This morning I did a ‘random’ Kardia (6L) ECG and it came back that I was in sinus Rythm with wide QRS. It was a one off and five mins later I did another one (and many others since) and all in normal SR.
I sent it off for a clinician review as I’ve been worried about it all day and they’ve come back really quickly, telling me my heart is stable, no abnormalities detected, but I have first degree heart block. They said if it’s a rare occurrence to ignore it as usually benign.
I’ve now looked at ‘Dr Google’ and wished I hadn’t, but read that beta blockers can cause it as they slow the heart. My HR is a little higher this week but still 58 at rest and usually in the low 60s, but I recently reduced my tapered dose again of bisoprolol this week.
Has anyone else found that bisoprolol ( or any other BB) caused them to have first degree AV block? Did it cause you any problems and did you need to come off the drug? Was it resolved?
My paroxysmal is only controlled by a very small dose of bisoprolol at the moment ( very small 1.5mg tapered dose)
Thankyou,
Teresa
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Teresa156
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AV Block is quite common. My heart rate often went to sub 40 and caused second degree heart block and my cardiologist was not concerned.When it started causing total heart block I stopped my beta blocker. Now at 60 bpm it is fine again and has been for months.
I would not worry with first degree HB as long as it does not progress to second or third degree.
Thankyou. How did you know you had it, was it via an ECG? I had an echocardiogram in November and various ECGs since but this morning was the first time I’ve seen this, or it’s been picked up.
What do you take instead of a beta blocker? I tried coming off bisop last Nov and failed - went into adrenaline over drive abc had an AF attack. Panicked and went back on it.
My second degree was picked up on an ECG by paramedics.
The third degree I diagnosed myself. My pulse went from 68 to 28 for about 10 minutes and then abruptly shot back to 68 and then back to 28. To me this is typical total heart block.
I was lucky that I had no adverse effects when I stopped my BB. I've never had AFIB but had AFlutter.
The Kardia will show the pattern of the arrhythmias but will not state the type.The atrial flutter has a fast but regular atrial contractions or P waves. Only about every fourth P pulse follows through to pulse the ventricles. This normally gives a steady heartbeat of around 120 BPM.
In Atrial Fibrillation the atrials beat in a chaotic manner (fibrillate) hence no P waves are seen on the ECG.
Some P pulses follow through to the ventricles but not at a steady rate due to the chaos in the atrials. This causes a variable heartbeat.
this is really fascinating. Still awaiting to find out a diagnosis but the fibrillating erratic beats now make some sense. I just need to capture them somehow
Sometimes it’s really hard to come off and can take months of very, very gradual reducing the dose and the time interval. Adrenaline rebound is a known complication and just another reason I hate the drug.
Hi CDreamer,Thanks - yes, awful drug to come off. Last time went from 2.5 to 1.5 for a week and stopped on instruction from cardiologist- I went into adrenaline rush and HR jumped all over the place - straight into Afib within 24 hrs😳 I hate it too.
I have been given the option to try nebivalol at my request, just a bit apprehensive as to how that will affect me, so holding back slightly….
Oh no 😳I can just imagine what you must have gone through. How long did it take for you to get back to a ‘normal’ HR? I read some take months and months….
Hello Theresa. Do you also take an antiarrhythmic? It could be the latter because they work by prolonging the heart beat to block errant electrical signals.I am typically 53 HR at rest and I take 1.25mg Bisoprolol before exercising or after emotional stress, together with 100mg Flecainide.
This will often bring down my HR to 50 and shows mild QRS elongation.
Does your Kardia give an actual value of the QRS, QT part of the wave complex?
My ECG monitor (1-lead WIWE) reports very mild variation from the norm.
Hi Saulger,Thankyou for replying. It seems that my Kardia gave an incorrect reading of wide QRS as the cardiologist ( from Kardia) who reviewed my ECG said my QRS was within range, ( not wide at all) but I had this first degree AV block instead.
I don’t take an anti arrhythmic. I have fleconaide as a PIP in case I have an attack, but haven’t had to take it since November.I was having them every 3 weeks before I took bisoprolol.
My Kardia is a 6L and I signed up for Kardia care which is why I asked their clinician to review it, I can’t tell what the QRS range was, it didn’t say. But their cardiologist said it was within range, so it gave me an incorrect reading. I have only had it about 6 weeks, first time it gave me anything different from NSR.
I do think it’s the bisop. I was having HR as low as 53 on 1.6mg. I have been weighing the 1.25mg pills in jewellery scales and even those vary in weight from 1.30 -1.42.even that .10mg seems to make a difference with my HR.
Like you, but more often, my ECG shows a "wide qrs" and I have been told this is owing to some degree of left-branch bundle block (LBBB). I was told this of no consequence unless my AF becomes more regular or prolonged. I gather that RBBB is more common than LBBB but that both are, generally, benign things to have.
In your case, from what I have read, your "block" occurs higher up the conduction pathway than the two "bundles" and is called "first degree" heart block. This apparently means that there's a slightly longer than usual conduction difference occurring in the heart between the atrial pacemaker and ventricular pacemaker. Like LBBB, I gather this of no consequence if the heart is otherwise normal and it is asymptomatic. Since you've been told not to worry, it seems to be a perfectly safe and quite a common thing to have. Whether a beta blocker caused this, I don't know, but a slow heart beat can show it up, apparently. and a beta blocker does slow the heart.
I would ask your doctor for more reassurance but, if he or she's anything like mine you'll be simply told not to worry!
When you say if asymptomatic, what are the symptoms to look out for? I’m on an anti arrhythmic and it’s lowered my heart rate to 40s/low 50s (very low 40s at night). I get an unpleasant feeling often when I stand up and move about, or sometimes when I walk a bit too fast - pounding heart and a slightly lightheaded/weak knees sort of feeling. About a month ago my dose of amiodarone was reduced because of this, but it hasn’t made a difference to my symptoms, whatever they are.
That's a hard question and I imagine that symptoms (as well as how we respond to them) vary a very great deal between people. "Asymptomatic" to me means feeling normal and being able to do things without feeling in any way out of sorts or worse. In your case, you are taking medicines that, presumably, are bound to have an effect on how you feel, so it must be hard to separate what you should be feeling from what you shouldn't. The low heart rate you have might, for example, not be able to recover quickly enough when you change your posture from sitting to standing, and this might cause a momentary drop in blood pressure sufficient to cause the symptoms you describe. In my case, my most common symptoms are a slightly racing heart (85-105 often, sometimes up to 130 bpm), left-sided chest discomfort, a feeling of palpitations and a slight shortness of breath, yet, quite often, all that shows on my Kardia is "NSR with wide QRS". Have you had an echocardiogram or a cardiac MRI, for example, and has this shown why you might get the symptoms you do?
For me (and from what I read many others), the biggest problem with this condition is that the anxiety it creates can easily magnify symptoms and bring us to imagine connections and imagined future scenarios that simply aren't there.
Thank you for your thoughtful reply. I had an echo in Jan last year that was normal but that was before I started on this medication and had these symptoms. What you said about my heart rate not being able to recover quickly enough going from sitting to standing is pretty much what my GP said - I haven’t seen an EP or cardio about it at this stage. I think you’re right about the anxiety - I never used to be an anxious person at all but since the a fib started I know I panic when I feel my heart doing anything even slightly odd.
Well, with your echocardiogram being normal, you can rest easy since AF in itself isn't going to harm you, even if it feels that it will. It is the racing heart that AF can cause that needs to be checked or it can weaken the left ventricle and lead to reduced pumping capacity. .
This was the case with me. In the early months after my ablation for atrial flutter, and still having chest discomfort and a feeling of needing to create deeply, I can't tell you how fearful I was about the future. Luckily, I was given an echocardiogram and a stress MRI, both of which showed that my heart was otherwise normal. Well, the sense of relief was enormous. We were on holiday at the time and the rest of the holiday was that - a proper holiday. That said, I was still having symptoms - and I still do at times, feeling the same kind of chest discomfort and need to breathe deeply, for example during a walk. So, I have decided that the electrical side of things must still be a bit awry and cause these issues even if the plumbing side is all okay. My "ejection faction" (a measure of the left ventricle's health) had dropped while I had my atrial flutter and tachycardia, down to 45% but that had gone up to just over 50%. I've been left wondering whether that isn't a bit on the low side of normal, hence my symptoms, but I don't know, and my doctor is happy enough.
In your case, you are being given a stronger drug than I am to correct the electrical side and rhythm issues, whereas I currently only have bisoprolol to use as needed to treat a racing heart and the very infrequent AF. I would think the drug is the problem for you, but, presumably, it's needed. It was one I was about to be given for my AFl if the ablation hadn't come along as quickly as it did.
Hi Ppiman,Thankyou. It seems the Kardia gave an incorrect reading, as the Kardia cardiologist who reviewed it said my QRS was within range, but I had first degree block instead.
I am a bit surprised that the Kardia gave an incorrect reading, as I though they were reliable. I did another one two minutes after this yesterday and it gave the same reading of wide QRS but ever since it’s been normal.
I did both of my ankle, but I often do it there, but I switched to me knee after the wide QRS and it then said NSR.
I don’t know what to think!
I think if I asked my GP, he’d say the same as yours 😳
My post above, posted to you before I’d finished so I had to quickly edit it Steve….Thankyou for coming back snd explaining it all though, I think I’ll have to try not to worry ( easier said than done) but if I get that reading again in future I don’t know if it’s wrong again….and my QRS may be in range but it’s the AV block again.
Maybe you are using the Kardia too much? What prompted you to use it? I only use my Kardia when I go into afib mainly to check on how high my heart rate is . Using it just to see what your heart is doing in the absence of symptoms may be making you more anxious.
Yes- banish to the back of a drawer! I know when I first got mine I used it more as it was such a neat wee gadget but once the novelty had worn off I stopped. I must confess I take it on holiday just in case I go into afib!
I will do 😊Though I would do what you do and take it away with me.
By the way, I sent off for that Vitamin D test….but I couldn’t face doing it when it arrived - the amount of blood they wanted 😳 I just couldn’t! I thought they’d just want a drip - they want about a teaspoon full. I just can’t! So it has to be a ‘wait and see and hope for the best’ outcome for the middle of next month instead.
A month ago I was told to increase Bisoprolol from 2.5 to 5mg. Yesterday hospital consultant told me to immediately go back to 2.5 as it was slow my heart to much. I have now been additionally put on Entresto 24/26 with a strict watch to be kept on other problems for the next 8 weeks. I have only taken it twice so far and feel much better up till now. I now take 26 pills a day of various meds that take a lot of organising.
Thanks for coming back,Yes, bisoprolol certainly does lower the heart rate somewhat, I started on 2.5 and my HR would go below 50, but it also woke me every two hours at night amongst other things. I’d rather not take it at all yo be honest, but I’m a bit scared, because I’ve already tried once - I find it quite difficult to come off as my hr went a bit mad last time, but it seems to stop my afib for now.
Hi. Yes I have paroxyl AF but only on Apaxiban due to my naturally slow heartbeat. I also have a first degree heart block but no one seemed even remotely concerned about that Best wishes
Thanks for coming back…if you get an attack, do you just wait for it to finish? Or do you have a PIP? How often are your attacks? My HR wasn’t fast originally, it used to go to mid 60s if watching TV for instance, so I don’t think I’m an ideal candidate for daily Bisoprolol, but it’s terrible to come off of.
It’s interesting and reassuring that they aren’t worried about your first degree AV block either though. Thankyou,
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