Hi, I have been on beta blockers and blood thinners now for 5 days for AF. The beta blockers have slowed me down where as I haven’t got much energy to do anything. My pulse is 59 beats a minute,
Should this pass as it’s getting me down and I feel a bit flat. The weather isn’t helping.
I went to see my GP last week and she cannot understand why I was given blood thinners as statistically I am low risk of have a stroke so she is going to write to the cardiologist to see why.
Hi, what dose beta blocker are you on? They are well known for making you tired, I couldn’t tolerate them at all. Heart rate of 59 isn’t too bad, do you know what your rate was before taking them? Is your AF constant or paroxysmal?
It’s not a bad thing to take blood thinners, they shouldn’t make you tired, usually given after age 65 for women unless you have a lot of other issues.
Hi Judi,
I am on 2.5.
Heart rate was anywhere between 60 and 75.
No idea what paraoxysmal is.
I am nearly 63 so a bit young.
Hi, paroxysmal just means you have AF episodes randomly that stop usually on thier own, not all the time. I think there is a fact sheet on here somewhere.
My Af episodes last anywhere between 2 to 12 hours and stop on their own and I usually go 3/4 months between episodes. I don’t take any meds apart from blood thinners/anticoagulant.
Everyone has a different experience with AF and doctors all have their own ideas on how to treat it!
2.5mg is a low dose but was enough to make me pass out! But a 93 year old lady I know takes 10mg with no ill effects.
Paroxysmal AF means episodes of AF which come and go often without warning. I’m not medically trained but it seems surprising that you were prescribed beta blockers because your heart rate was already well within range. It’s interesting that your GP appears happy to challenge the need for you to take anticoagulants but not so enthusiastic to query the need for you to take beta blockers. This might be because Anticoagulants are expensive whereas beta blockers are as cheap as chips (used to be!)
Sorry I got the numbers wrong. My heart rate for up to 130 beats per minute. It would only last for a couple of minutes and I would feel dizzy.
Sorry I am new to all this so confusing.
Take your time. Ask questions. You are among friends. When I start a new med I have many weird occurances including seeing things that aren't there. when I started a beta blocker and also when the dose was increased to bring my BP down more. In a few weeks, the secondary issues calm down. Carvedilol 12.5mg 2/day (beta blocker)
My GP has wanted to take me off warfarin and put me on something else. I am not willing to do so, as I have not seen a cardiologist since I had an ablation back in 2014. I have a heart rate between 45bpm and 170 plus bpm, so l expect in the not distant future who knows what will happen with my heart.
Hi there, only just seen your reply. As it’s a bit late, better if I respond in the morning……
Obviously it’s your choice to take whatever anticoagulant you feel comfortable with, there are a huge number of people who are very happy taking it. I opted to change to Apixaban several years ago and have no regrets. I changed because I travelled a lot and found it restrictive following a regular diet and was concerned if my INR was out of range when I got home. Medics, who had no ulterior motives, were saying that there is a slightly reduced risk of internal bleeding and I appreciated the feeling of freedom so for me, it was the right thing to do and I just hope it stays that way!
If I were you, I would consider asking your GP to refer you to see a specialist, preferably an Electrophysiologist (EP) who is a cardiologist who specialises in arrhythmias. I had a Cryoablation back in 2015 and whilst they can be very effective and the procedure has no doubt improved over time, if there were any irregularities with tissue around the pulmonary veins, it’s possible that you might benefit from another ablation. One of my PV’s was irregular and I definitely benefited from a second RF (radio frequency) ablation which I had in 2018.
One thing which is for sure, unless you take the initiative and politely push your GP into action, your current situation is unlikely to improve…..
that’s a bit different!! If the side effects continue to be troublesome, there are alternatives you can consider but you need to give your body a chance to get used to the medication. It’s unlikely that the anticoagulant is contributing to your tiredness……
Beta blockers help some but cause others more problems than they are worth. If your body doesn’t adapt within a few weeks the go back to your doctor and ask for another drug. Everyone gets Bisoprolol to begin with but many need to try some of the other rate control drugs to find one that suits them without zonking them out so much they cannot function.
Don’t settle for what you are given if something doesn’t suit you.
Best wishes.
I was given Dilitiazem, a calcium channel blocker instead of Bisoprolol. It makes me more tired than normal but I have got used to it now. It's one of the options if the Beta blocker doesn't suit you. Good luck
1.25mg of bisoprolol put me to sleep in 40 minutes or so. We are all different in our reactions to drugs/ dose levels!My GP moved me to Atenolol, another Beta Blocker, and that had similar effects with tiredness, and lack of energy although not as bad/ dramatic as Bisoprolol. My GP then decided I did not tolerate beta blockers and moved me to Verapamil a calcium channel blocker. That had no adverse side effects for me. However my Afib progressed and a cardiologist moved me to diltiazem, another calcium channel blocker. This caused some tiredness but nothing like the beta blockers.
So there are alternatives if you do need to move.
There are also other betablockers, but I did not try them.
All these meds are for " rate control"- they act to control your heart rate when in AFIB to prevent it going too high. Mine was normally around 165bpm resting, when in AFib.
Best wishes
I am on Verapamil and Atenolol, flecanide 100mg 2 a day as well so tiredness is an understatement.
Hiya, firstly the anticoagulants are important to prevent stroke your GP should know this. With regard to your beta blocker, it's cardio protective and helps control your heart rate. Generally, you get used to the type of beta blocker over time but do discuss with your GP or cardiology nurses. I use both to help with my AF and pacemaker
From my own experience I would say feeling tired with Beta Blockers is quite normal
Hello Cat,
You might want to talk to your cardio guy about rhythm control drugs like Flecainide. This stops Afib from occurring vs Rate reducers which just reduce the heart rate when you have an episode.
Afib is progressive so keeping events few and far between is a good objective. Rate and rhythm control drugs have side effects so you could discuss a rhythm control drug as a "pill in the pocket" where you take it as soon as you have an event and spend less time in afib until you progress to the point where you need it full time. Personally I prefer to endure the tiredness of the drugs vs being in afib.
Additionally afib strokes are very serious. You should talk to a knowledgeable Dr. before dropping your anticoagulant. You can do your own stroke risk assessment by doing an online evaluation. Google CHA2 DS2–VASc.
This board is a great resource.
Good luck
Hi
Flecainide is a serious med.
Tests like ECHO need to be done to find out if the heart is abnormal in any way.
If given Flec when your heart is abnormal is a big mistake.
My heart is enlarged so no Flec, no ablation, no cardioversion.
cheri JOY
I did not know that, l take Atenolol, Verapamil and Flecainide 100mg 2xdaily and not seen a cardiologist since an ablation back in 2014. My heart rate is between 47bpm and 170plus bpm. I expect they have forgotten all about me. Even though I have been admitted as my blood pressure reading was high 250 for hours. As we all know they only treat what you went in for, and avoid anything else going on.
Hi
I had to look up Atenolol. It is a BB Beta blocker and has side effects. Amongst them is tiredness and hypertension! The toxicity is high because excretion doesn't always happen.
Your range of H/R . Is 170 under exertion?
It is returning to normality is the factor here.
On Atenolol you should be regularly checked.
I have a blood test 3 monthly and I'm on CCB Diltiazem, BB Bisoprolol only for heart H/R and BP. Including PRADAXA 110mg x twice day.
You say that you have had an ablation but it seems you are still taking all those meds.
Alone without Flecainide will help your rhythm I have been told by my Dr.
Regardless I feel much improved with a H/R Day of 60s.
You should be monitored yearly until AF has gone or the symptoms don't bother you.
cheers JOY. 74. (NZ)
It does have a "Black Box" warning in the US. If you can take it's pretty safe and effective. I was hooked up to an IV when given my 1st dose just incase. I got the all clear and it stopped my PAF. It's been in use for 25 years.
Still you are right it is heavy duty.
Hi Cat,
From what I’ve read, your normal HR before you had any Afib, was within range,I.e in the 60s-70s, but in Afib can go to 130s, which is normal for Afib and can go a lot higher for some. Before I was diagnosed a couple of years back, my ‘normal’ HR was similar to yours and I too was told to take 2.5 mg Bisoprolol daily. My episodes of Afib were quite infrequent too. I now take 1,25 Bisoprolol abd 2.5 was too much for me.
Your Resting HR now of 59, isn’t bad at all, but you may find it goes a bit lower still over the next few days, as Bisoprolol is still getting into your system.
If your Risk is only 1 because you are female, you do not need anti coagulants until you are 65 ( I’m 57 and not on them)
I presume it was A&E that dished out the Bisoprolol and Anti coagulants to you? You could ask if it’s possible to start taking 1.25 mg Bisoprolol with your GP? Try and have that conversation soon, as it will be easier to low the dose before too much more gets into your system.
Have you now been referred to a cardiologist at the hospital so that you can have an echo cardiagram investigation done? This should be what they do next.
Hi Teresa, my resting heart beat is 50 at the moment.
I saw a private Cardiologist who gave me the medication.
The meds is making my acid reflux worse. I am on Lansoprazole for a hiatus hernia.
Will have to contract my GP.
Lucky I am off work this week, I have my Daughter and Grandson coming today.
Ah,
It wasn’t clear where you’d got them, but now I understand.
Are you certain that you are still in AF with a pulse of 50? I didn’t realise it was that low now - how are you monitoring your heart rate? Is it irregular and not in rhythm?
A pulse of 50 can make you feel very tired - So it might be that, if you aren’t actually in AF.
There are alternatives to beta blockers which may make you feel better, especially if it’s aggravating other things but you could speak to your GP about that.
If however you are still in Afib after 5 days, this may be the reason they gave you anticoagulants.
You need to see a cardiologist who can help you decide on bisoprolol amount.If your HR is in the normal range, bisoprolol will lower it (below normal) and also reduce your energy level (and may make you dizzy ehen standing, impact your sleep and add weight).
As for your acid reflux (gerd?), there are 3 others your GP can try (pantoprozole, dexitrant, rabeprazole). I have tried them all and found 2 (12hrs apart) works best. Dexitrant worked best (1/day) but not covered by my Canadian drug plan.
I have afib but never notice it.
I take bisoprolol because my HR became regular at 100 (very high for me) but am trying 2.5 instead of 5mg daily because of side effects. Your cardiologist should agree to lower yours for a trial period.
I have paroxysmal AF and I chose not to have an anti coagulant as I was low risk. A few months later I went out of rhythm for about 12 hours, felt ok for a few hours then had a heart attack. All the tests showed it was caused by a blood clot formed when I was out rhythm. Thank goodness the clot didn’t cause a stroke. I take the anti coagulant twice a day now and feel much much safer. (I also take bisopropol and feel ok on it.)
I'm so sorry to hear that.
Hi
If your beta blocker is metoprolol ask your cardiologist to change it low dose Betaprolol which I found did not make me breathless or no energy. Also did not give me pauses at night.
At 70 my stroke with AF happened at night 2am. Later a 24-hr monitor counted 47 avge hbpm at night. I was not on any meds except I have a B12 deficiency.
I understand AF is one count on Chads scale and 1 for being female.
I chose PRADAXA 110mg x twice it has a antidote.
If there is any risk of a blood clot forming the specialist will recommend DOACS the modern anti coagulants.
Talk it over at your next appointment.
Although I take mine daily a missing last March prescription which I had a 3-mth supply he did not believe me and wrote it in his report.
My stroke was an Embolic Ischaemic type. That means the AF irregular heart beat formed a clot which got stuck in my left frontal lobe.
My carotid arteries were squeaky clear but a shadow on my thyroid ended up as cancer and could have caused the AF. 4 months later thyroidectomy and 12 lymphs removed. 2 were affected.
So we all have reasons why we have AF. But some folks do not.
Weigh up risks but specialists usually are the best to make decisions. Ultimately it is your decision. I declined RAI Radio Active Iodine and suppression. I was low risk and it was my decision. 3 years have passed and every year my scan is clear.
cheers JOY. 74. (NZ)
Hi
Correction ...NOACS not DOACS. Anticoagulants.
When I upped my B12 more energy. When I was controlled by CCB Diltiazen down to 88-96 and then 1 year later in 60s H/R rest Day I have even more energy. And I lost 3kg plus I think helped.
I so want my energy back. I used to be first running 100m at aged 40!
I'm telling my group of kids and grands to slow down walking to brunch - perhaps they were hungry too.
cheers Joy. 74. (NZ)
I didn't take the anticoagulant I had been prescribed and had a major stroke resulting in being completely paralyzed on my right side. Please take heed. Also you should be on 5 mg, not 2.5 at your age. I now take my 5 mg tablets twice a day with no side effects. Apixaban is generally very well tolerated and I can assure you that you do not want to end up on a stroke ward like I did, missing a piece of your brain. I don't take Bisoprolol as it made me tired all the time and my consultant said I could stop it as I was controlling my Af with my diet.
All the best.
Roy
Hi Roy,
I’m sorry to read what happened to you, but I think you might be incorrect in saying that at certain ages, Bisoprolol has to be at a certain dose. Some people have trouble tolerating it, even at small doses and a small dose of 1.25mg is still very powerful.
Teresa
Sorry Teresa but I think you've misread my post, I said nothing about the Bisoprolol dosage that either of us were on. My dosage comments were all about Apixaban which comes in 2.5 mg or 5 mg. 2.5 mg is only for age 80 and over although I will stay on 5 mg until the consultant tells me to change. I'm almost 80 now. Sorry if I was not clear on that.
All the best.
Roy
Apologies Roy,
Though in my defence, Cat was quoting 2.5 mg as the Bisoprolol dose she is taking. She’s never said what her anti coagulant actually is (or the dose of it) so I did think you were referring to the bisop.
Teresa
Sorry Teresa, I misread this as being about the anticoagulant. I'm very pro anticoagulant after my experience. So keen to promote them. I hope you understand. All the best.
Roy
Hi Judi,
I am on 2.5.
Heart rate was anywhere between 60 and 75.
No idea what paraoxysmal is.
I am nearly 63 so a bit young.
Of course Roy,
I totally understand. I only wanted to make it clearer to Cat at the end of the day, as she is new to all this.
Best regards,
Teresa
Hi
I did the same as you, Teressa.
We're glad that Roy made clear his statement meaning...
cheri JOY. 74. (NZ)
Why must she write to him -? can't she just phone him and sort it out over the telephone so you know here you stand, she just needs to note the conversation on your file .Seems an awful waste of time to write in this day and age - don't they even conduct consultations over the phone in the UK?
Bisopralol didn't just slow my heart rate, it also dropped my BP to the point where I was too tired to get out of my chair. My GP changed it. Beta blockers and I just don't get on. As for the risk of stroke; mu understanding is that anyone with AF is at risk of stroke and needs what you call blood thinners but they won't make you tired. They are actually anticoagulants. They don't thin your blood even though that's what most people call them; they make it less sticky. You will find yourself bruising at the slightest bump but don't worry about i t.
I’ve long wondered whether a problem with beta blockers isn’t that, taken when the heart isn’t racing, their action, which is then on a “normal” heart, might be to reduce its rate and output a bit beyond what is required to allow enough oxygen to be supplied to the body. I’m not sure of the science being that though. I know that doctors generally like these drugs and seem to feel that they offer lots of long term benefits.
I’ve been taking daily bisoprolol (1.25mg) for some months now rather than, as before, only as needed, but it hasn’t affected me in the way you describe. However, I feel pretty washed out most days which I put down to my insomnia which maybe masks any effects from the bisoprolol. I often wonder if my heart itself isn’t working as well as it might since my arrhythmia started, also. I’m sure many here must wonder and worry about that.
On the anticoagulant issue, you might have been given this as the cardiologist is inclined towards stroke prevention more than the norm or the guidelines. My experience is that individual doctors have their own thoughts on matters like that as the evidence is less than clear.
Steve
Hi
In my experience even 10mg Bisoprolol alone doesn't lower my H/R at rest. 156 avge on 24-monitor Day is not controlled.
But by introducing CCB Diltiazem and reducing to 120mg AM and Bisoprolol 2.5mg PM I have controlled H/R and BP and even allows my 47avge H/R Night alone.
120-124 /. 69. BP. and H/R 60s DAY. Great.
cheri Happy Joy.
Even 1.25mg of bisoprolol a day reduces mine significantly, Joy. You must metabolise the drug in some unusual way. I think some people's livers might vary in the way certain drugs are cleared from the system.
Steve
Hi
I think in my case the Bisoprolol lowers the Systollic 140s - 150 down dramatically then last June yet another H/Specialist that I have a Sod=ft Systollic Heart Murmur.
Bisoprolol 1.25mg was not enough and my H/R rapid was back without the Diltiazem. In NZ we have not a lower dose of Diltiazem than 120mg. Which I am on.
On BB Metoprolol H/R avge 187, Bisoprolol 156 no pauses at night. So 30bpm difference but not enough to control them for me.
Diltriazem 120mg AM first 88-96 H/R avge Day December 2021, November following 2022 in 60s avge Day now.
Interesting, eh. JOY
Was that every night? That's fast. Thank goodness the diltiazem works, Joy.
Steve
Hi
Only 47 avge at Night regardless of med.
Listed 187 and 156 were avge Day rate when I couldn't exert myself at all. The public heart Cardiologist left me uncontrolled. She had the results of the 2 x 24-hr monitoring.
It was then after 10 months of 156 I went private. A H/Specialist who worked at hospital and private.
Thank goodness for him. He sent me a extraordinary Christmas Card last Christmas.
I have his email so I keep him up-to-date. I declined a December 2023 with her and said put me in his (public) list otherwise I will go private but tests public.
cheri JOY
If you're not currently in afib, ask your doctor for a trial off of daily beta blockers.
I only used similar drugs during an afib episode and for a short time after, never on a daily basis in between episodes. No reason to suffer side effects from a drug that may not be helping.
As to thinners, the possibility exists that you were only put on them temporarily right after an afib episode. If that's not the case, then your GP is correct to question long term thinners if you have a risk score that does not warrant taking them. In that case, the risks of the thinners would outweigh their benefits.
Jim
I to have blood thinners and i sometimes question it,but having a stroke isnt worth the risk.so I stick with them.
I am 72 years old and have been taking beta blockers since I was a young mother of 7 with three toddlers. I remember telling my pharmacist that I was going to have to quit taking them because I could barely move. He strongly advised me to continue to take the timolol saying that my body would grow accustomed to it. I followed his advice, and soon stopped feeling that dreadful fatigue. I sincerely believe that my heart would have given out by now if I had stopped the beta blockers. I take 100 mg of metropol every day, and have no side affects. Try to stick it out for at least a month. Best of luck to you!
Whoops! I had three toddlers. It just felt like 7, I suppose!!
Hi
Oh.
Metoprolol with me was the culprit. Started on 23.75 x 3 day then down to 2 and then 1 made me breathless 187 avge Day H/R, and high BP remained. Fatigued and no energy!
The 24-hr monitor showed 2 x 2 secs pauses during night.
My stroke was at 2am when I had no meds and then diagnosed with AF.
But the 4 days later scan of carotids - all clear - showed a shadow on thyroid. 4 mths later had all Papillary cancer out which included 12 right lymphs. 2 affected.
There was an argument that I had to wait 6 months post stroke but my surgeon and anaesthetist said no, a.s.a.p.
Imbrace, an ACE broker made me cough, Metoprolol above banned on my allergy risk.
Those on metoprolol should be changed to bisoprolol where AF is present says the Heart Specialists.(NZ).
cheers JOY. 74. (NZ)
The loss of energy is most likely due to the beta-blockers. As. For the anticoagulants, you’re only a couple of years away from the age where these are recommended on the scoring system.
I suspected AFib for years - strong family history - but it was never caught on ECG. My worry was increased in that both my sisters had strokes - one at 64, the other at 65. I’m ten years younger than they were, and you can imagine how I felt as that age approached. Neither sister knew they had AFib before their strokes.
In 2019 (age 63) I had a retinal vein occlusion - luckily treated successfully. (It was scary as I couldn’t see with the affected eye for a couple of months.) Although I had some blood tests, my heart rate was steady and I was told that I didn’t have enough risk factors for anticoagulants even if it wasn’t. I remember getting quite upset and saying that I felt like a ticking time bomb.
Anyway, at 67 I was diagnosed at long last, and it has rapidly become persistent. This time I got the 2 score points for being female and over 65. I jumped at the chance to take them really, given the family history. Who knows if the retinal vein occlusion would have happened if I had been on them at 63?I guess they need a ‘cut off point’ but there is nothing magically different that happens on your 65th birthday.
I have got used to the Bisoprolol that I’m on for persistent AFib, but I do get tired in the afternoons, and my legs get tired on hills plus stairs. In sinus rhythm, 1.25mg would give me a resting HR in the 40s - I couldn’t have taken a higher dose. Now I’m persistent I take 5mg daily.
Symptoms related to tiredness 
Tiredness & Weight Gain
Extreme tiredness post ablation
PAF and tiredness. What's the connection? 
New to Afib- tiredness 
