I take nebivolol (betablocker) to control heart rate, and verapamil (calcium channel blocker) as a pip, which I understands affects rhythm ? As I understand it, AF is an irregular heart rate, which I think then gives an irregular rhythm? But you can have an irregular rhythm without having af? I have tried web searching but have just confused myself even more 🤣🤣🤣
If rhythm is irregular, surely heart rate will be? And visa versa?
Heart rate is beats per minute so your pulse. Rhythm is how it beats so in AF you may have high rate AF where when you are in AF and your heart rate will be over 150 and over 200 or 300 in some cases whilst in AF. I have low rate AF so my rate doesn’t go up in AF and my resting heart rate is in the mid fifties and hardly ever goes over 120 to 140 when exercising but my rhythm is irregular though my heart rate stays pretty much the same as it always was. Hope that helps. A paramedic once said my AF is regularly irregular. Like morse code where . Is normal heart beat, it may look like ….. - ….. - ….. - where as other peoples AF would be totally chaotic and a lot. lot faster.
Almost grasping it but not quite ….. 🤣 Until I started nebivolol, my pulse would be all over the place from anywhere between 40 and 183, fluctuating like a mad thing at all rates between . I ended up in a & e for the first time when it was peaking at 183 and showed no signs of settling down. Lovely team in a & e, sorted out a pip (verapamil) and a week later I spoke with my gp re a load of blood test results - outcome, prescribed nebivolol in place of bendroflumethiazide. To help with blood pressure and af episodes. . (Stopped bisoprolol over 18 months ago, replaced with bendroflumethiazide for bp) GP and pharmacist seemed happy with the new plan. Feels ok (I am a nightmare to prescribe for as I react to non-active ingredients 🤣) and it’s only by looking on my Kardia records that I noticed how many episodes in July. The nebivolol seems to be keeping the erratic range lower, don’t think it went over 130. So my Af is chaotic x
This could be fun! Both beta blockers and calcium channel blockers help to control the heart rate, they also tend to reduce blood pressure so it’s a bit surprising that you take both even though one is taken as a PiP. This may be because either your heart rate and/or blood pressure is low and they don’t want to suppress it further unless you are in AF which may increase your heart rate. Normal heart rate is between 60 and 100 beats per minute. This can be difficult to assess if you are in AF and the heart beat is irregular. Normally, when in AF and you want to check your pulse it’s best to take it for 10 seconds and multiply the result by 6 or 15 seconds and multiply by 4 to get an average bpm. Some monitors such as Kardia are able to cope with a fast irregular heart beat.
Irregular heart beats (rhythm) can be fast, slow or anywhere in the middle, they are just irregular and this is why a rhythm control drug such as Flecainide is used either as a PiP when an episode kicks off or as a regular maintenance dose after an ablation or a cardioversion to help keep the heart n regular rhythm.
This is another good reason for asking your GP to refer you to see an EP……usual caveat, I’m not medically trained!
I ought to add, although it’s the most common Arrhythmia, AF is only one of many Arrhythmias…..
I must admit, when I first started nebivolol my bp was erratic and dropping rather low. The verapamil works very quickly as a pip, but I do keep an eye on my bp. I really don’t want my gp/arrhythmia nurse fiddling with my meds, I want to know what is happening with my heart now, and explore options as it seems to be getting worse.I still can’t get my head round the difference between pulse rate and rhythm - is it the mechanism of how it works?
Pulse relates I feel to the strength of the heart pumping the blood round. Rhythm is like a song, sometimes slow sometimes fast.
Pulse is how many beats per minute the heart beats, doesn't matter if it's strong or weak. Rhythm is how the steady, or not steady, rhythm the heat beats are doing. It starts from one node in the heart which triggers others, so it can be normal or abnormal rhythm, as there is a defined way in which the heart should be triggering to keep the rhythm normal.
Imagine your heart as a skipping rope …how often the skippy ropeHits the Floor is the BPM and how the rope quivers and moves and the shapes it makes is the rhythm-like a dance
Both nebivolol and verapamil affect your rate, beats per minute, not your rythym. Nebivolol is a beta blocker and will have more effect on your BP. Verapamil is a calcium channel blocker and will have a quicker and more drastic effect on your rate. N either will usually affect your rythym. If you are in Afib you will probably stay in afib. Flecanide, Amioderone, Tikosyn ate drugs meant to change your rythym, for example from afib to NSR. If your rate is between 60 and 100 and you are not getting other symptoms they may not be necessary. An ablation is meant to control your rythymand may be more effective if done early in the process. Hopefully you are taking an anticoagulant to help prevent a stroke. You should be seeing an Electrophysiologist to have the best cha ce of sorting this out.
Thank you. Yes, was on warfarin for years, now on rivaroxaban. I found through web searching that verapamil is also effective to treat both heart rate and rhythm too…….I certainly get back into NSR quickly after taking it as a pip…..according to my kardia monitor. I intend to ask to be referred to a EP when I phone the surgery tomorrow……if I can get through., and if they listen to me. Fingers crossed. Thank you for your response and advice 😊
When you feel your pulse, a normal, regular heart beat is fairly obvious, You just feel it pulsating at a steady and consistent rate. The speed of the beat doesn’t obviously vary but depending on what you are doing, it may be a little fast, a little slow but it shouldn’t be irregular. In other words your pulse should feel regular. I’m not sure how else to put it.
If it’s very fast, but still regular, a bit like an ack ack or machine gun then you could have atrial tachycardia
If it’s a bit like Peter Sellers and Sophie Loren singing Goodness Gracious Me and beating all over the place then the chances are you are in AF…..I’m sure Dr Sanjay Gupta has produced a fantastic video explaining everything 😉
Yes, I love your analogies, that is one of my favourite scenes! 🤣 So if you are in af, rhythm wouldn’t be regular, which is what I thought. So one med is to return the hr to a better, regular speed and the other to settle the rhythm into a regular pattern? Still don’t think I should be having as many episodes as I am…….. but at least it’s not permanent! 🤪
Still not quite right, neither drug will have much affect on rhythm as both are rate drugs which is a bit of a conundrum but that may have something to do with you having a relatively low heart rate and/or low blood pressure. As ethereal mentioned, neither of the drugs you take are designed to control rhythm……which is where we came in.
I did say from the outset that this could be fun 😂
Yep, certainly will be entertaining! Though I did find research that said verapamil also had an effect on rhythm - think one of the bits was from the Mayo Clinic, so I have no idea now 🤣🤣🤣🥰🤣 x,
Years ago when I was diagnosed with high BP, my GP prescribed 120mg verapamil and 10mg Lisinopril. I am checked every six months and there was no need to change anything, One day I was weeding in my garden and scratched my shin on a sharp aloe prickle. Although I did my best first aid, it seemed to be getting infected after a couple of days. My usual GP was off duty so I saw another who prescribed an anti biotic, which obviously did not agree with me, because after vomiting about 10 times I was vomiting flecks of blood. I phoned my doctor's surgery and I was told to go in immediately, and my HR was 140 and an ECG showed AF (not surprising as all my family on my father's side have it as do my 4 sisters). Since the doctor was concerned about a dissection, I was sent of to a Cardiologist (I was in NSR by the time I got to him) His office is at a cardio hospital so he admitted me for the weekend for observation. While I was there, he considered my BP was too low, took me off my BP meds and replaced them with 2,5mg Biso. I was taking my BP regularly and within a couple of weeks it had shot up despite the Biso. My doctor phoned the Cardio and my BP meds were reinstated alongside the Biso which I hated. I was never prescribed anything for rhythm, but take Xarelto as an anti coag. My arrangement with my current Cardio is to stick with my BP meds, and take 1,25mg of Biso if I feel my HR is up (I usually take it when it is 110 BMP). I find a glass of ice cold water usually knocks it back into rhythm. I don't really have any symptoms with AF, neither do I have a selection of gadgetry to frighten the wits out of me, as I suffer from anxiety as it is!
I hated biso, and I don’t feel it did much for my bp (was always around the 140 /80-90 mark), felt out of it, muzzy head, aches & pains, forgetful, couldn’t exercise, exhaustion was off the scale! Gp replaced it with a low dose of bendroflumethiazide for bp, as I was having so few episodes of af. But recent blood tests showed high uric acid (side effect of bendro) plus the af was kicking in more frequently (ended up in a & e for the first time start of July, where I was prescribed verapamil as a pip) so I am still getting episodes, but not with such a high hr as before the nebivolol. But still having a detrimental effect on my day to day life. I have contacted a private EP’s office to find out what they can offer and, of course, cost. 😊 I like my Kardia, and my bp machine, but I am not obsessed by them, I am fascinated by how the body works, so use them more as observational tools.
That’s probably right Tilly. Apparently Sotalol, which is another beta blocker, can also help with controlling rhythm so Verapamil may have similar characteristics too…..just keep taking the tablets until someone qualified tells you something different 😉
Definitely will. I do feel better than I have felt for a long time, it’s just these darned af episodes breaking through! Thank you x
I am prescribed Sotalol as a replacement for both Flecanide and Bisoprolol. It controls my heart rate and rhythm.
I have nebivolol for my rate and it’s blood pressure lowering properties- I was on bisoprolol for about 5 years, been off it 18months(was making me I’ll) , didn’t need anything apart from anti coag and a bp med as had barely any af episodes. But recent blood tests showed I had very high uric acid, a side effect of the bendroflumethiazide, so gp & I agreed to give nebivolol a go as it should help bp and af …. Hr not so high when I get an episode, but still too frequent 😊 I think I understand the hr/rhythm stuff better now 🤣
Heart rate is how many beats your heart averages in a minute, regardless of whether the beats are evenly spaced as in normal sinus rhythm or unevenly spaced as in AF. Rhythm is what you have in music so a regular beat but AF has no rhythm, completely chaotic. Nebivolol, being a beta blocker, should reduce the rate, reduce BP and may have a mild effect on rhythm. Verapamil, a calcium channel blocker affects rate and BP and also may have a mild effect on rhythm depending on the cause of your AF. I agree that that seems an odd combination. My cardiologist told me I couldn’t take extra diltiazem (CCB) as a pip because when my heart went back into NSR the rate would be too low.
Hi ButterflyA Priv Cardiac Specialist put me on both Diltiazem 120mg am and BB Bisoprolol 2.5 pm. They need to be separated.
PIP of CCB is risky. My H/R dropped 100 on 180mg Diltiazem. It gave me lightheadedness.
cheri JOY. 73. (NZ)
My EP:
“Imagine you are walking briskly along the road. Suddenly you trip, something has broken your stride, and to keep from stumbling you begin to run but instead of becoming stable and stopping you run faster and faster.
This is AF in increased rate (but probably caused by a tiny impulse or trigger - a pebble on the imaginary path - which initially affected your rhythm, possibly a vagal trigger).
The best PIP for this is a rhythm control drug ie flecainide, not a beta blocker.
Imagine you are walking briskly and decide to run, but you run and run go too fast and you stumble and try to catch your steps as you hurtle along clumsily. This is AF in high rate which then puts your rhythm out and it becomes very irregular. This may be AF triggered by high stress / anxiety / exercise?
The best PIP approach here is to start with a beta blocker although you may benefit from a rhythm control drug too.”
Not the full picture of course but it helped me!
HiTilly's PIP is the CCB Calcium Channel Blocker and not a beta blocker.
Sounds like the GP is not conversed enough and Tilly should see a Public or Priv Cardiac Sp. No dr talked about CCB. All they did was put up my Metroprolol which I declined as I became breathless and fatigued on exertion.
cheers JOY 73 (NZ)
Thank you x
Read this on what AF is, it may help understand it better
nhs.uk/conditions/atrial-fi...
Thank you, I have an understanding of what af is, but got confused with some of the conflicting things I was coming across when rhthym and rate were being mentioned 🤪 I will have a read if the link later. X
Hi TillyI take CCB Diltiazem tried on 180mg but brought down my heart rate within 2 hrs by 105!
On Metroprolol H/R 186 avge day
on Bisoprolol H/R 156 avge day
Night 57 H/R avge for both. 2 pauses with Metroprolol.
The Specialist agreed 180mg too high so treaked
120mg Diltiazem Calcium Channel Blocker am
separated Bisoprolol 2.5 pm
I am CONTROLLED from Dec 2021.
I suffered a stroke with AF inSeptember 2019
I was diagnosed 4 days into my hospital with a shadow on thyroid
thru the carotid arteries scan.
I was lucky.
A problem with thyroid can cause AF because of the Papillary Cancer.
In Feb following my caring surgeon and anaesthetist operated in Feb 2020.
I declined RAI Radio Active Iodine and then being suppression of the TSH level.
Apart from their own risks I was LOW RISK for cancer to regrow or come back.
AF is an irregular heart rythmn. Just 3 weeks ago this new Auckland Cardiac Specialist listened to discover a soft systolic heart murmur.
The irregular can be mild to persistent and to intermittent.
The beta blocker Bisoprolol dropped my h/r by 30 only.
I have rapid especially during the day.
Bisoprolol is the better beta blocker for AF. It should be the first med with AF.
It doesn't bring the H/R at night which stays at 47.
Beta Blockers tend to help rythmn but it is more important to CONTROL Heart Rate than ryhmn.
Blood ant-co-agulants are very important because of AF. Blood can clot. The specialist gives each patient the level of risk, age etc.
My BP is now 123/73. with H/R day between 77-88.
It is important I was told to separate CCB and BB. They are contra with each other.
Your specialist will be keen on your detailed history and from there make decisions.
I have never heard of PIP of CCB!???
CONTROL is no.1 step.
cheri. JOY
NZ doesn't worry about rythmn.
Hi JoytotheWorld, I can’t tolerate bisoprolol, or several of the other alternatives, so it was quite a task for the a & e team to find a suitable pip for me. I have to be careful of what non-active ingredients are in the meds or makes me ill. I keep an eye on my blood pressure, hr - I also have a single lead kardia. Since the start of this year I have begun to have more frequent af episodes. The nebivolol has reduced how high my hr goes in an episode and the verapamil stops the episode almost in its tracks. I have checked with a pharmacist I trust that it is ok to take as a pip with the nebivolol. They said it was, there would only be an issue for concern if I was prescribed the two to take together. I am glad for all the info and feedback from people on this site, it helps one to feel better informed .take care x
TillyYour H/Rate is per minute so count it for 30 secs and double or 15 seconds and x by 4.
Cheers JOY. 73. (NZ)
It is confusing because both the top and the heart are rhythmical or regular in their contractions, but the "rhythm" that is referred to in AF is the regularity of the beating only of the top chambers - the atria, as opposed to the rhythm of the bottom chambers, the ventricles.
In fibrillation and similar arrhythmias, it is only the top two atrial chambers that become poorly and "arrhythmic", meaning their regularity of beating is disturbed and changed from normal. The bottom chambers, the ventricles, remain pretty much normally rhythmical and continue to pump blood to the body and lungs (when the ventricles lose their rhythm, this is a medical emergency). When the atria lose their rhythm, it is called an arrhythmia, usually atrial fibrillation (~99% of arrhythmias, I believe) or atrial flutter (~1%).
What might help is to know what the heart does when it beats. This is what I've learned.
The process begins when an electrical signal forms in specialised muscle cells situated at the top right of the heart, in the right atrium - a spot called the sino-atrial ("SA") node. When this fires, the top muscle only of the heart contracts and squeezes blood through one-way valves into the bottom of the heart, the ventricles. It also sends a signal to another knot of cells atop the ventricles, called the atrio-ventricular ("AV") node.
When the AV node fires, the bottom of the heart contracts, but always a fraction later than the top, giving time for refilling. The firing of the AV node causes the left ventricle to pump oxygenated blood to the body, and the right ventricle to pump de-oxygenated blood to the lungs.
Both the top (atria) and the bottom (ventricles) muscles of the heart squeeze rhythmically at a rate determined by the brain. The normal average resting rate is about 72bpm. Thus, both the AV node and, fractionally later, the SV node fire at this same average rate, increasing and decreasing with energy requirements. The pulse you feel in your neck, wrist or chest, for example, is the ventricular rate, and the feeling itself is from the two valves above the ventricles closing, not from the top or bottom squeezing, which cannot be felt at all.
When the electrical circuitry of the atria changes from illness, disease, age and other factors, not all yet fully understood, then the regular rhythm of the atria changes. In atrial fibrillation, it causes the atria to quiver or twitch irregularly; in atrial flutter, it causes the atria to beat regularly but far too quickly (~300bpm).
This disturbance means the regular and rhythmical signal of 72bpm sent from the top of the heart no longer occurs. Fortunately, the SV node is able to respond to this and take over control of the ventricular pumping. This safety mechanism tries hard to ignore the troubles happening above and keeps the ventricles pumping at a fairly steady rhythm and healthy rate to supply the body with oxygen.
But it cannot now do this perfectly. Firstly, the blood it receives is no longer pumped and relies on gravity and being sucked down by the ventricles themselves. That's why the heart output ("ejection fraction") can reduce with atrial arrhythmias: the body can feel tired or slightly short of breath or chest aching occur. It also acts to boost adrenaline and cortisol levels to help distribute the blood better, which can create a strangely anxious feeling, sometimes one of "impending doom". Some notice this and the reduced flow much more than others.
Steve
I don’t think that’s quite right, sorry. My understanding is that the atria quiver very fast and irregularly and the AV node can’t keep up and passes only some impulses to the ventricles which then beat irregularly but not as fast as the atria. A lot seems to depend on the pattern of beats in the ventricles, some lucky people have a slightly irregular ‘pattern’ so hardly notice it at a reasonable rate while other unlucky people have a chaotic rhythm which is very disturbing. Sometimes my heart puts out a few very slow beats followed by very fast beats which gives a reasonable average but is also very distressing.
Yes - thanks for that. The role of the AV node is clearly enormously complex, variable and still controversial so far as I can read. Certainly it acts as a back up pacemaker but as you say, it allows some of the electrical impulses through in an irregular fashion that varies by individual.
Your kind correction led me to reading the article linked below. It’s truly comprehensive and seems to cover the latest research and thinking. You might well find it interesting:
Thanks again!
Steve
I'd just like to clear up a few things that might mislead you on this. Normal heart rate is often quoted as between 60 and 100 beats per minute, but that is intended to cover normal conditions during normal (in)activity. Resting heart rate when you are asleep, or otherwise inactive and at rest, can be as low as mid to high 40's, normally 50's. An athlete during a race will have a heart rate well above 120, maybe as high as 180 depending on fitness.
Also, when suffering from AF, not all heart activity will produce a pulse, so taking your pulse rate does not reveal all. This is because if the heart beat is badly mis-timed (as it can be in AF) it might be a minimally filled heart that beats, not causing an actual pulse of pressure. The only way to check your heart rate when in AF is to use a device that measures the electrical activity of the heart, not the pulse. The pulse is a reliable indication only when not in AF, i.e. when the heart beats in normal sinus rhythm.
You won't get a simple answer because it's not a simple question.
First you have to understand what both terms mean.
Heart rate is the easy one. It's the number of beats per minute. The beats can be taken at the wrist pulse or on an ekg you can count the number of QRS complexes. You count whether the beats are evenly spaced or not.
Heart Rhythm, on the other hand is an umbrella term that encompasses both normal and abnormal rhythms. We call normal rhythm NSR. The beats are evenly spaced for the most part (unless for example you have normal rhythm with ectopics) and all else is good.
Some of the abnormal rhythms (arrhythmias) have evenly spaced beats such as aflutter and some unevenly spaced (irregular) beats like afib.
As to the specifics of your post.
I take nebivolol (betablocker) to control heart rate, and verapamil (calcium channel blocker) as a pip, which I understands affects rhythm ?
Both nebivolol and verapamil have both anti arrhythmic as well as rate lowering qualities. They are sometimes prescribed by themself or together. From a rhythm point of view there are stronger anti-arrhythmics such as Flecainide.
As I understand it, AF is an irregular heart rate, which I think then gives an irregular rhythm?
Yes.
But you can have an irregular rhythm without having af?
Yes, the term is "arrhythmia" and that can include aflutter and others.
I have tried web searching but have just confused myself even more.
Yes, it can be confusing both to understand and explain and hopefully this
helps a little.
Jim
Heart rate is an absolute number-60 beats/minute is just the fact that there are 60 beats, no matter how they come. In normal sinus RHYTHM, there will be the same time space between each beat, a very steady thump, thump, thump, very even, just like rhythm in a music piece. In AF, some beats come close together, then some will be farther apart, chaotic-thump, thump..........thump.......thump,thump, thump....thump. The "music" is "off", you'd tell the band leader he needs a new drummer!
You can have a normal RATE (60-100bpm), but the rhythm could be irregular (chaotic) . Similarly ( a different arrhythmia), a very fast rate (>>100bpm), but the rhythm is spot on. No definitive and necessary correlation between the two observations.
I think I got that right?
Rate = how fast it goes Rhythm = it what way it beats.
Like a runner......... May run fast or slow but he could run straight (steady) or all over the place (irregular).
Afib is not the only arrhythmia. Too slow or too fast are two arrhythmias, but the other kinds have to do with meter (as in music). Afib can cause the top parts of the heart to be “off beat” (out of rhythm) with the bottom parts. When that happens the atria sometimes start to beat faster and faster to compensate so, in afib, you can get a super fast heart rate with an irregular beat.
atrial fibrillation then high heart rate 
High Pulse Rate and Irregular Rhythm 3 days after Ablation 
Low Heart rate, should I be worried? 
heart rate and sweating at night
Rate and rhythm control meds
