Ectopic Heart Beats

[Massa]

Hi, following a chemotherapy induced AF a few years ago I was put on 5 mg x 2 per day of Bisoprolol and 10 mg of Amlodipine and more recently 50 mg losartan.Blood pressure now where it should be and stable. Also made some life style changes in particular diet and no alcohol. Lost a stone since Jan 2024 but also noticed that my HR in the morning is just below 60 BPM but can be as low as 54 BPM. In January is was around 64 to 68 BPM and had been for a considerable time. Might be coincidence but the mix of diet and weight loss seems to have dropped my resting HR by up to 10 BPM. At the same time I seemed to have developed palpations that are very much similar to the symptoms of an Ectopic Heart beat. The irony is that once I have eaten and been on the move for a while my heart rate jumps back up to the low to mid 60s and the palpation seem to almost disappear. Almost like everything needs a bit of a kick start. Being an anxious person though this does not help matters. Just dropped of the Holter Montor which would have pi key up this mornings episode (was okay yesterday). Could it just be that the meds, in particular the Bisoprolol needs tweaking back a bit as my HR is dropping a bit low? Thanks

[Happyrosie]

would well be worth, via a medical professional of course, tweaking your dosage. Losing weight definitely takes a little of the pressure off your heart so that it doesn’t have to pump so hard to get the blood all round the body.

[Massa in reply to Happyrosie]

Thank you I am awaiting the result from the Holter Monitor and the thoughts from Cardiologist and GP but the only thing I can think off is that the meds are now too strong causing my resting HR to drop to low and possibly causing ectopic beat. I have also read that stress / anxiety and poor sleep quality can slso bring these on. I struggle with both.

[Hidden in reply to Massa]

I had a problem with my resting heart rate which dropped to below 40 at night? My bisoprolol dose was halved a a pacemaker fitted set to make sure heart rate didn’t go below 50 ? I would make an appt with a medical professional

Hope this helps

[Brainboxes]

My ectopic beats are always worse at rest (i.e. slower heart rate). My cardiologist said this is often when ectopics are the most noticed. I also have a few hours relief from the ectopics after my evening main meal (the cardiologist said after eating a big meal heart rate usually increases)

[Massa in reply to Brainboxes]

Thanks Brainbox that makes sense as was i am up and about and pulse is into the mid to high 60s low 70s they are less noticeable. Do you just live with them? Don't know whether the Bisoprolol that has lowered HR is causing them or as you say just making them more noticeable at rest. Can anxiety and lack of sleep make them worse?

[Brainboxes in reply to Massa]

Hi, yes anxiety definitely makes them worse. I get between 4 to 12 ectopics per minute (depending on good bad days) for 5 years now. I had an echocardiogram which showed structural normal heart, so despite the high number of ectopics, all the doctors never seem particularly worried. I have just learnt to live with them, but some days at their worst, i do still get worried thinking about heart failure, etc But just got to trust in the doctors that they know what they are doing and it will be ok

[Qualipop]

I would say yo u're on the right idea. Could be your b isopralol dose is a bit high. I hope the holter shows it and they tweak your meds.

[Debkowski]

Sounds like me with the bisopropol HR as low as 53 at rest then up.to.60s in the day with exertion 124 ...I've lowered my amlodipine as it increases he tightness in my left side. Maybe check on uour bisppropol amount with GP. Wishing you well

[Massa in reply to Debkowski]

Thanks Debkowski, do you mind me asking if you are also experiencing ectopic beats when heart rate is down in 50s low 60s. I have noticed that as soon as I eat might heart rate tends to go up, which is what you would expect, maybe to high 60s to very low 70s and the ectopic beats disappear

[Sailing63]

Hi Massa, read your post with interest. 18 months ago I started getting a strong heartbeat with occasional missed beats. I too was on Amnlodipine 10mg and then had Ramipril 2.5mg increased to 5mg as my BP was 145-55 / 80-85 and my resting HR was 52-56 BPM as averages. Advised GP regards irregular heartbeat and a period of adjusting meds followed to the point I had to go to A&E one day in Oct as I was concerned regards the strength of the heart beat. I too was offered Holter and an ECG and a BNP blood test (shows health of heart I was advised) and I removed myself from all meds as I wanted a "clean" report from all the above. When at A&E I was advised nothing to worry about, occas missed heart beat quite normal but was prescribed Bisoprolol 2.5mg per day. This reduced my HR to 47-49 BPM. I have always been quite/very fit and very good with diet and exercise. This year has been one of ongoing HR issues. I was diagnosed as B12 deficient but not pernicious anaemic 2 weeks ago and am in middle of 6 loading doses. I hope that this clears the irregular heart beat, if not then its back to GP. I now only take Bisoprolol when I feel its needed but want to find the cause and then ensure treatment plan is correct, not hap-hazzard as it now seems. My once ideal HR of 52-56 is now averaging 60-65 and I too have lost 4 kg this year (now 89kg). As an ex frequent gym goer, long dog walker and golf twice per week (10hours in total walking) I have lost my confidence to push myself in these activities "just in case". I feel my GP thinks I am becoming a health fraud, I think he isnt taking palps seriously enough. All my tests above came back fine which helps with anxiety, and I find the Bisoprolol fantastic as it seems to calm everything down within 30 mins for a 24 hour period. However, I still, like you have anxiety as I havent been able to uncover the reason for this change. I plan to finish my B12D program and if palps havent disappeared I will insist on a "stress ECG" and a Cardio appt. M<y GP set a 120/80 BP target which I never achieved. I am 60 but again very fit and active and will accept 140/80 with 55-60 BPM. These "ectopics" are a worry but I am determined to progress to a diagnosis and a treatment plan. I am learning to engage positively with my GP and I suggest that this is a good tactic for all, as its our health at stake. Go well.

[Massa in reply to Sailing63]

Hi Sailing many thanks for your reply. I am 63 this year but like you have kept myself fit all my life playing competitive squash and team football back in the day till my knees gave way then I started cycling doing 5,000 plus miles a year up until a few years ago. Scratching my head on this one but in my head I think it's the meds that maybe need dialling back a bit but hopefully should find out soon and will post an update. Thanks again for sharing you experience and thoughts

[Massa]

Quick update, the results from the 48 Holter Montor has confirmed Ectopic Heartbeats but no episodes of AF. The cardiologist has suggested to up my Bisoprolol from 5mg twice a day to 6.25mg twice a day but with my HR dropping down to 54 early morning it was not what I was expecting. For the past four or five days I have also been taking the pill in pocket Flecainide 50 mg twice a day which seem to have made a massive difference to the Ectopic beats that I notice and when I do take my pulse it's far more regular.

Not sure whether it's stress, anxiety, diet, or meds that have kicked all this lot off. Obviously it can be self consuming as you try and figure things out but the only other point worthy of note is that I have been on Mirtazapine for a couple of years and with the support of the GP came off them by end of Feb. Four or five weeks later I started to have these Ectopic beats that increased my anxiety. Its like a downward spiral, you have a few, you think about them, you become more anxious, then have more episodes.

Not sure how the Cardiologist will be able to work out the cause but at least the Flecainide is reducing them.

I have to wait for an ECG before they will advise the next steps.