Atrial fibrillation flaring after virus and struggling with higher bisoprolol dose

[santamola]

Has anyone got this, or have experience of dealing with it?

I've had it for five years and never had an issue really as it was well controlled. I take bisoprolol. I don't have to take blood thinners as I was given a Watchman device (google it, too long to explain!) as I am prone to gastric bleeding. All good so far yes...

Then two weeks ago I got a nasty virus, the usual cold, cough and razor blade sore throat. First such thing in years, and it wiped me out, still have the residue. Out of the blue in the second week of being ill the AF went all over the place, heart rate up to 140, back to 60 - doing a complete dance! I didn't feel it much but my watch told me and gave me a bit of a fright!

I made appt with cardiology and consultant wasn't one bit worried, but doubled the bisoprolol dose to calm the heart rate. And that's where it all went south. I just was on the floor with weakness, dizzyness and a very low HR. Called them and am awaiting a return call - won't be over the weekend anyway. So I intend to reduce the bisop tomorrow back to what I was taking and hope for the best.

Has anyone had a bad reaction to increased dose of beta blockers like that. I'm falling asleep in my soup ha ha. I don't want to second guess the medics but I really can't tolerate the higher dose of bisop.

DH is on bisoprolol, waiting for his second catheter ablation at the regional centre. He's currently on 3.75 mg morning and the same dose at night - they did try him on 5mg twice a day but his heart rate was dipping into the low forties and he felt utterly dreadful. They've tried sotalol but that didn't work at all. Can you ask about splitting the dose if you don't already?

Any kind of viral infection absolutely wipes him and his AF can be horrendous for weeks after. Hope you feel better soon.

Thanks @BridgetJonesV2 Thanks for your reply, it's reassuring to know that others had a reaction to high dose bisop also. My normal dose is 3.75 per day and that worked perfectly. I'm assuming the virus triggered this episode, anyway it's doubled to 7.5 and that's just too much for me. Consultant did say I could reduce to 5, but pharmacy dispensed 7.5 pills and I now need a new script oh la la! So I'll take the smaller dose as usual and try get the arrythmia nurse to ok 5mg instead of 7.5.

I can't even climb the stairs without wilting, and I was that person who walked miles a day, ran up and down the stairs, did the garden for hours and so on. I want to get back to that! I'm 68, but (before the increased dose) an active 68 and I want to keep it that way!

Oh the joys!

They seem to prescribe very odd doses - DH has a 2.5mg and a 1.25mg to get his dose. He's been in permanent AF since January, and he's permanently exhausted - breathless going up stairs, can't carry anything heavy. He's 61 and there are times he says he feels 91 with it. He feels horribly frustrated with the delay in the ablation too, he's been on the urgent list for well over 12 months now sadly. The last one worked for 3 years.

What is your HR now?

I have dilated cardiomyopathy and take Bisoprolol in the morning and at night (with other meds for the heart).

When they first upped the Bisoprolol I was floored with exhaustion, nausea and napping like a Nanna. It took a good 10 days and some additional drug increases (Candesartan) and Dapagliflozin and a diuretic called Furosemide to sort out the fluid retention and give me some energy again.

Please do get your kidneys checked, eGFR creat as I found my kidney function was poorer on higher Bisoprolol, causing fluid retention and tiredness.

The range today was 44 - 132. Only put my watch on at 8.30am so it could have been lower overnight. The high HR lasted for about an hour and happened after I tried to do some housework. But I gave up. I'm feeling OK since about 4pm and it's all settled down again. Right now it's 67.

TBH I'm not used to having episodes, but I suppose for many others it is constant. I don't like it at all though, it's the unpredictability of it that's so disconcerting.

@Sminty2 Good idea. I'm due six monthly bloods soon so will mention that to GP. I have normal kidney function at the moment, well up to now anyway!

Has your cardiologist talked about any other medication. I am on Flecainide for paroxsymol AF, it controls the irregular rhythm rather than just lowering the heart rate. I was on bisoprolol for about 3 weeks after I was diagnosed two years ago and I did have dizzy spells on it.

I’m in permanent AF. I’m on 12.5 mg of bisoprolol, 62.5 of digoxin and 5mg of Apixiban. I’m breathless and dizzy all the time. I get very exhausted and can’t do anything. It’s awful.

Morning everyone in the Afib family! I got over the weekend ok since I unilaterally reduced back to 3.75 bisop a day. I'll be a cardiologist next! Still spiking all over the place usually when active, like getting out of bed, going upstairs, that kind of thing.

I don't feel it at all even when it goes up to140 yikes, so I think I'll take the bloody watch off for today to give me a rest from checking it!

Arrythmia nurse off duty today, will contact me tomorrow. I hope.

As for other meds, my consultant is an EP, an electrophysiologist. He is not worried at all 😳since I don't have symptoms and have the protective Watchman device also, and just wants better rate control. That's fine but the dose is too much for me all at once! No other meds like flec needed he said, and I am not a candidate for ablation just now.

I suppose I'm lucky that I don't feel it, but the constant spiking does eventually harm the heart, that's my main concern.

Sorry for the essay, and I hope everyone is doing OK.

I make DH take his Apple watch off quite regularly as he gets a bit obsessive with it. I've been reading up about the Watchman device, sounds fascinating. DH is on blood thinners and he's permanently freezing. He's sat in his clothes tonight with a thick dressing gown over the top! The Cardiologist was very insistent he's on them though until at least 3 months post ablation.

I was put on them post covid as got long covid and really chronic neuro issues to lower my BP and reduce my headaches I was getting every day - even at 2.5 I felt mighty peculiar , really heavy legs and kind of woozy ! I weaned myself off after 3 months by reducing and reducing and it was Garda’s they are tiny to start with - but they did help towards my recovery

Yes the blood thinners can make you feel the cold a lot more. I was on them myself up to the day I had a very serious gastric bleed. Transfusions, blue lights, the works. I had to have an iron infusion later aswell as haemoglobin was on the floor. That's when they decided a Watchman was for me! It's quite an interesting procedure alright, but was just an overnight in the hospital. I take low dose aspirin now to keep clots away from the device, but the cardiologist who did the job said I could come off that fairly soon as the inside tissue will have grown over the device and protect it from clots. They will have to go in and do a trans oesophageal echo (ugh) to make sure the device is all covered up with my epithelium - that's the big word they used for the skin inside me covering it!

One step at a time. Got to get the dose of this flipping Bisop sorted soon, hopefully tomorrow sometime. I bet they will go mad that I reduced the high dose myself, but I couldn't go on like I was. I hope I don't get put on the naughty step!

Oh my, that was me on the high dose, all floppy, legs like lead, and a head full of mush. Couldn't go on like that at all. Hope you're doing ok now.

Not AF but atrial tachycardia which is a form of SVT. I take calcium channel blockers which are similar to beta blockers.
My symptoms always spike when I'm ill, stressed or over heated. Otherwise I can go months and be fine apart from occasional spikes of high HR which self resolve.
I've been ill with some gastric problems recently and my HR has been all over the place. I can't get seen by cardiology any time soon because I was discharged as stable a few years ago. I have flecainide as pill in the pocket but I'm a bit nervous of using it. My GP says they will most likely increase the dose of my calcium channel blockers so I this thread is interesting.
Hopefully OP yours will calm down once you've fully recovered from the virus?

Yes it’s 3 years on and one day after around 6 months it all just stopped and I felt 100% normal again, literally overnight - it was so weird, neurologist told me it was a classic case of post viral neurological attack - and with Covid she had seen it quite a lot in previously fit and well- vaccinated and unvaccinated. I had never had beta blockers before and they are apparently quite old school these days but they certainly made me feel really odd, strangely my H was given them once before for panic attacks and he chucked them down the toilet after a week as said it made him feel like he had a mild stroke- again the mushy head and heavy limbs feeling.

It is very well known indeed that beta blockers like bisoprolol, and especially bisoprolol, make some people feel seriously crap and life stops being worth living.
I am sick of cardiology professionals saying they are not worried about what is happening to patients ... "It's fine ... no problem." What they mean is you are not likely to drop dead immediately. They are not bothered about your quality of life. So YOU must make them bother about it.
I have been through the cardiac mill.un a big way ... heart attack, atrial fibrillation, stent, pacemaker, AV node ablation. It is a non stop battle to stop cardiology just pursuing the algorithm and dishing out drugs as per the list.
The patient gets lost in the maze. It is bloody miserable.

Let them go mad at you, it can't be as bad as the drug. I was only on 1.25mg of the evil Bisoprolol for three months following my first episode of AF. Refused to take it due to not being able to function at work, brain fog, tired all the time, waking at 3am with headaches so bad I vomited, and, best of all, the really vivid violent nightmares.

@Crikeyalmighty So glad you made a great recovery. That Covid was some mean old sod wasn't it. So many awful post viral stories. Good to hear you are out of it now.

@Mischance I 100% agree with you about box ticking by cardio teams. Honestly I'm losing faith in them bit by bit, although they did sort the Watchman for me, something I will be forever grateful for, since I will never have to take blood thinners. You have (are) been through the mill haven't you? It is so true what you say about quality of life over dosage and drug. I reckon they just look at their computer screen and don't think the patient in front of them is human at all! I hope you are doing OK, as best you can. Anything to do with the ticker is scary isn't it?

@Namechangergtr Gosh you had a really bad reaction to such a relatively low dose. Do you take a different drug instead now? I've been on 3.75 bisop for over five years now and I'm well used to it. The problems happened when they DOUBLED it without titrating, by increasing the dose bit by bit. But we are only numbers on a screen after all.

@TheCoty Your symptoms sound exactly like mine, and I often wondered if I actually had Afib at all, the episodes were so rare, except when I was ill or under stress. But that's my diagnosis! I'm feeling OK today, but still spiking a bit, will know more tomorrow hopefully and surely they will issue a new script - or they'll go mad that I unilaterally changed the dose myself, to keep myself from falling over ha ha! Hope you're doing well now.

Not taking anything now and feel so much better. It probably took about 6 weeks for my sleep to improve and the nightmares stop. Interesting what you said about whether you really had AF as mine was caused by an infection. The positive thing is that it led to them discovering a much more serious heart problem that I was completely unaware of. I'm about to start Warfarin which is the only drug they're recommending for the other heart issues. Really not looking forward to starting that but no other option whilst waiting for a new heart valve.

@santamola I once had paroxysmal AF.
It felt the same as SVT.
It was only registered and on record because I was in hospital at the time. It was before I was properly diagnosed and I went to the GP who realised I was in SVT. They called an ambulance and I was put in resus at A&E because my heart was originally in SVT then switched to Afib.
As far as I know that was the only episode of AF and my cardiologist agrees.
Infection is always the biggest trigger and the worst was covid.
I take calcium channel blockers instead of beta blockers partly because I have asthma and partly because they are slightly better for SVT.

@TheCoty That's interesting. I know I have Afib, much as I don't want it! SVT doesn't have the irregular pattern of heartbeat when in Afib, it's just FAST! As far as I know anyway.

So my arrythmia is fast and chaotic. I think SVT is fast only. I could be wrong though!

In case anyone is interested, the arrythmia nurse called back. Dosage changed to 5mg, that's a result!

BUT.... when I gave my phone readings, said they want me in next week to do a cardioversion. I have to have a trans oesophageal echo aswell. Ugh, Ugh, Ugh. Had this done before a few years ago. The cardioversion didn't work, instead I was put on a drip of some med to control rhythm. It made me very sick.

I hope the cardioversion works this time. Fingers crossed. Not looking forward to it one bit.

@santamolaI’m an AF sufferer too. Are you in the UK under the NHS? I’m guessing not as you actually have an appointed nurse to speak to and are being offered a cardioversion over the phone.

I refuse to take Bisoporol as it lowers my heart rate too much and I can’t function on it. I find it easier to just cope with the AF.