As posted previously had cardioversion on Wed. Was taking 7.5 bisopolol. However heart rate is low to mid 40s. Spoke to cardiac nurse who contacted consultant who said to cut down to 5. Should I not cut down slowly or will this be alright. Feel so cold, not sure why they seem to work in 2.5s rather than 2.25
Any advice would be greatly appreciated
Deb
Thank you John for your response
I would do as your consultant has advised, you don't really want your heart rate as low as it's going and you're only cutting the dose by a third. This could be the start of reducing it gradually.
Thank you Jean that’s sensible advice. I feel awful today, can hardly keep my eyes open despite I can’t sleep at night and i feel so cold
I suppose it is a bit of a shock to my body to go from averaging 110 to 47
I think the tiredness is more likely to be from the high dose of bisoprolol you're taking. Let us know how you get on with the lower dose please.
Will do Jean, thank you for replying
The Doc knows best though they do not get it right all the time, don't do anything without your Docs agreement. Personally (and its only personally) I believe too high a dose of Bisoprolol can cause arrhythmia and make things worst, it caused my arrhythmia to morph into Afl (though the Docs said it was the Flecainide, however they ignored that I morphed into flutter before I started on Flecainide), whilst too low a dose will be ineffective.
As an example when on 2.5 I never morphed into Afl, when on 5 I very occasionally morphed into Afl, when on 7.5 I nearly always morphed into Afl. Now a cardioversion and an ablation behind me I am on 1.25 only and back to normal self, though I still get the occasional ectopic normally when my heart rate is low (50s) when resting, these tend to be worst after taking too much sugar.
Thank you, I will contact cardiac team this week and ask for advice
Literature does tell us that higher doses of a drug can cause higher side effects. I disagree with you that "The doc knows best." Some GPs are not up-to-date, plus they blanket prescribe rather than tailoring to the patient.
Right after my second ablation my GP raised , for blood pressure, my Amlodipine from 5mg to 10mg which caused me immediately to go into 6 consecutive days of arrhythmia. I was mad. He could have added a lower dose of another class.
Now, when I was first diagnosed with AF, this same GP prescribed 120mg Verapamil, then increased it to 180 mg "in the hopes we'd get lucky." Verapamil is a rate control drug designed to keep the rate down; it is not an anti-arrhythmic drug to try and get you back into sinus rhythm. He should have sent me to an EP rather than hoarding me until I went PERSISTENT. My case was pathetic, but I won't go into it.
What I am saying is I wish I had not followed blindly what this GP prescribed since he was certainly out of it.
You are so right with your comments about 'doc knows best.' I have had Af for 6 years. At first it was short lived bouts then the episodes came more frequently. I have had
7.5 mg, 5mg , and 1.25 mg Bisoprolol prescribed for me over the years. This does not stop my arrhythmia, and as I have never had a problem with rate , I do wonder why am taking it. Apart from one hospital consultation a couple of months after I had my first episode, when I had a series of tests to confirm the diagnosis, I have never been seen by anyone other than my GP. I have asked three times to be referred to see an EP and each time I have been told it's not necessary as my BP is well controlled and I am on Apixaban. He isn't in favour of me trying Flecanaide either. He said that some people prefer to be in Persistent Afib, because at least they know where they are with it!! Now I AM in Persistent AF and have been since February. I am fed up with this now, and wrote him a very nice letter two weeks ago, explaining the impact that Af has on my life and asking him," to consider sending me to an EP" at our local hospital. I haven't heard anything back from him yet. All very frustrating. Like you, I am not prepared just to listen to my GP any longer, as it's my life and I want to try anything that could improve my health. On the plus side he leaves it up to me to decide which dose of Bisoprolol I need to take and just tells me not to take more than 10mg a day.
Oh!!! What a horrible GP. Bisoprolol is a beta blocker which means that it is not designed to stop arrhythmia. The anti-arrhythmic drugs are. He is certainly not up-to-date. AF begets AF. It took 6 years without seeing an electrophysiologist but your GP , hoarding you, finally got you to the persistent stage . Your GP isn't even being honest with you. GPs are not authorized to prescribe anti-arrhythmic pills (Flecainide), so his reason is garbage. His worst comment is:
" He said that some people prefer to be in Persistent Afib, because at least they know where they are with it!!"
What planet is he on? Because you are now in persistent AF between 3-4 months, your heart is now getting rapidly remodelled and fibritoc. AF BEGETS AF.
I include this article from the founder of the modern ablation technique:
afsymposium.com/library/201...
Specifically:
"First of all, we have compared different subsets of persistent AF based on continuous AF duration. The number of targeted regions increases with the duration of continuous AF: from three to four in the first six months of AF, four to five in months six to 12 of AF, and six to seven in long-lasting AF."
Translated, that means that if you were to go to the ablation route, not only would your pulmonary veins have to be ablated but also from 3-7 targeted areas depending on the length of time you have been persistent. That also means that by the time you get to ablation because you have not even seen an electrophysioloist yet, you will need several ablations.
In my opinion, before more time passes , I would dispense with "nice letter," and write a DEMANDING letter that he refer you to an electrophysiologist immediately because you are being kept in persistent causing your heart to be remodelled. If you don't get a response from your GP, go talk to the manager of the cardiology department of your hospital.
I say the above with concern because I have a similar story although not as bad as yours. The result was that I had to go to Bordeaux, France to get an ablation at the six months stage, and it took three. I was one of the worst cases at the six months stage--all caused by the initial GP hoarding. The worst damage is done when one first goes into persistent. Good luck to you.
Thanks Cuore--I think it is time to make my own arrangements and pay privately to see an EP. I may have misled you over one thing. My GP asked me what I hoped to achieve by seeing an EP. I said I may be able to try something like Flecanaide and that was when he said it had side effects and was quite negative about it. I already knew that GPs couldn't prescribe it. Another GP said she would refer me, but the waiting time was 2 years and suggested I go private if I could afford it. Time to do what I think is right.
Good decision. Let us know how you get along. Two year's wait; that's insane. What country are you in--Canada or UK? It has to be UK because private clinics are banned in Canada, at least in British Columbia, Canada.
I'm in UK. I asked my usual GP, who thought referring me was unnecessary, if I could at least see an arrhythmia nurse. He replied that those clinics were very busy with 'younger' people who needed cardioversions. I 'm 69, but I didn't see myself as being on the scrapheap just yet!! If I don't hear from him within the next few days I will speak to another one of the GPs, who was happy to refer me. best wishes, dizzielizzie
Wonder how old your doctor is? Sounds as if he should retire and let the "younger" doctors who are more up-to-date take over. He wasn't even honest with you that he was not licensed to prescribe anti-arrhythmic pills. He is over-reaching his authority by condemning you to permanent which is the path he has placed you on unless that is the decision you have chosen.
I am 77. I had two ablations at 74 and one at 76. All three in Bordeaux, France, and I paid for them myself. I have now been arrhythmia free for one year.
Now, these are your words , as written above, about a GP who was happy to refer you:
"Another GP said she would refer me, but the waiting time was 2 years"
Because, as you say, you went persistent in February, you have been persistent for 4 months. Therefore, in referring to the already quoted above Dr. Haissaguerre's article (the inventor of modern day ablation), you are at:
"The number of targeted regions increases with the duration of continuous AF: from three to four in the first six months of AF"
I suggest you ask yourself the question, do you have more time to wait?
I say this with a disclaimer: I am not a medical doctor, but I have been through the ringer with an incompetent (in AF) GP and cardiologist. I was 6 months persistent for my first ablation, and if I had waited any longer, I would never have been able to return to sinus rhythm because I was one of the most complicated cases at the six month's stage. Hopefully, I am not trying to pressure you what to do; I am merely trying to explain the probability of what might happened based on my experience of which yours is similar in terms of waiting time and being allowed to go into persistent rather than being referred to an EP for an ablation which would have been my choice to have it or not.
With the mind-set of your GP, I doubt you will hear from him in the next few days. He has resisted referring you and he considers you too old. Arrhythmia nurses do not do ablations.
Went for a private referral to a consultant specializing in ablation. You can find out local contacts and their profile from the web. Chose to do this because local health area just kept delaying and too busy to even write a letter back to GP after Outpatient visit. I think I found the names through various private healthcare providers. The consultant was even doing consultations 10 miles from where I lived at a private hospital there. Very thorough look at my medical heart history. Would never have gone private if my next door neighbour hadn't had success with a private referral for a knee replacement (her second). My heart problem probably started 10 years back but only been really noticeable in the last 4 years. really good assistance from my GP who doesn't want me to stay on a continual drug regime any longer than needed
I was originally put on 10mg Bisoprolol. It made me a total zombie and I was frozen. My GP reduced it to 7.5 at first and then down to 5mg. I still felt awful so I now take 2.5mg at night. This timing works better for me although I still have some days when I don't feel really with it. My hands and feet however are still always cold, so much so that even on the hottest nights I still wear bed socks in order to avoid cramp and get to sleep.
Dropping the dosages immediately caused no problems at all. Best wishes, Sue
I'm on 10mg Bisoprolol - as recommended by my Doctor, and approved by the Hospital. My Pulse Rate is usually between 40 and 47 bpm. I seem to function Ok on that.
The Hospital consultant told me not to let the bpm fall below 40, and to seek medical advice if it does.
Unfortunately my hr falls into high 30s
Waiting for a 72 hour ecg
