Ive just had a 48 hour monitor which showed all afib all day and night low heart rate 40s 30s plus tachycardia several times
my cardiologist stopped metoprolol weeks ago and now wants to stop diltiazem but wouldn't you think he would suggest a pacemaker?
Had all drugs plus 3 ablations
Yes I would! Can you ask to get referred to an EP? Or if funds allow go for a private appointment with an EP and then transfer to their NHS list?Good luck xx
Yes I'm thinking of going to pay for a private EP I had one 11 years ago when I had my ablations unfortunately he's not in my area any more I've moved a long way since then but a cardiologist isn't an arrhythmia specialist I will look for another one Many thanks
Janet
How long did your heart rate remain in the 30's, 40's, and at what time ? Many heart rates become low during sleep or inactivity for short periods of time. Insure your cardiologist is aware.
As stated above, best to see the results of discontinuing diltiazem and discuss results/pacemaker need with your cardiologist.
Since your cardiologist is familiar with your medical history with the stent would trust his advice.
Speaking from my experience, cardiologists are an arrogant bunch, sometimes doesn't seem they listen, but they are very sharp, intelligent individuals (99%).
🙂
Mine is like that he always thinks he's right when I mentioned could it be the covid vaccines I have had all 3 and this started a couple of weeks after the first one he quickly said NO not the vaccines.I have a fitbit sense it picks up overnight heart rate there are usually 14 in 40s and 30s
In the daytime it also alerts me when under 50 or over 110
This happens all day long my resting rate used to be 65 now it seems to keep going lower to 48 at the moment.
I will try the diltiazam reduction and see how I get on
Thanks for your advice
Janet
I wouldn't really trust your Fitbit.I have one as a guide Charge 4.I have other ways of checking & last week felt bad so checked with pulsometer.134 .Fitbit showed 83.checked with fibricheck,emay (like Kardia) all 124 - 134.I have had persistent Afib . Paroxysmal prior to first AZ jab.But viral infections always sent me into AFib.
Hope you get sorted out soon.
I think you need to see how your heart is without the diltiazem, before considering a pacemaker. That does seem the obvious thing though if your pulse rate stays so erratic.
How are you feeling health wise?
Jean
I'm tired of constant afib the rate going so low makes me breathless to not take diltiazam makes the beat go into tachycardia He's been my cardiologist for 17 years I don't want to offend him but I can't keep switching drugs he doesnt seem to take it seriously
I was ok till I had a stent fitted in May now I don't know what to do
You say your cardiologist isn't an EP, but I don't think EP's fit pacemakers do they? It's usually a cardiologist and yours must have fitted many and know what he's talking about. Sounds like he's trying everything before going down the pacemaker route, which sounds the right thing to do. Perhaps after having the stent put in and blood supply to the heart improved you no longer need AF medication. I'd certainly try what your cardiologist has suggested and although your rate may be a bit bumpy to start with, it could right itself in a few weeks. Have you ever tried half a diltiazem?
I can understand how you feel downhearted because of the way you feel. Does your Cardio arrange an ECG every time before you see him? If so , looking at that should tell him what you need to try.
Hope you find a solution and can soon feel well again.
Jean
Good point Jean cardiologists do put in pacemakers but I have been on every drug to try to control afib and settled on metoprolol and diltiazam for rate control which put me in persistent afib with all ok.Then before the stent the afib returned along with bradycardia and tachycardia
I can't half the metoprolol dose as its a capsual
I'm confused now as I've already had 3 ablations so that's as far as I can go probably if I saw an EP we'd be back in another ablation route.
My choices are limited meanwhile tachycardia and bradycardia rule my life maybe the triple vaccine has some connection
I have Metoprolol Tartrate 50mg tablets and break them into 12.5mg doses, that's in the U.K. I always try to get the Accord brand in every pill I take as colour free and made in the same county where I live. My sister in the U.S. tells me stories of a lot of the pills there coming from China. If your heart rate is going too low you don't want to be taking Metoprolol. I can't think of any solution for you other than a pacemaker, perhaps a node ablation too.
I'm going to keep my fingers crossed that coming off all your meds will help and you'll have a nice mid range pulse. Please God let that be.
Jean
Thanks Jean you've lifted my spirits
Yes Jean - EP’s do fit pacemakers but they will usually work within a cardiology team and choose to delegate to a general cardiologist who specialises in fitting Pacemakers but it will depend on which type of Pacemaker is advised and how the team work.
There would be a waiting list anyway - way back pre-COVID there was at least 6 week waiting list locally.
Thanks for letting me know CD.
FYI EPS do put in pacemakers at least mine did,
Agree with Jean, Diltiazem lowers the heart rate and blood pressure so I think it makes sense to wait for the outcome of stopping it before rushing into having a pacemaker fitted. Once fitted, I believe you are dependent on a pacemaker for life…….
So flapjack your for me stopping diltiazem as well I can but try thanks
Hi. Reading further. it was Metropolol made me breathless. Bisoprolol another beta blocker does not.
I hav a Diltiazem and Bisoprolol at night combo. But 120mg am and 2.5 Bisoprolol at night.
Balance is important.
There's such a lot of drugs. I cant have ACE which made me cough.
cheers JOY
How long did you come off metoprolol before breathing became better as mine is still bothering me after 3 weeksOh and resting rate is also 49
hiIMMEDIATELY.
No breathing problems with Bisoprolol or Diltiazem.
I thought that you cannot take Metoprolol with Diltiazem. But one can take Bisoprolol.
You haven't got a cold or COVID?
Ask for an xray of your lungs.
You don't smoke or with someone who smokes?
cheri JOY
Never smoked husband hasn't either no I don't live or mix with smokers .I'm triple jabbed no covid no cold no cough Been taking those 2 meds together for a few years both originally double the dose
What are your dosages - double!!!
I only took 3 x 23.75 and I was in trouble with fatigue, no energy and breathless. Trying to 'keep up' with daughter and son in a shopping mall.
A friend takes equivalent to 4 x 23.75 Metoprolol but he has too much blood so he has to get lots taken off!
If Diltiazem 360mg is a normal dose! 360mg would probably stop your heart.
To have us the forum comment we do need to have DETAILS of your dosage. You cannot stop Diltiazem suddenly. 180mg brought my heart rate resting from 110-120mg to 51 within 1-2 hours. Calculate that. Bisoprolol was reduced from 10mg to 2.5mg separating by moving it to the night.
I believe sometimes you should be in hospital to introduce or take away a drug.
Cheri. JOY
Originally I was on 47.5 metoprolol and 240 mg diltiazem I ended up in hospital I couldn't even stand up They stopped all meds that night as my heart rate was very low.
After I came home I was put on 23.75 metoprolol and 120mg diltiazam I was told to tweak the diltiazam if my heart rate went too high
It's been this dose for years now but after I had a stent for blocked arteries in May this year my heart rate has gone berserk afib which was under control came back and my recent holter test showed 48 hrs in afib with bradycardia.
Dr took me off metoprolol but still have low beats I'm not following orders to come off diltiazam as well I'm getting a second opinion
I have a pacemaker and am not dependent on it . It only kicks in when my HR drops below 50 and is only working until the rate returns back over the same
What does the pacemaker do when the heart rate goes high Dave?
Nothing it switches off once the HR reaches the set point my high rate is supposedly controlled with drugs . It's the pace and ablate that leaves the pacemaker in full control and if I'm honest I think I would opt for that if offered
If you have a search on this link there is a booklet with information on pacemakers.
I think seeking a second opinion from a doctor of your choosing can’t harm. By the time you get that you may be in a better position to judge what may work for you.
All I can say I have no regrets about Pacemaker although I was very hesitant at the time.
People are seeming to rule out an EP and as I've already been down that route ablations etc I will try to stop the diltiazam as well.My cardiologist is getting grumpier the older he gets maybe at 66 yrs he should retire he's not as empathic as he used to be
The theory on Pacemaker and bradycardia/tachycardia is that with a pacemaker you can then give some sort rate control drug without the concern that the heart will drop too low so that when you get the higher HR which may (or may not trigger AF) there will be some HR control.
By ‘people’ do you mean the responses here or medical opinion? EP’s don’t just deal with AF but I still think that a private, second opinion from another cardiologist/EP would be advisable. I think it is always helpful to have a different opinion, even if it only confirms the first. Bar one, all my doctors have been very supportive of second opinions. The Bar One and I avoid each other!
It sounds as though your QOL is greatly diminished by these drugs and I would be concerned if your doctor is not listening to you. We are not there to please them, they are there to advise accordingly and for you both to make an informed decision on best way forward.
I think it’s quite scary stopping drugs without guidance or support. How is your GP with all of this? Have you good support there?
That's interesting your very reassuring and informative so a pacemaker means going back on a beta blocker that's good newsMy GP doesn't think much of my cardioligist she thinks he has shares in pharmac the way he dishes out pills
He literally told me to stop metoprolol not wean me off it and now stop the diltiazam
I think I will get a second opinion there is a new cardiologist where I live and he's from the Uk
Good thinking from all. I guess what I'm wishing for you is that your cardiologist would acknowledge your experience. The idea of a 2nd opinion if you can get it sounds wise. Please let us know how it goes.
See if this is something you may want to try
Were there any pauses in your heart over the 48hrs, that may be a driver to get the pacemaker.
Yes Jock there were quite long pauses between the R-R intervals it looked like about 18 boxes between them a few timesAlso on the kardia print off I had lowest heart beat 0 a couple of times cardiologist didn't mention them
I think I’d go with the views of an expert who has knowledge of your heart scans and history. A pacemaker must have its own risks, too. A second opinion might be the way forwards and with the few hundred pounds it will likely cost will likely be reassuring.
Steve
Yes I'm getting a second opinion it will cost $400 nz I'm at a loss what to do really so perhaps that's best
I suspect many feel as you do. I know I do at times. It's becoming clear to me that although cardiology is mostly science, a lot of 'art' is involved; add to that the less than likely chances of getting a truly caring doctor who will give you time and interest... Life, eh?
Steve
Wow!! Not a dr, but what is he doing for the AFIB? I have AFIB and my EP did pacemaker for that reason to prevent my HR from getting too low. Mine is set at 70 bpm. Is he giving you anything to stop the AFIB? are u taking blood thinners?
I would discuss with him and get a second opinion. Sounds like a serious situation to me!! maybe you should also go to the ER?
GOOD LUCK
Hi. Is your Heart Rate 30s,40s,50s during the day?
I had 2 second pauses whilst using Metropolol.
Finally taken off it. Then went to Bisoprolol. But not controlling the156 HB AF during day. No pauses
Put on 120mg as 180mg CCH Diliazem am and 2.5 Bisoprolol at night.
A better balance. Day 77 average. 48HB at night. Resting. No pauses.
Patience in having a balance.
Control in rythmn and rate.
cheri. JOY
In some ways similar i had been taking 120mg metoprolol for several years no problems.Then although I've been taken off that drug completely I still get overnight rates always in the 40s occasionally 30s.
Cardiologist wants me now off diltiazam but when I did that I got a 3 hour bout of tachycardia.
In the daytime with no metoprolol I still have lots of low beats of 40s
I can't take Bisoprolol as I have just had a stent fitted in May so coronary disease as well
The holter monitor showed several pauses quite long ones 4 seconds or more and the kardia device also gave me a lowest heart rate of zero twice so I'm yet to find that balance you have with meds or pacemaker
HiUm you mean 120mg Diltiazem NOT Metoprolol. I was taking 3 x 23.75 at once, then separated them then reduced them down to 1 x 23.75.
The ECGs showed my heart under stress. Plus I was tiredafter short flat walk and slept immediately after. I always wanted to get home.
cheers JOY
Yes my mistake 23.5 metoprolol is was on double that but halved it now not at all..Same as you very tired after doing very little I've made an appointment for a referral to another cardiologist
Good morning! Here it is night time in the freezing north east US snow covered for the last month. 18 small boxes pauses is 0.04 seconds ×18=72 seconds. 1 minute and 12 seconds is very significant... I would get answers from my cardiologist.Concerning the pacemakers, there are different types, some like mine work on demand, it only kicks in when my heart rate goes below 49. Furthermore, I have a defibrilator, that kicks in when my heart rate goes above 180. Pacemakers are generally not well understood, including in the medical community...
I hope you get answers really soon.
Hello from hot and Sunny New Zealand. Yes I thought the length of pauses significant but my cardiologist didn't mention it .
So your happy with your pacemaker you dont get out of breath just walking up a slight incline?
Do you take any medication at all now?
We could use your New Zealand heat, it is snowing again, my wife would like me to shovel the driveway. I am covid positive, off work for a few days, so I got a good excuse.... Fully vaccinated and boosted, my symptoms are not severe Concerning the pacemaker, my life is as active as before. I still ski and climbed my stairs with no shortness of breath. The first few months after being fitted, yes I had shortness of breath but little by little I got my strength back. With your pauses, a pacemaker seems the best option
Hi Fairgo. I take Sotalol, the minimum 80 MG, only in the evening. My afib attacks being only at night time. My pacemaker is like my angel guardian, it only works about 10% of the time.
Hi fairgo45. Sorry to hear of your heart rates being so low. All good advice given to you. I was in the 50 's and breathless so I don't know how you're getting through your day. I had 8 sec pauses before I got my PM in '18. Very glad I got it. My life has been renewed. I don't tolerate the meds so they're not an option. My advice, go for the pacemaker asap !!! Best of luck to you. Sarah from San Diego ❣
Thanks Sarah Which type of pacemaker did you have and was the av node left untouched?
That'll probably depend on what effect your medications have on your condition fairgo45. Those can, and do induce the sort of fluctuations you are describing, and a pacemaker wouldn't be a routine suggestion until after all other avenues have been explored first.
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