Just thinking about Bisoprolol which I take a 7.5mg Daily along with Entresto 49/51 mg, Aspirin 75mg, Eplerenone25mg Pravastatin 10mg,
Heart Rate was Avg 70 BPM now it's around 40 so Bisoprolol " saves " 30 beats per minute !! so 30 X 60 = 1800 Beats per hour X 24 hrs 43,200 Beats per Day X 365 days per Year = 15,768,000 per year.
So someone on Bisoprolol saves approximately ( over 10 years ) 157 million Heart Beats !!
Is there anything wrong with my logic that this must do you some good especially for someone with a Damaged Heart ??
Arithmetic maybe a little suspect it's an approximation after all. Interested to hear other views on this.
Regards
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Prada47
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Wow, 7.5mg of Bisoprolol. My heart would most likely stop with that dosage. I take 1.25mg which results in a heart rate of around 55, occasionally droping inot the low 50s. I was on 2.5mg, but suffered terribly from hypotension when I stood up after sitting down for a while. I still get it to some extent on 1.25mg. Presumably you are not affected in this way.
I had been on 10mg for over a year then Cardio for Heart Failure said he thought I was over beta blocked and reduced it to 7.5mg been fine on it ever since !! Wally if you look at the NICE guideline it says what EF is recommended to be on Entresto. I just said to my oh I believe Ectopic Beats are a lot better since increasing Entresto to 49/51mg twice a day. !!Need a conversation with Heart Nurse to increase to maximum dose. Side effect for me is a cough and ( sorry ) coughing up flem !!! Can be slightly light headed on standing up but have learnt to take it easy after sitting down. I o still get breathless for no apparent reason but I put that down to the Heart Failure even though I have a reasonable EF at 43% I do have an impaired function on the NYHA scale !!
Ramipril gave me a cough so they changed me to Candesartan. Getting lightheaded standing up is because your BP drops. It's called orthostatic hypotension. I had that and they reduced Candesartan from maximum 32mg to 16mg. I'm on 8mg now.
EF 43 is good.
I was 40% a few years ago and my heart failure consultant said that's plenty.
Below 35% you need to be on anticoagulants because the blood stagnates and clots form. I'm on warfarin anyway as I had DVT and PE and clots in my heart. I'm on them for life.
1.1 Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people:
with New York Heart Association (NYHA) class II to IV symptoms and
with a left ventricular ejection fraction of 35% or less and
who are already taking a stable dose of angiotensin‑converting enzyme (ACE) inhibitors or angiotensin II receptor‑blockers (ARBs).
1.2 Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be performed by the most appropriate team member as defined in NICE's guideline on chronic heart failure in adults: diagnosis and management."
I have been down to 27 % EF after further stents (and after CABG ) it has improved.
I have also been on 32mg Candesartan but Entresto stops the need for that Med.
My NYHA classification is grade 3 It just goes to show what a lot of us already knew that EF is just a number and the Heart Failure Team tend to go on symptoms rather than just the ef number. Also a lot depends on how the optimisation of medication worked for you as an individual !!
When the doctors that treated me for severe heart failure EF7% sent me to Harefield Hospital for a transplant my transplant doctor said to me, we can do this test and that test but can you climb a flight of stairs without getting breathless.
This was a simple activity indicator of how well I could function and I liked his simplistic no nonsense attitude.
Eventually I didn’t need a transplant as my condition improved and I was discharged back to a general hospital to a general cardiology team.
Yes, when I requested a reduction from 3.75mg to 2.5mg my GP said that the aim was to get me onto 10mg. I asked him whether he was willing to accept full responsibility for me keeling over and expiring. I didn't get a reply to that. On 3.75mg I am at risk of falling over when I stand up. Like you, 5mg would probably have me bed-ridden.
My heart, valves and vasculature are essentially healthy, but under attack from my useless autonomic nervous system and the bombardment or not, of adrenaline and noradrenaline depending on the boom bust nature of the reuptake system. I had a starting point of exhaustion and severe chest, neck, arm pain with gasping, due to massive rises and falls in BP and HR when I tried to exercise (initial heart effect symptoms 2009) and eventually just walk, or sometimes when asleep, or stand up. Now on Bisoprolol I have a permanent dull chest pain and constant breathlessness instead, so a steady illness sort of fug state. To be honest I can no longer get my legs to move enough without them feeling like lead to see if the severe pains may kick off again. It seems that regardless of the reason for taking this med, it exhausts everyone and puts them in this dulled out fog.
A reply poster to my post further up, says that Nebivolol made a big difference for her, has anyone else tried it. Also is anyone actually intolerant to B Blockers but taking them anyway along with antihistamines because their specialist says so. My way or the highway type of thing.
My BP is still out of control.
Many thanks
I’m in trouble again, my heart is struggling. I’m waiting to see my cardiologist.
I’m going to ask her about Entresto. I think I’m a candidate due to left ventricle dysfunction. Ejection Fraction around 35%.
His BP is currently in the low 100's over low 70's but he's never been able to optimise his candesartan or beta blocker as sometimes his BP dips to as low as 80's/50's. They're tweaking his meds at the moment to try and titrate up this meds but not looking likely, Entresto does lower your BP which is why they're being cautious with him, his nurse said she would never prescribe it for him. Your BP is similar, you're on a lower dose of candesartan but a higher dose of bisoprolol, so would be interested to know if they do prescribe it for you.
Gobsmacked, fair play Wally44. I think I need to make some changes to my medical team line up then, shake things up a bit🙂
in reply to
I’m in St George’s in London. One of the best hospitals.
Why do you ask. Everyone has to get those tests to find out what is going on with their heart failure.
I have a heart failure consultant and an electrophysiology consultant because I have an ICD defibrillator. He did my catheter ablation for atrial fibrillation which was caused by Ivabradine.
Are you not in UK?
in reply to
Yes I’m in UK, I just have to fight and scrap for every bit of care I receive. I’m very impressed with the service you get at St George’s.
in reply to
That’s wrong. Your GP can refer you to a hospital of your choice through the ‘choose and book’ system.
Just find a hospital with a heart failure consultant. A general cardiologist cannot deal with heart failure.
I agree, overweight and HF not good but I personally wouldn't be doing a fasting diet with HF, not sure that would be good for your heart at all. Why not ask your GP/nurse for referral to a dietician? I know someone who's recently been referred and she's doing really well with the diet.
I have two Cardiologists one is a Specialist in Intervention the other is a Heart Failure Specialist. My Heart Failure Nurse reports to the Heart Failure Cardio.
In the Middle of this is my GP who is absolutely wonderful. I would /do trust her with my total care, she keeps the Cardiologists straight when they differ on my treatment !! Even though the communication between them is OK
One reason for having both Cardiologists was that my CABG went a little wrong. Circumflex went OK but RCA was beyond bypass. The LAD was bypassed but the LIMA was connected to a branch of the LAD not the LAD. As a consequence I never improved with Breathlessness or Angina after the surgery.
To cut a long story short current Intervention Cardiologist spotted the error during an angiogram and corrected it by inserting 2 stents in the LAD. and I have been better since, so Isosorbide has been stopped Yes Result
I do have a very positive attitude and don't let this sh** get me down
I don't blame the surgeon who connected the LIMA to the Branch I suppose it's difficult when your Heart is stopped after being packed in ice slush !!and your patient is being kept alive on a by pass machine . One thing I never followed up was when I was in ICU I was on a ventilator for a longish time as it took a while to bring by body back up to Temperature I never asked Why !!
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