Hi Newbie here, I have a question about my worsening palpitations, diagnosed with high BP and LVH last year, had a 48 hr ECG and which showed a very brief episode of Broad Complex Tachycardia ( which by the way I did not feel at all, 10 fast beats captured in 48 hrs), plus some ectopics which I did feel, was on several BP meds but doc recommended Bisoprolol 5mg as well, had another 48 hr ECG in October 2019 and that was all clear but still showed palpitations, doc was unconcerned. In November after a night out and a few drinks (three or four in total) they got much worse and carried on for a few weeks, all day and night. They seemed to go away in January. In between that I went on a long haul holiday where I continued to suffer from them. Doctor decided to put me on 10mg Bisoprolol a day just before I went. Also had an echo and full bloods, which all showed normal.
Just over a week ago same thing, had a glass or two of wine and beer and the next day they were back with a vengeance, one night they were so bad I couldn't sleep. A mixture of normal rhythm, missed beats, fast beats and what felt like flip flopping, thuds the whole lot, felt very anxious as well which probably made the whole thing worse. I have also been woken a couple of times with a missed beat followed by 7 or 8 fast beats and straight back to normal. BP was raised higher than normal last week and my BP machine kept notifying an arrhythmia was detected.
I have a 7 day event monitor next week which I hope captures them so they can diagnose what they are but I just wanted to see if this sounds like Afib?
What I don't get is that I'm on the largest dose of Bisoprolol and it doesn't seem to make any difference to the palpitations?? Anyone had similar?
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Thecyclist
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I gather that the effects of bisoprolol are not linearly dose dependent. Whether I was on 10mg or 2.5mg the effects and side effects were very similar (making me wonder whether 10mg was ever needed).
To slow my fast heart rate, I needed a small dose of digoxin, which worked really well.
Your symptoms could be ectopic beats arising near the pulmonary veins, which I also have and which I’m told are both common and harmless. Apparently, however, this is the same site where fibrillation originates, so it’s possible you’re having a bit of this and a bit of that!
The symptom you’ve had that is likely the worst for you is, however, anxiety (i.e. a fear of disaster). I had this when I had atrial flutter and tachycardia last year (before my ablation) - indeed anxiety, and health anxiety in particular, are a part of my life.
My advice to you is to try very hard indeed to relax by taking your doctor’s good and realistic advice to you that your health is not in any way being compromised by your various arrhythmias. They will neither kill you nor make you ill - even if it feels that way! Anxiety is the cause of many of our ills.
Palpitations just means you are aware of your heart. Ectopic beats are common to ALL people and are not generally treated as they are benign (albeit annoying when they become very frequent.)
What you describe does not sound like AF which is quite distinctive as it has no recordable rhythm but easily seen on an ECG. I think it is obviouis that you must stop any alcohol now,as many of us have, as this is a known trigger for arrhythmias regardless of what they may be.
The first treatment for any arrhythmia must be life style changes so read up on these and see if you can't improve your quailty of life (QOL) without drugs such as bisoprolol which tend to reduce quality of life .
Hi there, I have this sort of thing and, as you know, I was also diagnosed with high bp and mild lvh.I had a five day event monitor recently which showed ' a low burden of both atrial and ventricular ectopics and an occasional run of atrial arrhythmia lasting no more than eight beats'. My cardiologist concluded that this was 'very reassuring' but it doesn't always feel like that when it is beating all over the place!He put me on propanolol 10mg twice a day, which helps a bit, but I agree that anxiety, tiredness etc. doesn't help.Luckily I don't drink and I've knocked caffeine on the head too.I guess you get used to dealing with it in time.
I note you were diagnosed after a hyperintensive bike ride? How much cycling do you do? Not medically trained but understand Endurance sports are linked to AFIB and enlarged hearts, Incidentally I was once diagnosed with mild LVH at an echo , my GP was not especially concerned at the "mild", I took it as slightly abnormal. An echo is not an exact science, it is an opinion of the operator based his /her experience of what is normal. I also understand that this mild LVH could also be caused by long term high blood pressure. I would have thought that the bisoprolol would also be lowering your BP??
Of course being anxious increases your BP, and will also affect you heart rate. Worrying is bad. Your doctor is not concerned, you are undergoing tests you should not worry. Easier said than done but it's possible. I have had an ablation to stop my afib, not had afib for over two years. I still get ectopics. Multiple types as you have described. I mostly ignore them . They come and go I have done months with hardly any then I can have a week or two where I have long runs , with ectopics missing 3rd beat , 10th beat 21st beat 4th beat , all random, beats in between regular. Then they go away. I don't have any known triggers. However you seem to have recognized alcohol as a trigger. Stop drinking, at least while this is sorted out. If this stops the ectopics you have part of the answer.
Thanks all, great replies, yes alcohol is definitely a trigger, I've not drunk much since being diagnosed with the hypertension last year, but have had the occasional drink, weirdly seems to be red wine that is the worst, both bad episodes came after a glass of red. I'll be knocking it on the head, not worth the worry as I hate the episodes. I had thought these were mostly ectopics as my in between beats are regular but the two nights last week were something else. I don't drink caffeine now either.
The episodes become self fulfilling prophecy's, you get one, get anxious, get another and then worry some more, then a load and all of sudden you think the worst. I have managed to keep it in check lately but last weeks episode seemed to make it worse.
I just didn't get that the Bisoprolol didn't seem to make it better. It has lowered my BP and HR and my BP has been well controlled at an average of 115-120/70-80 last week it was up to 150/90 which is I know its not terribly high but its the highest its been since last year.
I don't cycle at all now, I will start again when the weather gets better but I was cycling 50+miles a week up very steep hills and much more in the summer. Originally doctors had thought the LVH was via cycling but latterly concurred most likely through undiagnosed hypertension over a few years. I confess to being a latter day Mamil and not a seasoned lifetime cyclist, doctor did say I was probably overdoing it!
I suffered with palpitations and was put on Bisoprolol 2.5mgs. Not only did I have terrible side effects from this med but also palpitations became worse. I am now trying to withdraw the Bisoprolol on consultant advice as it made my feet numb and also my blood pressure drop so much that I was continually feeling very light headed and faint whenever I stood up for up to 15minutes at a time. Now that I am withdrawing from these they are an even worse nightmare. Insane anxiety (which I have never suffered previously) breathlessness and insomnia. (Only 9 hours sleep in last six nights) officially now been told I have severe sleep depravation, also many other withdrawal symptoms and only withdrawing at 0.01mg per week.
Some people are lucky and never have side effects or withdrawal symptoms I hope you are one of the lucky ones. I am going to loose a year of my normal life due to this tiny tablet.
PS I started to take 300gms of Magnesium Citrate a day and this helped my palps tremendously.
No AF is not necessarily the way your going, the key is to get an accurate diagnosis and this is not as easy as you may think. Your alcohol intake has a significant bearing on your condition - but is it the alcohol or is it the nitrates (or something else) in the drink? Alcohol can deplete you cells of magnesium (if you take a PPI this becomes a double whammy), try taking a magnesium supplement (not oxide) but be aware that it can take months to get the full benefit in your cells - blood tests can show good magnesium levels yet your cells can be depleted. There are also may other things that could affect your condition.
One word of warning from my experience high dosage of drugs can cause Aflutter or other arrhythmia, Bisoprolol at 2.5 was fine for me but at 5 it occasionally started other arrhythmia and when I combined this with Flecainide it gave my really bad Aflutter to the point of collapse.
There are other things you could try as I believe self help, especially at the stage your now at could be of more benefit than Drugs or Ablation.
I would advise you:
Cut out alcohol and any drink containing caffeine
Get plenty of sleep
Don't get stressed (can be difficult but try)
If you take PPIs e.g. omeprazole etc cut back or if you can stop them)
Cut out all nitrates in your food - eat healthy
Drink plenty of water especially very first thing in the morning
Make sure your iron levels are OK
Eat a banana a day and an avocado twice a week
If your condition is worst in the winter take good quality Vitamin D supplements
You may feel the difference in a few weeks but it may take months to have a significant effect on your condition.
Most important is to do what your Doc says, they know far more than we do - but they don't know everything, hence self help may be the best way forward for you now.
I was diagnosed with af in 2015 given 2.5 msg bisoprolol daily. Irregular heart beat continued but was less regular. Constantly monitored myself via Kardia phone app and kept records which I sent to my specialist on a regular basis. (He was happy for me to do this ) At the end of 2018 on returning from holiday I was experiencing many more instances ,went to doc and he prescribed an additional 2.5 mgs. On thinking through my issues with heartbeat were frequently worse after alcohol. I therefore stopped drinking completely at end of Jan 2019. In June 2019 i attended my appointment with specialist and explained what had happened and stated that I believed I now didn’t need the second 2.5 mg bisoprolol. He was happy that I stopped it and monitored which I did in Aug . I now experience no issues at all ! Just taking 2.5 mgs once daily!!! I am considering coming off them completely although I do have the occasional beer now without issue.
Alcohol was definitely a trigger for my symptoms but appreciate we are not all the same.
Manumad54. I bet you find that drinking beer and irregular beat is not consistent. I considered everything and panicked in case it was beer, you have to have some enjoyment in life.
I have a really enjoyable life thanks. I’m sure there are many others that have a fantastic life without beer also !
Try this and see if it helps:
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas, Thyroid (sends signals to the heart to increase speed or strength of beat), Adrenal Gland (sends signals to increase heart rate), Sympathetic Nerve (increases heart rate) or Vagus Nerve (decreases heart rate), Hypothalamus Gland or others - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
I have always thought all Afib patients have a similar problem happening within our bodies that is causing our afib problems. After 17 years of watching my afib come and go, and logging everything I eat, I am pretty sure our hearts are fine but we have a problem with a gland(s) or an organ(s). For example:
1). The Sympathetic Nerve INCREASES the heart rate.
2). The Vagus Nerve DECREASES the heart rate.
3). The Adrenal Gland INCREASES the heart rate (with adrenaline), heightens
anxiety.
4). The Thyroid Gland both DECREASES and INCREASES the heart rate, and
heart strength.
5). The Hypothalamus Gland produces hormones directing other glands to do
stuff.
6). The Pancreas processes sugar, which cause other glands to do different
things.
7). To further complicate the situation, when one gland stops working, sometimes another gland will try to pick up the slack.
Plus - there are lots more glands in the body, plus don't forget the organs, which (some) also influence the heart rate, for example:
Medulla in Brain: Heart rate can be increased or decreased by impulses brought to
the SAN or AVN by nerves originating in the medulla oblongata of the brain.
The endocrine system of gland processing is complex – it’s a wonder it works at all.
For a neat picture/information on all the glands, check out this URL: (Ctrl and click):
Medications, chemicals, foods etc. can all cause our glands and organs to mis-fire. For me, sugar (and dehydration) are causing some gland(s) or organ(s) in my body to mis-fire, sending mixed signals to the heart - for example, telling the heart to beat fast and slow at the same time. This would explain why a healthy heart sometimes beats abnormally. It also explains why my heart afibs when I eat too much sugar, because the heart does NOT use sugar to contract (uses fatty acids) so obviously sugar/dehydration is causing something to misfire which in turn is directing the heart to afib. In our old age, I suspect a gland or organ is not working as it used to, causing afib or other heart palpitations. Unfortunately doctors and researchers don't know what it is (yet). In the meantime we will have to listen to our bodies VERY closely to see what is causing our problems and reduce or eliminate our afib by reducing what triggers it.
Thecyclist, AFIB has to be diagnosed through an ECG capture. There are many reasons for palpitation and if you have High Blood pressure then, I would suggest you ask for 24 hour ECG to rule out Ectopic beats. I had PAF 5 years ago but now get Ectopics on occasion which, were made worse by high blood pressure. Blood pressure tablets put a stop to them but still get them from time to time. That Bisoprolol will reduce your heart rate but will not correct the rhythm. When you reduce or stop taking Bisoprolol especially if you are on 10mg per day (the max) please do so by reducing dose over a few weeks getting down to halving the smallest of doses and then splitting those every other day. Trust me, you do not want the anxiety and inability to sleep if you come off of it too quickly.
Thanks Rich. I've got a 7 day holter being done this week which will hopefully capture something, I've had 2 x 48hr ones and multiple 12 lead ones in the hospital but nothing captured. Doctor is offering a Implantable Loop Recorder if this doesn't do the trick, although I may see if I can buy a Kardia mobile instead as I don't fancy the ILR.
Yeah coming off 10mg is filling me with dread as I get anxiety and insomnia while on 10mg!
You did well to get offered an implant, I would love one of those even now. It is really frustrating when the ECG does not show any irregularity. It took 3 years to diagnose my PAF, they had me down as anxiety until then. I literally had to demand an ECG during a bad episode and bingo. You wait 2 -3 weeks in Cornwall for a 24 hour monitor and a few days for the 10 second option, it is a joke. Ambulance guy told me to call any time it is a heart concern as they all carry 12 lead ECG. I am glad it was captured whilst still PAF as fix rate is higher.
Hi
I have an implantable loop and it has been no problem and also you will know if your heart is doing something it shouldn’t then the monitor will pick it up and you will be called to the hospital. The monitor downloads automatically every couple of nights then you do a full download which only takes less than 5 minutes once a month. It took less then 10 minutes to implant and other than a very small scar you will not even know it is there, if you are not happy you can always request it is removed.
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