Potential AF? Bisoprolol for management?

[Tryingtofindhelp]

Hi everyone,

I’m mainly looking for advice, tips, anyone who has experienced something similar and how they now go about managing it.

I started having episodes of heart palpitations at the back end of 2020, where my heart rate would randomly spike to over 150bpm when resting, as it only happened a few times didn’t think much of it. 2021 was a clear year, however 2022 these episodes started happening again and they were worse - heart rate rising between 170bpm - 196bpm when resting (accompanied with feeling dizzy, ill, sweating, tight/painful chest).

When these happens it seems that the rhythm itself is still fine, it’s just really high.

These episodes would last between 5-10 minutes, and after attending a&e and having an ambulance out a couple of times, attending the GP multiple times, blood tests and a 24hr ecg fitting they put me on bisoprolol. I was still having episodes on the lowest dose, so they then sent off for me to have a Cardiology appointment and upped my dosage. A year later, my Cardiology appointment is finally coming round, and I was just wondering is it likely they’ll just keep me on these tablets for life? Is it likely they’ll even try to find the cause if I’m no longer having these episodes on these tablets (have been on 2.5mg since the middle of last year, and have been giving the green light to take an additional half if I can feel it coming - note I’m a 27year old female).

Generally, my heart rate when doing anything besides sitting/lying still is around 120-130bpm, and I tire and get out of breath very easily (also b12 deficient).

Anyway, just wanted some advice on this, or any useful questions I should be asking the cardiologist next week. 😊

Is it likely I’ll just stay on the same tablets, will I need any tests? Has anyone experienced anything similar? The episodes can be really scary!

Thanks!!

[Tigger_2]

Bisoprolol seems to be the go to medication for your symptoms.

The usual process is to start you on a low dose, 1.25-mg daily in my case, then ramp it up to the maximum of 10-mg taken as two 5-mg doses daily.

I used to be on Atenolol 50-mg daily, equivalent to 5-mg Bisoprolol.

I get episodes of bradycardia (<40-BPM) that get past the pacemaker set to 70-BPM.

Why they are treating bradycardia with a betablocker is a mystery. Even the GP says it doesn't make sense.

I had a one-off tachycardia (>200-BPM) which kicked off the Bisoprolol and they seem to have forgotten the underlying (>18-years) complete heart block.

[Tryingtofindhelp in reply to Tigger_2]

So I guess there’s a potential then for them to put the dosage up, if I’m still having an unusually high heart rate from not doing much.

I’m sorry, it doesn’t sound like you’re getting the best help. It does sound odd to treat bradycardia with blockers, from my understanding the majority of them lower things like your heart rate/blood pressure?

In your instance is it just a case of medication and the pacemaker?

Thanks for your comment also, it’s appreciated and helpful 😊

[devonian186 in reply to Tryingtofindhelp]

I am on the same medication and others after a heart by pass. There is some underlying problem if your resting heart rate is so high and surely it is that factor you need to get to the bottom of?

What is your Blood pressure morning and afternoon? Is that also high? If you have an appointment coming up it would be useful to take it twice a day for a week so that you have some facts and figures your doctor can look at.

It would also be useful to jot down other notes such as your typical diet and exercise. Do you have asthma?

[Tryingtofindhelp in reply to devonian186]

Hi,

Yes agreed, that underlying problem definitely needs to be investigated, just worried I’ll likely be fobbed off since it’s taken awhile to even get to this point.

Blood pressure is fine in the morning and afternoon (not sure if these tablets could be masking that though). That’s a good recommendation, thanks!

Not an asthma sufferer. Have also been tested for overactive thyroids, and diabetes which they thought could be causing it initially. Really, they’re just doing guess work without doing any other tests besides blood work.

A&e staff have said SVT, GP has guessed Wolff Parkinson White Syndrome. So who really knows, haha.

[devonian186 in reply to Tryingtofindhelp]

If you go armed with facts and figures on your state of health and jot down questions you want answered so they won't be forgotten during a consultation, then you are less likely to be fobbed off. Good luck

[1234_6 in reply to Tigger_2]

Could it be that they are using the Bisoprolol to stop / minimise the extent of ectopics that are occurring which are helping to cause the Bradycardia? That's what they are doing with my Bigemniy. It sounds illogical that they slow the heart further but it seems to work Now my pulse rate is around 58bpm & I'm tired still, but having less ectopics & not completely exhausted all of the time.

[Tigger_2 in reply to 1234_6]

Thanks for that.It can be the only reason that the Bisoprolol has been whacked up to 10 mg.

But the GP and another "off duty" cardiologist disagree with the reasoning.

It hasn't worked and the prescriber isn't monitoring it either. Just as well I am.

The net effect of the PVCs and pacemaker is that my BP and heart rate are way too low to the point of being plain dangerous.

The worst of it is the fact that it's taking so long to get to the bottom of it.

Personally, I think that the problem lies with the pacemaker setup or it's type and it cannot cope with the frequent ectopics.

As an 18 years on pacemaker patient, personally I think the outpatient side of things has deteriorated.

In 2016, I had to be admitted as an emergency when the already low battery on the pacemaker died, simply because it was allowed to.

Luckily I was at home and not on a flight across the Atlantic.

[1234_6 in reply to Tigger_2]

Congratulations / well done for 18 years on pacemaker .... I do hope that you get seen again soon and the meds issue resolved to your satisfaction.Generally comments on the forum seem to indicate follow up is slipping. I'm guessing this occurs as they stuggle to hit their kpi's to see new patients within set timescales. I know the waiting lists for cardilogy is being triaged to try and ensure those most at risk are seen quicker, but it's a shame if others, whether new or existing patients, slip through the net and are ill again. Unfortunately our NHS seems to be struggling in all departments but especially Cardiology.

[Douglas91 in reply to 1234_6]

Bisoprolol indeed stops ectopic beats but it doesn’t have any effect on the heart rhythm and doesn’t stop the frequency of A/F occurring. I think doctors use Bisoprolol to bring down a high heart rate and thus try’s to reduce the burden on the heart. It isn’t effective as a rhythm control drug to be honest and as in my husband’s case is only used short term as sotalol is way more effective for him His NSR is and has always been on the low side since he is very active and plays competitive sports all his life. Bisoprolol makes him very lithargic even on a low dose of 1.25 mg and his quality of life is compromised which brings on a raft of other negative emotions and feelings which he never gets on sotalol.

[Deejay62]

Hi sorry to hear what you’re going through.

I’ve had arrhythmias all my life so I know how uncomfortable they are. I was rest assured when an EP once told me my various ones can’t kill me even though it feels like that.

I think you should write down all these questions for the cardiologist when you see them, and remember to take that list and ask them questions, if only for your own peace of mind.

Although you are well controlled they might want to do test to find out what arrhythmia you have, and if they want to leave, add or change your treatment. They’re the professionals. And remember we are all different.

You are in good hands because they treat people all the time with various arrhythmias. All the best Diane

[Tryingtofindhelp in reply to Deejay62]

Thanks for your comment Diane,

That’s good reassurance you had! I’m hoping because my appointments hasn’t happened super quickly that it may be similar for me, I’m terms of it just being really uncomfortable/scary/ non-urgent.

I’ve started my list of questions, and the comments on this forum have really been helping with that. I’d be happy with them running further tests, just so I even know myself what type it is (if it is that) and can research other ways which may help to control it.

Thank you for your kind words with it all, and helpful background! X

[Deejay62 in reply to Tryingtofindhelp]

All the best and let’s us know how you get on.

[Flossrudy]

I am on bisoprolol to lower my heart rate. Take 2 5mg , in the morning and at night. I expect to take them for life

[Tryingtofindhelp in reply to Flossrudy]

Can I ask, are your 5mg tablets much bigger than the 2.5mg ones?

[Flossrudy in reply to Tryingtofindhelp]

No they are very small. Bisoprolol does nothing for my BP only heart rate

[Pinky1985 in reply to Flossrudy]

I’m on 10mg am and 2.5mg at night they are real hard at first so tiring but they have helped lower my heart rate it was very high too it’s a good tablet I’m on it for life they’ve told me they did loads of tests but in the end just discharged me inappropriate sinus tachycardia I do wonder if I had Covid it started in 2020 before tests were given out other than for sore throat or continuous cough I get breathless on exertion I’m only 38 just turned but this drug is a good one I’m told for the heart mine got titrated I started on 2.5mg xx

[Douglas91]

It’s difficult to comment on what the consultant is likely to suggest and do in your particular case I can only tell you about what my husband has experienced in his life with A/F and maybe that might reassure you as to what you could expect. My husband’s a/f is what they call PA/F which means he gets episodes that last a few hours no longer than 7 days. It can progress to persistent A/f He’s had 3 episodes this year. The first attack he ended up in hospital for 3 days and the consultant changed his meds from sotalol to Bisoprolol which my husband feels didn’t control the rhythm and it reduced his resting heart rate to below 30 He then had another 2 episodes very quickly within a few weeks and the a and e doctor changed his meds back to sotalol which appears to be working. Bisoprolol is a good medicine for many heart conditions as it reduces heart rate but in my husband’s case his heart rate has always been on the low side as he has a very active lifestyle and plays competitive badminton at least 3 times a week. Your consultant may suggest you have an implantable loop recorder inserted under your skin to monitor your heart rate and rhythm continuously which isn’t as scary as it sounds. Over a period of a few years the consultant will review the recordings and can get a better idea of what the problem is. Unfortunately it’s a case of trial and error and sometimes there’s no definitive answer or treatment other than trying different drugs and being under review. I’d say don’t get too worried you will be it’s understandable but seeing you have been waiting some time for your consultation I’d be inclined to think your consultant isn’t overly concerned so just take it one step at a time. Good luck 🤞 x

[Tryingtofindhelp in reply to Douglas91]

Hi there,

Thank you for your comment!

Can I ask if there’s any triggers that your husband experiences that progresses it? I have to say I haven’t found any triggers when it’s happened with myself.. everytime it’s happened is when I’m generally at my most relaxed lying down or something, which has been frustrating.

I see, I’m not overly active (now trying to be more) so it may be a case that they just keep me on this, as my heart rate isn’t low at all.

Implantable loop monitor does sound scary, haha. Where on your body does it go? I’m guessing near to where your heart is? Would they lower my dose of bisoprolol to get accurate readings of what’s going on when I’m not on the tablets? 🤔

Thank you though, reading that has given me some extra questions that I can jot down and has been really helpful! Thank you x

[Paulbounce]

Hi TOFH. 120 - 130 at rest is far to high IMO. You could up it wth your doc's say so but be careful. Sorry but 120 - 130 at rest is far to high.

Paul

[Tryingtofindhelp in reply to Paulbounce]

I guess with it being high all the time, it would contribute to why I’m constantly tired all the time too!

[Pinky1985 in reply to Tryingtofindhelp]

Yeah they said that to me your heart is working too hard so you will be exhausted 😩 it’s horrible I know what it’s like x

[Paulbounce in reply to Pinky1985]

It's too high Pinky, HR of 130 bpm at rest is not acceptable and needs dealing with.

Paul

[Douglas91 in reply to Tryingtofindhelp]

I wouldn’t get too hung up over your heart rate. Some people have low heart rates and some people have higher ones. What matters if you feel ill or have symptoms that are bothering you then it’s best to get it checked out x

[Wanderinglady]

Hi, I have permanent Afib plus MVA. The Afib was diagnosed first and I was given Bisoprolol 2.5 mg (once a day) and Edoxaban which is an anticoagulant. I find I cannot drink caffeine and need to be careful with alcohol otherwise my heart rate will increase. I suggest you give one of the nurses at the British Heart Foundation a ring and ask them the same questions you have asked us. You will find them very helpful.

[1234_6]

Just wanted to wish you good luck and to say don't worry about being on medication for life - if it helps then take it.

[Douglas91 in reply to 1234_6]

I agree nobody wants to be on medication long term but I think of it as lots of people take vitamins and over the counter drugs long term for years and years and never think twice about taking them. They are still medications if you think about it. They alter the chemistry to help maintain and control processes within your body just as Prescription Only Medicines do. Everything you eat drink or do is a balance between the benefits and side effects. Another thing to remember not everyone gets side effects and doctors are very vigilant in their prescribing of higher risk drugs and will take care that the drugs do more good than harm.