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AF Association
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Newly diagnosed - bisoprolol not working?

Hi - I’m a new member. I’m writing because I was expecting improvement by now, but it hasn’t happened and I’m hoping for reassurance.

I’ve had two bouts of frightening but fairly short-lived severe symptoms, both while climbing stairs, four weeks apart. Both were like “attacks” in their suddenness and overwhelming. I was forced to sit or lie down, breathing deeply, feeling “muzzy- or light-headed” and with a sense of “impending doom”.

The second time, I was admitted to hospital and told that I have atrial flutter. They found that my heart rate was 155, which lasted a long time then dropped to about 100 after, I think, a beta blocker. I was sent home the next evening with 5mg bisoprolol and 20mg rivaroxaban, and a plan for an echo cardiogram and then electro cardioversion.

Today, four days on, I still feel “very rough” much of the time with milder but similar symptoms of slight chest pain, balloon feeling under my left rib (I have troublesome hiatus hernia, too), slight “dizzy” head, slight headache, and a deep fear of another “attack”. A trip to town went okay but was hard work throughout. I’ve also had a “distanced” sensation on one day.

Nothing I do will get my heart rate below 100, and it has occasionally gone up to 145 but briefly only. I expected the bisoprolol to have sorted that out. It seems that the flutter is on all the time.

I’m sorry to have “gone on”. I hope someone will give me reassurance. I’ll be going back to my GP next week if things stay the same.

36 Replies
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Four days is nothing in the grand scheme of all things AF. You need to keep talking to your GP and if he/she can't help you then you need to see a specialist in arrhythmias. Bisoprolol is the easy first option treatment but a consultant may offer something stronger. Be patient and try to relax. It will be a long journey and there are no shortcuts.

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Thanks Bob. I'll see my GP next week. I'm under a cardiologist - I suppose I could phone the unit at the hospital but they were so crazily busy. I was hoping my heart rate would be lower, I suppose and that I wouldn't keep feeling quite close to having another "attack" with the fear that maybe something worse is around the corner.

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Aflutter can feel bad, the good news is that it can be relative easily cured (or at least significantly improved). Get the echo cardiogram and have a cardioversion asap if you continue to have Aflutter. Bisoprolol does help prevent attacks but with me it did nothing to revert an attack to NSR. The fix is an ablation but the Docs may wait to see how prone you are to an attack whilst on Bisoprolol - some even get fixed after a cardioversion but there are no garantees. I have been posting my Aflutter experience on this site if you would like to take a look it may give you some further information.

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Thanks. I'll read your posts for sure. This website has proved so useful already. The bisoprolol currently doesn't seem to be helping as I feel an attack coming close if I do various things. Even shopping, yesterday, was far from a pleasant and normal experience and I was glad to be back home. Lying down in bed at night is my most comfortable time, although, in general, afternoon or at least evenings seem best.

Thank you again for taking the time to reply. It is much appreciated.

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Sounds like your heart is irritated/inflamed, best to be inactive for 4 or 5 days and take some magnesium (not the oxide) and perhaps an Epsom Salts bath (use the full packet (about 5 cups). Once the irritation has calmed you will be able to gradually do a bit more without feel like the symptoms are likely to start. Unfortunately the Docs do not give these conditions the priority we think they deserve.

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Thanks. I’ve read about magnesium and might try it. The cardiologist insisted my heart itself seemed fine but I’ve yet to have the echo cardiogram. I’ve a suspicion it’s blood pressure related somehow.

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Hi Ppiman and welcome to the forum which I'm sure you would rather not be a member of.

What you are describing are typical symptoms of atrial flutter and the effects of taking your bisoprolol. That is all except for the balloon feeling under your left rib, others may have experienced that but in my 14 years with flutter and fibrillation I haven't. Most of people's symptoms are quite similar, but we don't all experience exactly the same effects with or after an attack.

Just about every member on this forum will be able to identify with your post. After an episode it can leave you feeling tired and off colour for quite a few days. It sounds as though your heart is still racing, so you won't feel right until you can have it cardioverted back into its normal beat.

Bisoprolol is a pill which people have reported on here can make them feel totally drained until the body gets used to it. Sometimes it's necessary to try a different beta blocker or a lower dose. I would have a chat with your GP and see what he advises if things don't improve.

Heart arrhythmia's are extremely common, you would be surprised at how many people have them, but carry on with their normal daily lives. One thing to remember is that they are extremely unlikely to cause death and anxiety almost appears to feed and keep them going, so it's important that you really try your best to stop worrying.

Practice slow deep breathing, it could help make your symptoms disappear. I sometimes think that not breathing correctly is the cause of all our problems. When you walk upstairs, or exert yourself be aware that you will need to breathe a little deeper.

I see you are into healthy eating, that's a good thing. Try to avoid any foods or fluids that have artificial additives and stick to a plant based one, also drink plenty of water so that you don't become dehydrated which can be another trigger. Some people swear that by taking magnesium taurate or citrate tablets has helped reduce their symptoms.

If you go to the AF home page on this site you will find lots of helpful information. Also Dr Sanjay Gupta a cardiologist from York hospital has made lots of helpful recordings and put them onto YouTube. Search on there for Sanjay Gupta York. He explains everything in a kind and easy to understand way. He's also mentioned recently about the connection between having a hiatus hernia and heart arrhythmias.

Feel free to ask any questions (we always say that there is no such thing as a daft one) and know that we understand exactly how you are feeling.

Jean

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Thank you so much. I've watched a couple of the videos. They are very interesting and helpful. I suppose I am being impatient. After my first event 4-5 weeks ago, I recovered quite well and I put it down to my hiatus hernia and "vagus irritation", not directly to my heart. Now, after the second event, I know what it actually is.

Dr Gupta tells that many people hardly know they have this (he's talking of Afib nor Aflutter, though, I guess) - well, in my case I absolutely know it and I am rather disabled from carrying out normal activities, as I soon start to feel unwell, and that another "attack" is imminent.

So - thank you, once again for your kind reply. It has helped me a great deal to understand things better!

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When I was first diagnosed, I ran around like a headless chicken - there was something wrong with my heart - was I going to die! I paid privately for an echo-cardiogram rather than wait, how could they expect me to wait! When I look back I realise how unnecessary that was, but nothing was clearly explained to me about my condition and I didn't know of this forum. I guess nothing was explained clearly to you either?

I understand totally how you are feeling disabled by your flutter, it really is a horrible condition. At times I found it hard to walk from one room to another, thank goodness I live in a bungalow. I hate to think what it must be like for you having stairs to climb.

After a few years with rare occurrences, I found that my attacks came every 4-6 weeks. Attacks are usually more widely spaced when the condition first hits us.

It's really important that you listen to the advice given here as most of us have had the condition for a long time and discovered the things that help. You really must stop worrying about having another attack, do anything to take your mind off your condition and how you are feeling, don't sit at home worrying. I used to drive to a nearby town and was able to shop in just one store, before I had to come home. It made me feel more normal to have been out, despite how I was feeling. Visit friends who make you laugh, or ask them to come to you. Once while with a group of friends and having a laugh, my heart reverted to sinus rhythm.

I live on my own and struggled with the garden, I'm a little garden proud and the lawn needed cutting. I went out and did it, full of self pity. Then came in with a sore heart thinking I really shouldn't have done that and I've probably made the situation worse, but that evening I went back into normal sinus rhythm. Honestly, you will not get rid of your flutter by sitting at home thinking about it. How's it going to go back to normal if you're sat still - it will just stay as it is.

I really feel for you and desperately want to help with advice that may get you better again.

Please practice deep breathing and try to do something that brings you joy and takes your mind off of your heart. When friends come don't sit solemnly telling them in detail how dreadful you feel. Tell them that quickly, explain you are not going to dwell on it while they're visiting and move on to happier topics.

Please let us know how you get on.

Jean

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Hi Ppiman,

Rome wasn't built in a day ................. trust me ! I agree totally with BobD.

So, how long is it since you were put on Bisoprolol - 4 days or 4 weeks (or have I read this out of context).

To be honest, I suspect the real dynamic you is fighting - head to head - the mighty Bisoprolol and so long as that continues I doubt that the Bisoprolol will be able to do its job.

So, what is it's job, some healthcare professionals prescribe it for heart rate control and some see that it has properties for blood pressure control and prescribe it for that. I have it to control my heart rate which it holds at around 65 bpm day in, day out, year in, year out. I accept it may make a tiny contribution to blood pressure control but only a tiny bit as I am on more orthodox medication for that.

I've been on 5 mg of Bisoprolol for 9 plus years now, its truly my best mate BUT as I commented on here the other day it is not the type of drug the patient plays around with him/herself - only under professional medical guidance.

Given your HH and this balloon feeling you refer to have you considered that all this and more may, just MAY, come from a dysfunctional Vagal Nerve and the type of food you are eating. Have you noticed if certain foods cause these issues you describe to improve or worsen. Just a thought may not be relevant.

Do, do try and relax, try not to think of all this, don't demand too much of your body, just sit back and enjoy the ride .... well, in a manner of speaking :-)

The more you fight things the harder it will be to benefit from any medication (you are prescribed) to work.

If you have only been prescribed Bisoprolol 4 days ago it just hasn't had a chance to work. 4 days is a totally unreal expectation !

If you haven't read the bit of paper in the packet do so ! You'll learn about the drug.

Good luck, stay kool, be patient.

John

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Thanks for that. I expected to bisoprolol to help more quickly, for sure - patience is the key, it seems. I’d read it kicks in rapidly somewhere - but must have been mistaken.

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Try not to worry Pp (easy to say I know). There are many different med`s for AF - some work for some people and not for others. It really is a case of trial and error - there is hope I promise you. I agree with John above - be patient ;-)

Enjoy your weekend.

Best,

Paul

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Thanks Paul. This morning is the muzzy head, headache, weird chest, lowish BP, variable heart rate, feeling sluggish time!

It’s kind of you to comment.

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It`s a nightmare Pp I know. It`s best to try and get an early night and a good nights sleep - it works wonders !

Hope you feel better soon.

Best,

Paul

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Thanks again. Sadly - and maybe this is what’s caused it - I have had insomnia for many years. I fall off to sleep easily enough, but then wake, wake, wake. . . Most days, I’m drained but act like I’m not, of course. The attacks both happened after particularly bad nights when I decided to be too active. I guess there’s a link.

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A lack of sleep kicks it off for me too ! I`m not really an advocate of sleeping pills but I find a small dose of zolpidem works wonders. Used as back up when you really need a good nights sleep it`s worth having. Ask your doctor about it.

Melatonin is also effective for some afibbers. Ask Mr Google - it`s cheap and can be bought online on eBay. A small dose 1 - 3 mg might help.

Best,

Paul

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I’ve been taking zolpidem on and off for years but this last year, I’ve tried to stop using it and have managed without any problems to do so - I still take as and when, though. It only gives me 3 hours of sleep, sadly, whatever the dose, so I often take it around 3am for that reason. Melatonin doesn’t work for me sadly. I’ve read it’s for “sleep onset insomnia” rather than “sleep duration” so maybe that’s why?

Insomnia is a real pain - now made worse as I’m in my sixties by frequent nighttime loo visits. The bisoprolol seems to be adding to that problem, too. Tiredness has utterly ruled my life for years - although atrial flutter is doing that now and is far more disabling! 😳

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What about Zopiclone Pp ? That helps you stay asleep - could be worth mentioning to your doc.

You can buy Melatonin in slow release as well as the normal version. Might help you stay asleep if it`s released during the whole night.

Best,

Paul

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Thanks. I’ll look into the melatonin. I’ve got some zopiclone - my GP is excellent at trying to help whichever way he can. Sadly it only works the same for me as zolpidem but also leaves a very bitter taste in my mouth next day.

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Have you had a sleep study done? Sleep apnea is a known cause of AF. so this is definitely worth following up.

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I did see a sleep specialist but years back - he didn’t do anything to check if but he did say he was sure I didn’t have it. I don’t know how he could know. He put my sleep troubles down to my busy anxious personality.

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Try asking your GP specifically to be tested for sleep apnea. Your problem may have changed since the original referral.

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Thanks. I’m seeing him next week and will ask. Extreme tiredness can also cause arrhythmia I’ve read. What a life, eh?

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I found taking magnesium eventuallly decreased my loo visits, and improved my sleeping. Try magnesium taurate (good for hearts) or glycinate. Citrate is ok and cheaper. Don't use magnesium oxide, and don't take so much magnesium that you get the runs - that will make your heart worse, as you will be losing essential electrolytes as well. You can also try Epsom salts in the bath, or spray-on magnesium (from a health food shop).

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Thanks again. I’ve been looking on Amazon and will get some as a trial. Fewer nighttime loo visits would be a blessing.

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Does anyone know what makes an “attack” happen? As I seem to be in flutter all the time, when an “attack” happens and I am forced to sit or lie down, what brings that on given that I already had the background flutter? And why does whatever happened take so long to settle?

Also - sorry for these questions - does anyone else get the massive amount of gassiness and burping that I did after the attacks?

Thanks again!

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Try asking this as a separate thread, and you should get some interesting answers.

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Thanks. I’m new to this forum. I’ll try that. I’m actually having my longest period of “normal” heart rate for a week - I think this forum is helping me relax! 😉

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That's great! That helps us all!

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It’s accompanied by rather low blood pressure so not perfect but for now I’m pleased to not see 105 bpm every time.

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Having atrial flutter rather than fibrillation is actually an advantage. It means that a cardioversion is more likely to be effective. Even if the effect doesn't last it means that the next step, a ablation, is easier to perform. I have been lucky and am still in normal heart rhythm two years after a cardioversion, but that puts me in a minority.

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The cardiologist said similar and that flutter can often be the easier to cure, but harder to treat with drugs - and with worse symptoms while it’s on.

From what I’ve read the cardioversion seems likely to be temporary - although I suppose and hope it could be that most people who do well on it don’t write about their good news? I’m glad to read you’re still doing well - I bet you’re pleased!

All day till now I’ve been enjoying my first long run of normal heart rate - but just risked edging the lawn while my wife used the mower - and it’s back to 102bpm for now! It has a fixation with being just over the 100 and occasionally 145.

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Bisoprolol is a horrible drug. I have been on it more than 2 years and it has caused me weight gain and makes me feel bad. I am desperate to stop it and hopefully try another with less side effects if that is possible. Its not much use for my tachycardia either.

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Poor you - it’s bad enough having to put up with horrible symptoms. I hope your doctor can find something better.

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I have had heart flutter treatment with Bisoprolol for 5 years. Unfortunately I developed a slightly swollen top lip and sore top lip and tongue. It affects the skin in different people in different ways. After 3 years of seeing junior skin doctors, I saw the head consultant who diagnosed Lichen Planus - in my case it seems to have been "drug induced" An alternative - calcium channel blocker did not suit me at all - whole body retained water. I have had a great success now going to an experienced nutritionist and cannot speak highly enough of learning what diet YOUR body needs to benefit from the foods you put in it. Also the whole regime of when to eat and how much rest and even meditation. I am much improved. Others have recommended deep breathing. One version of "meditation" can be enjoyed with "box" breathing. You breathe in to a count of four, hold for 4 while the gases exchange, breathe out for four, and hold for four - and so on. This is also terrific for when you wish to fall off to sleep as you are so engrossed with keeping to the peaceful pattern, you fall asleep without noticing. Quite separately, I recommend a TV set on the wall like in a hotel, with a time button to set for 20 or 40 minutes, or whatever you choose - so you can listen to music or watch whatever knowing you can dose/relax but enjoy knowing the TV will turn itself off as programmed. Good luck and very best wishes with lots of relaxation techniques and the right diet for YOU Wendy

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Thank you, Wendy (my wife's name, too). I like your idea to help sleep as I suffer with insomnia (which, it or the tiredness it creates, might have been a contributory cause of my atrial flutter).

I do eat really healthily, except for a liking of pudding and chocolate - but again, taken with care. I'll consider your advice carefully, however.

I seem to have persistent atrial flutter, at least for now, and that is, I gather, hard to treat as well as the most troublesome. That I can confirm, as I just cannot live a normal life since any kind of extended exercise, or just walking uphill or rapidly around a large shop, brings chest tightness and an awful feeling of lack of control and "impending doom". I am getting much better at recognising the leap in heart rate from ~75 > ~105 > ~150bpm that takes me to the tipping point and, today, I managed to get close to it, then make it go away.

Steve

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