Will pulse rate ever again be less than 100 bpm?

[Titania70]

You’ll probably say ‘Ask your GP’. But I can’t even get a phone appointment with GP. My last request, last week, resulted in a conversation with the practice pharmacist, which, while helpful with regards to medication, didn’t answer my other questions.

The story is, I have AF, which was diagnosed just over a year ago. With Apixaban 5mg and Bisoprolol 2.5mg per day onboard, the AF has been controlled, giving a reasonably even pulse of 58/60. Beginning of June I fell and hurt my ribs, making deep breathing and coughing painful. Avoiding these movements as much as possible made me develop a chest infection. This in turn made my pulse soar to 120/130. Antibiotics were prescribed at A&E, and chest infection duly abated over following week. Meanwhile, Bisoprolol was doubled to 5mg a day. Now, 1 week after antibiotics finished, my pulse is still fast, usually around 100 while seated, and about 118 when I move about doing not much, like making a cup of tea, etc. Still taking 5mg Bisoprolol following pharmacist’s advice. She is going to phone me in a weeks time to see how I’m doing on that. As it is, I can’t do much before feeling I’ll. What would you do? Have any of you been in a similar position? Am I simply being impatient?

[mjames1]

I think you should ask your GP. Oh, sorry, not an option now so you're stuck with us

So first of all, when you say "I have afib" do you mean you're currently in afib, or do you mean you get afib from time to time? If the latter, how often do you get it and how long do episodes last.

Not uncommon for pulse rate to rise during and post infection. That said, not a bad idea to check your pulse during these spikes to make sure you're in normal rhythm versus having some sort of arrhythmia.

As to the bisoprolol, if you're not in afib most of the time, I would question your doctor why you need to be on it, not to mention having your dose increased. Bisoprolol really knocks a lot of people out and while it has its place, it's often dispensed to afib patients like candy, for no good reason.

Just read a recent anecdote about Dr. John Mandrola, who is both an ep and has afib. He said, it was one thing prescribing Flecainide every day in his office, it was quite another thing when he came down with afib to have to take that little white pill himself. I think every ep should be required to go on a short trial of the medications they prescribe before prescribing them. Then they might understand a little bit more what we're going through.

Jim

[CDreamer in reply to mjames1]

I’d support that requirement for EPs. 😮‍💨

[Titania70 in reply to mjames1]

Thanks for your reply. Until the chest infection, I got episodes of Afib a few times a month, that lasted a few mins to a few hours. Since the infection sent pulse up, I’ve been in Afib. Can you say what you mean by EPs please? I don’t know that abbreviation

[mjames1 in reply to Titania70]

"ep" is short for elctrophysiologist, who is a cardiologist with extra training in heart arrythia's like afib. They are also the ones that do ablations.

So if you're in afib now, the bisoprolol is probably appropriate to help control the rate and what you are experiencing is normal. Once you get out of afib, the bisoprolol is questionable but certainly not cut and dry.

Any plans for getting you out of afib like electro cardiverson or medications like Flecainide?

Jim

[Titania70 in reply to mjames1]

Thanks. No plans for electro cardioversion or Flecainide. Cardiologist I saw last year was happy to review in 2023.

[CDreamer in reply to Titania70]

No you are not being impatient - you are not being monitored or receiving medical support so are naturally concerned.

High heart & AF often comes with chest infection and can continue after the infection clears and AF become persistent so probably a good idea to get in touch with your GP and ask for a referral as soon as possible. Persist but if you are suffering I would strongly urge you to go to a walk in UTC (urgent treatment centre) - there should be one near where you live.

Any infection will cause inflammation throughout the body and inflammation will trigger AF even when normally well controlled. The damage to rib may mean you are also shallow breathing which won’t help lungs to recover and you won’t be able to clear mucus so be careful as you can end up going in circles. Shallow breathing/infection/AF. That happened to me earlier this year.

Have you had an X-ray? You have a lot going on in your body so your symptoms may not all be down to meds.

[Titania70 in reply to CDreamer]

Thanks. You are right, I need to be more persistent. I was in A &E 12 days ago. Had an X-ray then. It was chaos there. They sent me home on foot. Almost collapsed while getting prescription in pharmacy.

[Singwell in reply to mjames1]

That would certainly be interesting. I'd want Diltiazem on that list for sure. Plays havoc with the digestion, makes you photosensitive and its very alarming watching your veins dilate if you're slim like me!

[mjames1 in reply to Singwell]

Hey, you're taking away the one drug I can tolerate lol We all react to these drugs so differently.

[Singwell in reply to mjames1]

🙃 we're all different aren't we? I manage in Diltiazem but with some reservations

[Paulbounce]

I'm not a medic. However I think your HR at rest at 100 beat's a minute is to high. If it raises to 118 getting up to make a cup tea it's to far to high. I would be a little snecky about this one. Go to A@E and walk a mile before you go in. Your HR will shoot up to maybe 140. You may have to stop in for a night but they will check you out.Best of luck Paul

[Hidden in reply to Paulbounce]

I agree, but pick your times, avoid Friday and the w/e, early Tuesday or Wednesday is good but hopefully you will have improved before then 😉

[Titania70 in reply to Hidden]

Thanks.

[mjames1 in reply to Paulbounce]

Good advice. About twenty years ago I was concerned I might be having a heart attack. Flash forward I wasn't. In any event, I called my cardiologist and he said head to the A&E and he'd meet me there and organize some testing. Then he said, "make sure you tell them you're having chest pains and trouble breathing", which were two symptoms I hadn't mentioned to him. I guess from experience he knew the right words to use in order to get taken seriously and to be seen.

Jim

[Paulbounce in reply to mjames1]

Hi Jim.

You won't go to heaven heh - however it's one way to make you are checked out

👍 I've taken that one on board. Nice one.

Paul

[Titania70 in reply to mjames1]

Yes, the buzz words make the difference. I had no problem getting taken to A&E. But when there, it’s hard to be seen. So many lining the corridors.

[Singwell in reply to Paulbounce]

That is good advice. Turning up late morning not on a weekend maybe? So you actually have a chance of being seen by a cardiologist

[Titania70 in reply to Singwell]

Thanks

[Hidden in reply to Singwell]

Early morning on a weekend works well! (Speaking from experience)

[Titania70 in reply to Paulbounce]

Thanks. Wouldn’t have to walk a mile for that rise Paul.

[Hidden]

You poor thing! You've really been through the wars. I'm in agreement with others' comments - you need proper assessment, there's too much going on here for 'phone triage'. I too suggest you go an urgent care centre. It's also a disgrace that you can't get an appointment with a GP. Being British we do hate making a fuss, but I think the time has come to make a fuss!

I do hope you get some proper medical care and start feeling better very soon.

[Titania70 in reply to Hidden]

You are right, I hate a fuss, but I think it’s time to make one. It’s a shame that it’s come to a point that only those who shout loudest are attended to.

[Ppiman]

I was wondering whether you'd phoned 111 and what came of that? It must be deeply frustrating and worrying not to be able to be looked at professionally. It really isn't acceptable, but the parlous state of the NHS is a fact of life that isn't being recognised by enough people, sadly, and, as a result, the government are not being held to account. Our elderly friend fell down last week and was stuck on the floor with her 88-year-old husband, a man with his own medical problems, doing his best to help her. The ambulance took just under ten hours to arrive.

This leaflet seems very useful: ouh.nhs.uk/patient-guide/le...

Steve

[Titania70 in reply to Ppiman]

So sorry to hear about your friends plight. I had similar situations with my mother in recent years. She was 93 at the time and I couldn’t lift her. I did call 111 12 days ago when hr shot up. They didn’t hesitate. Sent an ambulance which arrived in just over 1 hour. But A&E was awful. Very busy. Was first in corridor, then, because of chest infection, I was put in separate room alone, door closed, no buzzer to call nurse. Nobody came for ages. I’m not keen to repeat that experience. Thanks for leaflet.

[Ppiman in reply to Titania70]

Indeed, you wouldn’t want to repeat it. When I had my atrial flutter and ended up in A&E I couldn’t fault its smooth and speedy efficiency.

But then came the nightmare: a night on a “holding ward” at Glenfield hospital with a single cardiologist on duty and three crazed folk shouting and talking all night long leaving the rest of us wondering what had become of the world. Never again.

Steve

[Titania70 in reply to Ppiman]

I know what you mean.

[Singwell in reply to Ppiman]

I was offered a 'holding ward' during the height of the Delta wave...I told them I'd rather take my chances and go home. I'm pretty sure I'd have ended up with COVID if I'd accepted that option. 17 hours on a trolley with poor folks semi isolated coughing their lungs up. Blooming scary! Reckon it was my 'two mask' strategy that saved me.

[Ppiman in reply to Singwell]

It sounds as if it might. We’ve just ordered a box of 20 3M K95 masks ready for the next round.

Steve

[Singwell in reply to Ppiman]

Already here according to the Zoe people. 1 in 21 have it, something like that? Strongly suspicious of last week's weird flue like thing I had. Ticked every one of the 5 most common symptoms of the Omicron sub variant but tested negative throughout.

[Ppiman in reply to Singwell]

We both had similar at Christmas and twice since (!) but with negative tests.

It seems the risks from the new variant are that it causes mild symptoms in the main. More have died from omicron than delta in many parts of the US I gather, however, mostly elderly or otherwise prone thanks not to general severity of covid of course but to the sheer numbers catching it.

Steve

[Hidden in reply to Titania70]

Ugh, that's awful! I had a dreadful experience last year with A & E during a really bizarre attack of something called Transient Global Amnesia. Out of nowhere, after taking a nap because I was feeling unwell, I had complete short term memory amnesia. My housemate said I suddenly turned up, looking like death, and asking how he got here, how I got here, obviously completely confused. Of course I don't remember any of this as I had amnesia! He called 111 who said I could be having a stroke or TIA and would send an ambulance. Ambulance service called after some time to say they didn't have an ambulance available and they would send a taxi. I was put in a taxi , on my own, with amnesia, and arrived at the large area hospital A & E which was packed, half the people not wearing masks, and there I sat for 5 hours. I was terrified because I really thought that I'd had some kind of brain bleed - and until I was properly assessed there was no way of telling that I hadn't. After several hours my daughter, who lives in the US and who works for something equivalent to NICE, was desperately trying to get through to the hospital as she was frantic that I hadn't been assessed after 3 hours. She eventually got through to another department who kindly looked me up on the computer and told her that it said that I'd left the hospital before being assessed! The whole thing was a nightmare.

Having said that, I went to A & E a few months earlier (during the first big Covid wave) when I had my first AFib episide. I went at 7 am on a Sunday morning and it was deserted. I walked straight in, the staff were lovely, it was like night and day compared to my other experience (which had been on a Friday afternoon).

I don't blame you for wanting to repeat your experience!

[mark66uk]

I have had the same thing diagnosed with PAF in 2019. Dillitiazem 300mg to control rate. My resting heart rate was 98. Took up cycling to get fitter and rate was 140 before turning a peddle. Got up to 100 miles a week. Had ablation this week and hr is now 75. Keep pestering them.

[Titania70 in reply to mark66uk]

Thanks, I will.

[2learn]

Hi, my experience is that having a pulse below 60 was seen by medics as a concern for someone over 70, I just thought I was reasonably fit. Medics seem much happier if your pulse is 70-100 which they seem to consider as normal for over 70s. Therefore they can be much less interested in your 100 pulse than you would expect or hope. I can only suggest to try and push your GP, last resort would be private consultation which could recommend stuff your GP would have to implement under NHS.

[Titania70 in reply to 2learn]

Thanks.

[jd2004]

Since Covid my heart rate has never been back to normal. I’ve had af for 7 years with only a few breakthroughs but since what was a very mild Covid the af kicked in and has stayed with me for the past 3 months. Won’t go into the visits to a and e but they didn’t help. Trying to see a GP is very difficult and actually seeing a cardiologist within a few weeks is impossible so I went private. No answer to the link with Covid but another medication change prescribed. Not sure if this is helping but I’ll wait a while before making another appointment. My advice is that if you have contact with someone in your gp practice keep it going. Your calls and issues should be logged which, if you need to be seen, may give you faster access to doctor if needed.

[Titania70 in reply to jd2004]

Thanks.

[Cat04]

My heart rate suddenly went to over 100 eleven weeks ago. After a visit to the gp who did an ecg it was shown I was in aflutter. After 5 days staying at 130bpm I spoke again to gp surgery who told me to ring 999. 12 hours later I'm tucked up in bed in hospital. The hospital's ecgs said I was swapping between aflutter and afib but as my cardiology team is across the border in another county, as soon as I said I wanted to be seen by them I was told they couldn't refer me to another hosp and I had to get a referral from my gp. Discharged from hosp 3 days later on digoxin & increased bisoprolol.I was then expedited to an urgent (telephone) appt with a registrar who is now writing to my gp to put me on sotalol & review me in 6 months.

Still running at over 100, in afib/aflutter at rest and over 120 on standing & moving from the sofa. I told the registrar that despite digoxin/bisoprolol my bpm are still the same (ish) he replied "oh no it'll have come down a bit!"

I have telephoned the med secretary at the hospital who was so helpful, gathered all the missing documents from the other hosp, pulled it all together to get it all in front of the registrar to sign off the letter to my gp. She did say present myself at a&e if I wished but ringing 111 would be a waste of time.

Fingers crossed for my gp to action the aforementioned letter!!!

[Titania70 in reply to Cat04]

Good luck. So much seems to rest on where in UK you live.

[Rainbowlad]

Titania70,

No, If I were you I'd try again to get a G.P. appointment.

[Titania70 in reply to Rainbowlad]

Thanks I will. I’ll have to flex my pester muscles and see if they still work.