I started Bisoprolol 5mg and Apixaban on Monday having spent the weekend in Barts with my chest looking like it had a ferret inside the skin running around like crazy. I've had episodic AF ( I realise now) for nearly 20 years and definitely booze related, but which has become much more sensitive over the past couple of years. I had Covid in 2020 and it seems to have gotten worse since then, despite me dramatically cutting down on alcohol. Last weekend's episode took just 2 pints of 3.5% proof beer to trigger. Up until the weekend I'd self-medicated for those 20 yrs using Hawthorn which had worked really well. Also, up until Saturday the hoopla that my heart goes through although uncomfortable and worrying, had been painless. But this time it was accompanied by pain with each stutter and contraction, which is what finally prompted me to call 999. Since then I've been in semi permanent AF with the medication thus far seeming to have no effect.
A thousand questions but firstly, does anyone know how long the Bisoprolol takes to kick in and what's the chances of it making the AF symptoms lessen? I'm really tired at the moment but no other side effects yet. Can I expect that to receed as I get used to the medication?
I was a high intensity trainer and have a resting beat of 56, even though I'm 68. 20 odd years of doing over a thousand sit-ups, several hundred press ups and squat thrusts/burpees per session, followed by an hour of weights, all three times per week. Is the link that well established between AF and high intensity training, not that I can do anything about it now.
I've read the beta-blockers can cause impotence which is a major fear. Can anyone confirm that? At the moment any physical movement e.g. climbing the stairs, seems to be triggering a new episode and I'm gagging to get back down the gym just to do some light work, but am worried what might happen. How much capacity does having an ablation have on the heart? I realise it's probably early days to be talking ablation, but after 5 days on meds having had no effect, I'm already looking past medication as an alternative. Silly I know.
Many thanks in anticipation. So glad I found this place.
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The good news is that if you completely stop alcohol and moderate your training, that may be all you need to fix your afib. Some do well on beta blockers like bisoprolol, but many, including myself, do not. If you fall into the "not well" group, ask the doc about switching to the calcium channel blocker, diltiazem. Does the same thing, but for many without the undesirable side effects. Never to early to think about ablation, but first you might try an anti-arrythmic drug like Flecainide. It can be taken daily to help prevent episodes and/or taken as needed (pill-in-pocket PIP) to get you out of an afib episodes, usually within a couple of hours.
The meds you are on -- bisoprolol and aphixaban -- don't really "kick in" if what you mean is stopping you from going in and out of afib. Aphixaban is a blood thinner to help prevent strokes. Bisoprolol is a beta blocker to help control rate, but a weak anti-arrythmic, so do not count on it keeping you in normal rhythm, be it one week, 8 weeks, or 8 months.
If you're looking for something to keep you out of afib, then you want a different class of drugs, called anti-arrythmics, like daily Flecainide, assuming you have a structurally sound heart. Flecaindide should start working within a day or two. I had a rough first week on it, but after that only 2-3 episodes within the year and each only lasted a few hours. I'm now looking into having an ablation, but Flecainide bought me the time to go about it methodically.
Thanks Jim that's really useful to know. The Doctor in A&E did say that whilst the medication was concentrated on controlling the rate, a by-product was that the intensity of the arrhythmia tends to reduce and stops becoming like having a rabbit up your jumper. Anyone else experience that effect reducing? The thing is at 56bpm I don't have a high resting beat.It only becomes high for the duration of the AF episode. Bisoprolol doesn't know that though does it. So will it take my resting beat down too low when I'm not in Afib??
Probably. Being on daily Bisoprolol at that dosage might make you feel a bit zombified once you get back into sinus rhythm. It had that effect on me. But the important thing is to find a regime that will put you back into NSR and for the moment going down the gym is not really on. You have put a big strain on your heart due to you past overworking of it and ignoring it's messages that all was not well. You need to treat it kindly.
Thanks Auri. Ok so on Saturday (yesterday) the Biso started to feel like it was working. Although I could feel my heart doing skips etc, the sort of thing it used to do when threatening to trip over into an afib episode, it never actually did trip over. But throughout the course of the day Boy did I feel funny/strange. Zombiefied as you put it, is probably an apt description. PLUS I went to the National theatre for a production and going up all those flights of stairs was a real struggle. It felt like I was out of breath, but when I gasped down great gulps of air, it didn't help. Also had some big dizzy spells. Like really dizzy. Dont know if that's the Biso or Pixaban, but I nearly keeled over a couple of times. Are all these side effects something I'll get used to and eventually learn to ignore or will they actually go away do you think?
Some people adapt to Bisoprolol and get on fine with it. Others don't . Those side effects are more likely to be from the Biso than from Apixaban. Women tend to do worse on Bisoprolol. Some people have found that taking the pill at night rather than in the morning helps with side effects. Those who have adapted to it say it takes a few weeks .I went to my GP and told him how awful I felt and he told me to cut the dose in half. Then I cut it myself to 1.25mg. But I did not have another episode of afib for over 18 months . I got my own cardiologist to change it to Nebivolol which lots of people here said had less side effects. But I have PAF and now my episodes are much less symptomatic than they were at first. You need to address life style issues as well. Bisoprolol can lower blood pressure as well so the dizzy spells could bedown to that.
I too have a low resting HR - mid 50s when sitting around and down to 44 for some period every night. I wouldn't describe myself as an athlete but it's just always been like that (I'm 66). I've found that I can't take the Bisoprolol for that reason. I developed paroxysmal AFib about 18 months ago and was initially given 2.5 mgs of Biso to take when an episode started but the first time I took it my HR went down into the 30s that night because it seems to stay in my system for so long! I was then given a 1.25 mgs dosage but I don't take it any more because I was then given 200 mgs Flecainide (an anti arrythmic, as Jim said) which I take as a PiP (pill in the pocket) which I take at the beginning of an episide and thus far (touch wood) it stops the episode in about 30 minutes. I do find that the Biso seems to take quite a while to take effect too. A while ago I panicked a bit when an episode started (for no real reason) and took a 1.25 mg Biso having not done that for ages. The Flec stopped the episode pretty quickly and normal service was resumed, then a couple of hours later I got up from sitting and nearly fell over. My BP was low and I felt really not right for a few hours, which I'm pretty sure was due to the Biso, so I won't be doing that again!
Usually now when an episode begins I take 10 mgs of Propranalol along with the Flec. It's a beta blocker, same as the Bisoprolol but not the one usually prescribed for heart arrythmias but I find it works really well for me. It acts faster than the Biso but is quite 'mild' - enough to take the edge off both HR and anxiety when an episode hits but doesn't have a dramatic effect on my HR for hours and hours like the Biso.
That's just my experience though, and I am very sensitive to medications, so this approach might not work for other people.
Hiya,
Just my own experience ... Bisoprolol kicks in pretty quick and you should notice your HR becoming more controlled. For my money Bisoprolol is a HR control drug which has some properties that lend itself to blood pressure control as well. I have been on 5 mg since January 2010. Prior to AF my HR was upper 90 bpm. On AF diagnosis it clocked 156. Now it is around 62 to 67 bpm, with overnight HR dropping to as low as 46 on occasions. I feel great !
The bigger problem with Bisoprolol is coming off it or cutting it back. Read the paper in the packet ! You have to wean off it very, very gradually.
High intensity trainer ......... well that says it all dunnit ...... what's it done for you ?? Patients like you, marathon runners, olympic grade cyclists etc often end up as AF cot cases. Anecdotal evidence suggests fighter pilots too. What's with you guys and gals that you need to punish your bodies ?? 😱😱
If you do your research more thoroughly you'll find evidence that quite a few of these marathoners die. Are you asymptomatic by the way ? How do you know you are not in full blown AF when doing all this whiz bang energetic stuff.
Back to my first para now .......... your heart naturally wants to beat to a certain natural rythmn and rate. AF stuffs around with that and your heart does whatever it wants, out of rythmn and high rates. Then you wanna do all your intensity stuff ......... think forces as in physics ......... all these competing forces are at work ........... something is gonna give out in the end. Goodnight Vienna !
Hope you get my drift.
By the way, I'm 78, had paroxysmal AF since 65, quite unfit, don't care what peeps say, don't exercise and still manage to pass a DVLA medical annually to drive a bus, notwithstanding my BP issues and AF issues and Osteoarthritic issues and all the junk of medication that goes with it all. My AF is now highly controlled with only 2 events last year and none this year thus far.
TBH I'm only too glad to be like I am than to be like you are. An observation really, you sound like you are addicted to your high intensity stuff. In a way I understand because in my teenage years I was a devout cyclist, but not intensity stuff, I was athletic .... high jump ..... also enjoyed much tennis at a social level ....... then I discovered women and booze ........ and the rest is history. But then I also have AF genetics in the paternal side of my family. So even if I'd led a pure life I may well have got AF anyway if only from pure genetics. My daughter was diagnosed with AF during both her pregnancies. Once she stopped breeding no more AF. Nowadays she practices Thai kick boxing and is like a stick insect. We'll she how she is in 25 years time when she is in her early 60's ! 😂😂
Aren't you being a teeny weeny bit pessimistic about marathon runners dying? Here in South Africa we have the annual Comrades Marathon, it is a Super Marathon i.e. nearly twice as long as the standard marathon, often run in very high temperatures. Thousands of people train intensively for it and run it, this year the entry is capped at 20.000. It has been going for 101 years with entries from all over the world and over the whole history of the race only 8 people have died, meantime I can name at least eight people who are sedentary, who have either suffered heart attacks or died from them in the last couple of years. So really everyone has a choice, we are all going to die, soo die happy exercising, or die happy sitting watching TV!
I wouldn't mention it if it hadn't been covered by UK media for those deaths in Britain. The Australian media also covered those deaths in Australia, one pf whom was an Olympic grade cyclist. So no I'm not being pessimistic at all. Nor alarmist either. My point also was that its a walk on the wild side if you are asymptomatic, in AF and don't know it and go out jogging, running cycling or any other ....ing!
I'm 69 also on Bisoprolol, 2.5, with no side effects and my pulse rate is in the high 40s. Since I've stopped training my afib is much better and I don't go near a gym, just keep to easy jogging. I can drink lots of alcohol with no afib. The strange thing is that I find the only way out of an afib attack is with some serious physical activity like a long run or 4 hour cycle ride. Some attacks last for up to 12 days. The main thing the Bisoprolol does is keep my pulse rate down during an attack. I can't take flecainide because heart is not up to it. I'd give the Bisoprolol a bit longer to see if it settles down
I think you will find all the medicines have trade offs. Beta blockers made me poorly....I tried 3 so I moved to a calcium channel blocker, Verapamil....been miles better since BUT it can cause damage to your kidneys .......regular blood tests required.
Beta blockers commonly make people feel tired.... that's because it's a generic meds that slows your whole body as well as heart. Having said that some people do well on them
What I find is that I adjust after about 3 days and start to feel okay but I know I'm still in afib. I can still exercise but get breathless. The last few have only been 2 or 3 days long and attacks have become less frequent since they upped the Bisoprolol from 1.25 to 2.5mg. No problem with libido
I was 49 when I got diagnosed with supraventricular tachycardia. It is not AF, but I can pitch in with a few observations about Bisoprolol. I am fit and my resting HR was 56 before medication. I started with 2.5 mg which perfectly controlled my SVT. I felt poorly for a week while my body adjusted to Bisoprolol. After that, I had no noticeable side effects. My general practitioner had mentioned the risk of impotence (I am male), but my own research showed that it is a rare side effect. There was no change to my libido. After 2 years dosage was increased to 5 mg, with no increase of side effects. I have been on Bisoprolol for 6 years and I can only say good things about this drug. But everyone is different and I have read numerous testimonies of people who could not tolerate Bisoprolol. I was concerned about bradycardia during sleep. I reassured myself by purchasing a finger monitor that records HR and O2 levels through the night while I slept, and draws a chart. My HR and O2 did not drop significantly during sleep. I suffer from mild tinnitus for a few years and I have read that Bisoprolol might cause it. I am totally willing to live with this minor side effect to avoid the risks related to an ablation. I have noticed that Bisoprolol can cause hypnic jerks if taken before sleep, so I take it in the morning. Hope this helps.
I was wondering whether your echo scan showed any enlargement of the atrium? A study I read a while back showed that a slightly stretched heart muscle - a natural effect of high intensity exercise or obesity - can cause or aggravate AF.
I've also read that the alcohol in weak beer is unlikely to trigger AF, rather it might be the bloating it causes, pushing the stomach into the diaphragm and against the heart itself, setting off ectopic beats, which then trigger AF in prone individuals. Similarly, stretching high, kneeling down and even climbing stairs can all pull at the diaphragm.
Bisoprolol takes about 1-2 hours to achieve a slowing effect. I find it helpful and it is my "pill in the pocket" even though it is slow to act. I very much doubt it will cause impotence but I have read of that possibility; more likely, it seems to me, is that most people taking it are over 70 and might have reduced sexual function.
An ablation will likely be offered if the symptoms of your AF are significant, but consider that more than one ablation is likely and that it is considered a progressive condition regardless of treatment. My son's colleague is 76 and has had, I believe 5 ablations and his AF (along with atrial flutter) has recently returned. He can't have any more ablations, but he's fine.
I started with 2 minor bouts of Afib 2 years ago. Scared me so I quit drinking and started exercising and lost 35#. No drugs or episodes for one year. Figured that I got this beat, so I went back to the bottle. I have been an alcoholic for 40 years. An alcohol induced bout of persistent afib resulted. After a cardioversion, I am now on Flecainide 50x2 and have not touched the booze for 7 months. I was on beta blockers too for a while but they lowered my heart rate too much and hindered my exercise too much. Doing well now and exercise every day. Will try to reduce or stop flec after I lose some more weight. The bottom line is that afib is many times a result of a crappy lifestyle. If you think that you have gotten rid of it and can go back to your old, bad habits, you may be DEAD wrong. Besides that, it is nice to get up with a clear head. Good luck to all.
This is great forum but you do have to be selective and also remember that no one here knows enough about your condition to provide definitive advice.
Bisoprolol is a beta blocker in that it prevents too much simulation of your heart by limiting adrenalin type hormone stimulation, this may help some and not others in that if there is less stimulation there is a chance that you reduce or stop arrhythmia starting and/or reduce its severity. It starts to kick in about 30 minutes but will not reach full effect for a few days. It has a half life of around 24 hours so in the first few days and weeks you increase the benefit as more is active in your body. That's not to say it will work.
There are rhythm control drugs like Flecanide but this is not good for everyone and can make things worst, but it does work for many.
True there are many high activity people that do get arrhythmia and some may be attributed to the intense exercise over a long period, however these people are likely to be pre-disposed of the condition and the exercise has triggered it. For many exercise will benefit the heart.
Alcohol is a poison in that it reduces key electrolytes that your heart needs for SR. Magnesium being a good example. The difficult bit is knowing how much alcohol will cause the damage, everyone is different, I was totally off alcohol for a year (thought it would be very difficult but after 8 weeks I did not miss it). I considered that after a year my electrolytes would have but up and I now drink in moderation.
Self help also includes drinking plenty of water eating bananas and avocados, limit caffeine, leave 12 hours (14 better) without food and plenty of rest.
Final bit of advise is the Docs do not always know the right medication and quantities for you (higher doses can be more harmful) so go with your body and speak to the Doc if you think you need more or less, tell them exactly how you feel, exaggerating will only result in the wrong medication.
Many thanks for taking the time to reply. I've already dramatically cut down on my alcohol intake to around 5 pints of 3.5% proof beer a week. All over the course of a weekend though, which I don't think helps. I'd given up altogether in December 2021 to Feb 2022 in an effort to see if it was the alcohol doing it. It was clear it was. Having done that exercise though seemed to reduce the amount it took to trigger an AFib attack. Previously my consumption had been more like 20 or more pints over the whole week, with no days off. I'd previously self medicated very successfully for around 20 yrs using Hawthorn, but over the past 18 months it finally became less effective at staving off attacks of AFib. At this stage I'd be delighted it I could have just a couple at the weekend, which I could savour lol. Seeing the specialist in May, by which time I should know more. But thanks for your wise words.
Please see my reply to Hettyhen today in this same posting as it was meant for you as well, particularly regarding exercise, having a little drink and Bisopropol. Good luck
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