Bradycardia and beta blockers

I’ve had two cardioversions in the last couple of years but have just reverted to AFib again in my sleep waking up with it and a heart rate in the 50’s. My heart rate historically b4 I started with AFib 3 years ago held at around 72bpm as I was fit and active but now I’m lapsing into the bradycardia range more often and waking up with a low heart rate between low 50’s and low 60’s. I have been diagnosed with sleep apnea but was unable to tolerate the over face mask. (Requests for a nose mask go nowhere). I have sourced and wear soft silicone dilators in my nose when sleeping. The thrust of my question is whether taking a beta blocker is helping or hindering in these circumstances?

[pottypete1]

I don’t think you should be worrying with your rate only going down to circa 50bpm.

My EP took me off betablockers because I was experiencing a slow heart rate. To put it into perspective my heart rate was slipping into the high 30s and even now after stopping Bisoprolol my resting heart rate is still regularly in the 40-50bpm area.

However if you are at all concerned talk to your EP to get professional advice - we are all different.

Pete

[Hidden in reply to pottypete1]

Thankyou for that Pete - Puts things in perspective.

[mav7 in reply to Hidden]

Good advice from Pete. Do talk with your EP about your concerns.

HR in 50's, 60's seems not unusual when waking.

May want to ask your EP about wearing a holter monitor or other medical device for an extended period including while sleeping.

[Hidden in reply to mav7]

I am struggling with the concept of taking beta blockers when I am already registering 50-60bpm (all my life which was very active I was 70 bpm so why isn’t reaching that bpm the target instead of beta blockers and bpm of 50?)

[mav7 in reply to Hidden]

Your EP can answer your concerns.

But do ask about wearing a holter monitor for a continuous period. This would ease your mind and provide valuable input for you and the EP.

If you do not have, may want to invest in an Apple Watch or Kardia to help you monitor your heart rate. But the holter monitor or another medical device would be best.

Best to you !

(If it is any consolation, many, including myself (avg HR 80), wish we had a HR in the 50-60's )

[Hidden in reply to mav7]

I’m having a telephone consultation with a doctor on Wed so will ask him. I have a 6 lead Kardia which is very helpful.

[JeanetteH]

My heart rate is about 50bpm due to beta blockers.I have a pacemaker to stop it going below 50.But I also get atrial flutter which was 150 bpm maximum .Ive had 3 ablations and a cardioversion recently but reverted back to a fib after a couple of weeks.I have paroxysmal a fib and atrial flutter.I have wondered about sleep apnoea as I read it is often the cause of a fib and most of my episodes are in the night but my last episode was early evening when I had a chest infection. Cardiologists have suggested I have an AV node ablation and I am considering this since it would leave me drug free except for the anticoagulant.But yes the betablockers slow the heart rate down.I had to stop them before my last PVI ablation and after 4 days had AFib but you have AFib permanently so the drugs are not working.Im on Sotalol but was on Bisoprolol before which wasnt working.I think the body gets used to the drugs after a while but if heart rate is slow the doctors dont seem to be worried about it when my heart rate was 80 but irregular they sent me home from hospital and I was told perhaps I could learn to live with it but I went into atrial flutter 140 bpm within a couple of days and had to have a cardioversion.

[Hidden]

I don’t honestly want to take beta blockers if I can help it. I’ve always been fit and active with bpm holding at 70 until I got AFib (in lockdown may I add so the onset could be stress related. It seems counter productive to take beta blockers when my bpm is now 50-60 and perhaps I’m better off with stress relief meds.

[Popepaul]

Pre afib my HR was about 56 sleeping and about 75 when awake and at rest. During afib my HR goes to 120 to 150. As you know this high BP causes fibrosis within the heart. Bisoprolol can help to avoid this tachycardia and hence reduce the subsequent damage.I have been taking bisoprolol for 6 months, my HR dropped to about 52. I felt comfortable like this but it did reduce my capacity for vigorous exercise.

I recently titrated down from 2.5 to 1.25 mgs. My resting HR has gone up to about 65 and I feel fine at the moment. I will increase the d osage if the frequency of AF increases.

I think that bisoprolol is efficacious but I seek to optimise the benefits from a minimal dosage.

[Hidden]

illustrates how different we all are in our responses. I feel terrible if my HR is in the 50’s. Also I’m intolerant of Bisopropol.

[Popepaul in reply to Hidden]

You are right, we are all different and the subject matter can be complex. There is no miracle cure.I note that you have referred to stress and possible stress relief medications. I would avoid this approach. Many anti anxiety drugs are addictive and are unhelpful in the medium to long term.

Deep breathing, yoga and mindfulness is likely to be a better option.

Regards and good luck.

[Hidden in reply to Popepaul]

Thanks for advice but the stress I refer to was when I was in lockdown on my own. On the heels of this I put my house up for sale and moved - a very stressful time as many would agree I think. I’m not reliant on any other medication than that strictly necessary for an under active thyroid and AFib. Currently my local GP practice is so shambolic in the management of my repeat prescription that some stress is inevitable when they can’t follow a 28 day cycle (even with the aid of a computer) give me former meds that are no longer on my repeat prescription, and, without consulting me, stop a medication. Needless to say after a year of this I have the forms to join another practice!

[Popepaul in reply to Hidden]

I hear what you are saying about your dissatisfaction with your GP. Any interaction with health services is stressful, this is especially so given the post covid shambles that seems to prevail.I also recently changed my GP due to a lack of response and treatment. This is despite diagnoses of afib and proste cancer within the last year. I have been unable to get any appointments.

Luckily I have had sufficient savings and this has enabled me to receive private treatment and advice.

For repeat prescriptions I recently started to use the NHS app. It has worked well to date.

Regards

[Hidden in reply to Popepaul]

ditto on accessing private health - it was the only way I could have a Cardioversion in a reasonable timeframe. I also pay for private blood tests for hypothyroidism as the NHS guidance on testing is a joke!

[Popepaul in reply to Hidden]

It is unfortunate that so many people are now forced to go down the private route. I am sorry to say that I do hear lots of accounts from friends/associates about a general inability to engage with health services in a timely fashion.I used to work for the NHS and I always took the view that all clinicians are doing the best they can in difficult circumstances. It helps me to plod on.

Regards

[Ppiman]

I used to take bisoprolol as and when needed for infrequent AF and mild tachycardia but this year I have started taking it daily (1.25mg) with success so far. The problem is that this drops my resting rate at time to below 50bpm. The cardiologist I saw was fine about this however if it was not symptomatic.

A friend has been using a C-PAP machine for years now and swears by it, but I would struggle as I have a stuffy nose much of the time. I gather the drop out rate is enormous with them.

Steve

[Hidden in reply to Ppiman]

I do have unpleasant symptoms when my HR drops below 55-60 unfortunately which affects every aspect of my day to day as I feel so awful with aching type discomfort from my throat down into my windpipe. I was tried on a CPAP machine with both a full mask and a half mask - both of which made me claustrophobic and I pulled at them in my sleep. I’ve invested £££ in a nose mask but can’t get the nhs to give me back the machine that delivers the air. SO FED UP!☹️

[Ppiman]

I’ve had years of insomnia with nothing that improves it and now worsened by night time loo visits, so that feeling of being fed up is one I feel often enough. Life can be hard going.

Steve

[Hidden in reply to Ppiman]

Too right! Comforted to know I’m not alone in my nightly wandering to the ‘little room’ 😂

[Ppiman in reply to Hidden]

I've just been swapped from alfuzosin to tamsulosin and I had high hopes but, no, worse at night if anything even if good in the day. It seems to me that as soon as my body turns horizontal, the problem starts. There seems to be some kind of connection with constipation, which is another bugbear I always need to keep on top of.

Steve

[Hidden in reply to Ppiman]

I too suffer from constipation no matter how much attention I pay to my diet😕

[Ppiman in reply to Hidden]

I've been a sufferer for years and was told once after a colonoscopy that I have a convoluted and long bowel and that would likely be the cause. Such fun. The doctor that I saw for my prostate troubles told me to avoid constipation like the plague, ha-ha.

However, I have found a way: a daily glass of Sunsweet prune juice with breakfast, with about eight sun dried prunes, stewed in the same juice. It works truly well and is at least a natural treatment. Sunsweet is the best prune juice but Tesco have stopped selling it now and the Benefit brand they still sell is thinner and less consistent, so more is needed. If I ever find the prune method doesn't work, then I take either a laxative dose of Milk of Magnesia before bed, or Andrew's Liver Salts at breakfast. They never fail and, again, are a reasonably 'natural' treatment.

I have a regular monthly order of sun-dried Bulgarian prunes from Amazon. They are by far the largest and nicest prunes available, being naturally dried, large and juicy (after being gently stewed): amzn.eu/d/5PYE1B3

Steve

[Hidden in reply to Ppiman]

Thanks for lots of good tips Steve👍 I do get prunes in (not as often as I should I suspect) as well as beetroot (mostly summertime in salads) and bran based cereal. I buy most of my books on Amazon so I will now have to add prunes to my order! I’ve rarely taken over the counter aids as I think it’s better to treat naturally. I’m not discounting them as sometimes circumstances could disrupt normal diet. Have a good day! Diane

[PleasantPink]

That is a desired effect of Beta Blockers for heart rate management, a lower rate would not be uncommon. Now as to if you need to be in that lower range only your doctor can prescribe. I see you have a consult with your doctor this week. Good Luck. Make sure you say how you are physically feeling when the rate is that low.

[Hidden in reply to PleasantPink]

Thanks very much for your supportive words🙂