Bisoprolol

[Gulmarrad]

I had heart failure early in June. I am at present taking 2.5 in morning and 5mg of Bisoprolol. I was on 10 mg originally. I take and monitor BP and pulse every morning. My pulse is regularly for last couple of weeks 40-44 . My dr has been trying to sought my heart meds out to regulate this problem. Should I go back to heart specialist.

[BenHall1]

A very simple answer is yes! do go back to the expert. Your own doctor is very likely to be just a generalist. Bisoprolol can be a tricky drug to get properly balanced and with 13 years of this drug behind me I would seek the advice of an expert. AND, if you are told to wean off it do so very slowly. Suggest you read the bit of paper in the packet. Heaps of useful information on it, especially if you have had a heart failure diagnosis.

[Gulmarrad in reply to BenHall1]

I was also diagnosed with arythmia while in hospital, that I think is why I was put on Bisoprolol. I take Bruce idea as well to keep fluid off my chest.

[BenHall1 in reply to Gulmarrad]

That's how I started on bisoprolol. I was admitted to hospital and the Specialist/Consultant diagnosed atrial fibrillation, a heart arrythmia.. Initially, during the first 4 months I had a problem, I developed random, full flow nosebleeds. At the time (in early 2010) I was prescribed 5mg to be taken in the morning. I did speak to my doctor to see if she had ideas and all she did was look up in her books of medicines and said, take it at night. I immediately took it at night and have never had a nosebleed since. She did not mess about with the dose, just the timing of when I took it. It was prescribed to me as a heart rate control drug and now after nearly 13 years it holds my day time heart rate perfectly at around 64 to 67 bpm - week in week out as regular as clockwork. At night when asleep my heart rate often drops to low 50's and occasionally as low as 46. ( I wear a Garmin health tracker at nigh to keep a track of whats happening when asleep). Some healthcare practioners prescribe it to assist with blood pressure control ... if thats the case its no good for me for that. It perfectly controls my heart rate as I have said. I take different medication for high blood pressure.

[Ppiman]

I suppose the answer depends upon what your last tests and consultation revealed and what the cardiologist told you.

For myself, I think, once the tests and specialist advice have been obtained, unless things are importantly different from what is expected, then a GP is well placed to look after patients with heart conditions since they have a wide and useful experience compared with a specialist who tends to see an individual patient as a kind of snapshot.

I’ve been told that bradycardia is safe if relatively symptomless or if it worsens under certain conditions. Getting a beta blocker dose right can be hard and, from what I’ve been told, a pacemaker is sometimes needed to speed up the heart so a disincentive dose can be given. Again, I would say that a good GP likely often has the right knowledge and experience to guide regarding this.

Steve

[pusillanimous in reply to Ppiman]

I agree, my GP is marvellous. I visit the cardiologist annually, but basically so he can examine me with his fancy machines and send a report to my GP. I have never known him to alter her prescription !

[Ppiman in reply to pusillanimous]

That’s good to read and the same here. People’s experiences differ but having worked closely with both in the past, in general, I think GPs have a unique and useful experience.

Steve

[pusillanimous in reply to Ppiman]

Yes, I'm in South Africa and if there is any query when I'm with my GP. she will just get on the phone to the Cardiologist for his opinion. This has only happened once and quickly resolved telephonically.

[Ppiman in reply to pusillanimous]

Gosh, that would rarely if ever happen in the UK under our beleaguered NHS system. Is yours privately run health care?

Steve

[pusillanimous in reply to Ppiman]

Yes, we have what are known as Medical Aid Societies, non-profit making organisations to which those who are able to afford it, pay a monthly subscription. All admissions to private hospitals are covered as are most visits to doctors and specialists. We have a public system which is overloaded. Unlike the NHS, all doctors and specialists apart from those employed in public hospitals ,are private practitioners, and have to work 5 or 6 days a week to earn a living. Patients vote with their feet, so doctors treat their patients with respect if they want to put food on the table !!!!!

[Ppiman in reply to pusillanimous]

Gosh, how different. Our specialists work for both the NHS and the private system to the detriment of the former it seems.

Steve

[Tigger_2 in reply to Ppiman]

Yes, doesn't it just.

I'm having a bad time at the moment with ectopic beats causing bradycardia even with a pacemaker fitted.

It's not so much the condition that worries me, it's the specialists who have kept me like this for 30-weeks. A cardiology consultant took over 10-weeks to grace me with a 10-minute phone call. He promised an urgent check but nearly 6-weeks on I'm still waiting.

A registrar phoned me three weeks ago and recommended a full ECG, but still waiting.

After a bit of digging around, I found the consultant worked for at least two other private hospitals and ran his own business.

No doubt that's why I'm still waiting.

The sooner GPs can directly organize tests the better. Consultants have too much power in the NHS.

[Ppiman in reply to Tigger_2]

I’m not sure how the system operates but I’m sure it’s not to our benefit! I know consultants are roundly fed up, too.

Your GP practice will have a 12-lead ECG, so they should be able to do that for you and send it to the consultant’s secretary.

When I was admitted to Glenfield Hospital on Leicester in 2019, I was confidentially told that the whole unit - the largest in our area - had a single cardiologist available, I knew that at the nearby Spire private hospital there were three cardiologists taking private patients.

Steve

[Tigger_2 in reply to Ppiman]

Thanks for that.

My GPs have been quite helpful, but they can only do so much.

They did an ECG, but trying to locate the focus of ectopics is too specialized.

Two of them have contacted "my" consultant on my behalf but to no avail.

Funny you mentioning Spire. The consultant who was supposed to get back to me worked for them as well. They can hardly complain about being over-worked when they have these other interests to juggle.

I'm old enough to have seen the NHS rise from nothing, improve and now struggling with patients paying the price.

[Ppiman in reply to Tigger_2]

I’m nearly 70 and feel anger at the last decade or so with our NHS. The complex interaction with the UK’s private system seems at fault. The changes to forcing nurses to have degrees and degrading half our nurses to become NAs seemed to another part of its many problems, back in 2000.

Steve

[opal11uk]

You are mirroring the same as myself, heart failure, increased Bisoporal, formerly 2.5 mg now 10 mg, recording daily H/R and B/P and regular appointments with Cardiology in one form or another. I also have Edema and take a water tablet which thankfully is reducing the fluid build up in my legs. I had gone into constant A/F but now regulated back to sinus rhythm and hoping to stay that way. Yes, go back to your cardio until he has managed with careful monitoring to get the dosage right for you. I have a Pacemaker so my rate doesn't go below 60 miles an hour, in my humble opinion the rate you quoted is low which is why I had the Pacemaker fitted in the first place. Good luck

[Tigger_2 in reply to opal11uk]

I have heart block and a pacemaker since 2005. Not the same one obviously.

Now, the pacemaker isn't controlling ectopic beats and I often fall back from the 70-BPM minimum setting to less than 40-BPM. So far, one blackout and several involuntary falls due to the low blood pressure.

My 1.25-mg Bisoprolol daily has been hiked up to 10-mg and still the symptoms persist.

I don't understand the logic. What's really needed is for someone to look into why the pacemaker isn't doing it's job but getting anywhere with the local NHS cardiology people is proving a frustrating, long exercise.

[opal11uk in reply to Tigger_2]

I agree with you, once your paced your heart rate should not fall beneath that figure so I would go back to the Cardiologist and ask the question, maybe the battery needs changing etc., good luck x

[Tigger_2 in reply to opal11uk]

Hello

They know about it, but no explanation so far and nothing from the hospital 30-weeks after it started.

The battery is fine, but I'm very cautious about what they tell me as pacemaker number one failed on me in 2016.

If you want to spoil your day, get your PM technicians to let the battery fail by squeezing the last millivolt out of it.

Emergency ambulance and PM changed the next day. Good job I had nothing planned or was halfway across the Atlantic..

Wasn't best pleased.

[bantam12 in reply to Tigger_2]

Presumably you have had a pacing check ? the pacing techs should be able to fast track you if they see anything worrying on the pacing download info. If I have an issue with my pacing I call the techs direct and they book me in for a check.

I’m currently having an issue with my pacemaker where my rate is dropping just below the 60 it’s set to so will see what they find.

[Tigger_2 in reply to bantam12]

Thanks

Done the check in person and via bedside monitor.

Each time I get "pacemaker is working fine".

The trouble is there seems to be a disconnect between me telling them what's wrong and them passing it onto the consultants.

Frankly, I'm fed up with them. It's one of the reasons I'm here.

I have at least a decade of heart rate readings and they all follow the set rate. The rate was 60 and was raised to 70 BPM this year. It occasionally went to 59 or 69.

Since January 2023, I've been getting below 40-BPM and it makes me feel unwell.

The hospital knows about it, the GP knows about it, but that's as far as it goes. The consultant wrote a short note back to the GP with "ectopy".

They've fiddled around with rate settings and taken me off Atenolol and put me through Bisoprolol from 1.25-mg to 10-mg daily.

I have a Medtronic on DDDR. I have some electronics and programming experience and my guess is that the extra ectopic beats interfere with the PM timing and "fool" it into thinking it's delivering the right rate.

The hospital knows that they need to locate the foci of the ectopics and maybe ablate them. It's just the lack of communication.

I have a theory that there's some bad blood in my regional hospital and cardiology is not a happy place. I won't name them, but over the 18 years I've been seeing them, the technicians, not the consultants who I've never seen since 2005, have become increasingly detached from the patients and that culminated with the face to face clinics disappearing altogether. It used to be local and friendly, now it's not.

The bedside monitor arrived on the doorstep and that was that. For what it's worth, even the bedside device failed after one year.

[bantam12 in reply to Tigger_2]

I’m pretty fed up with my cardio clinic, the consultant changed my meds and discharged me off the list with no follow up at all, that was 2 years ago and apart from the pacing techs who are very good, I’ve no cardiologist despite ongoing problems. One minute he was saying I need another angiogram next breath off you go and don’t come back ! The whole system is a shambles with nobody communicating even the simplest information, it’s left to the patient to chase everything.

I had to have an MRI 2 weeks ago so my pm was set to safe mode then reset and its since then I’m getting constant ectopics, pauses and a few readings below 60. I’m sure when it gets checked again they will say all ok but something isn’t right and I wonder if the MRI has somehow messed my pm up.

I wish you luck in getting somewhere, not easy.

[southkorea]

yes. !! Go to the top x

[Vonnegut]

Definitely! 1.25 of that stuff was too much for me and if that is your pulse rate cut down on the stuff immediately!!!

[JOY2THEWORLD49]

Hi

Please check .. but I thought that you should not take BBs Betablockers if you have had or have heart failure.

cheri JOY. 74. (NZ)

[JOY2THEWORLD49]

Hi

I do too think Steve is wrong in thinking GPs are the 'cats in pyjamas".

From Stroke with AF in hospital my first med was talked about. I was discharged with Metoprolol which I said no to.

Any amount of persuading a known Locum to change was not effective even though I was breathless, fatigued and couldn't sustain any sort of exertion. Mind you he made me have driving test even though I had waited the 4 weeks to drive again. I had to wait another 6 weeks. Bty the way the instructor/testing person gave me 10/10.

I demanded to see a Heart Specialist at 1 year 3 mths. Saw a lady who changed me to Bisoprolol and said that for AFers this is the better med. Doesn't usually interfere with breathing.

Still left me on avg heart rate of 156 down from 186.

No Gps and some specialists dont follow through.

A private Heart Specialist who also had worked at the public hospital introduced CCB Diltiazem. Best med ever for me. A reduced dose to 120mg AM and BB Bisoprolol 2.5 PM control H/R and BP.

GPs or our Public Heart Specialist left me uncontrolled for 2 years 3mths. Angry yes. No followup from Stroke just for the Thyroid Cancer which I was internally looked after.

One needs to find right Heart Specialist and an understanding GP.

But I have found a 80 year old Locum doctor. She has had AF and she is interested in me.

Its no good a GP who simply lowers the dosage of a med given by hospital. Or up it.

cheri JOY. 74. (NZ)

[JOY2THEWORLD49]

Hi

Yes we are talking about us as AFers.

Specialists prescribe according to your heart problems. AF just one of them.

Drs do refer AFers to Heart Specialists. But they tend to put existing meds up or down and do not change them like BB to a CCB. It was pointed that H/R was not controlled. It needed sorting, an introduction to another med as ablation was out because ECHO showed an enlarged chamber.

You have no idea how I felt with 187 H/R and then 176 H/R on the changed BB.

No quality of life and GPS then weren't listening to me. One said that I should stop the Metoprolol - then I was not on anything else. My Chemist I talked to said "no way". As my usual Dr was on holiday I had to return to this other Dr. I told Him that I decided not to stop M... against what he said. He replied "Just as well because the last patient he told to stop landed in hospital within 4 days later".

GPs I understand who don't specialise learn across generally all the facets of medical conditions. Specials do another 3 years in their specialty. That becomes a more intense learning.

cheri JOY 74. (NZ)

[2learn]

yes see heart consultant as low pulse can be indication of something more serious. What was your regular pulse before taking bisoprolol, it could be your dose needs moderating.

[Qualipop]

I was just in hospital for 4 days with arrhythmia. They wanted to give me bisopralol but I'd already had problems with it dropping my heart rate much too low after my heart attack so they prescribed something else to which i turned out to be allergic. This happened after I got home so I had to ring my GP. He contacted cardiology who suggested another drug b ut as my GP knows how badly I react to drugs, he did his own investigations and wrote back to cardio and advised me to take nothing. I wouldn't have taken that advice from any other of the GPs but this one knows my history in detail for many years. Had it been any of the other GPs I would have ignored them and gone back to cardiology. You need to be VERY certain of your GP and if at all concerned or unsure, get straight on to cardiology.