my husband is in permanent af, he is on Bisoprolol and Apixiban. His heart rate is low around 50. He gets out of breath and tired easily. He had the Bisoprolol increased but this made him unable to walk far withought sitting down , this has massive impact on his life, and Bisoprolol reduced back to where it was as he manages that better. Doctor has told him it could cause heart failure. He has had a lung X-ray and no fluid there, but trying to see a doctor is near on impossible. Should we be worrying about heart failure. Has any one else had this, if so how do you manage it ? Thank you all for any support.
permanent AF: my husband is in... - Atrial Fibrillati...
permanent AF
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Byke
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Bisoprolol is a beta blocker designed to slow the heart.
I was taken off of it because I have conductivity disease which slows my heart down.
I am being offered a pacemaker, has this option been suggested for your husband instead of Bisprolol?
Pete
Pacemaker instead of Bisoporal........not in my case
BobDVolunteer
Controlled rate is vital to prevent Heart failure . HR Should be between 60 and 100. Beta blockers such as bisoprolol will cause breathlessness. Perhaps discuss alternative methods of reducing HR. Calcium channel blockers?
Some possible alternatives to get his old life :
1) surgical ablation such as mini maze -- this frequently works where catheter ablations do not. This can will get him both in normal rhythm and off bisoprolol. MummyLuv a member has had one.
2) Switching from bisoprolol to a calcium channel blocker. Many of us feel better off of beta blockers.
3) Pace and ablate. He will require a pacemaker and probably will remain atrial fibrillation, but hopefully he can reduce or come off the beta blocker completely.
Jim
Bisoprolol a beta blocker, calcium channel blockers and any rate rhythm control medication caused fatigue and breathlessness for me - made me feel far worse than the AF ever had so in the end I was taken off them. I have permanent low rate AF my average resting heart rate is mid to high 50's with no medication other than anticoagulants. I make sure that during exercise (I usually go to the gym four times a week) to keep my heart rate to under 130. At one time on Bisoprolol my rate went down to 36 and usually wallowed around 46 to 50 making me very breathless and fatigued - one morning I had to rest after walking the dozen or so steps from the bedroom to bathroom and then from there to the top of the stairs had to sit down and couldn't make it down the stairs. My wife rang the hospital, my cardiologist was on duty and he told her to stop the Bisoprolol. They then tried me on calcium channel blockers and other rate and rhythm control medication and a mixture of a couple over the next few months but usually after being on them about 3 weeks the fatigue and shortness of breath was there. It is worth while your husband asking to try either a dosage change or medication change to see if that helps. Has he seen a cardiologist or Electrophysiologist (EP) or still under the care of the GP? If he hasn't seen a consultant then you should ask to be referred to an EP, a cardiologist who specialises in arrythmias if possible. It may even be a good idea to pay for a private consultation in the first instance, as the wait for the initial consultation can be long these days. This will cost between £200 to £350 but you can then ask to be put on that consultant's NHS list for further tests, scans and consultations.
All the best
According to my cardiologist beta blockers & calcium blockers are counter productive if you have a low resting HR. I don't know why the resting HR isn't taken into account when prescribing these things?
Thank you for this, we will discuss this when ( and if ) we get to see a doctor, ideally would like to see a cardiologist.
If I'm ill I can see a doctor within 24 hours If I become worried about my permanent AF, I can see a doctor within 24 hours.
I don't take a beta blocker as I am also asthmatic. I was once prescribed bisoprolol by a well meaning hospital doctor, despite me telling him I have chronic asthma. It wasn't a trouble for 7 weeks, but then I had painful rashes caused by it according to skin specialist GP, and while I was being weaned off it I had a very sudden exacerbation of asthma, causing emergency admission to hospital. My heart rate is within the normal range. I only take Warfarin because I have permanent though asymptomatic AF. I was offered a calcium channel blocker but a specialist GP advised that I didn't need it of my heat rate was within normal range.
An EP, electrophysiologist, would be better as they are the electricians of the heart rather than the plumbers as has been mentioned previously here.
Hi
In 5 years never seen an Electrophysiologist.
Question 1. Control. Is it the rate or rhythm because of rhythm symptoms needing to control?
2. Control of BP?
At 186bpm at rest - Day on Metoprolol , it was rate control needed.
At high Systolic level - it was BP control needed. It would also assist to bring down a 90 Diastolic.
To my mind unless ablation was considered I did not need an electrophysiologist. As you are on Flec it was considered rythym that needed controlling.
Also if you had structural damage and could not have an ablation considered a Cardiac Specialist is just fine. Some specialists are in both fields.
I have seen 4 different heart specialists, 1 had done ablations and the best one was a private one who did work some hours at the base hospital as well.
cherio JOY
You should have seen an EP if you have atrial fibrillation as they are the cardiologists who specialise in electrical problems in the heart which ours is! Enough now!
but trying to see a doctor is near on impossible
Is it possible to see a GP for evaluation and possible referral in a reasonable amount of time ? If not and he is having problems breathing, consider going to A&E.
If not done recently, he needs an echocardiogram and a full evaluation to determine proper medication and therapy. In the interim, continue to monitor his heart rate and blood pressure.
Thank you for your response. Trying to get an appointment for cardiology through doctor, but really struggling with getting a doctor appointment. Will keep trying
Why are you struggling to get a GP appointment? As I've said I can get one within 24 hours. So why can't you?
In the last year I had an exacerbation of asthma, I filled in a form online on a Sunday afternoon, and was given an appointment on the Monday morning.
I don't often seek medical advice, although, in November 2023, I was taken to hospital by ambulance at 4am due to an allergic reaction to stale tobacco smoke oñ a friend's clothing. I was discharged the same day. I've only needed a GP once in 3 years though I've had annual blood tests and jabs.
We have to complete a form on line, we can get a phone call from a doctor within 2 weeks, but when my husband asked for a face to face appointment he was told they don’t have the doctors rotas so would have to fill form in on line but it could take 2 to 3 weeks to see one face to face. We would go to hospital but when we ring 111 for information re this they say not emergency and to make a doctor’s appointment. He doesn’t become unwell enough to go to hospital, I think he needs medication change. Thanks for your response, it is always helpful to see what others think.
I would suggest you push to see a cardiologist that specialises in arrhythmias, called an Electrophysiologist or EP for short. Many have done this privately to progress things if that’s affordable.
Best wishes
What Buzby says is critical. I also think getting off the beta blocker will help - and i think stopping it now is a low risk or possibly risk free experiment. I am in persistent a-fib and my resting heart rate varies from 50 up to 90.
Look into a pacemaker - but bear in mind that a pacemaker cannot stop or prevent a-fib. So also discuss an ICD with the EP when you get the appointment.
Thank you for this, I think we will go down that line, and probably see one private so that it can ease his mind. Doctor doesn’t seem bothered, but once heart failure is mentioned it becomes urgent to us.
Make sure it’s an EP and not just a cardiologist. I spent almost 3 years on medication with cardiology and then asked to be referred to an EP which led to my ablation and wish I’d done it sooner.
Best wishes
PS Heart Failure is a poor name for the heart not pumping as well as it might be and many live for many years with that diagnosis, it all depends on the severity and what causes it. I wish there was a better term used for it.
hi I have permanant AF well controlled with meds I have no other heart issues and am very well however when first diagnosed was on bisoperol and apixoban but got very breathless I do have asthma thoughh but was taken off bisoperol as consultant said not good if you have asthma put me on verapamil plus apixoban and have no issues regarding breathlessness I feel perfectly well and can live my life perfectly well
Thank you for that, it sounds as though he may need a change of medication
After my heart attack I was prescribed Bisoprolol 2.5 mg, I took it for a year so my heart could heal! It always made me more tired and it was a struggle to keep working as well in a busy restaurant kitchen 👌
I tried taking it in the evening but that didn't work for me either!
After a lot of professional research I told my GP this medication isn't working for me and that my blood pressure was dropping to under 50 to 90 👌
Same with Statins which caused me more trouble then good!
Now I just take the Aspirin and Ramipril, that's it!
Sad thing is we haven't got enough GP's or Consultants, some have gone private or try their luck abroad!
To be in Medical professions or Nursing professions now is very challenging and demanding due to increase of our population and illnesses!
When you have caring GPs, Consultants etc you are very blessed! 🙏
I must admit I have had exellant care from my GP and the consultant Dr imrie at Fairfield hospital I am very lucky going off some of the people and how long they have to wait for follow ups etc
Yes and it's a blessing isn't it 👍🥰
yes your right I definitely can count my blessings best of luck hope everything goes right gor you👍
Link to the patient resources on AFA website
heartrhythmalliance.org/afa...
There’s a couple of sheets on AF and Heart Failure but I would start with the AF fact file.
Best wishes
I downloaded this information now 👌 Thanks Buzby! Very informative altogether! 🥰👍
I have this and it was due to fluid overload so have just recently had my water tablet doubled from 20 to 40 mg a day and it has helped a lot. I would add that I have a Pacemaker and still take heart meds as a Pacemaker stops the rate going below 60 and the drugs help prevent it rising higher but once you have fluid overload in the mix then that problem puts extra stress on an already irritable heart and results in swollen ankles/legs and breathlessness.
I would try not to worry. If his rate is low the AF will be unlikely to cause HF, I gather. My elderly friend is 91 and has had AF permanently now for many years and his heart remains okay.
It might be that he could try a calcium channel blocking drug, rather than a beta-blocker, or that he could manage without either. Has his GP ordered an echo scan in the past? If not, I would ask for that and see what it reveals. If your worries are sufficient, a private appointment is what many are feeling forced to pay for. These are about £200, plus a fee for the ECG if your GP won't do it for free. An echocardiogram would be a further £350 or so, if not done on the NHS.
Steve
Thank you, we have talked about going private and trying to get to the bottom of this. He has had a lung scan for fluid but that came back ok.
I suggest that you both go and sit and sit and sit in your GP waiting room until a GP sees your husband - and then perhaps pass you on to a cardiologist if there are concerns.
I too am in permanent AF on Apixaban and Bisoprolol with a resting HR of 60 but also have a pacemaker because cardiac syncope gave me stoppages with faints and blackouts when my HR went too low or stopped altogether. Yes I am tired , fall asleep easily when reading or watching TV and walk slower but many conditions and medications (and I have a few!) cause tiredness as a side effect - not just heart failure.
So get that GP to check and reassure you or not - stress is an unwanted and unnecessary side effect.
Do you know what, you’re right, I think we will just go and sit there until someone sees him. Thank you , sometimes you don’t see the woods for the tees
Hi
No amounts of dosage.
I was diagnosed with Stroke Embolic, Rapid & Persistent Af and Day 4 Thyroid Cancer.
On Metropolol 23.75 x 3 left me breathless, fatigued and I was forever sitting down to rest. 24hr Heart Monitor showed above and 186bpm Day with pauses at night. I reduced down to 1 but above was there.
I needed a drastic reduction in heart rate.
1 yr 5 months under now a Hospital Heart Specialist. Changed to Bisoprolol my dose went up and up no control H/Rate Day. 156bpm. But now no breathless or pauses. Could exert myself.
But left uncontrolled H/Rate Day.
2.1/2 years
AM CCB Diltiazem 120mg controls H/Rate Day 60s. Night 47bpm my normal and avg.
PM BB Bisoprolol 2.5mg controls BP
PRADAXA 110mg x twice
Heart Rate ? avge 50s. Reduce the Bisoprolol. That is why 24hr heart monitor best to see how meds and doses are working.
There is a BB med which only works on Systollic level. The 2.5mg Bisoprolol controlled my Systolic and Diastolic correctly. Systollic was worse.
Ideal BP. 110-120. /. 69-79
What is his? Heart Rate - get moving. Perhaps 60-80bpm at rest.
Breathless could be due to Bisoprolol if he has asthma. Also could be AF. But what does the ECHO read? Structural damage. AF diagnosis, type?
cheri JOY. 75. (NZ)
Thank you for your response, I take on board what you say, he doesn’t have asthma or any other problems with his health. I think we will get an appointment with a private cardiologist, and go from there, but maybe sit in doctors surgery and wait until we are seen by a doctor
Hi
But I don't get asthma but my sister gets excema (in the family of asthma), but I can't take ACE blockers because I cough. I also rubbing oestrogen on leg the back of my leg shows rash and bleeding.
Metoprolol BB is banned as apart from other side effects makes me breathless.
cheri JOY. 75. (NZ)
Has your husband investigated a pacemaker? It could be a game changer. He sounds like a good candidate.
He has now got an appointment next Tuesday so we will talk about all the options available to him then including pacemaker. Thank you for your response everyone has been very supportive on here.
I really hope your husband recovers from his extreme tiredness and breathlessness Byke! It's so upsetting and stressful to see your spouse suffering! Hope you get the right treatment for his AF, VERY VERY SOON 🙏🥰🙏🥰
thank you for this, it means a lot to see that this site is so supportive. We are going to the doctors next week and will hopefully get some answers
Hi, has he had scans of his heart to find out if there are any issues
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