I have posted around this topic before, but am in need of help really. I am 56, morbidly obese, most of the weight on my bottom and legs. Arthritis has made walking difficult and so chronically unfit. I take bisoprolol (varying), flecainide 200 mg, omeprazole 20 mg daily.
4-8 wks ago HR 120-130 in Persistent AF and sometimes flutter. 3 episodes where walking I suddenly couldn’t breathe. 2 of these episodes after ‘meals out’ where I was suffering from severe upper abdomen bloating. One episode caused me to go to Aand E where I was checked thoroughly and told it was Intestinal Colic or reaction to bisoprolol. It was not heart or lungs.
3 weeks ago gastric bypass refused at point of surgery because of HR and they noticed breathlessness on walking. Went to GP about breathlessness, they didn’t examine me just said it was AF. Also spoke to an arrhythmia nurse who said it couldn’t be the bisoprolol because that only affects people with Asthma. They said it definitely wasn’t AF as I had never been breathless before. Upped my bisop to 10 mg/12.5 if needed. I was walking round the block daily (huge improvement) and doing exercises and so gaining flexibility.
About a wk later I had a blip, a few days of overwhelming depression and I ate stuff I hadn’t eaten in years. For some idea, I am highly sensitive to pesticides and preservatives so I grow our food, keep chickens. We don’t use food shops at all. I had some Chinese takeaway, I had some wheat flour, I had some sugar. For the first two days, no effect at all. Then it kicked off.
Tues. Noticed hr had reduced from 120/130 to 85/95. 10mg bisoprolol had worked.breathing problems worsened struggled to get round house. Very swollen and painful stomach, diarrhoea.
Wednesday. Breathing so bad had to stay in bedroom. Too out of breath to get to the bathroom. Wed night could not lie down because couldn’t take a full in breath. Noticed that I had a temperature. Stomach very bad as yesterday. Tested for covid, negative.
Thursday. Stomach eased slightly, breathing slightly easier. left room and came downstairs, pain going away. Breathing slightly better. I could manage maybe 20 steps. That night my breathing in bed was easy, but I had a temperature and took paracetamol. Realised I also had very bad hayfever symptoms, mainly clogged nose, throat and post nasal drip made chest feel very congested. Wondered if I had a chest infection. Phoned surgery, told if emergency to go to hospital. Appointment for 20th to see a locum again.
Friday. Stomach much better. Still with diarrhoea. Chest bad , felt heavy. Walked into garden. Very noticeable that as soon as I walk a band of my stomach running just above my navel (poss transverse colon )goes tight and hurts a lot. As this happens my breath stops. So I walk fine 20 steps, sudden swelling, pain, breath goes. That evening noticed something that had happened before. I can’t walk 20 paces outside without stomach swelling/ breath going,but I can now jog on the spot for over 200 steps. Had a good nights sleep.
Saturday/yesterday - terrible. Still couldn’t walk more than 20 paces without stomach spasming. Post nasal drip bad and very noticeable pressure in chest and back. Warmth in oesophageal area suggesting bad reflux ( I don’t feel the pain of reflux). Voice very hoarse, suggesting reflux. Before bed tried the on the spot jogging and various exercises. Again they didn’t cause breathing problems other than expected. During the night I awoke and was unable to breathe in. My breathing was slightly laboured all night - I couldn’t breathe gently. This morning my oesophagus feels clogged and I feel acidy. My chest is mildly crackly.
I have never had a chest infection or lung problems. My obesity ( I have been heavier) has never caused breathing probs. Nor has my AF. My food sensitivities have caused short term bloating /shortness of breath a lot - they go hand in hand because there isn’t enough space in there. The hurting transverse colon stopping breathing has happened before has caused breathlessness and malaise but never this bad.
hr today 90.. Spirometer reading normal. Blood sugar 5.2. I have ordered an oximeter to arrive today. I can hold my breath for 55 seconds. I am slightly clammy. My aches and pains have gone. Light slightly phlegmy cough.
I’m sorry for such a long post. I feel hung out to dry by the doctors and I am quite frightened. My most likely scenario is severe gut inflammation and bloating affecting lungs and causing slight fever. Plus normal hayfever/spore allergy for this time of year causing throat irritation. I do get this twice a year. But I’m just guessing
My question is a), how likely is the reduction in AF heart rate, likely to be the cause of the breathlessness and b) does it sound like the breathlessness is caused by bisoprolol ( or flecainide)!.
Or if anyone has any other ideas why I can’t walk and breathe at the same time,,,.
if you got to the end of this, thank you.
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Rhiannonimity1
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I've never been overweight, but one night I had problems with breathing like you and it was a lung infection which turned to pneumonia.
Now come on you know the cause for a lot of your problems is your being morbidly overweight. Please, please eat less and you will be amazed at how much better you will feel. I lost a stone when poorly and to be honest felt so much better for that. Imagine to yourself re your weight just how many bags of sugar you are carrying around with you. You need to be living and enjoying life, not anchored and unfit by your weight.
thank you Jean. I always appreciate your sage replies, but in this case I do want to clarify a little. For a big person it is rarely as simple as just cutting down. There are so many other factors. I personally feel I have a daily fight not to put weight on and I only eat organic meat and eggs, homegrown veg and I trade eggs for a bit of cheese, butter and other dairy. As my food blip shows, if I eat other things they can make me really ill.
Well, I’m 79! We ( only my husband now) don’t grow all the veg but we do keep chickens and they provide eggs, which we eat as well as a little oily fish and lots of fruit, much of which is home grown though some bought as well as other veg.
It sounds as though your diaphragm is being paralysed when you walk? My husband hurt his back, trapping a nerve which controlled his diaphragm. He woke up unable to breathe and was turning blue, very scary! Who knows what your excess weight is pressing on? As Jean says, there is only one answer to your problems. Hopefully the consequences of your binge will encourage you to stick to the diet…..
Perhaps intermittent fasting would be helpful to you in losing weight. It has worked very well for me along with appropriate food choices and exercise. No calorie counting, weighing or portioning food, etc.
As for your current situation it is dangerous for healthcare personnel to basically ignore you. Sometimes we have to be the squeaky wheel to get the help we need.
thank you Nezzera. I actually only eat between 12 and 6 so IF for 18 hours a day. I think it helps me to maintain my weight, but sadly no weight loss. Having worked for years with dietitians it just seems my metabolism is very low/ efficient. I run well off low calories. 3 years ago I was also working full time as a gardener and was running about 3 stone lighter than now, but then I got arthritis and I can’t walk very well. The lack of daily physical exercise has really taken its toll.
That’s interesting, did a dietician tell you to do that? Because I would have thought you are effectively putting your body into ‘starvation mode’ where it hangs onto every scrap of nourishment.
Hello Buffafly. Yes and it was an nhs dietitian this time and they were French, newly in the uk. They recommended low carb 70 mg and IF. I have stuck to IF since then. Low carb comes easy to me as I can only eat what I grow, so potatoes and a little corn are my main carbs - although this year I have grown quinoa and amaranth - quite proud and excited.
I hear you Rhiannonimity1, that’s how I gained the weight. Hypothyroidism and low metabolism. Finally got the thyroid medication dose closer to correct. It’s quite a battle since GP just goes along with the very wide range of TSH.
And, that is an awful long time to go without food daily.
Keep pushing forward to get it right. It shouldn’t be such a struggle.
Not saying its a silver bullet but my wife when dieting struggled to lose weight when on Bisoprolol. When she was switched to Nebivolol she started and continues loosing weight.
She's still loosing weight but that will never cure her AF but maybe, one day, people (medics) will see her as a person with a heart problem and not just another 'fat person who brought it on herself.'...sadly that quote was uttered directly to my wife by an NHS consultant cardiologist .
Very sad. But if you are bigger it is a common thread. You brought everything on yourself. Bisoprolol doesn’t help with weight loss. Neither do many of the heart drugs - flecainide for example.
Thanks Rhiannonimity. Sorry that my comment seems to have highjacked your post. I'll refrain from continuing that subject here. Wife was on Bisoprolol for over 4 years so know where your coming from.
That’s appalling! I have never been overweight in my life but I have paroxysmal AF , I think as a result of a shingles episode when I got the pain before the rash and couldn’t get an appointment for nearly two weeks! It has also resulted in chronic fatigue! Mind you, the EP I saw privately, after the GP proved useless, didn’t think I had it at first and guess that might have been because I wasn’t overweight etc!
So sorry you have this problem with weight. I don't have a problem with being overweight but occasional gut problems. Have you read Dr Michael Mosley''s The clever guts diet? There's a section in there on achieving weight loss. I am not on commission!
I used Dr Mosley 's F plan Diet 2013 lost 4 stone,it retrained my way of eating and diet,had always had weight issues, anyway now2023 still weigh 9stone not 13 and feel so much better.Do give it a try,but be patient weight slowly off as you retrain your habits,it took me 1year.
Thanks for the recommendation. I’ve never been overweight but I’ve just started on some powders that are supposed to be good for the microbiome in an attempt to sort out my digestive problems and have now signed up to get the recipes hoping they will be all I need before the powder runs out!
good morning , your post really resonated with me as I too am overweight and it’s a constant battle to maintain , let alone lose weight . My own personal experience with bisoprolol is that at 10 mgs I really couldn’t function , walking was so slow and laboured , whereas I am normally very active and hike , swim regularly . This was only for 6 months prior to my first cardioversion . I have since been on varying doses and currently on 2.5 mgs with dronedarone as an anti arrhythmia drug . I asked if I could be reduced to 1.25 but my heart failure nurse said this wouldn’t be sufficient due to being heavier . My reason being I still can’t walk up a hill without being breathless and it feels different to being out of condition . So I have a feeling the large doses of bisoprolol may well be adding to your SOB . It sounds like you eat very healthily and within a very small window so no idea how you could eat less !
Wishing you all the best but please get checked out again , don’t be afraid to be a nuisance as it’s your life that is at risk x
Hi Ossie. Thank you for your reply. Over the last day my gut issues h@ve eased. I no l9nger am really bloated. I had a terrible night last night. I couldn’t take a full breath. What you say about bisoprolol is really interesting. I am really fatigued as well. Thank you.
I used to get breathlessness with AF which would be worse when heart rate went over about 120.I also had terrible breathlessness with bisoprolol. Couldn't even tolerate 1.25 mg. Was given inhaler which I was using regularly despite not using one for 20 years before being prescribed bisoprolol. Haven't used it since coming off it.
I think this may need further thought on the part of the prescriber. Obviously you need to keep your heart rate down but there might be a better medication for you.
I think they could also be offering you advice and help to get more active. As you say, this is something you are struggling with.
I find it very disheartening that everything gets put down to your weight. Of course it will play a big part, and you know that too, but that doesn't mean that other factors should just be disregarded. And it's not simply about food, as you point out. Though again, obviously, this plays a big part.
Must be very tiresome for you and probably quite unhelpful overall.
I once saw a cardiologist whose primary advice was to lose weight and made me feel quite ashamed. I've always been within healthy bmi range, exercise daily and eat healthy but I had an underactive thyroid that caused a 2.5 stone weight gain over a relatively short period. Lost it all (with a lot of effort) once on thyroxine. The annoying thing is it was the drugs they gave me (amiodarone) that caused the underactive thyroid. And I could not exercise due to the bisoprolol, so I felt somewhat powerless at the time, and made to blame. Not a nice feeling.
Thank you for such a lovely long, positive reply Full of Heart. After a bad night I do have a gp appointment this morning and am going to say I want to come off bisoprolol. I will ask for another medication.
Hi Rhiannon , two things come to mind here neither of which are related to weight you’ll be pleased to know! (I happen to be a healthy weight and was very fit until I got AF).
First off, recent humidity here In UK has been very high. I am struggling with breathlessness even at night which is not normal for me. I have had to cut down the amount of walking I do in the day, and I’m more breathless than normal on hills. The humidity is worse for me than the heat. I have heard from others with AF who can’t tolerate humid conditions.
My second point is equally anecdotal, but I have heard that the new strain of Covid is less responsive to testing. My sister is convinced she had Covid recently as she was around people with the illness, but twice she registered negative. Maybe we are using old testing kits that are no longer so reliable!
Regarding weight - I understand telling people to lose weight is like telling someone with chronic fatigue syndrome to buck up - it’s like an illness in itself. It sounds like you’re doing everything you can. I was only able to lose weight by doing so very slowly over several years and it involved (an easy) change in diet rather than calorie counting. I used (and paid for) the Second Nature programme which is recognised and recommended by the NHS.
Hi Rainfern. This is really interesting, thank you. I hadn’t thought about humidity. Maybe pollen count or pollution. I have also been told that people with asthma or copd have been struggling around here. My mums gardener couldn’t work on Friday because ‘the air was too thick’.
My fever, stomach issues and upper respiratory tract problems went away yesterday, although I still have post nasal drip a little. It could well have been covid or a nasty virus.
I to am over weight about 5 stone, on bisoprolol I really struggled to lose weight, plus suffered with breathlessness. After my hybrid minimaze my bisoprolol was reduced to 1.25mg and I started to lose weight not much but some, plus my breathing improved so able to walk more.I then got a nasty chest infection which really set me back by about 4 weeks, my breathing deteriorated and weight went up a little. Last Wednesday my bisoprolol was stopped completely, my breathing has improved massively and weight is again coming off. As an aside for the first 3 days after stopping bisoprolol I suffered terrible anxiety and palpitations, not sure if this is just me or a common side effect of stopping.
I am always breathless in Af. And as Rainfern has said, the weather has been so humid and hot it's a struggle to find enough air sometimes. Best wishes.
hi 4 chickens ( I am 29chickens) . I am happy for you that your breathing has got better you must be so relieved. It is interesting to hear how much impact bisoprolol has.
Like you I am in that delightfully named ‘morbidly obese’ category and like you, I have experienced a little of what you mentioned albeit not as severely.
Several years ago I experienced a period of about a week where I felt like I needed to take an extra breath, like breathing normally wasn’t satisfying my oxygen needs and that this happened all the time regardless of what I was doing. I went to the GP who said it was probably stress. I didn’t feel stressed and so couldn’t accept the diagnosis and did my own research on ‘air hunger’. I found out that whilst there are certainly medical conditions that can cause this, another is that for various reasons we can sometimes over breathe, breathe more than we actually need, and that we develop a kind of muscle memory so that when we return to appropriate breathing levels, it feels like we aren’t breathing enough. To test for this you can try fighting the need to breathe whilst concentrating on breathing slowly but deeply it’s best to lay down and watch your stomach rise and lower if you can repeatedly resist the urge to take an extra breath, it might be that you don’t actually need to and you just need to train your body to breathe slower and deeply.
A few years later though I had another episode. For decades I’ve had problems with my lower back where it would go into spasm and I would be in agony and barely able to walk for weeks and on occasions, months. One of the side effects of this is that my middle and upper back muscles would then try to compensate for the lower back muscles and would eventually tire and get strained causing more pain.
During on episode I noticed I was very slightly out of breath again. Again it felt like the need to take an extra breath rather than being out of breath but as I could barely move with my back at the time, maybe it would have been worse if I was moving around. I was being treated by my osteopath and she noticed that my diaphragm was in spasm, I hadn’t mentioned the breathing as it was so mild. She did some work and over a couple of treatments the diaphragm was released and the breathing returned to normal.
She showed me a few exercises to help with it and doing them certainly aided in the recovery. Basically it was to lay on your back and breath in but to watch your tummy. Initially I could see that my chest would rise but not my tummy. This meant I was only shallow breathing and this required me to breathe more frequently. You then have to concentrate on relaxing the muscles around the diaphragm to allow your tummy to rise and fall. You have to keep repeating the exercise a few times a day because as soon as you take your mind off of it, you revert back to shallow breathing.
I’ve since had this several more times and in fact I can usually spot it before it gets too bad as I realise that I’m clenching my stomach muscles and if I relax them, suddenly I feel I can breathe again.
However, the simple reality of it is that whilst this can happen to anyone, it is far more common in those who are seriously overweight simply because our internal organs get squashed together when sitting and the muscles controlling the diaphragm can’t operate fully. There is also an increased risk of a hiatal hernia which not only can cause breathlessness but also AF so you may want to be checked for that especially if you have other symptoms.
Are they giving up completely with weight loss surgery? Have they said to lose a bit and then try again?
I’ve had 2 weight loss surgeries- sleeve being the most successful one.
Could you ask for a goal to reach? Then you’d know what you had to do? Then tell your heart people you need to get your rate down for surgery.
Eating ‘healthy’ food is not really helping is it? It’s quite simple (the theory). Eat less. I know that is the ridiculously hard bit. However it doesn’t sound like things are gonna improve until you do. It’s so hard to sustain it though so weight loss surgery could help you once you’ve shown them you can do a bit at least? That’s what ‘they ‘ like to see.
I’d make a nuisance of myself at the doctors until they re referred me to a bariatric surgeon and a dietician to kick start things.
Surgery isn’t the long term answer btw but it does get you started and to a place you’ll be able to feel better and gives your heart a chance. Then your hard work starts, keeping it off! All the new clothes and new life did it for me.
Thanks Lord Gabriel. So my bariatric surgery was due to go ahead on 18/ 8 . I wasgowned up when they refused to go ahead because of my heart rate and breathlessness. They said they will go ahead when these things are fixed. My hr is now under 100 bpm (albeit needing bisoprolol) but obviously the breathlessness isn’t. Then I assume I go back on the waiting list.
Great! So there is your goal. Upper body exercises and maybe and change of drug to help ditch the breathless bit. Lots of salad and hopefully soon your day for weight loss surgery will come. What area are you?
I’m so sorry you feel so bad. Have you been checked for Congestive Heart Failure? It sounds like you need a echocardiogram to check your Ejection Fraction. Afib will also cause you not to be able to breath very well. I don’t know what the health system is like in the UK but you really need to see the doctor to get your heart checked out. I have had CHF and afib for along time and I know the feeling of not being able to walk 5 feet before I have to sit down to catch my breath. Your medications may be causing the breathlessness also. It’s so hard trying to figure things out.
Part of cannot breath , might be some of the pills you are taking! I took Ffecainide and now I am taking SOLALOL, THESE PILLS MAKE ME OUT OF BREATH! Talk to your Doctor and ask him if there is something else it could be replaced with! I have AFIB about all the time and it is very difficult and depressing! .
Reading your post triggered lots of possibles as why you are switching from compensating to severe issues…
Forgive the long reply ..
I believe you have reached out to your Doctor several times now on these problems so it makes sense to try and find solutions closer to home.
First is to address the bloating.. and extra fluid in your lower half.. if you were able to reduce tummy issues and extra fluid you would ease some of the more troubling symptoms.
Eating potassium rich foods like bananas will help the sodium levels to drop but more importantly it’s magnesium that helps support this effect… because it is the main switch between potassium and sodium in the cells… eating leafy greens bananas and nuts will help you lose water… this alone will reduce the load on your heart and eases pressure upon the other organs including your lungs.
Bloating is often caused by fermentation… either yeast or bacteria…. eating fermented foods or using Apple cider vinegar will reduce yeast and bacteria …you only need a little 1 teaspoon in half a tumbler of warm water before food…
Long term PPI like omeprazole will lower magnesium and stomach acid which allows yeast and bad bacteria to make its way down below … add anything sugary or yeasty .. will cause further fermentation… hence bloating and pressure on the vagus nerve.
The diaphragm uses the phrenic nerve .. again pressure from swollen water logged vessels can impede your ability to breath deeply which makes you breath shallow and hyperventilate..
Water tablets often fix these troubling symptoms in the short term but will cause loss of electrolytes especially potassium.. you can eat quite a lot of bananas .. the green ones have less glucose and provide fibre below which increase good gut flora if take alongside probiotics.. oats too.
Calcium rich foods can cause imbalances in both potassium and magnesium levels.. so tread lightly.
Reflux often goes hand in hand with both weight and poor fermentation…
If you lay down too soon after a meal( less than two hours after) you will not only cause acid to rise but pepsin.. it’s the pepsin that causes those issues in the upper tube and throat.. you can sip a little sodium bicarb 1 teaspoon half tumbler at night just before bed you may release air and neutralise the pepsin in the oesophageal area.. two or three days max…
Supplements with chlorides like magnesium chloride … help the LES to tighten.again only after food not before 1/2 teaspoon is enough in powered form in a little water.
Lastly the LES is the valve at the top of the stomach… it works better when you increase melatonin in your diet… walnuts can help or 1-3mg melatonin before bed… when we are young our bodies make melatonin easily.. as we age not so much.. this retrains the LES to close at night… sleep propped up …until things settle down.
The vagus nerve supplies the stomach the lungs the heart.. and any undue pressure laying left or right will impede so “find” your most comfortable position.. avoid any antagonists…. once you gain more control you should focus on losing weight by intermittent fasting 16 hours without food … black coffee first thing with a healthy fat (butter, coconut oil)this increases the first burning principal the body uses in fasting mode.
There are lots of other things you can introduce as you turn things around but I would research water retention first.. deal with bad fermentation.. increase magnesium and potassium.. begin a regular walking plan as you gain progress.. no hills no heavy shopping… easy does it.. I really hope you find some ideas to help move towards health… best wishes UK.
Wow Jomico. Thank you so much for such a detailed and well- considered response. Will sort the water and acv tomorrow. It will probably take me a couple of days to fully digest your reply. Thank you so much
Your weight certainly isn’t helping I need to lose weight as well try to cut gluten out if you can I have all those symptoms when I eat gluten, I am gluten sensitive, but I find it hard to give wheat up. I am plant based vegan and have tried to cut out junk, if you can cut out all fats and dairy I lost 2 stones that way.
UPDATE. I went to see the gp today. He thinks it is a hiatus hernia/ diaphragm issue. He sent me to the hospital for a chest X-ray and next week I have an appointment for a blood test to check for heart failure. If those are ok - he will write to the bariatric surgery people and ask them to urgently put me back on the list. He confirmed my heart rate was 84 (brilliant). The bariatric people will do a hernia repair at the same time as the bariatric surgery. I am to keep active, set off slowly when I start to walk and walk really slowly until I ease into it.
I am so glad that the GP has given you a possible reasons for your problem and that you can now see a way forward. I always need to be given the Big Picture so I know where I am going. Good luck. X
You been through quite a lot… hopefully the tests will pinpoint the reasons for your symptoms…so you can fine tune a treatment plan… I know losing weight is more difficult if your metabolism is slow so do not get in a low way… be patient … you can turn this around… have faith and never give up.
My wife hasn't had hay fever for years and yet this year has had it quite badly despite taking anti histamines. It has resulted, as it often did before in some congestion which in turn has caused a lung infection so she is on antibiotics - last dose today. If your lungs sound crackly it is likely an infection (which it sounds like in this case) or fluid on the lung so either antibiotics to clear up infection ( if it doesn't clear on its own - if you are coughing up clear phlegm then likely it is not an infection but if coloured - usually yellow, green or brown then it is likely you have an infection so go to the GP) or water tablets such as furosemide to clear the fluid. I found bisoprolol made me breathless and I am not asthmatic so bisoprolol was stopped and I just take Apixaban anticoagulant. I did have a go with calcium channel blockers and a mixture of all sorts of rate control medication but all made me feel worse than the AF on it's own.
I hope you are doing your level best to lose weight. I know how hard it is when you have mobility problems but the biggest thing you can do to lose weight is eat less and if possible exercise more but the main rule is that the calories in should be less than the calories out. I understand too that whilst doing this at times we can "fall off the wagon" when we feel depressed or something happens and eat the food we crave but so long as we just leave that blip behind and then continue to eat sensibly and eat smaller portions we can carry on and lose that weight.
Take care of yourself. Maybe ask if you can be referred to a dietician - I seem to remember I answered a question a week or so ago saying that friend of mine many years ago did this when she found she just couldn't lose weight despite a strict diet and found that she shouldn't eat anything with yeast in or artificial sweetners - she carried on on a calorie controlled diet and then lost weight by cutting those two things out. You also may find that a gym near you does special classes for people wanting to lose weight or for people with Heart problems or mobility problems which may help you.
forgot to add in my first post that if you have hay fever we have been told it is also best to avoid eating any products from animals who eat grass so through the summer my wife always eats less dairy and meat. We eat very little meat any way usually eating pulses and stuff. Also milk is bad if you suffer with a phlegmy cough as this can cause more phlegm
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AF and breathlessness
What's AF like? Well...
Recently diagnosed with Persistent AF
