Should symptoms come and go on medication or never at all

[Andyb7612]

Hi can I ask anyone out there who takes medication for a fib as there treatment plan...if you still get symptoms but not very often does that mean the meds are doing there job or should there be no symptoms at all at anytime , sorry if this question sounds daft but I'm still new to it all and am on bisoprolol 2.5mg and my palpatations I was getting nearly everyday for either a few seconds or minutes I now don't get anywhere near as many but do on the odd occasion maybe once a fortnight now so is it working adequately or do I need to up the dose so I never get any palpatations at all at any time or is it just a case that having some bad days is inevitable ? Thanks andy

[mav7]

Best to consult your doctor who is thoroughly familiar with your traits. May want to ask him for a heart monitor which tells the story.

Are you taking an anticoagulant ? Continue to monitor your heart rate and blood pressure. May want to invest in a personal monitor device like Kardia, Apple watch, etc.

[Hidden]

Hi Andyb7612, I can’t really answer generally but can say that Bisoprolol partially controls my attacks. I started on a dose of 1.25mg and am now on 5mg around a year later and about to start using a further 2.5mg dose as an additional pill in pocket to see if that will help to dampen down a recent increase in episodes of AF. I can’t take an anti-arrhythmic like Flecanide for other health reasons and I don’t want any surgical intervention so ablation is off the table. (I am generally speaking, happy enough with the control achieved on a 5mg dose of Bisoprolol, but I hate having sudden attacks of AF when I am maybe doing something like enjoying an outing with family or friends and don’t want to be a wet blanket). Bisoprolol can be increased in increments up to 10mg a day, but that’s quite a lot to ask your body to cope with, given how sluggish it makes many people feel.It is important initially to discuss dosage and available medications with your doctor so that it can be titrated to give you the best result, as no two bodies will react to a drug in exactly the same way, and there may be better options for you.

[secondtry]

No experience of Biso. I would take action on Lifestyle changes for 6 months. No better talk to your cardiologist on medication.

[Singwell]

All to do with what you can tolerate I'd say. When I was first diagnosed I had no AF at all for 3 months, then a very symptomatic episode. In fact I changed my meds soon after this but continued to get AF episodes about every 2 months. Rather than upping my dose I chose (on advice) to take extra pill in the pocket as needed. When I'm not in AF I feel well so that works for me. I made a lot of lifestyle changes though and I think these helped too. Ultimately its about your quality of life.

[Leechg]

Hi, I take bisoprolol and still get af from time to time. It's just not as bad as it was without the drug. I have been told I can take an extra dose if I have a bad attack, up to 10mg per day. I have done this a few times but generally ride it out.

[Singwell]

Hi again. Just thought I'd add. Keep a note of palpitations, how often, how long, time if day, how uncomfortable. That'll help you and your doctor build a profile of your pattern. A lot of us here track our heart rates wuth Apple watches or a device called Kardiamobile which interacts with an app on your phone to create an ECG reading. I mention this because you talk about palpitations- these aren't necessarily the same as AF - so it's worth checking out.

[Ronnieboy]

13 years ago I was diagnosed with AFib,after a fairly bad attack, I was put on bisoprolol,ramipril and xeralto and alvorstatins later.I used to get regular irregular heartbeats fast heartbeats slow heartbeats ,in the end I ditched the lot ,with some encouragement from my doctor ,apart from the xeralto, lost 3 stone in weight and haven't had a misplaced heartbeat since . Were all different, in my case it's what I eat.

[wilsond]

First of all don't tinker with medication yourself.Yes I am on Flecanide and Bisoprolol as a maintainance dose ( 250 g and 1.25 respectively) but still get occasional breakthroughs of AFib,and rarely Aflutter.

Glad that meds keep IT quiet 95%of time (fingers and knees crossed!)

Are you anticoagulated? Strongly advised.

Watch out for things that are likely to produce AFib, dehydration, alcohol,caffeine( for some) but try not to get obsessed with finding the Magic Trigger for AF ,as that way madness lies! It's such a random condition which does it's own thing a lot !

Hope that helps x

[KMRobbo]

I am not medically trained . Bisoprolol is primarily a rate control medication. It stops your heart rate going too fast if you have an AFib or tachycardia. So Bisoprolol alone may not stop a palpitations. There are several rate control drugs. There are other classes of medication used which are rhythm control drugs( anti arrhythmics) and they are used to try to keep your heart in rhythm. I used to take both as I suffered fast rate Afib when I had an attack. ( typical 165 bpm resting) .

I only took Bisoprolol for a short time as it had very bad side effects for me ( don't worry about that you clearly don't have them!) Everyone is different with drug reactions.

You also been to understand that AFib presents itself in different ways to people and has different causes or triggers. I never found any triggers for mine.

Finally you also need to know that everyone has what are known as ectopic beats ( beats out of place) . You would previously probably not have noticed them. Now you are diagnosed and worried you are so much more heart sensitive and will notice everything. At my worst I could hear my heart beat, always listening for the start of an afib attack. It was crazy. Don't worry, worry is stress - stress can give you palpitations . It can become a vicious circle!

Best thing is to do what you are doing: ask questions, read about AFib, and learn about it but try not to worry about it.

Best wishes.

[Denise-]

My personal experience has been that my afib has reduced in both episodes and time. I no longer take bisoprolol because my heart rate was low, 38 -42 but the flecinade seems to work very well at keeping my afib under control. Hope this helps

[stoneyrosed]

I am ok on 2.5 bisoprolol but when AF became more frequent my Doc upped the dose to 3.5, I subsequently got low BP and became very faint on standing. Dose got put back to 2.5 and was prescribed flecanaide as a rythmyn control drug to work alongside, and was much more effective. I think it is what you cope with best, if any changes in your health consult your GP. You will know when to. Good luck.

[JOY2THEWORLD49]

Hi Andy

Sounds like you are almost in balance.

You will be called "controlled AF'.

I am like that now. More time on it and if staying that controlled the dr may raise your drug.

Pat your specialist on the back.

I felt much relieved because my AF was not controlled and I had been left.

A Private Cardiac Specialist put me on a CCB.

The best thing ever. More energy lower a heart rate by 40BPM.

You are on the right course.

Cheri JOY

[Tilly1957 in reply to JOY2THEWORLD49]

May I ask what a CCB is, please? X

[JOY2THEWORLD49 in reply to Tilly1957]

Hi

I was a put on CCB a calcium channel blocker after metoprolol and bisoprolol dont control my persistent AF.

Diltiazem but 180mg too much so settled on 120mg Diltiazem a.m and 2.5 Bisoprolol.

CCBs block calcium from getting into heart muscle which would in turn make electrical responses which give you AF rapid or slow.

Ask your cardiac specialist if he/she thinks it could assist in keeping AF under wraps.

Here in NZ no 30mg Diltiazem. 360mg is the top dose. My resting dropped from 110-120 to 51 on 180mg within 1-2 hours of taking it.

120mg my h/r drops to average 75.

So there are ACE inhibitors work like directics.

Beta Blockers like Metoprolol or Bisoprolol best for AF and doesn't interfere wit respiratory.

Calcium Channel Blockers.

Drugs work on rate or rhythmn.

Usually importance first is to CONTROL rate of AF.

As everyone says AF comes in many types, persistent, some episodes, etc. Then rapid or slow skipping or pausing.

First get a firm diagnosis of your type. A 24hr monitor should pinpoint it.

% over 65b years of AF an irregular heart beat is high USA like 2 in 5 people.

Sometimes a like change and lost of weight helps your AF.

Sometimes AF needs control and others live with it and not serious. A rapid AF at resting is seriousand needs CONTROL.

cheri JOY. Take care.

[Teresa156]

Hi Andy,

It’s not a daft question…bisoprolol controls mine for now, on a fairly low dose (1.6 mg) as I’m trying to taper off mine. My attacks when I had them would be about 10 hours, but as they’re long and I haven’t had one for ages, I would take fleconaide as a PIP, but don’t like flec very much as it’s quite strong.

As someone said, what you are feeling could be ectopics, if they are only for a few minutes. I have just sent off for a Kardia, even though I’ve got an Applewatch as a Kardia would tell you if what you are experiencing is Afib, or ectopics.

It probably doesn’t help you what we all do though, as we are all . I also don’t know if I ever get breakthrough attacks through the night…I always expect that one day I’ll get an attack too, despite being in bisoprolol.

The higher dose of 2.5 that you are taking can take a couple of weeks to ‘ settle’ in your bloodstream too, even though it’s pretty quick acting every day and lasts 24 hours etc…how long have you been on the 2.5 now?

I would talk to your GP too ( or cardiologist if you can get appointment - or Arythmia nurse)

I’m not on blood thinners either.

Glad you managed to write a post by the way 😊

Teresa

[Andyb7612 in reply to Teresa156]

Hi Teresa, yeah thanks for the help on the post situation ,,,, I'm not the most technical minded 😉 ...I started on half dose 1.25mg first for 10 days then went onto 3/4 of the tablet for a week then ive been on the 2.5mg now for nearly two weeks now...yes I'm sure some of the episodes I felt were etopics as they were just like my heart missed a beat and if I moved position they would stop straight away which is weird..but some of the other palpatations were af but again if I moved position they would stop as well straight away or if I laid there to see how long they would last it was usually no longer than 20 mins or so ...im still waiting for the heart rhythm specialist at Blackpool cardiac unit to let me know what he thinks my traces are .,so its all up in the air at the moment for me...its my cardiologist that put me on bisoprolol but then referred me to Blackpool to see arrthymia specialist for second opinion I gather... ....regards andy

[Teresa156]

Hi Andy,

Give it a few more days on the 2.5 - it might make a difference, it does sound a bit ‘odd’ the way your Afib is going though….if you are sure it is Afib. Did they stick you on a monitor at hospital? Have you had a 24 hour ( or longer) monitor stuck to you yet? When I was first diagnosed, I got the bisop from A&E after being on a monitor there’s then I had to wait nearly two months, for another monitor that they stuck to me, which I had for 5 days….so your cardiologist wants a second opinion? Does he wonder if it is Afib then?

Sorry so many questions but it is intriguing.

What was your heart rate when you were or are in Af? It’s definitely irregular? You say you know you’re in AF. How does it feel? When I’m in AF it feels just really fast, I get a bit breathless and feel dizzy, but I don’t really know it’s irregular unless I either look at my applewatch or other monitor…. ( ie the Kardia that I mentioned) the Kardia looks simple to use and you download an app, my HR can go in the 180s 😳

I’m not an expert in all this, I’m really still a novice Andy, when it comes to meds , but like you, I do worry about this condition as you know and anything I can do to try and help I will do,

All the best,

Teresa

[Teresa156]

Do you have access to an Arrythmia Nurse? They usually give you a phone number to call for advice. They do at my hospital. They might be able to help and they can contact the cardiologist for you. You shouldn’t have to worry about this on your own. In my experience a GP won’t know what to do ( tried that) and you need advice….though as your episodes are short, try not to worry too much. Worry does make it worse, others are right, but it’s easier said than done, I know.

Teresa

[Andyb7612 in reply to Teresa156]

Hi Theresa ...yeah the cardiologist says its definatley af , but because I said I wasn't sure about the bisoprolol as I have a low ish pulse rate of 55 to 60 he referred me to the arrhythmia specialist to see what he thinks for alternative treatment ..when I'm in af my heartrate doesn't go up much at all really it generally stays round about the same apart from one occasion when it went up to 120 but I can feel it beating very irregular when it's happening...I had a monitor for 3 weeks at first and that's when cardiologist recorded my palpatations..arrhythmia nurse told me to join a forum for some guidance and support especially as I'm a bad worrier and to wait for response from arrhythmia specialist to decide what's best treatment ...the weird thing is When i first started with them they used to.last around the 1 to 2 hour mark before I got diagnosed but only got them every so many weeks or so then seem to change over time to very short episodes more frequently...

[Teresa156]

Hi Andy,

My pulse is 55-60 at rest and that’s on 1.6mg. It used to go down to 52 at rest on 2.5mg…is it at rest that it’s that? I mentioned it but told it was ok, even at 52, it’s when it gets regularly into the 40s they don’t like it. I must admit, getting in the 50s used to make me tired during the day , but it does get better after a couple of months as your body gets used to it. It’s some of the other side effects I’m not keen on, that you seem to be ok with so that’s all good. I’m guessing your HR used to be in the 70s at rest? Mine was too. If I go out for a brisk walk it gets to 115 sometimes higher if I’m going up a hill 🙂 I have had a couple of episodes going up to 120 for no reason just for a few minutes….I think you are like me and focussing on your heart and it does us no good. In the mornings before I take my pill my HR gets quite high I notice, but it used to before I was ever on it….we can worry too much, but it’s not easy. I’m always looking at me heart rate and it can become an obsession and make us worse.

My arrhythmia nurse told me not to Google, or join a forum! It’s funny how they are all different. It’s a shame they couldn’t give you more guidance themselves rather than ask you to join a forum though ( although this one is excellent 😊) I’ve been quite disappointed with my arrythmia nurses, I will be honest, as they do blame anxiety most of the time, but it’s the condition that makes us anxious,

So I wouldn’t worry too much about your heart rate If it’s in the 55-60 range when you are at rest. Mine has even on odd ocassions dropped to 49. I was told that was ok, as long as it doesn’t happen a lot and it doesn’t.

I know some people get AF at low rates….and the fact yours have changed since diagnosis, could be a coincidence and purely due to how the times passes…as you know probably they can get more frequent, but it is unusual I think from what i gather for them to get shorter, but look on that as a positive, because at least you know they will be over quickly. It’s the changing positions that stops them that’s odd, but we are all different. It could be your vagal nerve is very sensitive too perhaps? And you moving, shuts off the palpitations, but I’m only guessing. It’s one of those things 😳

So in a nutshell, I wouldn’t worry about that HR, but it sounds like you don’t really want to increase the bisop dose any higher as it will make your HR go lower of course. Hopefully they will come back to you soon. I’d chase the Arrythmia nurse in a few days after you’ve given your 2,5 mg dose a little longer and ask if you can have an update or get some advice. If you keep asking, they will do something….it’s when you’re quiet that they just don’t get back. In my experience anyway….

Teresa

[Andyb7612]

Hi Teresa....no my heart rate is normally in the mid 50 ,s as normal during the day even before the bisoprolol it was only late 50 ,s to 60 ish...it drops to 48bpm at rest at night I asked my cardiologist and gp and they both said that's fine as I'm quite fit and have always had a low pulse for a long time...if I felt dizzy or unwell with it then that's when to be concerned they added...i know what you mean about the worry it's never ending.. im off to talk to my gp tomorrow to see if there's any anxiety meds he could put me.on for a while to help deal with the worry...one thing that did give me a.little positive break was a video on YouTube by a cardiologist called sanjay gupta from York cardiology site about afib progression and he said not everyone progresses all the time and even when some do they find it easier to live with as it becomes normal feeling to them... the other positive note was a specialist saying medical research is improving all the time and there will be more effective treatment s in the future , so i guess that's true...but for now I'm hoping gp gives me something for the anxiety even if it's short term till I come to terms with it all... all the best andy...