day. Every time I walk up a hill it goes to 124. When it does this I have no choice but to walk very slowly or stop and rest. I am surrounded by hills. I keep talking to myself. People who pass me must think I am crazy. However I remember reading on this site that if you could walk and talk normally then everything was ok. My point being everyone has different levels of tolerance with their heart. I do what I think my body can tolerate. Fortunately it always goes to around 90 as I walk.

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I would go to A and E if It stayed so high as when I walk up the hill, because it makes me breathless and giddy

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OK ele - thanks for your post.

I`m turning off the computer now as need to go out in a few minutes. I`ll respond more in the morning as your point about walking (exercise) raises a good point for a-fibbers.

Leave it with me - I`ll post in the morning when I have more time to respond fully.

Best,

Paul

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