l have been taking my blood pressure and heart rate each day since returning home after a heart attack and angioplasty 4 weeks ago. My blood pressure is typically but not always low eg last night 114/57. My heart rate is always low eg last 5 days 43, 58, 45, 51,51. I am on the following medications:
bisoprolol 2.5mg in the morning
atorvastatin 80mg at night
aspirin 75mg in the morning
ticagrelor 90mg twice a day morning and night
lansoprazole 15mg in the morning
ramipril 2.5mg at night
Can anyone advise if they have had a similar experience and if so what if anything they have had done about it?
This is a new experience to me and I much appreciate the support of others who can relate how they have got on in similar circumstances.
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tennis-guy
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my MI happened 8 weeks ago and am on similar Meds. My blood pressure is always now around 85-95/60-65 with an average heart rate between 56-65. Seeing heart failure nurse next week and will see if that’s too low but have felt ok overall. It’s to protect your heart from overworking, but if the beats are continually very low and you’re worried, speak to your HF nurse.
Hi tennis-guy, I was on bisoprolol and my heart rate dropped to 31 at times making me feel awful so I was told to stop taking it. Bisoprolol can lower your heart rate thus easing the pressure on the heart so It would be best to speak to your cardiologist/doctor about it before stopping any meds as they could probably review it and maybe alter the dose etc depending on your circumstances.
my heart rate was often 40~60. But it went even lower which took me to A&E a couple of times. For me 41 was 0k but 39 was falling down time.
That’s quite a bunch of medications. Hopefully your GP will edge them down and eliminate a few.
Bisoprolol is often difficult, but it was ok for me.
I had clopidogrel in lieu of aspirin. Perhaps your GP will at least reduce from the 75mg to 30mg aspirin, in due course.
I am now way past 70 so my tennis rackets have retired to the loft. Plastic, metal and wood. I played mostly low key social tennis but I did play a huge amount.
I think you might need a few more weeks to settle.
Hi Ageingfast I am interested in your experience. If you don't mind me asking how long ago did you have your heart attack and when you went to A&E with low heart rate what did they do for you? How is your heart rate now? Thanks
mine was aortic valve failure. I had the op before it totally failed.
The valve op was four years ago, during covid lock down and nightingale hospitals.
When taken to A&E with low BP they put in a drip and I recovered within a few hours. The last of these incidents they gave liquid paracetamol. Which worked a treat. Regret that capsule paracetamol isn’t so effective. Maybe the dose is different. I was so far gone on the first episode that I didn’t know what was going on. But I came home within hours rather than days.
I now have a steady pulse of about 70 and my BP is around 130/70. So the heart op was a stunning success. No problems, I don’t even know the new valve is there.
Being ever so clever after the event, I now realize that I had not followed rehab properly after a stroke in 2015. Had I monitored things better then the low pulse could have been avoided. I think just sensible daily walks would have kept the trouble at bay. But I am not a medic. Just a retired accountant who used to live on a tennis court.
Do take it easy. And listen to your doctors advice.
Wow, I am accountant too. Have had no rehab yet (not sure if I am going to get any). No monitoring from healthcare professionals either. Should have follow up appointment with cardiologist in about a month but not had appointment through yet either. Don't know if the rehab is automatically put in place, you have to ask for or not available at all.
You might get joy from your GP practice, they might have rehab available. I was happily well pleased when I had bad pain in the Neck. My GP suggested I could book to see the practice physiothoroughpests. So i asked, thinking it would be months ahead, and she said there was an appointment that day, in an hours time. What a nice surprise. The very good physio gave me exact instructions and in a few days neck pain was on the mend. They also booked me in to a nine month course to avoid diabetes. This is a small town practice of four partners.
If they can now make GP appointments available then that would be total brilliance. Pink animals are going past.
Regarding our profession, I can’t keep up with the ongoing knowledge so I told the institute and far from being stroppy they gave me free subscription for life and they reminded me I could, and should, keep the letters after my name.. so I can sign off as Ageingfast, FCA.
Hi Tennis-guy, I’m 9 months down the line same meds and doses except for the beta blocker. My cardiologist took me off BB’s in hospital as my heart rate was dropping to 40bpm. My average blood pressure over the last 9 months is virtually the same as yours. Overnight sleeping HR drops to about 50BPM. Luckily no issues with drug side effects, can sometimes get a little light headed if I stand up quick, but think this my improve when I stop taking the Ticagrelor.
I request full lipid profile every 3 months from GP and all results very good. Followed rehab recommendations and started running again. So far so good. 😊😊😊😊
Thank you K9ndo. Your circumstances sound very similar to mine and your experience very useful to me. I would love to know a bit more about your rehab. When did it start? What kind of exercises did you do and how quickly did it progress? I would like to get back to doing some running and better still to playing tennis again. I am aged 59 man.
I was offered a 12 week rehab course whilst awaiting my stent . To be honest it was very basic with simple repetitive steps and lunges sometimes with weights. I am very fit for my age (68) and found this very easy. What was reassuring was the pre, during and post heart rate monitoring to make sure your not pushing too hard. Along with this was a range of exercises to do at home.
The rehab also includes lifestyle advice and heart health info.
On completing the rehab course the local authority provides discounted health club access for those who satisfactorily complete the 12 week rehab. I was then referred to the local councils heart health trained personal trainer who builds a training program for each individual. From there your on your own.
I really had the next 12 weeks, using the cross trainer/treadmill on airobic exercise trying to keep heart rate around 130 BPM..
Third 12 weeks carried on in the gym but also started doing park runs again. Done another seven so far 5km taking 33 mins trying to keep heart rate less the 130BPM which is not so easy. Cut out saturates lots of walking and cycling BMI dropped from 24 to 21.
That’s to date
Not seen a cardiologist or doctor since my discharge Sept 2023 which is very disappointing ☹️☹️
Thanks K9ndo. That is very helpful. I am glad you are doing well and with rehab support. I was doing couch to 5k before I had my heart attack and would like to restart. Obviously need to be careful. Would like to have proper oversight. Since it only 4 weeks since heart attack I think it too soon to start strenuous exercise but no offer of rehab yet is a concern.
Thanks Blackknight57. I am new to all this so it is very helpful to have some guidance as to what to expect and what is OK and what is not. A couple of thoughts. Firstly in the leaflet for Brilique (one of my meds) it says that a heart rate of less than 60 is considered abnormally low. Secondly I have been told to worry less about having a low heart rate and more about the related symptoms. My main symptom is tiredness. I am interested to know your perspective Blackknight57. Are you a healthcare professional or is your knowledge based on your experience of your own heart issues? Thanks again
You may wish to Google Nebivolol vs Bisoprolol. It is a newer generation beta blocker. It has a smoother delivery profile (less peaks and troughs over the 24 hour period). It also (generally) seems to less drastically reduce HR and allow for more exercise (my layman’s understanding is that it lowers HR, but relaxes blood vessels which has less impact on peak blood flow). Also has less effect on melatonin so supposed to be better for sleeping. The way it works also has benefits to arterial health. My GP allowed me to swap and it definitely works better for me, but everyone’s different, so perhaps not best for everyone.
Hi there, I’ve been offered Nebivolol and am feeling undecided whether to swap from Bisoprolol as I just don’t feel right on it. I’m on 1.5 Bisoprolol and am wondering what the is equivalent is of Nebivolol. Did you find the change over went smoothly, it’s what puts me off changing really.
I understand that it is supposed to be like for like dosage. That said, I was on 3.75 Bisoprolol, which is not a dose that Nebivolol comes in, so was started on 2.5, then increased to 5. This results in comparable, if not slightly lower BP, but HR now resting around 60 (was low 50’s, dropping to 40’s at night). I was also getting the odd PVC, but they have stopped with nebivolol. No side effects at all for me and I can exercise better with it. I guess it varies person to person though, perhaps you could try and switch back if you don’t get a good result?
Hi, I have been on similar meds since heart attack 18 months ago. My HR & BP were low before the HA and with the meds they're even lower, but that was the aim. BP is generally 85-100/45-60. I do feel a bit light-headed when BP drops below 90 and any heat makes it much worse. Summer is the worst!My HR is generally 45-55, but can also drop to 40 at rest. In general it does make me tired and I have to do things slowly, but am getting used to it. I try to drink lots, stay in the cool, sit down when I'm lightheaded and dizzy and take things easier than I used to.
You can always discuss lowering meds doses with dr if it's safe. I did try that, but I got short of breath & had increased angina, so went back to the original doses. Id rather be dizzy & tired than feel like I can't breathe properly.
You do get used to things with time, although it may not feel like it right now.
Post heart attack / cardiac arrest I’ve been left with bits of a few arrhythmia’s so they really want to keep me on bisoprolol. They want to avoid the anti arrhythmics with heart muscle damage. They tried to increase bisoprolol to 10mg, but I never got there at 7.5mg I was extremely symptomatic with BP 70/40.
Anyway I’m on 5mg a day but split into 2 doses morning and evening. This is working for me. My body took months to adjust to having a low pulse but now I’m okay unless its in the 30’s. Which is extremely rare now but does occur at times at night. The electrophysiologist and cardiologist are happy as long as I’m not symptomatic.
Hi, was put on the usual cocktail of medicines after my NSTEMI in Nov 2022 including 1.25mg of Bisoprolol. HR constantly dropping to low 40s and even into 30s. Nurse at rehab even commented when taking my BP and HR before the session started when it was 42 and I'd just walked up from the car park. I even had another nurse reluctant for me to take whilst in overnight until my HR went to around 60. After 3 months and many impressions of a slow moving zombie my cardiologist stopped it. Even now my my resting HR averages around 48 but will drop lower and I still set off the alarms at the hospital when the machine detects I've dropped below 60. Definitely worth a chat with your GP/Cardiologist.
Hi - first thing I’d ask is how do you feel- Blood pressure and HR is very specific to the person and whilst yours may be lower than the average person that’s not necessarily a problem so the key is how you feel. My HR at mid-50’s is absolutely fine but Bisoprolol lowered mine to 40’s and not fine so taken off Bisoprolol. I was on Ramipril (7.5mg as dose upped to help kidneys). Suddenly started getting the feeling I was going to pass out and blood pressure had lowered (diastolic in 50’s and too low for me to function) Stopped it and problem stopped, started it again and started again so now reduced to 2.5mg and seems to be OK (keeping eye in kidneys). Good luck and don’t be afraid to push the doctors on Meds as can often be the problem and don’t expect they’ll just do it as they didn’t with me and had to push as once you’re prescribed something you’ll stay in it unless you challenge it - Meds are absolute life-savers but they all have an impact and you need to know they are supporting your health but allowing you to have a life - best of luck
I can't be sure as it was 6 years ago now. I think it was swapped for a calcium channel blocker but I had problems with hat so it was stopped completely. Both my BP and heart rate were fine. It seems they have a set list of meds to give to everyone whether you need them or not. Your GP will know what to do for best.
Hope this helps it seems like you are in a similar position to where I was about a year ago I had a MI in April 23, Out of the blue I was a pretty fit 63yr old I was on the same drug regimen my bp generally around 115/70 Resting Heart measured by Fitbit usually between 48 and 51 prior to MI was about 10pm higher. For me it took about 9 to 12 months to settle down and start working on fitness again Gym & cycling I have had different views from cardiologists Some say keep hr low as it helps protect the hear others say it can be a bit higher to exercise I am dropping my bisoprosol fose to 1.25 to see how it goes Best wishes for your recovery like everyone says it takes a long time and everyone is different
I had to reply after reading your post as, apart from the fact that I am 3 (not 4) weeks post HA and emergency angioplasty (stent) and taking all the same meds (but take Prasugrel and not Ticagrelor), I could have written your post myself!
Both my resting HR and BP have dropped by about 20, that is, HR from (approx.) 68 to 55-48 and BP from 120/80 to 100/60.
I am a 56 year old male who tried(!) to stay fit and healthy and actually had the HA while swimming!
I saw a Cardiac Rehab nurse before leaving hospital and was given a structured exercise plan to follow (Day 1/2 - walk around house /garden; Day 3/4 - 10 mins walk; Day 5-7; 15 mins; Day 8/9 - 20 mins; Day 10/11 - 25 mins; thereafter 30 minutes walking per day). I have my first follow-up appointment this week with the local Cardiac Rehab team (including a physio for the first appointment) and am hopeful that I will get a bit of clarity re future expectations and milestones, etc.
I've not seen my GP since discharge but expect to do so in the next week or so and will have similar questions to you around meds and side-effects, etc.
Thank you Vilsugheart. The pointers on your rehab are particularly helpful. I have chased hospital today and am hopeful that they will start me on some rehab soon (we will have to see). I have seen my GP about the low heart rate and have been advised to reduce dose of Bisoprolol to 1.25mg in the morning from 2.5mg in the morning. Don't know how quickly I might expect to see any changes in my resting heart rate (if there are any).
I should add that the (booklet based) cardiac rehab advice is (as far as I am aware) fairly generic, in that it doesn't take account of my age or previous fitness level. However, the cardiac rehab nurse at the hospital was able to give more personal 'tailored' information, based on my medical notes, and as part of a general discussion, prior to me being sent home.
My husband heart rate was usually around 42 to 45, he went to the drs several times but they wanted him to stay on the same doses of same meds as you. However it got to the point where he started passing out when he stood up so after about 4 months they reduced the ramipril and bisoporal and has been much better since.
He’s now on 1.25 for both ramipril and bisoporal. He had a couple of reductions before he got a good balance. I seem to think one of them was originally 5mg but not sure which. Also he changed the times he takes them , now has bisoporal in the day and ramipril at night. We sought advice from cardio rehab team at the start who were really helpful, and then later on the gp.
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