Medication

Beta blockers and ectopics - not always a good combination

by Gemita - 2023-03-24 12:07:00

Piglet, I would agree that for some of us, beta blockers may not be the best choice for ectopic beats.  Your experience mirrors mine (but with Bisoprolol) and when I take the recommended dosage, my ectopics increase and with an increase in ectopic beats, this can frequently lead to other arrhythmias too.

I am sorry you are so symptomatic with what doctors would regard as benign beats.  However they are still arrhythmias and can cause a great deal of distress for some of us when they are prolonged and frequent.  Your symptoms sound intolerable.

Atenolol is an older beta blocker but still cardio selective at lower doses (targets mainly the cardiac cells), so it should still come without too many side effects unlike the non cardio-selective beta blockers which include Propranolol, Sotalol, Carvedilol and others.  Even so your ectopic beats are clearly not helped by Atenolol, so I am glad your doctor and pacing team have given you an appointment to be seen as soon as possible.  I was told Calcium Channel Blockers might work better for some of us with ectopics leading to other arryhthmias but I don’t want to change anything just now.

I have reduced my beta blocker dosage, and take every other day and this is working well for me (with my doctors knowledge), since I do not have high blood pressure.  Since ectopic beats have been the trigger for my faster atrial tachyarrhythmias, this means that I am getting fewer arrhythmias overall.  Of course anyone in a similar position needs to work with their doctors to see how to control their ectopics and if they are really so symptomatic, then I believe further aggressive measures could be tried (like having an electrophysiology study to see from where they originate, how they behave and what measures could be taken to better control them?  

Premature atrial contractions can come in at high rates too apparently (I didn’t know this) although most of mine seem to lead to slow, pausing symptoms and like you my heart rate during ectopic episodes seems so much lower (even though I was told this was not possible).  When ectopics “cluster” in the same location, they can lead to a rapid heartbeat 180-240 bpm.  This is called SVT, so PACs may not be so benign and may need controlling.  I hope you will soon get some relief from your symptoms

HR 33 with a programmed basal rate of 70

by Rch - 2023-03-25 03:21:03

Hi, if you are certain the HR is down into the 30s, I urge you to you to touch base with your EP or device tech before assuming they are all ectopies. Glad your blood pressures are holding up well despite HR in the low 30s. From your Bio, I notice you have Mobitz Type 2 block. So, was Atenolol first started for tachycardia of some sort or for hypertension or for both? 

I take Metoprolol ER for Atrial/ Sinus tachycardia and Lisinopril 5 mg for BP. I have a DDD for Mobitz Type 2 

Gemita; Marybird; Rch

by piglet22 - 2023-03-25 08:40:07

Can't believe this long comment I was writing disappeared.

Start again.

Gemita, Marybird, Rch

Many thanks for all your helpful comments.

Gemita

I have stopped taking on GP advice, the Atenolol 50-mg daily. This is to be substituted by Bisoprolol 1.25-mg in the interim before I see the consultant.

Right now I am in cold turkey, heart pounding and for the first time ever, getting a resting heart rate over 70 bpm, now 73. The PM base rate was 60 bpm, raised to 70 recently. Before, it rarely ever went over 60.

All this has come out of the blue and has rather taken over things.

A provisional diagnosis is ectopy, surprise, surprise.

What I don't understand is why the cardiology physiologists (CPs) knew this plus my concerns back in January 2023 but apparently did nothing about it. I would have thought it might be worth a mention to the pacing clinicians.

Chasing this up through the GP was a last resort.

I'm starting to get a poor impression of the local CPs. I don't think they like patients. I think they are a bit miffed since face to face appointments in the local hospitals away from the regional hub and a day out, have all stopped in favour of a bedside box.

They used to be nice friendly affairs in a nice atmosphere. Now they have to work in a grotty 19th century run down basement. Nobody, patients or staff like the lack of personal contact and it shows.

Marybird

Your experience sounds awfully similar.

I liked "ugly buggers"

I normally reserve that for the big fat slugs and snails that chomp my hostas and salad crops, plus the neighbour’s cat that uses my garden as a toilet.

I was surprised at how much beta blocker you were prescribed. It sounds as though it could fell a horse.

I guess each case is different and need different treatment.

In my case, the suggestion is that the Atenolol was making matters worse.

A big problem here (UK) and at my surgery is that they never really recovered from the pandemic and took the opportunity to change the way they deal with patients.

Gone are many of the face to face clinics etc. and medication reviews were the first casualty.

They employed a resident pharmacist who I saw once, but even that has stopped. Repeat prescriptions and simply just signed off.

It's little wonder that years on the same medication builds up into a bigger problem.

It's the way of the world now.

Rch

Thanks for that.

The low BPM is entirely down to the ectopics.

I liked the touch base comment then I see you live across the Pond. The NHS (free at the point of use as they like to say) here is in crisis with even the doctors on strike to make matters worse. Consultants on £265 per hour filling in.

There's no touching base here and triage by receptionist is the norm.

Yes, I have Mobitz Type 2 and remember the diagnosis - consultant - "I've got a diagnosis, you have complete heart block and you need a pacemaker" All done and dusted.

I have a Medtronics Ensura Surescan in DDDR mode, Dual chamber. I was having very slow heartrates below 40 bpm that never responded to exercise.

The Atenolol was for hypertension going back 30 or more years.

Best wishes and enjoy the Pacific.

Ectopic beats

by Gemita - 2023-03-25 09:37:01

Piglet, I always work in a separate application and then copy and paste my messages here, so that if that irritating Whoops looks like something went wrong message appears, I can log out, go back to my originally typed message, login in to Pacemaker Club and paste my message again.  It has happened to me and to others many times unfortunately.   Another tip is to use the backspace to recover your typed message from the Pacemaker Club, copy and paste it into a separate App, and save it this way, then log out and log in again and try to repost.

On the subject of doctors and ectopics, in my experience doctors do not worry about these arrhythmias because they are not regarded as serious and this is why so many of us struggle to be heard and to be seen.  When I started getting ectopics without respite, I was unable to function.  GP and cardiologist tried to reassure me that all was well and to go away and to live my life, but when I kept returning, complaining of  pre-syncope, breathlessness and chest discomfort and asking for longer term monitoring, they eventually picked up Atrial Fibrillation interspersed with the ectopic beats and other tachy arrhythmias.  It was a long and difficult journey to get the help I needed but once the AF was confirmed, attitudes changed.  Now I am listened to and helped if my symptoms need treating.

I think there is much more going on than simple ectopic beats to make you so symptomatic and I am glad that you have another chance to speak to your doctors and to have a thorough interrogation of your device to look for any events or other problems with your general health.

I hope you get an early appointment Piglet.  Perhaps you should prepare a few choice questions you want answered? 

Gemita

by piglet22 - 2023-03-25 10:51:12

Thanks for that.

I don't know how you find the time,

I've just picked up Bisoprolol and I hope it stops the withdrawal symptoms of Atenolol.

I'll keep you posted.

Somebody else's normal etc. isn't your normal and that's the bit they don't get until you start banging on about it.

On typing etc. this site doesn't have a lot of the features that many other forums do.

Many save drafts and have things like include URL formatting etc. There's no decent cut and paste no select all etc. etc. And no spell checker etc.

I normally do a select all, copy then paste into Word and paste back into comments.

Today, I didn't do that and made the mistake of going somewhere else on the site and came back to disappeared comment.

Maybe time for a makeover?

We should be treated based on our "symptoms" not on the arrhythmia seen

by Gemita - 2023-03-25 13:20:30

Piglet, yes I quite agree, with any arrhythmia, benign or otherwise, we should be treated according to our “symptoms” not according to the arrhythmia seen.  We all have different levels of tolerance and sensitivity to electrical disturbances and we need to find a way to get this message across to our doctors.  I am extremely sensitive to any change in heart rhythm and only feel well when my heart is in a normal sinus rhythm.  If we are truly symptomatic then I think doctors should be more understanding.  Until then we have to keep up the pressure since only we know what we can tolerate.  I hope low dose Bisoprolol helps.  You shouldn’t have withdrawal symptoms from the Atenolol while switching to Bisoprolol.  My husband is also on Bisoprolol like me and in any event low dose (1.25 mg) of Bisoprolol should cause you no problems.

I am quite good at moving data around rapidly between sites, so I haven’t really been held back by the lack of features here.  I wouldn’t like a spell checker feature which I always find a nuisance.  "Security” and keeping order is more important to me than fancy features and a lot of my time is spent focussing on keeping unwanted visitors firmly in check. I do appreciate though a lot more could be done to improve and upgrade the site.  We have got email notifications of private messages back and notifications of when someone responds to our posts back, so that is a great help.  I am only a housekeeper here, so an upgrade to the system is out of my hands.  I don’t spend time visiting other forums.  Pacemaker Club is my only online home and no, I don't know how I have the time for it either sometimes without neglecting other duties

Switching from Atenolol to Bisoprolol

by Penguin - 2023-03-25 16:35:12

Hi Piglet, 

I just wanted to pick up on your comment that you are struggling with withdrawal symptoms from Atenolol.  I assume that you have been switched from Atenolol to Bisprolol without a taper of the original drug and that you recognise these symptoms as Atenolol withdrawal symptoms. 

Have you discussed them with a pharmacist or your GP yet? 

IMO (and I am not medically qualified) withdrawal symptoms are telling you loud and clear that your body is not coping with the (possibly sudden and untapered) withdrawal of a drug that you have taken for a very long time. IMO the symptoms should not be ignored., particularly if you are struggling or feel unwell. 

Some people can switch from one drug to another (within the same drug family or from older to newer versions) without significant effects. Others can not.  People in the 'can not' group have to taper the original drug very carefully and sometimes much more cautiously than would be the norm or at the very least obtain medical advice. 

If I was you, I'd speak to a doctor or pharmacist who has some experience of beta blocker withdrawal and drug switching.   I hope that the symptoms improve for you.  

Copy and paste

by AgentX86 - 2023-03-25 22:35:38

I used to save to Notepad but it's really not necessary.  Just cut (right-mouse, cut), do your thing, come back and paste (right-mouse, paste)  it back.  In addition, by pasting into the paste "security" screen, you get a free speel czecher.

You have to use the RMB versions of cut and paste.  <cntl>C and <cntl>V don't work the same way.