Cardiologist pushing for beta blockers but my heart rate is slow anyway.

[Glen1677]

Historically I always had a resting pulse rate of 72 but since mid 2018 I've had a low pulse rate of around 50bpm when awake and 38-40 when asleep. An NSTEMI in 2019 followed by some really bad problems with tolerance to medications, mostly causing severe dizzy spells and near collapse but also frequent central radiating chest pain.

Working with my GP we've finally settled on a low dose statin and aspirin as my tolerance to everything is so low. I suffered repeated VT rhythm during a stress test in late 2019 and have since had frequent AF rhythm. I can't tell I have VT but I can feel the pulse shoot up with AF. Loop recordings show my "normal" heart rates are now 35-40 when asleep and 45-50 when awake.

I was admitted to hospital six times last year with AF and in October after a particularly bad AF episode given a beta blocker late in the evening. Heart rate dropped to 30 when asleep and barely above 40 when awake (though Covid regs were operating so no moving around). My cardiologist has all the data but wants to put me on a beta blocker which I'm not happy with. I feel my heart rate and a beta blocker are a bad combination, my history with meds is a nightmare and I live alone which probably doesn't help either.

Am I being over cautious or is it a justified concern?

[road2ruin]

Hi Glen,

I too have similar issues. I had surgery in 2019 and soon after had an episode of AF. I have a low heart rate, normally around 55-60 during the day and 40-42 at night. Even when I cycle hard I can't get it above 130bpm. I am on Bisoprolol but only a very low dose 1.25mg and it doesn't seem to have made a difference to my heart rate.

I have to say the doctors are certainly more qualified than we are to determine what is needed. If you are concerned talk to them, this won't be the first time they have had a patient in your position.

Good luck

[Glen1677 in reply to road2ruin]

I have stage 4 COPD and did cardio and pulmonary rehab. I can't win, cardio told me to work harder and the pulmonary told me to slow down. I did the stress test just as the rehab finished and it's as if something happened as the fitness has dropped off a cliff since then. I try to do a lap round the block everyday, just 400 yards though it's rare if I can make it without stopping now whereas before I could manage to walk for a couple of miles.

[thelma1960]

I can relate to that. I was put on beta blockers immediately after my ha. I kept passing out with no warning and banged my head. Was lucky I had no stairs in my house. The passing out was with no warning. Thing is my bp wasn't high anyway so making it go lower wasnt good. Wss told it was also for repairing my heart. The nurses at rehab ob served it and I was taken off them. One of the many problems I have hD with medication. I think the meds made more of a negative impact than the ha did

[Glen1677 in reply to thelma1960]

Yes I went from two daily medications to a dozen overnight after the ha and the side effects could be down to almost any of them. They really pushed hard to lower my cholesterol below 5 though it was far below that anyway. My bp was and has remained at 120/80. They did pick up a couple of things with the ultrasound both of which are defects from birth though nothing had ever come up in the dozens of work and DVLA related medicals I underwent over a period of 30 years . One is a muscle bridge on an ascending artery and in the words of the cardiologist is a "big bugger", I think that's a medical term though I'm not familiar with it.

I get on really well with my GP but I've never clicked with the cardiologist, if he's running late he always seems to catch a bit of time up by whizzing me through the consultation double quick. It's in, tell me his plan and out again.

Way before my HA my GP did say given the initial collapse beta blockers weren't really an option and I guess that's stayed with me. The hospital phoned today to let me know that they haven't had any data from my loop recorder for 9 months so it "may" have failed. That's pretty much the period the AF started so they don't have baseline details for heart rates beyond the brief stay before xmas.

[MountainGoat52]

My brother has irregular AF and the first course of treatment that he was put on was a beta blocker, initially 5mg of Bisoprolol, quickly lowered to 2.5mg and eventually to 1.25mg. With any dosage he felt unwell, weak and often tried to pass out. His GP took him off the medication and put him on Apixaban which I thought was more appropriate for stroke, but he does seem to be better on this.

Following a HA in 2017 when I had stents, I was put on Bisoprolol together with other medications. I had a triple bypass the following year. With regards to Bisoprolol, I had a similar experience to my brother, but I have found that I can now tolerate 1.25mg daily. The affect on my heart rate is minimal (daytime resting nominally 50 - 55). My cardiologist hoped that I would be able to take it as he was of the opinion it offered some protection to my heart and strengthened the muscle.

Incidentally, my GP was not particularly happy lowering the dose of my beta blocker from 3.75mg to 2.5mg, but as I was almost passing out when I stood up, he agreed to my request. This was subsequently lowered to 1.25mg in consultation with the pharmacist that works with the GP practice. She was keen to get a balance between the beta blocker and the ARB that I am on.

So what I would ask is whether there is any leeway in the dose of the beta blocker you are on? It seems that there may be some benefit from taking a small dose, but if the lowest dose available does have an effect on your heart rate then this issue needs to be raised with your GP and cardiologist.

I hope you get this issue sorted soon. All the best

Gerald

[Glen1677 in reply to MountainGoat52]

Thanks for the reply. I'm not sure which they gave me at the hospital but they had to split a tablet in half to get a low enough dose. I'm so used to having the telemetry recorders I can access the event history on them and they forget that. That's the reason I know I dip below 40 when asleep. When AF hits badly I can hit 250bpm quite easily though it's very hard to check accurately at that speed.

Apparently my loop recorder is a bit dodgy so daily transmissions aren't always working but they did phone this morning as they've picked up an overnight low of 31 this week and I'm not currently on a beta blocker. I feel less happy now that beta blockers and that pulse rate are a good combination to consider let alone go ahead with without some decent monitoring before and after.

[MountainGoat52 in reply to Glen1677]

I can their thinking if you are recording 250bpm as that is extremely dangerous. However, in suggesting a beta blocker they must be thinking that you will be okay at the low end of the scale. I would definitely discuss this with the cardiology team and ask them what they consider to be safe at the low end of the scale.

After my HA, I did meet someone while in hospital who said his usual daytime rate was 40bpm. Unfortunately he didn't say what level he got down to while sleeping and I didn't ask - I was just amazed at the daytime figure.