Hi, I was diagnosed with AF in July last year and put onto Apixaban and Bisoprolol.
I then really struggled walking anywhere with breathlessness and although I was Asymptomatic before being diagnosed I wasn’t breathless at all ( AF found during routine pulse test by Nurse).
I was advised to carry on with the meds as I was having a cardioversion in October, I have since had this and it was successful with a follow up phone call in Feb this year. I didn’t notice any difference to be honest. I have a Blood pressure monitor at home which also shows AF so I mentioned it to my Doctor who arranged an ECG which confirmed I was back in AF.
Since then I was taken off Bisop and put onto Verapamil to which I had an allergic reaction to with my first tablet!. I am now awaiting a reply to my GP from the cardio as what to try next as my Cardio has just moved my follow up call to May now.
I have noticed my breathing has eased since coming off the Bisoprolol though so hopefully that continues, it’s just I’m not on any “Rate” meds now.
I know no-one can say really, but do you think I could be put forward for another Cardioversion or medication to control the rate? Like I say I didn’t even realise I had it as I had no symptoms, I am 65 years old just to add.
Thanks for any information or thoughts.
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gentryman
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Slightly belated welcome to the forum, it’s good to hear that you are getting some medical support for managing your AF. Obviously I don’t know what you know so apologies if I’m repeating stuff you have already heard. You are right in that we cannot recommend treatment or medication but we can share our experiences. Firstly, the Cardioversion is a common treatment route for anyone who has persistent AF. It is not seen as a cure although it can last for several months, even years however, if it does work and the patient feels significantly better in normal rhythm, it does indicate that other, more invasive procedures such as an ablation might be worth pursuing. Ablations do come with risk, but although the risks are low, they do need to be careful thought through. If your heart rate without medication is comfortably below 100 bpm and not much less than 60 bpm then you could carry on without too many problems and there are many here who would be very envious. There may also be some lifestyle changes you could make which will help you to keep your AF within acceptable limits.
If I were you, I would consider seeing an Electrophysiologist (EP) who is a cardiologist who specialises in arrhythmias as they are best placed to advise on treatment options. Bisoprolol is a very effective drug for AF but it does have a reputation for causing side effects which for some, are more troublesome than AF symptoms.
For what it is worth, at the moment you are in a much better position than many other members and long may that continue……
Thankyou FlapJack for that, very reassuring and helpful. For me it`s not being able to ask any questions to my Cardio and just trying to gain information until that time arrives.
This is a just a thought, but as you said your breathing improved when you came off Bisoprolol, it may be worth considering.
Twenty years ago, I was diagnosed with an overactive thyroid and my GP prescribed beta blockers. Within a couple of days of taking them I was extremely breathless to the point of almost being unable to walk. We were on holiday so I just stopped taking them until I got home by which time my breathing had returned to normal. I saw the GP and hedidn't comment, just prescribed something else which didn't have that effect. (These days I would ask more questions, back then, I just accepted what the GP did or said.)
When I finally got to see the endocrinologist for the thyroid problem, I told him what had happened and immediately he said I was probably asthmatic as it sounded as though I had had a severe asthma attack. Further tests confirmed asthma and I have been told I cannot ever take beta blockers as they are not safe for asthmatics to take.
My husband takes bisoprolol as he has heart failure and I believe it is a beta blocker.
As your breathing improved when you came off the Bisoprosol, even if you don't have obvious asthma symptoms, it could be worth asking to be checked, as if I am right about the bisoprolol being a beta blocker, you could be experiencing the same symptoms as I did.
Asthma can be controlled but if you have it, certain drugs can have a really bad effect so it's a good thing to know if you have it.
I have had Asthma since childhood and mentioned this at the time I was put on Bisoprolol (Beta blocker) to my Doctor.
I asked to come off it or change it as I was sure something was not right. I came off it for a week and felt better, but then I received a call to go back on it and keep on it and the Apixaban until the Cardioversion and see how it goes ( the dosage was also upped).
Well I was breathless just going upstairs and if I went outside I could walk for about a minute then have to return home. I just put it down to the AF but couldn`t understand how I was ok off the tablet.
After the cardioversion had gone back into AF I said I just cannot take that tablet, so he said yes it can affect asthma in some people and put me on Verapamil (calcium channel-blocker), which I then had an allergic reaction to! typical.
I`ve been off the beta blockers for about a week and can walk short distances now which suits me. So I`m just waiting for the cardiologist to get back to my Doctor to see what tablet replaces those as the Doctor doesn`t want to make that decision.
Great insight and your description matches mine like you say re Beta blockers.
I was prescribed Biso by the Cardio (where I live we only have one EP in the whole province), I then questioned two different Cardios (I am mildly asthmatic overlapping chronic bronchitis which is defined as ACOS) if I should take it, both were adamant that studies had shown that Biso works directly on the heart and are safe for asthmatics. I was already taking just 140mg of Verapamil and 10mg of lisinopril for mild hypertension. So I got my current one to agree to my taking 125mg of Biso, if I thought I needed it (I am asymptomatic) but it makes me tired. My last consult with him showed a slight right side enlargement of my heart which he was not concerned about but attributed it to my lungs, he did not prescribe anymore medication - I just have a Symbicord inhaler for my lungs. Last week I saw my GP for my six monthly check and reported to her that my feet were a bit puffy so she prescribed a low dose Indapamide, Since then, at the same time I had a pneumococcal vac. I have detected an irregular heartbeat from time to time (I do not have any sophisticated devices, just a couple of BP monitors) I have to go for starved blood test sometime this week when it suits me (She wanted to see the effect of the diuretic and rule out kidneys), I will say one pill and my feet normalised ! But obviously. It seems different doctors have different ideas, both that I saw obtained their post graduate degrees in the UK!
As you say different Doctors, I have 3 at my surgery and depending who I see their views are different on the meds. I was on Furosimide for about 3 weeks by one Doctor for mild swelling in one foot, it worked and then when I saw another Dr I was told you don't need that and was taken off it
😀.Hope you get on ok with the blood test and I hope it was 1.25mg of biso you were on!.
Your GP is not well informed to say the least. To put a known asthmatic on Bisoprolol without warning them to look out for an increase in breathlessness and then keep them on it despite an increase is appalling. Were you told to increase your asthma meds? Do you know what your heart rate is with no rate control? If it is not high then there is little point in taking a rate control med if it ruins your QOL. The important thing is that you are anticogulated so getting stroke protection. It is often difficult to take the pulse when in afib so a Kardia device would be handy for checking heart rate. Bisoprolol can cause breathlessness in people who do not have asthma but many docs are loathe to acknowledge this. Some people can tolerate beta blockers others can't.
The Kardia is designed to detect afib so I think it probably outperforms some blood pressure monitors though maybe not all. It is a very easy to use device . Some people become a bit obsessed with using it . I only use mine when my pulse tells me I'm in afib to find out what my heart rate is - though I have to confess when I first got it I used it more frequently!
Beta blockers like bisoprolol should not be prescribed to people with asthma for the very reasons that you found. Unfortunately it seems to be about the only thing GPs either know about or are allowed to prescribe without instruction from consultant level. As FJ has suggested, time to ask to be refered to an expert in AF i e an electrophysiologist.
Thanks BobD, I think I will mention this next time.It does feel like the only decision is the Cardios decision ( fair enough ), but I’m not getting to even have a phone call with him as the appt keeps moving forward.
My cardiologist tried to prescribe Bisoprolol for me but because I take daily asthma medication and struggle if I get a respiratory virus my GP refused to prescribe it (much to my relief) and prescribed Diltiazem instead as a rate control medication - luckily the cardiologist had mentioned it as a possible alternative.
Although you are asymptomatic you don’t say what your usual average HR is. A constant high HR can tire your heart so it’s good to keep the rate lower than 100 - I am very comfortable with a rate of about 70 average, 60 resting. I have PAF (comes and goes) but even in AF I don’t feel too bad with and average of 80. So you may not really need anything other than the anticoagulant but if you want to explore options an EP is the consultant to see - not all cardiologists have an adequate knowledge of AF - being really polite here 😄
Good morningJust a thought,if you can afford it (175.00 ish) you can book an appointment with an EP or Cardio privately within daysof requesting. Then they will transfer you to NHS .
That's what I did in similar circumstances to you,in need of medical advice quite urgently and it was the best thing I did. ( Although I believe in socialised health care in these pandemic times some things gotta give!)
Welcome to the Forum and for sharing your recent experiences. I can see all the Members will offer you support and advice based on their own experiences, however, should you wish to contact the Patient Services Team at the A F Association for support or information at info@afa.org
Hi I have been diagnosed with AF for about a year . Came off bisoprolol and on edoxaban and verapamil. Still can’t walk much ! What pain it is ! I do have MV regurgitation bp controlled with ramipril Lots of tests but seems meds is the only answer for me. I am 77 !
You mention you have only been off the Bisoprolol for a week. I was taken off Bisoprolol (7.5mg) after a cardioversion and it took me about 3-4 weeks before I felt as if they were completely out of my system and the effects of widrawal had diminished so you may still find an improvement. Good advice to see an EP if things don’t improve.
Thankyou, managed a decent walk yesterday evening, about 15 minutes without any breathlessness.Nothing major like inclines but just getting out helped.
You will probably find you can increase your amount of walking gradually.Just pick a flat route with places to sit not too far from home.When I first went into Persistent AF I had this.Totally unable to carry on after about 20 mins and maybe half a mile.Exhausted & lightheaded as well as breathless.It can be ok to get breathless . Particularly if unfit.I just rest & have a drink of water .I can now do about 3-4 miles. But inclines knock me out.This is me .It. may not be you.
Briefly to add: I was put on Bisoprolol after PAF diagnosis a few years ago. I had had no symptoms of AF, but the Bisoprolol caused extreme breathlessness and fatigue, along with other symptoms. Initially it was agreed I could decrease the dose, but then eventually I came off it. I was a new woman. Bisoprolol just didn’t agree with me.
Another one here with breathlessness on Bisoprolol. I was on 10mg, then changed to Nebivolol 5mg now reduced to 2.5mg I'm also asthmatic but it's well controlled. Breathing now so much better
Hello Gentryman, I read your post with interest. The allergic reaction to Verapamil is known to me as I have also had a bad reaction to it. It appears if one has an histamine intolerance which can be tested through a blood test then verapamil is an absolute “no-go”. Instead of lowering my BP it raised it out of all proportion. I also noticed when I eat too many histamine producing foods my pulse goes up considerably or it even sets off an AF attack. I take Bisoprolol daily and that seems to control my BP and keep my heart rate down. I only take Bisoprolol and Aspirin. And manage my diet and lifestyle.
Hi, when I was first diagnosed i told the cardio that I am asthmatic and so take calcium channel blocker instead of Bisoprolol which seems to be working well. Worth considering when you can talk to a doctor bout it. I'm on Adizem.
Hi - you'll have had lots of useful replies, I am sure, but you might find this helpful, too?
Many organs throughout the body, including the heart and the lungs, contain "beta-receptors" within their cell make up. Bisoprolol is said to be a "highly selective beta-blocker" which means that it works almost entirely within the heart to slow its rate and, somewhat, reduce blood pressure.
In general, this makes it a very well tolerated drug and studies I've seen show most people experience very few side effects. In some more sensitive people, especially anyone with asthma, this is not the case and side effects can occur. The lungs contain many beta receptor sites and these can be affected by bisoprolol. Another possibility is that, in slowing the heart and reducing your BP somewhat, you are especially sensitive to these changes and become short of breath as a result.
When I took higher doses than I do now (for my atrial flutter), then I found bisoprolol caused me to feel chest discomfort and failed to control my racing heart.
Yes I totally agree with the sensitive part especially.
I sort of put up with the tablet thinking it was the AF that was causing the breathing problems.
But before I was diagnosed my asthma was well controlled which made me wonder if it could be the bisop that was doing it, I came off it for a few days and in that time felt a bit better.
I was then advised to go back on it and the dosage upped, at this point it was hardly worth going out as I was turning around to come back home breathless.
So yes I think it works well but not for lung related illnesses.
Why were you prescribed a beta blocker if your HR is normal, less than 100? In my opinion it is also questionable if the Cardioversion is useful for a paroxysmal AF. If successful it can only achieve what you have already regularly, return to SR.
At the time I was diagnosed I was put onto apixaban and bisop due to having a cardioversion in a few weeks time, I was told it would keep my heart rate down until the procedure.My AF is always there either testing on my home BP monitor or recent ecg's I have had.
I was asymptomatic and still am apart from feeling tired.
My HR at the moment is normal but not then.
I'm not medically trained so just going off what the medics say and advise.
I have not got asthma but could not tolerate even 1.25 mg of bisoprolol - itput me to sleep in 40 mins hsd other horrible side effects and massively reduce my HR. I tried atenolol another beta blocker, but although better was still bad. My GP concluded I could not tolerate B/BLOCKERS. However had to have rate control even though I was asymptomatic except of a high HR of 165bpm when in Afib. I went onto verapamil which was fine initially, but after 20 months struggled to control my high rate when in afib.However there are other cardio selective beta blockers you could try: I mentioned Atenolol already and there is also metroptolol. Drugs affect different people in different ways.; "One mans meat is another mans poison" applies.
There are also other calcium channel blockers. I went onto diltiazem, which I did not like as it had some side effects for me ( at the dose i was taking). But others on this forum are fine with it.
My advice is if you need a rate control then try them until you get one with no or minimal side effects.
Hi I am 66, got exercise induced Paroxysmal AF 2 years ago, initially very symptomatic (Cardiac ITU) then less so, then more so again. Pandemic restricted access to cardiologist/EP. I bought a KardiaMobil 6L (nudged by EP to do so). I can ecg myself whenever and wherever I want. I used its results to remotely inform EP about deterioration and got lucky to be offered an ablation last August - after a 2 month settling/recovery period my rhythm has been excellent. A couple of suggestions on KardiaMobil …. 1/ not best for you if you are fairly certain you have persistent/permanent AF, 2/ not best if it’s results are going to make you anxious 3/ send occasional ECGs to cardiologist/EP but not too many. Good luck youngster!
I too had lots of difficulties on Bisoprolol and other beta blockers and calcium channel blockers. Before my first successful cardioversion we found that it looked as if low dose 62.5 digoxin would work but was only on it for 3 weeks before the cardioversion so can't be sure as my side effects usually started after 2 or 3 weeks on the medication - the higher dose of 125 made me ill too and before my cardioversion I was in and out of hospital thinking it was the AF when actually it was either the beta blocker or the calcium channel blockers that were causing me to feel poorly. Since then even when back in AF and I have been 3 times and had 3 successful cardioversions and I am now in permanent AF I have not taken rate control medication. My resting heart rate is around 57 - sometimes a little lower and rarely - even when exercising do I get a heart rate over 120 - very occasionally 140 as a quick blip but I wear a fit bit most of the time to keep a check on heart rate and wear a heart rate monitor with chest strap when I exercise so watch my heart rate as I am exercising. My resting heart rate has always been low and when on beta blockers/ it would go down to under 40 (this was seen at the hospital when I was attached to heart monitor) - so no wonder I didn't feel well on them. If your heart rate is within correct range then there is not necessarily a need to be on rate control medication. I am friends and related to a number of people who can't get on with bisoprolol so ask to change medication. Do you have a Cardio nurse at your hospital? Ring and ask to be put through to them and they will be able to advise or ask the cardiologist to change your prescription - either amount or medication.
Hi,Thanks for sharing your information, it helps to know anything at the moment.
It seems virtually impossible to get anything from my Cardio at the moment.
After my initial phone call and then successful Cardioversion in October last year, I received a letter saying a follow up call would be done early Feb this year.
I received another letter last week saying my call has been moved to May now.
I have been off Bisop now for a few weeks and did feel better, but my Doctor wanted me on some kind of rate medication until talking to the Cardio.
I was then given Verapamil to which I had an allergic reaction.
The last few days has been a waiting game due to my Dr emailing the Cardio as what to advise medication wise. I have phoned and emailed the cardios Secretary but with no joy.
With the many helpful replies on here like yours, it does make me wonder why I cannot just stay on Apixaban and Amlodipine and see how I go?.
My resting rate seems to be within the range needed so I will ask my Doctor why I need rate control and more importantly why I was put on Bisoprolol to start with given I am Asthmatic.
I was unaware of the obvious connection until reading replies on here.
You will find that quite often now the secretary's are either working shorter hours and shorter weeks or even working from home. I would call every day at around 10 until I got to speak to someone. Hopefully you will eventually speak with someone. I hardly ever bother with e mails as I know from speaking to hospital secretary's at Maggie's Centres when they come to give us a talk - I am 5 years out from successful treatment/cure for early stage prostate cancer, that if they are away for any length of time quite often they know they cannot answer all the emails so just start afresh thinking that people will continue to try and contact them and they can then answer - hopefully before they go away again Good Luck.
Why the heart is pushed over to the stick out ribcage!
But I got drops of sweat from face. This continued with the thyroid out due to cancer.
It is the A.F and fast action of the electrical reactions.
Bisoprolol brought heart beats down from 186 to 156. But a private heart specialist put me on CCB Diltiazem and h.b dropped 40 bpm. But 180mg too much.
Balanced and controlled I have little face sweating.
My thyroid levels are perfect at 2.3 TSH and 21 T4. Cant blame that.
I had the energy loss and seeating before the stroke, before the cancer was removed.
Cross fingers I line up for my 2nd year anniversary of cancer removed next Tuesday. No cancer found last year's scan.
I think we are all different. Need the meds that are best which control and are balanced.
I take 120mg Diltiazem morning and 2.5mg Bisprolol at night. Metaprolol made me breathless and I still had 186bpm.
Take care and try not to worry, go to a person who is interested in finding the best meds for you.
Finally have my Cardiologist phone call on Saturday and just wondered if anyone can shed a light on one question I want to ask him?.
I`m still asymptomatic with my AF, my heart rate has been good around the 80`s and just on Apixaban.
I`ve had trouble with Bisop (asthma) and allergic reaction to Verapamil ( could have been food allergy related though) so my Doctor has been waiting for the Cardio to decide the next step.
I`m thinking, probably wrongly! that he may concentrate on the Rhythm side rather than rate.
Is there a Rhythm medication that may help restore sinus rhythm whilst not affecting my asthma or not affect it too much? I`ve had one successful cardioversion which failed soon after.
My main problem is breathlessness without much exertion and tiredness, but apart from that not too bad.
Just wondering what to ask really as it was Oct 21 when I had the procedure and no contact since.
Finally spoke to my Cardiologist who`s first question was am I still in Sinus Rhythm and how am I doing.I was stunned by this as my Doctor has been emailing him about a need for a sooner appt due to Bisop and Verapamil giving me problems.
I politely enquired if he knew my current situation, and he was not aware of any change and thought it was a follow up call to see how my cardioversion was doing.
He decided to put me on Diltiazem (I don`t know the dosage as he is informing my Doctor), and see how I go and if I don`t go back into Sinus Rhythm he may recommend another cardioversion.
Now, 1, I asked is Verapamil not similar to Diltiazem to which he said we will try it ( I`m worried after having allergic reaction to Verapamil).
and 2, My Doctor asked me when I told him, did you mention the Verapamil?.
I have to admit I told him that I thought the cardiologist was not listening to me, and with him not having my "details" to hand I just went along with it.
My Doctor is now awaiting the report the cardio to see what it says.
Trying not to be down about it ( as there are more worrying things in the World going on) I am willing to give the Diltiazem a go but can it put me back into Sinus rhythm? as I thought it was another Rate medication, Calcium-channel blocker.
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