I found myself in AF this morning, took my pip meds about 7.30am (150mg flecainide and 50mg metoprolol) I had already taken my morning flecainide of 50mg at 6.30am.
Kardia shows I am now in nsr but I am feeing ‘off’ so checked my bp.
I have taken 3 readings, 10 mins apart.
86/54
89/56
91/59 p55
Is this anything to worry about?
This is the third time in about 5 weeks I have used this pip combination, other times although bp was lower, it didn’t go this low.
Look forward to hearing anyone’s input, thank you
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Tilly1957
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Assuming you were not in AF at the time you took your BP, the readings are likely to be accurate. Given your age and the frequency of your episodes, I think you should contact your Doctor to discuss the possibility of alternative treatments. If an ablation is an option and there is an opportunity to get on what is likely to be a long waiting list then do it, there will be plenty of time to change your mind if need be
BP seems to be slowly moving in the right direction but if that changes you should contact your GP or ring 111
Morning Flapjack, thank you. I have a pre op phone consultation with EP next week, prior to ablation, which I have been told will be 3-6 months after the call. I have only recently seen a private cardiologist who referred me to the nhs for ablation. It was he who prescribed the Flec to take daily, then also as a pip with metoprolol if needed. My bp doesn’t go this low prior to the change of meds. And yes, the af had stopped when I took bp as I realise the readings are incorrect otherwise 🤪
My gp refused to refer me back to cardiology as he said the symptoms from my af weren’t bad enough (weekly, disruption of 4 out of seven days of the week, however the Surgery pharmacist did refer me for a medication review, which is why I saw the private guy as heaven knows when I will get an nhs appointment for that 🤣.
I was diagnosed with paroxysmal AF in Jan 2010. ( Quite some time before PIP's were used as they are today ). During the day my BP dropped from a normal of 136/80 down to 76/50 in a matter of hours. Saw my GP and he sent me to A & E immediately where my HR was clocked at 156 bpm and paroxysmal AF diagnosed and treatment started. I have to say at 76/50 I felt totally dreadful.
Yes John, When I finally got to a ward after my CPR my BP was 60/30 and I was barely functioning despite the pain. 2 litres of IV fluid later it was up to 100/65.
Low bp may be a result of a combination of the afib episode, dehydration and 50mg Metoprolol. Same with feeling "off". So hopefully it will be resolved quickly.
Electrolyte drinks like Gatorade may help it along. If not available, just hydrate with water and eat something salty.
Of course mentioned to your doctor but if they are not concerned, I would not be. Especially if it's a transitory thing.
The good news is that the pill in pocket seems to be working and converting you back into sinus rhythm. I always feel off for several days after an a fib episode, regardless of blood pressure. But I feel less off if I hydrate with an electrolyte drink.
I haven’t had low bp after an episode until I started the flec daily , and only after taking flec/metoprolol as a pip - and this 3rd time it went quite low. I will speak to my gp, although they will probably say I need to speak to the cardiologist as he prescribed it. Thank you for your advice 😊
Flecainide doesn't generally influence blood pressure, so it may be the metoprolol. Of course speak to your doctors however, if it just lasts for a day or two, I don't think there's anything to be concerned about.
thank you everyone for all the advice and information. My bp came up to 114/69 p56 just before midday - plenty of fluids plus salted peanuts 🤣. Feel my usual self now x
When I was first prescribed Flecainide as a PIP it was to take 100mg and a 1.25 mg of Bisoprolol if my heart rate was over 140 bpm twenty minutes after having taken the flecainide which it hardly ever was. I know we are all different but you do seem to have been prescribed a very high dose. Also, when I still had the odd episode of AF after taking 50 mg of Flecainide twice daily, it was upped to 100mg twice daily and that has virtually put an end to my episodes. I’m female, now 79.
Well we know how different we all are. Good luck finding what works for you and you need to consult an EP as they deal with our electric problem in the heart rather than structural problems which ordinary cardiologists specialise in.
Sounds to me like you should try (after a telecon with your cardiologist) increasing your daily Flecainide to a medium level of 100mgs x2 per day; it worked for me when I was having two episodes a week on 50mgs x2 per day.
Thank you, I am only just finding my levels with these meds, only been on them about a month. I know what the trigger was for this episode (I over did it) I am going to find out about reducing the metoprolol .
Phew.... there have been so many, most of which have been mentioned here on previous posts.
For me personally they have centred on moderating exercise, diet changes incl drinks, stress reduction on all fronts, enhancing the spiritual side, learning to breathe (James Nestor & Patrick McKewon on YouTube), new hobbies and more focus on avoiding other chronic illness threats as I'm now the wrong side of 70!
Yes & started Afib around 2008, formerly diagnosed in 2013, since then just 2 v short episodes but in the last couple of months some weird pre-AF feelings in the afternoon when walking 🤞🙏🤔.
For me, it’s Staying hydrated, pacing myself so I don’t get over stressed or too tired, try not to get too hot, avoid crowded noisy environments, no alcohol, reduced caffeine or drink decaf, avoid wheat, sugar, msg, fast foods. Gentle exercise. There are probably other changes I can’t recall 😊 everyone is individual
I had the grandchildren overnight, then day out the next day - morning was a watercolour painting lesson(the last one my friend was teaching, so didn’t want to miss it) followed by Christmas lunch, followed by grand child’s nativity play at school - I usually don’t do do much in one day 😂 all in all, a very pleasant day. Didn’t feel stressed, but obviously the heart electrics did 🤣🤣🤣 I know most of my triggers now (hopefully) ibususllybpace myself and space things out - I got cocky 😂
I am not qualified to give medical advice, but my experience has been that my BP may show as low as 70's/50's while in Afib, but bounces back a bit soon after NSR returns. If your BP does not come closer to your normal within a hour or two after NSR, I would consult with the doctor soon. The main guide for me is whether I start feeling light-headed or dizzy. If I have that going on more than a minute or so while sitting, I would probably call an ambulance.
I did so about 3 months ago when my readings were low during Afib, and I felt dizzy, but I also had Covid at the time.
It is hard to know what to make of BP and HR readings during Afib, so I go more by how I feel, being aware of any pain, shortness of breath or dizziness. Getting help can be a difficult decision to make. I felt very insecure about it when I first had to deal with Afib. I went to the ER with my first experience and was embarrassed when a doctor asked: "Why are you here?"
I was in nsr according to Kardia, when I took my bp. Absolutely no point taking it when in af - has to be done manually and I have never got the hang of that when I worked on the wards 🤪
51 Heart rate at rest when beginning to take CCB Diltizem 180 (1/2 dose) was too low (dropping 105bpm within 2 hours of taking it). A new med for me. But 120mg was fine AM and Bisoprolol reduced from 10mg to 2.5mg at night.
NZ Heart Foundation Nurse said BBs and CCBs should be separated.
Yeah I know what you mean about feelings. The day AF mugged me I thought for all the world like I was going down with flu - after all - it was early January 2010. My BP started the day as fairly normal at 136/80 ish. By late afternoon it was down to 76/50. That's when I hit the panic button, saw my GP and within a matter of hours was being worked on in A & E. But if it hadn't been for the fall in BP so quickly I'd have written the whole thing off as flu. It was when I was in A & E and later in the hospital cardiac unit they found I was also asymptomatic - so, at any time I could be in AF and not have any symptoms - one of the problems I later discovered.
How do they identify asymptomatic Afib? Is it through the EKG?
If your heart is not beating erratically or otherwise showing distress, what harm is being done? Are you supposed to take any precautions because of it?
Have you been continuously monitored by wearing a heart monitor?
for what it’s worth, I had an episode not so long ago, where I didn’t feel symptomatic, just a little off, used Kardia and there it was, ‘possible Af’. My hr didn’t go above 100,which is why I think I had little to no symptoms. So maybe that’s it, the hr doesn’t go so high? Is just a thought.
Once I'd been admitted to A & E and they'd identified AF and began treatment they kept me in the cardiac ward for another 5 days doing all sorts of tests and a constant run of ECG's. They also did an EKG and goodness knows what else that I now can't remember. It was during this stay that they detected the asympomatic heart, and wrote it in my discharge letter. So long ago now, nearly 14 years (2010). Maybe they did fit me with a monitor. Just can't remember now.
As the years have unfolded and I have invested in more modern tech like Kardia and an Omron BP monitor that identifies AF this write up has been proven correct over time. There have been many times when I have felt absolutely normal but this has not been correct according to whatever device I have been using.
I do nothing but keep calm and carry on. Nothing I can do.
The symptoms are what we feel and are aware of, some people don’t feel them or have any awareness of any symptoms (asymptomatic) but it doesn’t mean af etc isn’t happening.
My point is that a diagnosis of asymptomatic Afib would require the presence of something that evidenced Afib even though not detectable by the patient. What?
I don't mean to over press the issue, but I'm just curious.
Sorry if I confused things. It's not the heart that is asymptomatic ... its the patient .... who feels no physical symptoms or manifestations of AF. So, back in the day I suspect they fitted me with a monitor when in the cardiac ward, found that I had lurched into AF and asked me questions about how I felt. Felt nothing.
There would be other times when I could feel, beyond doubt that I was in AF, my chest felt like there were several squadrons of butterflies in dogfights ... or felt like in my chest was a bag of earth worms wriggling away. My last AF event that I can recall was between 18 months and 4 years ago .... didn't feel a thing, (clocked it on my BP monitor ) just feeling a bit 'off colour'. I might have been in AF more recently but I feel nothing.
Before I knew I had afib, I spent ages checking my bp, fascinated by how I could have low bp with a high heart rate and visa versa, with every combination in between 🤣 now I know better, and don’t even try to get a bp reading while it’s going on. I agree, I go by the symptoms too. And that is what all the treatments are for, isn’t it, symptom management. Overall I feel better on the daily flec doses, and I am having less episodes. X
I had a similar experience taking Amiodarone as the anti-arrhythmic and Bisoprolol as the beta blocker, but not as a PIP. Ended up halving my Bisoprolol dose to bring my BP back up again.
BBs should be taken at night because generally early morning is the problem, BP too low or too high and AF.
Never heard of Metoprolol as a PIP.
Hope you have had an ECHO, ECG and 24-hr Heart monitor t make sure that Flecainide is right for your heart. It is an anti-arrhymna drug and if your heart is not structually normal it will cause havoc. I can't take them. Also Metoprolol gave me pauses at night (with a avge heart rate of 47).
Yes, had all the tests, I was getting weekly breakthrough af episodes since covid at Christmas, paid to see consultant privately, as too long a wait in nhs, he referred me for echo etc through nhs(all done, heart clear) ablation (consultant appointment next week, op should then be within 3-6 months!) Flecainide to help minimise episodes until then. I feel pretty good on the daily flec, added benefit is it has reduced my pain from other health conditions 😊. The metoprolol is purely to go with the additional flecainide when I take it as a pip, so gets taken as and when. My daily betablocker is taken at teatime
My pulse was fine, when af stopped, as my resting rate is usually around 54-60. Low bp was after taking pip and Kardia showing back in nsr. All back to normal by mid afternoon. Thank you x
I have to make an appointment to discuss with gp, but all appointments are gone by 8am. I don't have an nhs cardiologist yet… the referral for nhs medication review was last May and I am unlikely to get an appointment through until next spring at the earliest, which is why I went private to see a cardiologist, who reviewed my meds and referred me for ablation through the nhs. I was on verapamil as a pip, which is really a no no, especially as take nebivolol daily. My next step is to try and leave a message for the surgery pharmacist …..if that fails, I will email the private guy and hope he will af advise without seeing him again (it has only been a few weeks) In the mean time, I will do my best to avoid the triggers I know set me off. If my bp had gone any lower and not started to go up I would have been off to a & e, although I don’t know what could be done. Had a nice chilled day today ☺️
Never had PIP. Was started on 25mg Metoprolol and 50mg Flecainide twice a day. The Flecainide was increased to 100mg and then 150mg before my PAF became infrequent.
I'm not a medical professional but I believe your Metoprolol PIP will predominately be for rate control. It can also be used for BP but given it has been prescribed for you as PIP you presumably don't normally have a problem with BP. BP tends to drop when in AF because heart is not pumping properly so taking Metoprolol as PIP would be to stop heart racing and pumping less inefficiently.
Obviously BP that's too low can be a medical emergency. However, I believe the focus is more on the symptoms you are experiencing than the specific BP numbers. If I have concerns like you have then I would consult with GP's office if during hours or go to emergency department at local hospital for assessment ASAP. I wouldn't be waiting for replies on websites to help decide what to do because (A) you might not get the right advice and (B) you might not get good advice quickly enough if it is a medical emergency
In addition, I'd be asking my doctor given what has happened, whether 50mg dose of Metoprolol might be too high and discuss whether there are other options e.g. lower dose or an alternative that has required effect on rate control but less impact on BP(???). However, if he's not concerned about your low BP (symptoms not considered dangerous) then he might be happy to maintain PIP dose and given you some advice on circumstances where you should seek medical attention when BP drops i.e. if you are experiencing nausea, losing consciousness, confusion, blurred vision etc. If he provides you with advice like that then you should ensure that others around you know about that advice too as you might not be in a condition to action that advice and would be reliant on others to know what to do.
Sorry, just read your last post. You also take a daily beta blocker i.e. you are already getting medicated for high blood pressure and taking Metoprolol 50mg (as well as Flecainide) as PIP, which is also a beta blocker. I'd also be asking doctor whether taking both close together if you have an AFIB event around the time you take your normal teatime beta blocker, is a potential problem. If you have a problem with low BP when you had PIP in morning imagine what the potential impact could be if you had AFIB event in evening and took both your teatime beta blocker and your Metoprolol PIP close together.
the beta blocker intake is for hr for the af, not blood pressure management. I asked these questions you raise when the flec & metoprolol where prescribed and I know he answered and explained very well, but I cannot recall what he said. This time, I took the pip about 7.30am, I take my daily betablocker around 5.30/6pm, so was well apart. My resting bp, am & pm, when I bother to check it, is usually around 120-128/ 58-64 roughly, resting hr rate stays around 54-64 . Even with the lower bp my hr was the around the same(once back in nsr) I love knowing how things work, fascinates me. Oh, and I can also take another 50mg metoprolol 45min after the first if hr doesn’t settle down. Which I did the first time I took it…. Bp didn’t get too low then. Thank you for all your info, very helpful
Thank you, beautifully explained. And yes, i definitely wouldn’t rely on responses on websites or forums before I took action. I was curious of anyone else’s experiences while I was waiting. My bp didn’t drop any lower, and slowly began to come back up. I am now waiting for a reply from the private cardiologist who prescribed the meds. I trust him, he diagnosed me years ago. I can’t speak to a gp at the surgery without making an appointment, and they are all gone by 8am…. If need be, if I have to take it again, I will adjust the metoprolol. In the mean time, yes I am seeking guidance & advice from the medical professionals.
My cardiologist (his nurse, actually) told me to always measure blood pressure before taking a dose of metoprolol tartrate and to only take that particular medication if systolic was at least 100.
She said that there’s a risk of passing out otherwise.
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