I was diagnosed with PAF last spring and put on bisoprolol plus a blood thinner. The dosage of bisoprolol has since crept up to the maximum 10mg per day as the PAF has become more frequent and longer lasting. I have been struggling to get my GP to get me an appt with cardiology for a meds review and/or discussion about ablation, then yesterday I had an episode during which my pulse rate went down into the 30s. I rang 111 who directed me to A&E, but not before telling me than such a low rate meant my heart could stop at any moment. Not exactly words of comfort.
I did go to A&E but they delayed getting the ECG done (although the could see my heart rate on arrival was 35), so of course it had all settled back intoa normal rythmn by the time they did. I was moved into a waiting area without being told what they proposed doing with me and waited... and waited. After five hours of no further contact with any medical staff I asked when I could expect to see someone and was told that they were very busy and some people had been waiting 2 days.
I discharged myself and this morning have made a private appt with my cardiologist for Wednesday.
Please, does anyone have any advice or even words of comfort, especially about the low pulse rate? It has utterly spooked me. I live alone and am not managing very well to keep a lid on my anxiety about how this is developing. Many thanks.
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In the last 6 weeks or so I've had a bit of the reverse problem. Paroxysmal AF is highly controlled but I'm on Warfarin and Bisoprolol. My Bisoprolol was at 7.5 mg, and although I tolerated this dose well for the first 12 months, gradually I went down the gurgler and it was causing my HR to drop as low 39 bpm, constantly in the 40's and up to mid 50's. Ended up functioning like the Zombies from the land of the Living Dead. Got fed up with my GP and my useless surgery I took the initiative and reduced my own dose to 5 mg. I spread this over 4 weeks. I did however get hand delivered a hardcopy text of my issues and my own actions. Hell, I thought the whole damn place was gonna go and self destruct. Surgery's don't like hardcopy, easier to misfile or deny something online - disapears into the ether. Not so with hardcopy.
Nowadays my actions proved themselves and I'm on 5 mg and with a nice jolly old HR of 63 to 67 bpm ..... Lub Jub, feel like superman and so much more energy. The point I'm getting to is this ..... my surgery employs a surgery based Pharmacist who I was eventually shunted off to and who agreed with my plan. So what I'm saying is .......... don't wait and stress out over the low heart rate ( easier said than done I know), GP's and Cardiologists are the least likely ones I can think of who can advise you on your Drugs party bag. You would in all honesty be better off seeing your local Pharmacist and getting a consultation ..... they are the ones who know all about the drugs, how to take them, how they interact with other meds ..... look ! its what they do !! To be honest the NHS of 2022 is about as much use as a chocolate fireguard and our surgery now has reduced initial contact with patients down to a thing called e -Consult, where the patient goes round ticking boxes on an online form - none of which adequately provide for a description of the patients ailment. I gather this is becoming more true of more surgeries around Britain.
Meanwhile, try and destress, encouraging anxiety to creep into your life is just the sort of thing AF feeds on with many people, try and relax and keep calm and good luck for Wednesday. What is your blood thinner ( anticoagulant), Warfarin or one of the newer ones.
I've tried all sort sof combinations of bisoprolol throughout the day. Currently on 7.5mg in the morning and 2.5 in the late afternoon, which up until recently was the time of day my episodes were happening. Now it can be anytime.
My heart dropped so low the nurses came rumning in! But almost immediately I went into normal rhythm . Almost a natural cardio version! So dont worry !
Sorry to hear what you have been through, not surprised and had similar experiences. AF is not considered an emergency so I think you are doing the right thing by getting a private consult as you obviously need a thorough exam and assessment.
The one encouraging thing I can offer is that you were able to remain upright and conscious. That is encouraging. I would go on symptoms and how you feel rather than judge too much by numbers. Some people tolerate very low rates which others would not. I can tolerate quite high heart with very low BP rates which others cannot.
It needs sorting of course. Wednesday is nearly here so in the meantime just take care and keep well hydrated and electrolytes up and stay calm and practise your slow breathing techniques.
I’m afraid I am so biased against Bisoprolol I’ll not comment too much except to say once I came off it altogether I improved - but that took a lot of time. Bisoprolol should be reduced very, very slowly and gradually and do remember that because it is an Adrenaline Blocker as well as a Beta blocker which can cause some people symptoms of anxiety.
CD: A beta blocker is by definition an adrenaline blocker. The beta blockers we are all familiar with are "selective" blockers of adrenaline on the beta-1 adrenergic receptors in our heart. I put the word selective in quotes deliberately, as none are 100% selective, and all have some activity in blocking the effects of adrenaline on the beta-2 adrenergic receptors, which are locate in the airways (and less in other areas), and this unwanted action at beta-2 accounts for most of the respiratory side effects, and why our beta blockers are contraindicated in asthmatics.
This happens to me after an afib episode, my heart rate goes down into the 30s, no one has told me about the heart in danger of stopping, yikes, I can’t take beta blockers because of this, so I would think 10 mg is quite alot if your hr is going so low. You definitely need advice from a cardiologist/EP, I have waited 3 months so far for an appointment re my low heart rate, but things are pretty bad here so expect to wait a lot longer!hope you get some good advice on Wednesday, please let me know, take care.
My cardiologist will not let me take a higher dose of my calcium channel blocker, which I take instead of bisoprolol, because he said that if I reverted while a higher dose was in my system my heart rate would be too slow. I have had pauses of several seconds when I reverted to sinus and a pacemaker has been mentioned. Fortunately my HR doesn’t go as high as it used to when I have an episode so I don’t need the pacemaker yet.
Sorry don't know anything about Biso as only given Fleacinide. Definitely a good move to book a private cardiologist appointment; make a list of your questions (apologise when you take it out) and don't leave without all the answers....that should help your anxiety.
Also be prepared to change cardiologists if you can't for whatever reason develop an understanding with the first. Again to ease anxiety, it is so important to have faith in your medic.
Sorry to hear you are suffering and hope you get some answers Wednesday. I was prescribed bisoprolol as a pip but haven’t taken any due to my low resting hr but mine only goes to 48/50.
Please tell me I have read it wrong. Did you really mean some people had been waiting 2 days in a&e to be seen?
Hi. Yes, that's what they told me. I think that I was placed in a specialised offshoot rather than the main A&E and it's possible that the 2 days referred to a wait for admission to a bed. But the nurse who said that to me didn't elaborate (it's just what I picked up from odd comments made by other people in the waiting area) but was merely using it as a way of telling me that my wait was likely to be very, very lengthy and so far I had nothing to complain about. The reason I got so annoyed was the total lack of communication about what the process would be or occasionally checking in with me on whether the AF had returned at all . When I arrived my BP was very high and my pulse rate very low but once it stabilised it was as if they lost interest and I was forgotten about.
Whilst not on as higher dose as you my wife has had to balance her Bisoprolol doseage to keep the attacks down but the HR at a not too low a level. No dosage has been perfect but currently life with the PAF are fine.
The private appointment is for the best. Bisoprolol on its own will not affect the rhythm of the heart (i.e. the AF), it will only slow down a racing heart. of the kind some people get when in AF. Sometime this slowing will stop the AF.
Are you taking 10mg because your heart races often, or when the AF strikes? If not, then perhaps you could use it "as needed" (what doctors call "PRN"), rather than taking that dose daily. This is a question for your doctor. This will depend on how long the episodes last since the bisoprolol takes about an hour to work (but keeps working, then for about a day).
A persistent rate below 60bpm is called bradycardia. I can get this the day after I take a bisoprolol tablet (even 1.25mg). I gather that if this continues it can increase the risk of developing ectopic beats and other heart arrhythmias (a "bradyarrhythmia"). Sometimes a pacemaker is used alongside the high dose of betablocker to increase the heart rate to normal (pacemakers only increase a slow heart rate, they don't stop AF, although one special kind can do this).
Thank you all for taking the time to reply to my post. Your thoughts and ideas have been very helpful to me in gathering my questions for the consultant tomorrow. I know that I am fortunate to be able to afford the fees for going private and that not everyone has this "luxury" available to them and must therefore try to contain their anxiety until the NHS can fit them in. I will update you on the outcome tomorrow.
I was wearing a heart monitor when my pulse rate dropped very low. I held onto the sink to keep from fainting. Received a call from the monitor company and then my EP. Within the week I had a pace maker inserted.
The private consultation was very useful. I had an ECG and ultrasound and there had been no deterioration in the heart structure over the past 18 months since the last ones. The consultant has fitted a 7 day monitor and will review my meds once he has seen the results of that, with the possibility of dropping the dosage of bisoprolol and adding in flecainide or possibly an ablation. I will have to pay the cost of the monitor but the NHS wait is at least 3 months and I think it is worth the investment to help reduce my anxiety about this. He thinks the CAT scan I had done in May 2019 is recent enough not to need repeating. He said that the pulse oximeter is probably inaccurate as I was able to walk and talk ok even though it was reading around the low 30s BPM, and to try not to worry too much about it.
I remain appalled that so many people have to wait so long to be seen on the NHS, whether for an initial consultation and/or follow up tests. I don't want to get political about this, but something has gone very, very wrong and needs fixing asap.
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