Bisprolol 2.5mg post heart bypass surgery. Low RHR resting heart rate.

[Sportsnut]

Hi there. I am 64 and had heart bypass surgery in January 2023. The hospital put me on 2.5mg of bisoprolol per day. Despite the inevitable ups and downs following invasive surgery i am recovering well but struggle often with feeling unwell with light headedness mild nausea and tiredness. My resting heart rate is 48 due to a lifetime of fellrunning cycling swimming triathlon. The manufacturers leaflet says bisoprolol should NOT be given to anyone with rhr under 60. I believe this is why i feel unnecessarily unwell and i am trying to pesuade the dr to reduce the dose. Does anyone else have a similar experience?Fyi i had a single bypass no heart attack no heart failure my heart is strong only one artery was narrowed and is now bypassed.

[BeKind28-]

Hello

Bisoprolol can be one of those drugs that is not easily tolerated

I did have 3 heart attacks which left some damage to my heart and then I had a triple Bypass

I am on 1.25mg of Bisoprolol alongside other medications to

I think the best thing you can do is telling your Doctor how you feel or if you are still under a Consultant try and contact their Secretary and explain how you are feeling and could they either pass the message on to the Consultant or have a phone call

I hope you manage to get this sorted out I do not feel great on them but I don't think they are affecting me as bad as they seem to be affecting you

Good Luck I hope you get it sorted x

[Sportsnut in reply to BeKind28-]

Sound advice much appreciated many thanks

[BeKind28- in reply to Sportsnut]

x

[Hrty]

Yup, had problems with low hear rate on Bisoprolol (1.25mg). In the end the Cardiologist agreed to stop it. Might be with searching for "bisoprolol" on here as there have been quite a few posts. Good luck.

[Instructor57]

I actually came off Bisoprolol today !I was on 1.25mg.

Heart attack Feb 27th and 3 stents.

I'm 66, I have intentionally lost over 2 stone since my HA with diet and excercise and during this time my rhr has been getting lower and lower,

Pre HA it was normally around mid to high 50's

Since HA it has dropped to sometimes just over , and occasionally just under 40.

Also my evening (so I also assume) night time blood pressure has been fairly low .

I have felt a little light headed in the evenings, and a little dizzy if I jumped up of the sofa too quickly.

Quite cold hands and feet also .

I have also recently re run couch to 5k , walk a lot and I feel as I am regaining fitness I am not really needing beta blockers!

So today is the first time without!

Time will tell I guess.

It's certainly worth having the conversation.

Good luck !

[Sportsnut in reply to Instructor57]

Thanks for your reply very useful info for me.Could i ask?

Did the rehab give you a max heart rate when you did the 5k?

Did you have to ask to be taken off bisoprolol or did they volunteer the removal of the drug?

I hope you feel better for cpming of it.

Best wishes

[Instructor57 in reply to Sportsnut]

My initial rehab was a telephone/ online course and they suggested when I was just walking for around 45 minutes to try and keep my HR to around 115 max .When I was given the go ahead to re start C25k I asked my cardiologist and he just said don't worry too much about the numbers just keep it comfortable.

And tbh I only ever run/jog at a conversational pace anyway.

My usual route has a couple of inclines (but I guess as you are a fell runner you would call them flat 😂)

On the inclines it gets to about 135 -140 Max .

As for coming off the Bisoprolol it was really by mutual agreement between my GP and myself .

It was suggested I had the option of reducing or splitting my dose of ramipril (I'm on 2.5mg) or the option we both felt was right of coming off the Bisoprolol and reviewing in 2 weeks .

He asked my what I wanted to do and I just said to follow your professional opinion.

[Sportsnut in reply to Instructor57]

Thats great. Thanks again, much appreciated. Keep going with the Parkruns they are a great for everyone.

[Instructor57 in reply to Sportsnut]

No problem 👍

Haha, I've never actually done a parkrun 😁Usually just local road running

[ChoochSiesta]

Coincidentally, my doctor phoned me this morning (I know!!). Said that my hr of 45 was too low due to 2.5mg Nebivolol. Prescribed 1.25mg until September then check hr again. Said needs to be 60.

[Sportsnut in reply to ChoochSiesta]

Very reassuring many thanksGood luck with your recovery

[Gail1967]

I too couldn’t cope on 2.5 - felt like a zombie- constantly tired. I had mine reduced to 1.25 which I cope on - although heart rate is slow which is often pointed out to me on health checks!

[CyclingTime]

Hi I mentioned it yesterday in a separate reply. My RHR is 45 normally and bisoprolol made me very dizzy almost passing out when I stood up as it dropped my heart rate even further.

Spoke doctor we agreed to come off them , all I needed to do was take a 5 day twice a day blood pressure test and provide him with the results of that.

All was golden since then, no dizzyness any more

[Reggaelover]

Hello Sportsnut, I’m 63 and like you have a history of endurance sport - running in my case. My resting heart rate was always around 40 bpm. I was put on bisoprolol around 10 years ago following an episode of atrial fibrillation, later corrected by cardioversion. Apparently, the bisoprolol helps to protect heart function. To cut a long story short, it turns out I have a mitral valve leak and have been referred for surgery to repair it. Fortunately I have no symptoms and my other heart tests are fine - no significant coronary artery disease etc. I’m on 5mg bisoprolol daily and my resting heart rate these days hovers around 50 bpm. I do occasionally get a bit light headed if I get up quickly from sitting or lying down but other than that I’ve had no problems.

[Scroll]

Morning, not as athletic as some of you :), had a heart attack and stent fitted last year, I take 1.25mg twice daily of bisoprolol, with 5mg ramipril twice daily, resting HR is around 54 , drops to low 40s during sleep, bp is anywhere from 106/67 to 116/71, think I have been lucky as it doesn’t seem to effect me, yes tired at the end of the day, and the cocktail of meds in addition to the 2 mentioned are bound to have an effect, but luckily doesn’t seem too adverse at the moment.

[Seal59]

My husband has the same symptoms as you and has always had a low heart rate but with Metoprolol it is now down to 39! Every time he asks the doctor the doctor is reluctant to change anything. I think he may have to go private and speak to a cardiologist. My husband is nervous changing things as he once got his statin dose reduced and that was when he had his heart attack. It may have been a coincidence but we’ll never know. If you still have access to the cardiologist I would discuss it with him.

[Lexi72]

Hi sportsnut, I have. Bicuspid aortic valve and on 2.5 biosprpol to help control ectopic beats and also losartan to control blood pressure. I am reasonably fit(but not as fit as you) and my resting heart rate was in the higher 40s typically 46 but on the biospropl is now down to 42. I was concerned it was so low and asked the counsultant before taking the biospropol. He wanted me to try it but said if I felt dizzy etc or faint we would reduce it back down To 1.25. I seem to tolerate it quite well but as the other heR

[Lexi72 in reply to Lexi72]

Sorry post was sent before it was finished . If you search the site you will find that there are lots of posts about heart rates which indicate that there is wide variation in heart rates . If you are sporty it can be in the low 40s. Also the degree people can tolerate biospropol will vary If you are having symptoms I think you should definitely talk to your cardiologist or doctor as very low heart rates can be dangerous. All I was trying to say is that there is a lot of variation in what is normal and how biospropol affects people. Hope you get this all sorted and carry on being sporty best wishes

[ForestryPine6]

Yes I've only been on Bisoprolol 5mg per day for 2 weeks and I'm sure it makes me tired not sleepy but fatigued and dizziness when I get up, I'm all over the place but it helps my hypertension so I will stick with new medication for 3 months and hope the body gets used to it and don't feel so drained.. I hope your body gets used to them, give it time and see how it goes, wishing you all the best 🤞

[pjw17]

Hello,I'm from sporting background in my case cycling and have had low HR for years . After HA in may 20 was put on biso low dose but couldn't function properly with usual symptoms.

Came off it after about 2 weeks.

Still have low HR tho in low 40s at rest.

[Woodywoo36]

Hi and it's good to hear you are doing well. My brother had a heart attack and stents fitted and was also put on Bisoporol. He was ok for a few days but then his heart rate dropped to the 40's and he felt just as you described so they told him to stop taking it. He is on other medication for BP though and that's why they said he could stop it. They are trying to find the meds that work best for him. Would they let you try half the dose perhaps or a different beta blockers? Hope you get sorted x

[Gstyle]

morning

I had the same last year for blood pressure. They took me off them. I’m 49 and had a heart attack in late May 23. Stents and now recovering. Due to bisoprolol making me feel really rubbish for months last time I’m not on them post mi. Have a word with your team. I have a medium intolerance in my records now and although they discussed them I was firm and have an alternative. Not a beta blocker. Be firm with them👍🏼

All the best and Speedy recovery

Jason

[Bush73]

Morning

Very similar experience with Bisoprolol

Why don’t you just buy a pill cutter and cut the 2.5 in half

Try for a week !

I did maintained good control with little side effects

Keep BP daily readings and check pulse

Hope you get back to normal soon

Best

Vic

[fixedrider]

In short yes, similar experience.

I had a double bypass in June 2019 and have been really well since, very happy. I was on 1.25mg Bisoprolol amongst the other usual drugs. At Easter, I passed out in a chair and, after tests, a Holter monitor, etc, the cardiologist took me off the Bisoprolol on the same basis - natural low heart rate, lifetime of club and related cycling making it lower, etc. My resting heart rate can easily be in the 40s. Also meant that, in occasional club races, I could get my heart rate up to something like 220-age, where previously I'd struggled to get within 20bpm of that!

Unfortunately I did it again last week, after three months off the drug and 12 consecutive days of cycling when helping on a Scout expedition, so due more tests. You can see my heart rate dipping into the 30s when it happened, on my Garmin records. But that's still only twice in four years, so very positive overall.

[Sportsnut in reply to fixedrider]

Great to hear your positive experience. Its good to know that you were able exert up to 220-age.

I read some of your other posts and we seem to have a lot in common.

Could I ask......

How long after your operation were you able to exert at 220-age?

Did you reach the a similar level of performance as before the surgery?

Since the operation in Jan 23 I have rode 800 flat miles (turbo/road/gravel) longest ride 100 miles and monitor the HR with a Garmin on the bike. Also some jogging up to 7km and swimming up to 2500 meters and pilates classes.

This seems like a lot to many people (especially Dr's & Nurses) but not to me.

I never have any discomfort when actually exercising but periodically it catches up with me and I feel unwell and have to back off for a few days. Bisoprolol is definitely holding me back.

[fixedrider in reply to Sportsnut]

Yes back to a similar level of performance. That was always "Not very good" 😜 Nothing unusual in coming last in club 10s before or after the operation, but I am not doing times any worse than before, and the weight loss advised after my original incident does no harm. I've always regarded training as slightly cheating, and done 10s to see what times I could manage, which may give you the idea.

Arguably, even before the op, I was putting more emphasis on (shorter) Audax events. I've done quite a few since the operation, usually at your 100km distance. I've signed up for a few 200km ones also, but DNSd some feeling under par - I can relate to your point about backing off for a few days. Nearly completed one a couple of months ago, but for a series of punctures. I did the RideLondon 100 miler last year (2022), but that's not particularly hard for anyone used to distance riding (and who isn't actually trying to ride with the front group or anything!)

I wasn't sure whether Bisoprolol was holding me back, but did notice the very low heart rate even when flat out (20 below age expectations as above). I'm not sorry to see the back of it. The specialist who discharged me was very relaxed about my attempts to get my heart rate up, and was simply impressed that I could get it to 20 under, and that was only a few months after the operation, so I've never worried that I was overdoing it.

Regarding recovery, that was disrupted twice. First, I was one of the unlucky few who pick up an infection in the operation, and was straight back in days after being released, for 6-8 weeks of treatment for vomiting etc. That threw everything out. By the time I went into outpatient physio, I was several months on from most people, and pushing to get active, but the numbers said I was only newly released. So, the physio team went really cautious and were forever asking me to back off. I also did long walks to get my steps numbers well over daily targets, and took the offer of discount membership in the local (council-supported) gym when physio ended. And discovered a sudden interest in numbers, reflected in Garmin watches, wearing an HRM when cycling, and so on - I'd never really cared before, and now I'm often looking. I'm even using cadence sensors, which have limited relevance to heart condition, just because of that new interest in numbers.

The second disruption was Covid, less than six months after I came out and before I'd tried any racing. I dabbled in Zwift as part of recovery but, all of a sudden, club runs and club races were all on that platform, and I went into it quite heavily. Albeit with the lowest-end set-up known to humankind (my pain cave is a single-speed wheel-on set-up, outside on the patio). So some comments about maximum heart rate relate to measurements from that.

Sorry for the length of this, especially for any other thread participants mad enough to have read this far. However, your experience of needing to back off is really interesting and, as above, something I can relate to. Also, since I've now had two instances of passing out, linked apparently to low heart rate when taking a break, it's quite relevant - I'm due proper tests, and the doctors rightly won't be drawn without the results, but it's in my mind that I may need to watch out for too many days of repeated effort without a break. The latest incident was after 12 days or so on the trot running cycling activities on a Scout expedition. So anything you share on that I'll read!

[Sportsnut in reply to fixedrider]

sorry typo longest ride 100km 62 miles

[LindyMc]

Been there done that Definitely ask asap. GP likely to be the quickest to respond. Its really vile isn't?

[Jak8]

I have been pretty active all my, 74 year, life but also abused myself, smoking, drinking and dope culminating in a heart attack in Greece in 50s then triple bypass in UK. Fit again after 5 years and back to normal until cardiac arrest in France in 2012. Fit again quite quickly with ICD although heart progressively deteriorating so thru this period ended up on Bisoprolol, Entresto and Zoare. Suffered from severe posturial hypotension then collapsed while rising from a crouched position in my allotment. Kept in A&E under observation for 4 days awaiting a part time medic to arrive. Finally discharged with reduced Entresto script. Still suffering extreme postural hypotension so I starbelow ted to measure my BP and found I was suffering what I would consider to be hypotension with BP often below 80/50. Thoughout these episodes I was undertaking a brisk daily 5k in an hour walk with no adverse effects. But I was still on 3 forms of BP reduction medication. Questioned this with cardiologist/medic who agreed it made sense to stop all BP medication. Continue to monitor BP and still managing 7k hikes but much slower. BP fine and typically mid 90 over mid 50s. BP is highly variable between people. As suggested try weaning yourself off but monitor effect closely. Take care Jak

[Elsabounre]

Sometimes the Docs follow the protocol from the Drug makers..but you know how you feel..I an LBBB patient was also given 2.5 of Bisoprolol together with Entresto ..26mg..both doses proved too high as it caused a very low BP..so I broke each pill into 3 pieces..they are not always evenly broken..so I check BP before I take any..it has happened that BP was low and I took none..or depending on reading a smaller or larger piece..if it was a bit higher..My Cardiologist is ok with this and we do 2 echos a year to see if the heart has changed..till now..EF is better and BP is under control..so each patient reacts differently to drugs..it just needs regular control of your BP for you to find the right dosage..

[Beater]

Bisoprolol ruined my life. I couldn't tolerate it and cardiologist would not return calls. 11 months after AVR and cabgx1 I was passing out after going to the washroom. Heart rate was so low and couldn't get it passed 89 with vigorous exercise. Went down to 98lbs and collapsed in the street. Long story but I am bedridden after 26 months and now I have lots of other issues. Lack of medical care in my city.

[bagsypartime]

I take this after cabg*2.Plus the other one (ace inhibitor?).Read on here side effect low sex drive etc, but the docs keep you on it because it is NICE guidelines.

My heart rate was 54 and didn't see why i needed this drug.Been told docs keep you on it for at least a year but preferably for life.The argument is similar to statins or aspirin that statistically it is better.Outliers like yourself it's just tough, if a doc takes you off and then an adverse event occurs then someone might blame them.

I do have a question myself as there seem to be a lot of runners on this thread.My CABG was the most common kind, left mammary to LAD.When i run i can feel it bouncing about and this stops me- unless i hold my left chest.Is their anything i can do about this? Say a male sports bra or some kind of cheat?Others must have had this surely?

[Sportsnut in reply to bagsypartime]

Thanks for the useful information, I am learning all the time!

They have told me to limit my max HR to 125bpm at present so the best I can do is jog. I have done several shorts jog say 2km, a few 5km on the flat and got up to 7.5km on one occasion.

While jogging I felt fine with no sense of my chest bouncing like you experienced. Sorry I cant help you with this except to suggest that maybe a compression tee shirt or vest might help.

[bagsypartime in reply to Sportsnut]

Thanks.I was thinking this (compression vest) been looking.Just feel that as LIMA to LAD is gold standard others must have had this loose artery flapping about problem too.I find it hard enough to keep going as it is but this wobbly boob stops me.The alternative for me (a treadmill runner) is walking on an incline. That's okay but i'd like to run again and not struggle.

[Beater in reply to bagsypartime]

Excuse me? Outlier? You obviously like koolaid. Thanks for the support. Fyi, some people cannot tolerate the meds and the statins will kill you. Do a little research out of the box or get a magnifying glass and read the insert but then again ignorance is bliss.

[bagsypartime in reply to Beater]

a super fit fell runner with a resting heart rate in the forties is obviously an outlier and the meds are for a normal person that does not account for this.What are you talking about koolaid, sports nut wasn't offended by my comment what are you?

[Beater in reply to bagsypartime]

I apologize if you were not referring to me as an outlier. That's how I interpreted your comment.

[bagsypartime in reply to Beater]

I've reread and tried to see it from your side.Don't beat yourself up or feel bad.I can see this is an issue that has affected you and blunderers who apply one rule to everybody don't realise that for a few this causes real problems, and then it's even more annoying when this gets dismissed.Therefore your frustration is understandable.Good luck to you.

[Hidden]

Hi Sportsnut. I'm a little older (73 come the 19th August ) than you, but probably not quite as fit pre my double Bypass September 2022. I, like yourself, have never suffered from high blood pressure, average resting heart rate, high 50s to low 60s. Covered some 20,000 + steps playing social tennis 🎾 3 times per week so it was a bit of a shock to be told I had a severe stenosis at the top of the LAD. 4 months on from my Bypass I just couldn't put up with the medication 🙃 due to ghe side effects and took the decision to stop them all other than Omeprazole & a daily Aspirin. Touch wood 🪵 I'm feeling better the than ever. I would not recommend this course of action to anyone however, I was very fortunate to talk to a cardiologist prior to my decision to drop my medications and was given the OK by him. Hope my experience gives you some hope for the future best wishes for your future health. Denis

[mld78]

Hi. I was a race walker. I had to stop Bisoprolol due to my heart rate going too low and then my BP also nose diving. Medication prescribed after 24 hours on a cardiac ward. They didn’t ask about exercise etc. Just routine prescribing. Eventually GP realised the problem, and sought urgent advice! Cardiologist agreed to the stop of medication. Feel fine most of the time. No longer racing but walk everywhere. Told by a nurse, as ever, to let increase my exercise. Asked her why, and she responded that no one ever exercises enough!

[Jem64]

I'm also on them..awaiting a triple bypass .....having looked at the manufacturers' guidance there are several of my prescribed meds that advise it is not recommended should you have an underactive thyroid which I do...

[Sportsnut in reply to Jem64]

Good luck with the operation.

[Jem64]

Thank you...although I'm having a serious rethink about it...The meds have helped my BP and I'm on a better diet...I'm not certain that I need to resort to surgery at present...

[Prada47]

Hello "My resting heart rate is 48 due to a lifetime of fellrunning cycling swimming triathlon"

That statement goes to show that being Fit is not a guarntee of not having Heart Problems. Bisoprolol is one of the most prescribed Medications for Heart Problems it is not just to regulate HR it is also I believe a means of making the Heart Beat stronger. I think if you took Ten Hearts out of People and layed them on a table they would all show differing degrees of damage, so needing differing levels of Medication. You are on a low dose of Bisoprolol I used to take 10mg now reduced to 7.5mg just checked BP is 94/61 HR is 59 so it looks like 7.5mg is about right for me, I do manage pretty well on Statins, Entresto,Dapa, Aspirin and Eplenerone. It is one hell of a complicated task to get your meds right, me I am just pleased to wake up every morning not needing to worry about going Hill Walking or doing 50 lengths of the local Swimming Pool as mentioned above it may not do you a lot of good LOL

Hope you can get it sorted

[Sportsnut]

Great news.....the specialist has agreed to take me off bisoprolol. Half dose 1.25mg for 2 weeks then all being well reduce to zero. Thanks to everyone who contributed to the discussion. It was very informative and reassuring to hear from you all.