New to Afib. Advice about beta blocker needed

[Redporti]

I have just got my medication Nebivolol 2.5mg & was going to start it tonight at 10 pm so if I have side effects I will sleep through them. I woke up this morning and had a frightening Afib episode that wasn’t going. After an hour I decided to take the first beta blocker. Two hours later & the Afib has gone. Can I still take the next dose at 10pm tonight so I’m taking it at night or do I have to wait the full 24 hours? Thanks.

[Hidden]

You would probably tolerate having the dose a little early this time Redporti as the maximum safe dose for Nebivolol is 5mg, so there's some leeway there. And if there should be any side effect from a little extra in your system, night time's a good time to be taking it, so that if you have something like dizziness, it won't affect you so much while lying down. By the same token, it's not going to be life threatening by doing things the other way and waiting the extra time for the next dose, if you'd feel safer that way. Though you could provoke an Afib by taking the second course of action.

[Redporti in reply to Hidden]

Thank you. I was thinking I might take it at 3am when I have a toilet break then the following night start taking it at 11pm when I go to bed. You have reassured me that I can do it either way. I had my first day time attack this morning and it was really unpleasant. Within a hour of taking the beta blocker it was under control again. I just feel tired now & a little light headed. I’m knew to Afib and it’s all a bit scary.

[Hidden in reply to Redporti]

Between you and me I'm doing the 'take it late' approach to my own 5mg bisoprolol tablet. I've customarily taken it in the mornings but it can make me very sluggish, even though I've sort of acclimatised to it over time. The reason I decided not to take another tablet last night was that on a trial of 7.5mg bisoprolol for better control, I got bouts of dizziness and a really slow heartbeat. I think whichever way you tackle it, you'll be fine. Afib is a nasty thing, but it's more scary and annoying than it is dangerous. Read and listen to as much about it as you can, from reliable sources, of course. I get on a bit of a soapbox about this, but too many people have the condition badly explained to them. In itself it's not considered life-threatening. The biggest risk from it is of stroke and, if you have comorbitities you are likely to be given an anti-coagulant to help reduce that risk, but rest assured, other than the stroke risk and the dreadful symptoms, you will be OK.

[Redporti in reply to Hidden]

Thank you for being so reassuring. Unfortunately I have stage 3 kidney disease & HFpEF heart failure. Therefore I have been put on Lixiana (Edoxaban) blood thinners too. With todays episode of Afib I felt like I was going to pass out & that scared me. Hopefully now I’m on the beta blocker I won’t have anymore Afib episodes.

[Singwell]

The important thing you can take away with you is the medication stopped the AF. Personally, since you're on a low dose it seems, I think your idea of taking the next dose in the early hours of the morning us very sensible. And then adjusting until you get a regular pattern. Let us know how you got on.

[Ppiman]

My GP told me to take my beta blocker (bisoprolol 5mg) as and when needed (i.e. what some call a "pill in the pocket"). I'm lucky, so far, in that a beta blocker does stop both my tachycardia and afib, but far from immediately. I find that it takes at least 30 minutes to do anything.

I don't think it will matter when you take your tablet after the first few days as the blood levels reach what is called a "steady state". Their effect isn't extreme in any way, and taking a higher dose as needed is something that I've been told is quite safe to do and a good idea. Of course, you need to check that with your own GP as we each have different heart problems.

Don't feel too concerned about your afib; it's the tachycardia that needs controlling more than the arrhythmia and, so long as your blood is protected (if need be) from clotting, you'll be fine. You might not feel fine, of course, but you will be safe.

Steve

[Redporti in reply to Ppiman]

Thank you for the info. I have had a cough for about 3 weeks now and since I started on the beta blocker the cough has gone as well as the Afib. Can Afib cause a cough?

[Ppiman in reply to Redporti]

It doesn't me but I have read that it can. It certainly affects the muscles around the rib cage and the diaphragm, and I could well imagine that resulting in a cough. It creates the sense of needing to breathe deeply, too, something else that could lead to coughing, I imagine.

Coughs can be caused by so many things. Some people with acid reflux, for example, get irritation from acidic "aerosol" particles right from the stomach travelling to the top of the food pipe (i.e. oesophagus) where it meets the top of the windpipe (trachea). That reflux can, itself cause palpitations and they are known to bring on afib (this might happen through movement or irritation of the oesophagus, which, in some people, physically presses tightly against the heart). It's all so complex and, often, individual to each case. No wonder the doctors often scratch their heads.

Steve

[Redporti in reply to Ppiman]

I was originally told the cough & pain in my breast bone area were Costochondritis but now I’m not sure. I mostly get my Afib from about 9pm & then through the night. The cough starts then too. When I am not having any symptoms does that mean the Afib has gone? Or is it always there & causing other symptoms other than just fibrillation?

[Ppiman in reply to Redporti]

I think doctors often say "costochondritis" when they are, in truth, scratching their heads. I think you know your own body and, clearly, the afib does things to that region around your heart and that brings on a cough. My own experience is that I have various strange discomforting feelings from the area below my sternum and around into my back. I have it now, even.

You can check if the afib is happening, or has gone, by feeling your pulse. If it is regular rather than irregular, all is well. Also, you might notice some ectopic (i.e. "missed") beats - these can set off afib, but re generally harmless.

Steve