Bisoprolol dosage?

[Brain]

I am on 1.25mg of Bisoprolol daily but my atrial fibrillation episodes seem to be increasing since first starting this drug around 8 months ago. I never go a day without being aware of my pulse skipping beats. Although these episodes are for extremely short periods they are fairly frequent throughout the day. Would a higher dose of Bisoprolol help?

[BobD Volunteer]

AF is almost always a progressive condition so this pattern would be normal. I suggest you go back to your treating doctor and discuss.

[Ppiman]

I get far more palpitations or "missed beats" (which I'm told are actually ectopic premature beats, i.e. PVCs or PACs) than AF, and like you, often on a daily basis. Sometimes these come in such long runs (for hours) that the feeling is just like AF.

I only take a bisoprolol (1.25mg) when I get a racing heart (100-130bpm) and I put up with the palpitations except for when they go on crazily and too long, when I do take a bisoprolol. I had a bout of that two days ago, when my Apple Watch reported "Poor Recording". It wasn't that, it was just skipping so much that the Apple algorithm couldn't work it out.

Steve

[Brain in reply to Ppiman]

Your reply/explanation has given me some reassurance. I think I am experiencing the same symptoms as you describe. Thank-you.

[Ppiman in reply to Brain]

If you can afford it, the Kardia pocket ECG might help reassure you as it can differentiate between AF and ectopic beats.

I’ve often wondered whether ablations tend to bring on more of these palpitations, but I suspect it’s more likely to be just an aspect of a heart that has a less than perfect conduction system.

Steve

[Brain in reply to Ppiman]

Thank-you. I do have a Kardia (the dearer of the two) and used it frequently when first diagnosed (and paid for reports) but I rarely use it now. I also have an Iwatch 6 that I got so I could keep an eye on things but like the Kadia I rarely use it for the purpose I bought it. It’s just a time keeper now. I’m a bit of an ostrich. I bury my head in the sand. I don’t want to be reminded I have a problem. Not good I know. This website is great though. To be informed through the experience of others is so helpful.

[Ppiman in reply to Brain]

I’m the opposite - always checking in case it’s AF. I have an excuse (assist from my nature…), I also have something called left branch bundle block (LBBB) and I was told that frequent AF and a racing heart aren’ta good combination with that. So far, luckily, AF is keeping away much of the time.

Steve

[Brain in reply to Ppiman]

Just noticed you say the Kardia can differentiate between ectopic beats and AF. I am obviously brainless although Brain is my lD because I have never picked that up. From the ECG reading/chart how do I differentiate?

[Ppiman in reply to Brain]

Mine (6L with advanced determinations) has been fooled once or twice by rounds of ectopic beats, reporting them as AF. Generally, though, ectopic beats are PVCs (and sometimes PACs). The Kardia will report these correctly most of the time.

A PVC / PAC / ectopic beat / “palpitation” is when a ventricular beat comes in sooner than it should, leaving a longer gap till the next normal beat comes in, often with a bit of a “thump“. It’s still a normal beat, though, and this shows because there’s a small “P” wave from the atrial beat just before the big “R” wave of the ventricular beat on the ECG.

In AF, there is never a P wave as the atrium isn’t beating properly (it’s just vibrating). The small P spike is the atrial beat, which occurs just before the big “R” ventricular beat or pulse.

Steve

[Brain in reply to Ppiman]

Thank-you so much for that information. It’s been extremely helpful in giving me an understanding of what’s going on with me. 👍

[mjames1 in reply to Brain]

It it's bothering you, no sense guessing. You need to take an ecg with the Kardia when you feel these episodes. Kardia will differentiate between afib and ectopics most of the time. To be sure, email the ecg to your doctor or email it to one of Kardia's doctors for a fee. You can also post the ecg, here but remember, we're not doctors.

Jim

[saulger]

Hi Brain. Do You also take an antiarrhythmic medication? Bisoprolol helps a little but is more for rate control as it slows the heart down a few beats. I also take 100mg Flecainide before exercising, to stabilise the rhythm.

[BigArnie in reply to saulger]

That's really interesting about taking Flecainide before exercise, Saulger, as I have never heard that before! Were you advised to do that by a medic or did you see something online?

[saulger in reply to BigArnie]

Hello Arnie. It was suggested by a fellow sufferer on this site.I've been doing it for six weeks and it works a treat, in my case.

I do steady state indoor rowing for 45mins and the heart rate gets up to 100-105bpm.

You need to take it an hour or more before exercising for the combination to take effect.

May be worth a try, so long as you don't exceed the Flecainide 400mg per 24 hours (men).

[Brain in reply to saulger]

Hi Saulger. I only take Bisoprolol. I am tachycardic. I just assumed (always a mistake) bisoprolol was an umbrella drug for both AF and tachycardia.

[saulger in reply to Brain]

Hi Brain. Perhaps check with your EP. 1.25mg Bisoprolol helped me some with the Afib, in the beginning.

But after a couple of years I had to add the Flecainide 50mg x 2.

Now I just take 100mg Flecainide and 1.25mf Bisoprolol before exercising to avoid an episode a few hours later, in the night.

[BigArnie in reply to saulger]

Many thanks.

[Brain in reply to saulger]

Hi. I only take Bisoprolol. I am tachycardic. I just assumed (always a mistake) bisoprosol was an umbrella drug for both AF and tachycardia.

[marvaldebaran]

When I had sepsis 5 years ago, I developed paroxysmal AF. My day to day situation living with it is similar to that of Ppiman. I take 2.5 mg bisoprolol daily to help ward it off. Since that sepsis episode, it's common for me to have a few to ten short bouts with ectopics daily. In my case, I can readily feel the difference between a few ectopics, and a PVC rhythm, and AF, although strapping a BP cuff on my wrist makes the sensations more pronounced. Usually, the ectopics are just a single odd thump or perhaps two odd thumps within a minute, and then the episode ends. I was terrified of them at first, but eventually I learned that they seldom lead to AF unless I go into "panic attack" mode. However, if I feel my heart starting to race around 120 bpm, that's another matter entirely. I very rarely have Afib episodes, but when I do, I take another dose of bisoprolol and an aspirin and try self help methods to end the episode. Deep breathing doesn't work for me, but doing a mundane task, like folding laundry, or drinking cold water, or Valsalva maneuvers do, at least so far. Fortunately, my AF has not yet "progressed," but I do work at limiting stress as the episodes I've had almost always seem triggered by stress.

[Suesouth]

Hi, I take 5mg in a morning and 2.5 at night, still get palpitations and ectopic beats during the day! Last AF episode was January!

[JOY2THEWORLD49]

HI. my private heart specialist was determined to get me 'af controlled'.

He was right in putting me on CCB DILTIAZEM 120mg a.m and 2.5mg Bisoprolol p.m

The doctor can put you up to 10mg. It did not control with avge day @ 156bpminute.

I am balanced with BP 123/72. and heart beat 93 but reducing.

Night is 48 bpm both averages. And at rest.

On exertion my AF shows itself.

cheri JOY

[AussieHeart]

Ask about Flecainide.. put on 50mg twice a day as same as you and it controlled rhythm I had to drop it down as gave me too much energy!!!! Use 1.25mg of Bisoprosolol for intermittent high HR as needed

[Surreychica_1]

Well I am on 1.25. I found a higher dose made it worse and made me very tired.

[Tellingfibs]

As has been said within this thread, not all ‘crazy’ heartbeats are Afib - just everyday palpitations that everyone gets. That’s what my GP told me. As you have a Kardia device with Advanced Determination, I would use it and maybe it would reassure you. Once you get a report, you can read the explanation for it. I have had Afib for 5 years ( am 70 year old woman now ) and I was on 2.5 mgs of Bisoprolol for four of those years. Last year, the GP increased the dose to 5 mgs as I was getting quite a few episodes of tachycardia, and that resolved the issue. However, more tachycardia came along in the autumn and another GP was too nervous to increase my dose in case it lowered my blood pressure too much. I got to see my cardiologist in January who put up my dose to 7.5 mgs, which didn’t help and a couple of weeks later, my ‘helpful’ GP increase my dose to 10mgs. I asked him if that was the highest dose recommended and he said “ yes, but don’t worry, we have lots of tools in the box ! “ I also asked if it was possible to reduce my daily dose of Bisoprolol and just use extra as a Pill in the Pocket, but he said Bisoprolol didn’t usually work quickly enough to be helpful that way (they take between 2 and 4 hours to have any effect ). I know that some people reading this do take them as PiPs, but every case is different and they may take other drugs too, which I don’t. So, the crux of this ramble is to suggest you check your heart with your Kardia device, as you already have one itching to be put into service, and to pester your GP/ cardiologist about further management of your symptoms. If you don’t contact them, they will assume you are on an even keel. The ball is in your court. And for everyone who has read this to the end - you are very patient !

[Tomred]

same dose and same thing with me, ive wondered would higher dose help also, though i was first started on 5mg which knocked me for 6.

[56-er]

Why are you on Bisopropol?

[Brain in reply to 56-er]

I was having episodes of ectopic beats / fast heart rate/ chest pain. Heart raced when walking on a low level even surface and I struggled on inclines. Heart Consultant diagnosed AF and told me to go back to my GP and follow their instruction. GP put me on 1.25mg. bisoprolol but did say to me that should I feel the dosage is not helping she would increase it to 2.50mg. Also told me I was Tachycardic. Although I seem to be having ectopic beats/fluttering more frequently than when I first started on the drug, and occasional chest pain (doesn’t last long and on a scale of 1-10 it sits at 1) I have not yet gone back to my GP. The bisoprolol, although of help with my condition, has had a negative effect in other ways. I just don’t have the energy I had before starting on this drug. I feel if I increase the dosage I will end up like a zombie.