I am being prescribed Bisoprolol pending further tests after an acute cardiac event. It is acknowledged that it is unlikely that I have a heart problem (I've already had an angiogram and that showed I have very healthy arteries). My question is when taking this drug merely as a precaution can there be any harm caused?
Bisoprolol fumarate - Harmful? - British Heart Fou...
Bisoprolol fumarate - Harmful?
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LiziJ
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Bisoprolol has a mixed reputation on here. I took it for years at various doses without any issue at all (I have a very mild arrhythmia for which beta blockers are the primary treatment), other people will probably reply to you to say they found it very hard to tolerate due to side effects. It seems to be a 50/50 split in experiences, but it’s worth bearing in mind that boards like these are populated by lots of people who are having challenges with their heart health/condition, or the diagnosis thereof. There are tens of thousands of people taking beta blockers (and with heart conditions generally) that are not members here, and in many cases that’ll be because they have no issues and are just living their lives, so the response you get here, whilst still helpful, may not necessarily be indicative. Or have any bearing on what you will experience. I’ve personally found that all side effects for any medication can potentially settle with time, so sticking with things for a few weeks can be beneficial as long as things are tolerable; putting anything new inside it is going to require a period of adjustment for our bodies.
Sometimes people find that any side effects with bisoprolol are dose related, so more at higher doses, but in terms of causing you physical harm, my understanding is that no, it won’t, even if you don’t really need it. Beta blockers have an effect on heart rate and blood pressure, lowering both slightly by blocking adrenaline, and that’s essentially all they do. Disregarding potential side effects, unless you have asthma or already suffer with hypotension or bradycardia, they’re not going to cause you a direct problem.
LiziJ in reply to
Thanks Charlie_G for your detailed response. You highlight my main area of concern very well. I am prescribed this drug (and others) pending further tests 'just in case' and it seems that I don't have a hear problem but did have an acute cardiac event (elevated troponin now returned to normal after suffering shock and trauma by being stuck in a manure bog and needing rescue). I was in hospital for 5 days but blood pressure, heart rate, ECGs and angiogram were all normal. So I am, as you suggest mainly concerned whether Bisoprolol can cause bradycardia and hypotension if I have normal rates of both. However, it is reassuring to hear the Bisoprolol won't cause me harm even if I don't need it and hopefully my cardiologist will take me off it once I have had the final two tests (echocardiogram and Cardiac MRI).
in reply to LiziJ
It’s a difficult one, but in your shoes, and with significant cardiac history in my family, I would personally make the call to go with it until I’d had a clean bill health. They’re not going to recommend you take something ‘just in case’ if there’s a strong possibility of the treatment causing you harm in the interim, and beta blockers literally only block adrenaline. That’s why they’re also used in anxiety, and also for benign tremor. In terms of drop in heart rate and blood pressure, my understanding is that these are pretty mild; I had excellent blood pressure pre bisoprolol, 110/70 most of the time, and only got into issues with low bp and orthostatic hypotension (falling blood pressure on standing) when my dose went up to 7.5mg and above. Although you can go higher in specific circumstances, the max dose is generally 10mg. Similarly, at lower doses the reduction in heart rate is negligible; off the top of my head, I seem to recall reading somewhere that it drops less than 10bpm on average when taking 5mg or below. Unless you’re already in the 50s for resting heart rate, a drop of 10bpm is going to be negligible for most people.
Whilst we all have to make the decision that’s right for us as individuals, bearing in mind that they were concerned enough about your troponin results and presentation on the day to order an angio and keep you in for several days (neither of which are things they do lightly), and as long as it is a relatively short term situation, I’d probably err on the side of caution and follow the advice if it were me. The heart is a little bit too vital to take chances with, and if you do find you’re having major issues, you can always speak to the medics about stopping.
LiziJ in reply to
Thank you Charlie_G, while my heart rate is in the 50s (I was on 24-hour tracking in hospital and it was mid fifties for most of the time) the dose of Bisoprolol is low (1.25mg) and so it seems that staying on these drugs for the time being is the safest approach and yes it does have to be borne in mind that they were concerned enough about my heart to not let me home until they had the results of an angiogram. This conversation has been really helpful. Thank you 
Ramilia in reply to
Thanks for the part of your post relating to heart rate and dose of beta blocker, Charlie_G. I'm interested in this particularly as I am on 1.25mg of bisoprolol and have a resting rate of 54 on average. My BP is on average 110/70, so I hope to be able to come off the bisoprolol in a few months' time after my next cardio appointment. On your figures, and assuming I'm an average patient 😁, a rise to around 64 for HR sounds okay to me.
These conversations are always valuable because they give us all food for thought when dealing with our own feelings and our discussions with doctors. Thanks!
Hi LiziJ,
Has your Cardiologist considered non obstructive coronary artery disease as a cause of your event?
In particular a severe coronary artery spasm.
Stress and the cold are the major triggers of coronary vasospasms.
Beta blockers can actually make coronary vasospasms worse. I spent 5 days in CCU after being prescribed beta blockers, before my diagnosis of vasospastic angina was confirmed.
I suggest you discuss your concerns with your Cardiologist.
Thanks. I will see if I can contact my cardiologist. I haven't had any contact with him yet. I just have a name but my angiogram was very positive so hopefully that indicates I won't have the issues you mention.
A routine angiogram will not detect coronary vasospasms or microvascular dysfunction.
I hope you don't have either of the conditions too. However it is important that they are recognised and treated appropriately, or excluded.
I have had an angiogram - pristine arteries the consultant in the cath lab said.
However pristine coronary arteries does not mean your coronary blood vessels are working properly.
Some people's small vessels fail to dilate or stay dilated in response to extra demands such as exercise or stress.
In others the blood vessels go into temporary transient constrictions vasospasms.
These functional disorders of the blood vessels cannot be seen during a routine angiogram.
Some of us when we are first confronted with our heart events, can go through a grieving process for our former sense of well being.
The emotional fall out from any cardiac event can be profound and can take time to recover from.
The Cardiac Rehab team are usually well placed to help.
OMG what a trauma for you. Apart from your heart event , I hope you are ok otherwise 🤗
I had minoca last April, atypical presentation. Classed as heart attack because troponin was at 117 , very low but still elevated. They ran every test possible and found nothing. Was told maybe stress or muscular issue (had breast radiation) or microvascular may have been the cause. Also told nothing can be done, and was prescribed the standard medications. My family doc. told me that even though they could not definitively find a problem that for a few months to take the meds. to help the body recover from whatever happened to raise the troponin. I have since stopped all meds. ,except aspirin, some with approval some not.
That is really helpful thanks. Quite similar to my results so far, except my troponin was a bit higher peaking at 391 (but now back to normal).
Troponin test is a life saver, my doc told me that when any level of elevated troponin is detected you are monitored very closely as it can be rising for as long as two weeks, and that is an indication you are having or about to have a heart attack. So they take it seriously and you will have a hospital stay and every test. So it's reassuring to know your level was going down, mine did as well . I felt guilty taking up a hospital bed and basically needed no care.
Yes, that is how I was feeling too and then also that I was wasting everybody's time. I am also self-employed so there were financial implications, and I need to travel long distance to support my elderly and frail mother and so there were other considerations. Of course health comes first but I was thinking that I was OK 
Have you seen this website written by patients for patients living with Microvascular and vasospastic angina?
The group is supported by 30 world leading Cardiologists.
I don't feel that ' nothing can be done' is appropriate.
Microvascular dysfunction and vasospastic angina are serious heart conditions which require appropriate treatment.
internationalheartspasmsall...
I investigated it thoroughly , with the help of Dr. Google ;), and discussed it with my cardiologists. I have had 3 angiograms and the most recent two was told the same thing and there is nothing they can see to fix. My most recent one upsets me because my records must show suspected microvasular yet they didn't run the test when they had me in the cath lab. They are noncommittal in a diagnosis other than calling it minoca. I must say that I have no angina or issues I am aware of so I don't see myself as a heart patient even though something caused my symptoms on that day and raised that troponin. Thanks for the link, I will look into it.
Soppybat in reply to
What an excellent response, a pleasure to read such balance!
Sewing19 in reply to
What a balanced reply. 👏
Hi , Charlie has already given really good advice .
In my (very limited) experience, bisoprolol has worked as it should and I’ve not had any difficulties from taking it . (I’m not sure if I have built up a tolerance or if my symptoms are worse , hence a recently increased dose ) .
I distinctly remember at the beginning of being prescribed bisoprolol thinking what a relief it was to not feel my heart racing all the time as it had felt utterly exhausting .
(I was prescribed 1.25mg for approx a year& it was increased to a still low but slightly higher dose (2.5mg)recently. )
If I were in your position, I’d take the bisoprolol pending any further results.
N
LiziJ in reply to
Thanks. Yes I will. It has all just been a shock especially as I don’t feel unwell. I am overweight but fit and healthy and enjoy my long walks. Now I have these four new medications but I am following the advice. I did email my GP and ask if I could stop taking them but the advice had been consistent so I will stick with it.
in reply to LiziJ
Hi
You’ve gone through a fair bit of trauma recently & from what I know it can be tough to get through that immediate, critical period , but harder in many ways in coping with what gets thrown in after . (Ie -these new medications, tests, doctors…lots of uncertainty ). It’s definitely a good thing you’ve been able to contact your GP & get a reply . I hope the medications you’ve been prescribed do help, and that the tests you’re waiting on happen soon .
👍 N
LiziJ in reply to
Thank you Nina that is really kind of you to say.
Hi , I’ve been using this beta blocka for nearly two years to help with menopause symptoms of anxiety and palpitations , I take the lowest dose 1.25mg before bed , I’ve had no issues , I’m 54 and my resting heart rate was about 64 bpm before them it now 60 . I’ve had no side affects at all .
Ask the person who prescribed it.
I was started on 3.75mg after my HA. Following consultation with the Pharmacist at my GP practice, I am now on 1.25mg. My resting heart rate is mid 50s which is fine by me. At a higher dose of Bisoprolol my pulse rate was too low and I tried to pass out when standing up after sitting for a while.
I am sorry to hear of your experience. I am also on the 1.25mg dose of Bisoprolol and this is not so much of a concern to me as I come to terms with what has happened. I am more concerned about the atorvastatin.
Drawing on my own experience it is the early days which are the most difficult, especially when nobody, neither you the patient, nor the doctors have full information about what is going on. I had a stress echo which suggested I had multi vessel heart disease. I was given a load of drugs including atorvastatin and bisoprolol as a standard package of protection until an angiogram could be arranged so the doctors could see what was going on. I had the angiogram and lo and behold it turned out that I only had mild atheroma in one of my main arteries, so the conclusion was the problem seen on my echo was being caused by the micro blood vessels. Another drug was added to deal with that situation.
I then took myself off for a private consultation with a specialist in microvascular angina who worked with me to find the best combination of drugs for me.
My main point in telling you this is that sometimes a diagnosis can be given immediately and the appropriate action taken. In other cases it takes a while to establish what is going on and for a while you may be taking drugs which are not necessary when the full picture is known.
There is also the point that we each respond differently to different drugs. You seem to be OK on bisoprolol whereas for me it caused a whole lot more problems than it solved and it was a happy day when I came off it. But unless you get an extreme reaction to a drug which will be listed in the side effects it is highly unlikely to harm you in the short term.
I seem to have written a book, which was not my intention! The main point is that there is a process to go through which may take some time until the fog clears and you can see what's what.
Sure and I do understand and appreciate the message. My angiogram was normal. I am having side effects from my medication but they are not too severe. My morning ones cause me to be lightheaded and have a bit of a temperature (Bisoprolol, ramipril and aspirin) and my evening ones (atorvastatin) seem to have a sedative effect. Today I have diarrhoea as well but I am not sure if that is related. I am told that when I start walking again I may also lack stamina, but again I can adapt.
Your angiogram only showed that your coronary arteries were not obstructed. The angiogram did not show that the blood vessels in your heart are functioning normally.
Dunestar has given you some really useful advice.
Dunestar and I both live with non obstructive coronary artery disease, NOCAD.
Dunestar lives with Microvascular angina and I Iive with vasospastic angina.
Sounds like you are on the standard start off package of medication. CoQ10 supplement helps me with the lack of energy aspects of my medication.
Bisoprolol is prescribed as part of the protocol after a heart event, as is Atorvaststin and Ramipril (as they are cheap.) I had a widowmaker h.a. and received these. Bisoprolol 2.5 ,after a couole of years gave me 20kg weight gain and kidney stones which are a rare side effect! My cardiologist changed me to Ivabradine and I have no issues with it!Just letting you know everyone is different as are our reactions to these meds! Wishing you all the best and your test results sound good, try not to worry!
Hi,Here's my experience....
I have been taking Bisoprolol for three years, when my AF kicked in.
Obv I was rattled after 70 years of never staying overnight in a hospital and so I started to take home readings of Heart Rate and Blood Pressure every day and recorded them on a spreadsheet
This drug, as explained by my Doc, acts as a braking mechanism to control heart rate but it's very important to get the right dose.
In my case, I was taking 7.5 mg per day and the effect on me was to rob me of energy needed when my heart rate stayed at a normal level whilst exercising. This resulted in loss of breath and meant that I could not walk very far without having to stop.
Then Covid came around and of course, access to medical help was limited.
Remembering what the Doc said about Bisoprolol acting as a brake, I assumed that the dose was too strong and so sent my spreadsheet data to my Doc and when i finally got a telephone appointment, I suggested given the energy problem, that the dose be reduced. It was reduced to 3.75mg and had an immediate effect in restoring it.
After around three months, having got used to my newly restored energy, I decided to ask again for a reduced dose. This was agreed and for the past year it has been at 1.25mg per day.
My meds are being reviewed this week and based on my data, I hope to discontinue Bisoprolol completely.
So, my unqualified advice is to keep an eye on HR and BP yourself and spot any change from the norm. You don't say what your dose is but in my case 7.5mg was too much, 3.75mg was kind of ok and 1.25mg is ideal.
Try not to fret too much. Ask the Doc why the dose is whatever it is and ask him/her how it will be monitored.
Best wishes
Mike
Hi LiziJLike you, I suffered a major cardiac event 17 months ago, Not a heart attack! Also like you, my angiogram showed nothing wrong with my arteries. However I’ve been diagnosed with SLVSD and prescribed a cocktail of drugs.
I can only speak to you of my own experience in addressing some of your points. Atorvastatin was the first statin I was prescribed and I couldn’t tolerate it due to extreme muscle cramps so I was put on Simvastatin, I seem to be Ok on this. Like you I’ve question why I’m on statins if my arteries are fine and was told it is to help prevent a future heart attack, as my heart is definitely under stress. I also have been told by others in the know it’s an awful drug to take and to stop taking it! Obviously stopping any medication without discussing it with your GP / HF team is Not advisable. However after weighing up the pros and cons, I’ve decided to stay on the drug as I’m a 46 year old mum of 2 and I don’t want to risk not being here for my kids.
Also I believe you are concerned about Bisoprolol! I started off on 2.5mg and am now on 10mg. I told my HF nurse that I was extremely tired so I switched to taking it at night which seems to be better. However I was also told that even after a year, it was still early days to see the real benefit of any of the drugs, as it can take this long to be fully titrated and then another year for the full doses to really be working at max capacity. I have found that even when exerting myself it is very hard to elevate my heart rate now but then I guess that’s the point to this drug. One thing I do really notice though, is I now really feel the cold. Everyone reacts differently so I think it’s very important you have access the a heart failure team and you should definitely be having monthly blood tests for a while to check your liver functions. Good luck in your quest for information and I wish you all the best with your future health.
Thanks for sharing your experience. I am older than you (63 next month) but also feel inclined to continued with the drugs as I just don't want to take any risks but I am concerned about atorvastatin particularly. I will talk to my GP again about what seems a consistent theme - lots of side effects, some with long-term complications.
Hi I’m on Bisoprolol and atorvastatin, plus a few others. No side effects so doesn’t always affect people.👍
Just to add to the mix on Bisoprolol, I was first prescribed 2.5mg daily, not immediately following my heart attack, but 2 months later after a paroxysmal episode of AF. I didn't get on great with it. Lightheadedness and a dizzy feeling were the main problems, but also cold hands and feet. Long story short, I came down to the minimum 1.25mg dose and cardiologist eventually decided to take me off them which was fine by me because my pulse rate was going down to 42 at times whereas I'm normally in the 50s, and BP under 100/60. Unfortunately, once off them entirely, my pulse rate and blood pressure started to rise, and after about 10 days I was getting into the realms of too high.
Having discussed this with GP I am now following a compromise regime. I take BP and pulse rate each morning and if I'm 120/80 or less I don't take it. If I am more, I take half a tablet, 0.625mg. This seems to be keeping me between 110/70 and 130/90 with a pulse rate in 50s. Weird, but that's me, I guess.
It sounds as though you have found a good solution but it must have been scary.
Just to add to what you have said.... I too get cold hands and feet as I suffer from Raynauds Syndrome. Bisoprolol certainly makes it worse, but I am prepared to live with the issue as on balance I feel taking a beta blocker is worthwhile.
Please try not to worry so much about taking statins and beta-blockers. Millions of people round the world take them with absolutely no problems - on boards like this you are much more likely to hear about problems.I take 2.5 mg bisoprolol for ectopics, with absolutely no side effects, whilst my husband takes the same dose and does get cold extremities, but that is all. I believe you have been prescribed 1.25 mg, which is the lowest possible dose.
Statins get a particularly bad press, but again most people have no problems with them. Do make sure you get a liver function test after the first few weeks (this is standard practice at my GP), as your liver can be transiently affected. I switched from atorvastatin because of this and now take simvastatin with no problem.
I do think if you start with an open mind and not expecting every side effect on the patient insert leaflet, you will get better results. (And I used to be involved in writing the wretched things!).
P.s. I read about your horrendous time with your gall bladder surgery - must have been horrible - I had an ERCP but a straightforward surgery last summer, so I sympathise.
I was listening to radio 2 on Monday and a lady said she had broken heart syndrome which gives very similar symptoms to heart attack including raised troponin levels. She said it was brought on by a very stressful situation like yourself. She has made a full recovery. google.com/url?sa=t&source=...
Those of us who have suffered from Takotsubo syndrome prefer not to use the phrase 'broken heart syndrome' because it's a condition not only brought on by stress caused by grief. Around one third of cases are caused by emotional stress, one third by physical stress, and one third have no trigger at all.
I listened to the radio segment Rolo99 refers to, and unfortunately, the caller who was just about to explain more was cut off!
For anyone who wants to hear the whole segment, it starts at 1:02:06 here: bbc.co.uk/sounds/play/m00154w2. The specific mention of Takotsubo is at 1:20:37.
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