Hello everyone, I joined a little while ago but have been lurking. I'm getting quite frustrated with lack of medical advice so am turning to you.
I went to the GP in July 2023 concerned about palpitations and a year later saw a cardiologist who gave me a holter monitor and 6 months later sent a letter saying I have Paroxysmal AF. After another long wait GP texted to tell me to pick up the prescription. I'm concerned because I have occasional very low HR - sometimes down to 38 (according to a Fitbit TBF). Got to speak to a GP on the phone three weeks later - they said they would ask the cardiologist. Been waiting for another 3 weeks to hear back.
I have very short AF episodes every couple of weeks, had one a couple of days ago that lasted half an hour. Then for the next few days get very low HR. Today when resting it is 38-42. Not on any medication.
Sorry this is long, but does this happen to anyone else? Could it just be anxiety? What would you suggest I do? I'm 56, generally healthy and recently stopped drinking in case that was the trigger.
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Dunfanaghy
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Hi, can I ask what your prescription was for? I have a slow resting heart rate at about 50 BPM when I was on beta blockers it fell to 42 38 BPM. It sounds like your episodes of AF are not very long at the moment but this condition is progressive. Perhaps another chat with your GP is called for.
Thank you for your message. I'm sure I typed bisoprolol but it disappeared! I thought beta blockers would slow me down even more? Which is why I was fretting. GP is almost impossible to talk to,
I understand. On bisoprolol my HR went down to 33BPM and I ended up in hospital. If your episodes are infrequent perhaps you only need the meds when you are in AF. I take flecanaide to keep me in sinus rhythm and only take bisoprolol when I am in AF. My rate can then touch 150BPM 3 times the norm for me. I do hope you can get some clarification soon.
No it’s not ‘just’ anxiety but because you haven’t actually seen anyone to talk things over with I’m not at all surprised you are anxious because of lack of contact and information. May I suggest you ring the Atrial Fibrillation Help Line first thing on Tuesday and ask for advice.
I would also ring your GP again and ask them to accelerate your referral to cardiology saying your are very concerned about your low HR and the lack of investigation if you haven’t already had them - in particular - blood tests; echocardiogram; 24/7 monitoring and assessment for anticoagulant. Be persistent - they who shout loudest and longest……..
It could be arrhythmias—especially ones with ectopics or variable conduction. Pauses and ectopics can cause these devices to miss beats or misread, and that can make the heart rate look artificially low even if the actual heart is beating faster. The only way to determine what is happening is to have another holter. My watch can often read 0 and that’s because my beat is apparently lower than 30 however, I can assure you, it won’t be in reality.
With a slow heart rate - bradycardia - it is only really a concern when there are symptoms. If you feel light headed, dizzy and feel like you’re going to pass out then the heart isn’t beating enough for demand. If you don’t feel any of this, don’t worry unnecessarily about the low rates caused by the beta blocker.
Beta blockers often are looked upon very negatively. The thing is, they’re not just slowing the rate, they’re reducing the force and have cardio protective qualities. Your beta blockers is assisting with stopping your atria from damage and protecting the walls and valves.
I am on 10mg Bisoporal daily and it states somewhere in the contraindications that it lowers heart rate, for me thats not a problem as I have a Pacemaker as a consequence of my HR being slow, it may mean you need a change in your medication so pursue your GP or, if it was me, ring the Cardiologists Secretary and she should ask on your behalf.
hi, Bisoprolol has a heart slowing medication, I think you may be on too high a dose. Also Fleccanide is a good drug for heart beat regulation to keep it steady. However you don’t mention any anticoagulant cover.
I feel like Opal above that you should take charge of this lack of coordination between gP, cardiologist reporting and go directly to the cardiologists secretary. They are very helpful and can speak directly to their boss that day. I’ve always found they do far more than others in checking your concerns.
If you continue with bradycardia symptoms you may benefit from a pacemaker like I have, it’s an easy option, quick operation and keeps your heart beat up to 60.
But above all I think you need anticoagulants, be it just a small solvable asprin at first to just protect you from problems. I took one for years and it saved my TIA from being far more. I then was given warfarin for life.
Phone the cardiologist secretary and tell her your queries etc.
I’m on Nebivolol my resting heart rate can go as low as 36 BPM for a couple of weeks then it climbs up to about 45 beats when resting ,You didn’t mention the dosage of your medication. , usually they start you on a low dose .Its best to ring your Doc and tell him your concerns.
No medications -- well I far as I know there aren't any for slow only rapid.
Slow with palpitations could be missed beats and then when heart beat comes back.
I have slow at Night average. No side effects but on Monitor Metopolol was found to give my pauses and Day 186, fatigued, breathless. BBs did not control my rapid. Bisoprolol was 156.
I've heard that for slow a Pacemaker is installed which keeps your heart beating at a level. I heard my cardiologist say Day 80 avg bpm is the ideal beat p.m.
My 47 avg at Night is not discerning.
Very slow results and reporting is unacceptable Dunfanaghy. Results acceptable a week to 14 days tops.
Then letter to your DR and Specialist.
I would have hounded your Dr and Clinic.
Anything could have happened in between your waiting.
Tests scheduled I'm ringing the Radiologist Booking Clerk to make sure of the Dr's referral. Then I know and keep in touch with the clerk until date. Then some patience for results.
This is NZ but I fear this process needs keeping a track of.
My surgeon before retiring in December booked forward a C T Scan with Contrast for May. I shall be ringing up C T Bookings this week for May. I spoke to the Clerk in January and ast month. She has it .. waiting.
Hi - my story is very similar - I’ve had infrequent AF episodes- before the last one in January this year I’d gone nearly 14 months without yet in 2023 I was having AF (according to my watch) 3/4 times - started after a botched endoscopy sent me into shock - I had a 7 day holter in March this year and after pestering GP was told by text I don’t have AF but GP want to talk through results - I started with vertigo after an ear infection in January and it was this that prompted the holter- my heart rate is low - I’m 69 and it’s around 48-50 resting but it always has been low in the late 1980s I was running/swimming at national level and my resting heart rate was 38 - I was given a thorough medical and review by a cardiologist who brought in student doctors as he said they won’t see a heart that fit many times - I still swim three times a week (50 lengths each time) and assume this is cause of low resting heart rate - I wish you well and hope you get some support soon from your GP
hi welcome to the AF club, it has anxious moments! I had occasion AF for 15 years got gradually more frequent but manageable. I take Flecanide Accetate soon as I am aware of AF 200mg and then after 1hour another 100mg this seems to work almost every time in putting me back to normal. Recently I have started having occasional low heart rate which then with little exercise goes normal or goes into AF . I am in process of getting to see cardiologist about this new development. I stopped drinking a few years back as it was a definite trigger as is salt, or anything that can mainly cause higher blood pressure as I feel this is the main cause of AF for me. I don’t like taking tablets at all especially if effecting my libido ! Statins did that so stopped them , as can some blood pressure tablets but going to see what other alternatives there are . I have for 12 months now slept poorly only getting ; hours sleep this I think can be contributing to low heart rate , if you get really concerned and no joy from docs, if you AF gets prolonged go to Aand E they will get things moving in some direction . I wish you good luck and to all
Keep a diary for all heart issues for when you see the cardiologist. Consider a private appointment or accept you have to develop a more assertive and proactive, whilst remaining diplomatic approach, to the NHS.
I was diagnosed with AF 13 years ago also mid fifties was fit played tennis walked gardened rode my horse etc. came out of the blue . This turned into paroxysmal af so virtually constant you are lucky yours are short episodes. After several cardio version I had cryoballoon ablation this altered my life I get about 4 episodes a year now. Triggers for af are usually alcohol ( I never drank or smoked!) smoking etc hope they sort it for you.
Hi Dunfanaghy….I’ve had an average resting heart rate of 41 for last 6 months with low pulse readings of down to 32/33 at some times. No signs of dizziness or nausea etc and pulse goes up nicely when start moving. Saw GP last week and was told no problem if feeling OK as on bisoprolol etc. Yours does seem low if not on medication. I too have short episodes of AF every few months. Everyone’s different though so suggest you see GP if concerned to get some reassurance. Good luck.
Thank you all so much for your advice and support. I'm really touched. I am waiting to hear back from the GP, she told me she was phoning the cardiologist for advice, although that was nearly three weeks ago. Facing the rottweiler on the surgery practice desk would make me more anxious still! I wondered about flecaianide, as it would seem I need more evening out my HR than slowing it down? I'm not taking anything at all now (apart from trying out magnesium supplements) Mostly everything seems normal HR around 62-63 generally, but occasionally drops alarmingly and it seems to be just after an episode. This goes on for a few days then goes back to normal. I'm really heartened that you don't think the episodes are too bad, and grateful for your input
If your heart rate is slow it might be bradycardia if you are not on any drugs to reduce your heart rate. As I have recorded here before, when the lowest dose of Bisoprolol brought my heart rate down too low and the surgery didn’t come up with anything else, we found a private EP through the AFA and after he had introduced me to having a smartphone and a Kardia and the app, and I had sent him a reading of my heart in AF, sent a prescription for Flecainide to my surgery for me to take as a PiP ( pill in the pocket as needed to stop episodes when they occur). Now that I take it regularly I have been virtually AF free for over 2 years now and have even managed to stay like that even though I have reduced the first dose of the day to 50mg, retaining 100mg at night. Of course, we are all different but I hope you can get to see an EP and get the right treatment for you. If it is anxiety, meditation, mindfulness or slow breathing may help. You have found a helpful supportive group here, so I hope you’ll find what suits you from our suggestions. Well done for giving up the alcohol as I did, though I only used to have a small glass of wine with evening meals!
Firstly you said you are using a fitbit - I checked and apparently fitbits may under estimate the heartrate - that may be more so with afib. I took myself off betablockers as they lowered my heart rate too much. It took me 2 months as I had withdrawal effects - it states in the instructions to come off gradually. I would suggest this - phone the cardiology dept directly,explain the situation and ask for an appointment, that worked for me to expedite the appointment. GP's have a protocol to follow with afib, meds and referrals, and often in my experience don't know much about afib which is why you need to get back to the cardiologist. However also insist on the GP seeing you as well, insist on him also expediting an appointment, you have to pester and don't be afraid to - this is your life and the Doctors are supposed to be there to help us not fob us off! I don't think it's anxiety causing low heart rate at all although anxiety in just not knowing what is going on can trigger afib episodes itself. If you are getting short episodes it may be a food or drink triggering them - that can happen hours after eating, so worth looking at. Good luck.
As Vonnegut has mentioned stop alcohol. Direct linear relationship to alcohol consumption and arrhythmia, unfortunately.
Excess stress needs to be managed, that’s mental and perhaps less easily emotional. Much info out there re stress control. Don’t know where you live but if it’s linked to your name on this website then a regular walk along that stunning beach in Dunfanaghy? A doorstep de-stresser.
Also re HR. Best to get an ECG. Go to nearest A&E and tell them whatever you need to so that they can’t not assess you with ECG. Don’t be fobbed off by triage nurse. Insist on getting copy of ECG. You’ll then get some more accurate info and maybe progress from there via private route initially.
BTW if A&E anything like my local general hospital, take refreshments cos you’ll be there a while.
My heart rate used to drop suddenly from mid 60's to mid 30's in a beat. The measurements were done with my finger to my neck. I thought this was Bradycardia.When I checked it with my Kardia it showed Bigeminy with every second Ventrical beat missing although the Atrial pulse was present.
My symptoms are not too dissimilar to yours. I have PAF with few short episodes and was diagnosed with bradycardia at the same time following a 24 Holter.
I was prescribed Bisoprolol but as a Pill in Pocket should my heart rate get too high during an AF episode. I was told not to take it as a regular daily dose because of low resting heart rate which is around 50bpm.
That said, I was prescribed these tablets 14 months ago and haven’t yet taken a single one as any AF episode I’ve had has been short lived and it’s likely that I’ve reverted to NSR before they’ve had time to take effect. It’s even rarer that my heart rate goes above 100 when in AF.
I’m now 8 months overdue a review which my GP is chasing as ectopics are on the increase.
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