Paroxymal Only 6 episodes in 3 years, the longest was 24 hours. Shortest 20 minutes.
The latest and longest had me visit my cardio team, and they agreed an increase from 180 to 240 was called for, and, my BP had increased to 135.
No other issues or meds other than the recommended anti-coagulant.
The reason I ask, is that I am very active, and hike and cycle almost every day when weather permits. My concern is that it will “dip” or slow down my HR and BP to the point where I am exhausted all the time *see previous post about wrong meds.
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beach_bum
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Reading his biography it appears to be Diltiazem. But I don't understand his BP figure. I think he's asking if increasing Diltiazem from 180 to 240 will decrease his heart rate too much.
I'm a person who got breathless on BB Metopolol. Bisoprolol is better for AFers.
On Diltiazem my H/Rate shot down from 156 on Bisoprolol 10mg to 51 @ 180mg 1/2 dose.
Then twinked to 120mg AM Diltiazem CD up to 88-96bpm. It does not interfere with my normal 47avg bpm NIGHT RATE. Losing weigh 5-6kg the H/Rate has come down to 60s. I feel heaps improved on that H/Rate.
I'd be much worried about his H/Rate as BP wasn't much affected by CCB Diltiazem. With me it's my H/Rate controller.
When I tried without BB Bisoprolol my BP rose again.
When I tried without Diltiazem my H/Rate rose. In NZ there is nothing lower than 120mg.
As he tells us his systolic level - I wouldn't be concerned about it. I had a systolic Level of 150-160! Not his 130-135.
They are capsules so he can't half a 30mg.
He's on a higher level than me. It made me light headed. It took me down from 156 to 51 bpm. Down 60mg to 120mg up 30-40bpm.
Thanks Joy. I’m on slow release 180 atm. No issues with it all, except my BP is up into the 135 systolic range and they would like to see it down into the normal age appropriate 120-125 range. My concern is about lowering my BP and HR TOO low.
`158/71/67 is my current reading taken 5 minutes ago. That pesky sys will only go down to 140-ish on a good day. My resting HR is typically 60-65.
Sorry for the confusion and lack of info. Yes, it’s Diltiazem. I was switched to calcium channel blocker from a beta blocker because it rendered me physically exhausted.
Also, Diltiazem is also a BP reducer, which is also why the increase, my BP (systolic) was up to 130-ish, and they would like to see it down to 113-125.
I was just looking for anyone in a similar situation and how the increase in dosage affected them. Because of my elevated BP, a “pill in pocket” option was dismissed by my cardio team.
OK bBs did not go anywhere to reduce my rapid Heart Rate. My BP could also do with a nit of decreasing. Like I was 150ish over 90.
So after Stroke and diagnosis of rapid and persistent AF then 4 days later the carotid arteries scan showed a shadow on my thyroid, I was prescribed Metoprolol. 186 H.Rate Day and pauses at night. BP could still get high. I was breathless, fatigued and could not exert myself so had to have a sleep trying.
Struggled 1 year 3 months and demanded Dr to see specialist. I had said no to it because it made me feel .. as above and it did.
The hospital specialist changed me to Bisoprolol. I was increased up to 10mg with no benefit of control. No more breathlesxs or pauses now but 156 H.Rate.
Monitored 24hrs x 3 times before and after changes,.
Left so at 2 years 3 months the new Locum referred me to a private specialist. He was interested. H/Rate at rest 135 plus. Oxygen great, BP controlled. This specialist introduced CCB Diltiazem.
180mg (1.2 dose)AM Diltiazem within 2 hours decreased me down to 51.
I was lightheaded and didn't like it.
Between our NZ Heathline Dr and NZ Heart Foundation Nurse who had worked with my Specialist rung him.
120mg AM Diltiazem CD for Heart Rate control. It brought it down to 88-96 Day and 47bpm my normal level at Night.
Over that first year I reduced weight by 3kg and then another 2-3kg the following 6 months.
Now Day H.Rate at rest 60s morning and will creep late 60s afternoon. 47bpm still at Night.
2.5mg PM Bisoprolol to control my BP. 110-132. /. H/Rate 60s Day
You can have a CCB and a BB but separate them AM H.Rate Pill and BB PM pill.
I've been stable now over 2 years 6 months. So discharged from Outpatients.
2 operations since Thyroidectomy. Anaesthetists will operate if I front up with a H/Rate below 100.
As I have a severe dilated Left Atrium NO CARDIOVERSIONS, NO ABLATIONS and NO FLEC.. (ANTI-ARRHYMIC MED). I have an abnormal heart structure.
CCBs can't be used if your heart has a problem in the Lower ventricle chambers - hence Systolic problems. I do have a soft systolic heart murmur. (N worries apparently).
It is the CCB Diltiazem which acts as a non risky anti-arrhymic med - by slowing the heart.
How is your Heart Rate throughout the Day and Night at REST?
Do you need to loose some weight? Males. 30" waist? 2" OK plus only.
60mgs Diltiazem reduction put upp my Heart Rate by 40bpm. Its how you feel.
You may be like me and rather than up Diltiazem higher ADD low dose of Bisoprolol (Best for AFers.) IT brought my BP down enough. From 150-160. over 90s to 110-130 over 68-78.
Some folks are on 1.25 1/2 of mine.
A 24hr Heart Monitor would be very precise in how your med is affecting your heart in terms of BP and H/Rate.
Take care. Exercise is great for your heart and specialist says its great to put some challenge to your heart but NEVER PUSH TOO HARD. THAT's NOT GOOD. Walking to the top of my road is elevated and worse coming back when I get to the shops. He said GOOD.
I have been taking Diltiazem for8 years. Most of the time 250 mg. It was increased to 300 mg for a while when I had a lot of PACs and was symptomatic. It was reduced to 240 mg and now 180 mg because heart rate going below 60 and I felt lightheaded. I need to discuss with cardiologist as I am once again going below 60. I will say Diltiazem helps my blood pressure alon with Losartan.
I hate anything that makes me feel "less than" as I am so quite physical and formerly competitive. Thus you might like PIP or 300 mg one time flecanide for pill in the pocket for episodes. I suffer episodes like you describe.
Unfortunately your post gives little information. I think you are asking is whether increasing your (daily?) dose of Diltiazem from 180 to 240, will affect your ability to lead an active life. I don't understand the BP figure, is that systolic or diastolic?We are not medically trained. You may find someone who takes Diltiazem who can comment from their experience.
When I had paroxysmal AF I was on Flecainide rather than a Calcium Channel blocker. When I was found to be in persistent though asymptomatic AF, I was offered Diltiazem, but suggested I might be better not taking any medication, apart from an anticoagulant. 7-8 years later I've deemed my persistent AF permanent, and for it, take only an anticoagulant, Warfarin being my choice, after my body rejected Rivaroxaban.
If I was in your position I would cut down on a very active lifestyle, but not being medically educated I have no idea as to whether cutting down will improve your AF or BP.
It is known that over exercising can contribute to afib onset so those people who insist on trying to keep up intense exercise schedules once afib has reared it's ugly head are just likely to make their condition worse - like people who stick to being sedentary. Moderation might seem stuffy and unexciting but will give better long term results!
Trust me, I never overdo exercise. I never did, as I always listen to my body. I just do resistance and core training 3 times a week, and ride 30-50k 4 days a week, with a 4K morning hike with the dog to start my day. Nothing strenuous. I keep my HR under 140 when working out or riding. I’m just worried that going up to 240 from 180 will make me feel lethargic. I’m only 69, so I don’t feel like putting on the brakes too hard yet. When I did a stress test last year, the cardio team told me I was “very” heart fit, so no worries with that. Just this occasional frikin AFIB 😑
Well, I suppose it depends on age, current and previous health issues and condition. I m very fortunate, that I have managed almost 70 trips around the sun without any major health issues *knock on wood* …also, the is an Italian who started racing bicycles in his late 70’s won trophies in his age group in his 80’s and was still riding with family and friends after turning 100! So there is hope lol.😁
Well, my cardio team and GP would disagree with you lol. I have zero other health issues, and have been active my entire life. My previous activities were definitely not moderate…competitive soccer for 45 years, mountain bike racing for a decade, competitive squash etc. Those days are gone, I’m 69 and would do well on the pitch or court 😆 Winter DOES see me slow down…just gentle indoor trainer cycling and resistance bands 3 times a week 🙂
I have never had an episode during or after strenuous exercise. It’s always been after a heavy dinner…which I have totally cut out after the last 24 hr bout. Now it a large breakfast; small bowl of shredded wheat/granola for crunch/blueberries/craisins/banana, whole grain toast with PB and 2 black coffee. Lunch; large baby spinach salad with cherry tomato’s, cukes, shredded carrot, mushrooms, cheese, with a bit of chicken thrown in. Supper is light…small flatbread cheese and veggie pizza or a chicken breast or salmon with veggies kind of meals, no later than 6 pm for me. No more waking up at 02 0r 03 with a hammering heart.
I too have followed a very healthy lifestyle all my life,particularly after being diagnosed with AF at 53. I grow my own vegetables and taught nutrition.
I certainly don't advocate sitting by the fire in my slippers at my age, 64,but I do recognise my Electrophysiologists advice( cardiologist specifically for heart arrhythmia) to keep a keen balance between exercise and pushing the AF button.
AF decides what it will do,not us. AF is very common in athletes and sports people.
It is also progressive and can change without notice from occasional episodes at recognisable triggers such as stress ,exercise,etc to more frequent events which do not self terminate and need intervention of drugs used as a pill in the pocket to events which do not respond to intervention and need a daily drug regime to try to prevent episodes .
Thanks for all that, and I am acutely aware of my condition and triggers, and excercise is not one of them. I know many athletes, and many non athletes who have afib, and most started far earlier than I. I’ve had 4 episodes in the last 3 years. My cardio team dismissed the P in P solution because the drug would expire before I had an episode. All 4 episodes happened after a large dinner, eaten too late, and involved meat, so I have adjusted my diet to avoid a repeat.
My question was, is there anyone else out there with similar frequency, and high BP, who had their dosage increased, not frequency, just the amount; eg; from 180 to 240mg once a day slow release. It’s not because of increase in frequency of episodes, it’s because my BP is too high..this mornings reading 148/72/65 so wondering if the increase in med dosage will just bring down my BP, or will my HR…which is fine, be also lowered. I don’t want that, as my resting HR is already 60-65.
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76 years old with A F
apixaban and hematuria 
shortness of breath
3% Afib burden and proposed medication
