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Ask Dr .Saeed ahmed Your Own Question

Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4403
Experience:  MBBS/FCPS(R)/MRCP U.K(R), Senior Registrar Cardiology
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I have had 4 episode of AF over last 3 months the first one

Customer Question

I have had 4 episode of AF over last 3 months the first one chemically cardioverted. I am on bisoprolol 7mg dsily now. I continue to be very asymptomatic and have daily chest pain and feelings that I am in palpitations although my pulse is 55 have a general feeling if malaise occasionally light headed took both bp and pulse when I felt sick and what feels like palpitations and my bp is 92/53 pulse 55. One minute feels like bloating indigestion next can be sharp stitch like. Echo shows left branch bundle block bloods show slight elevation in WBC. Have still not spoken to cardiologist yet..... Concerned I may just be reacting to this beta blocker and wondered if it should be changed.

Been to hospital twice not indicative of MI but really am fed up not being able to do anything have 4 kids and am off work
Submitted: 2 years ago.
Category: Cardiology
Expert:  Dr .Saeed ahmed replied 2 years ago.

Dr .Saeed ahmed :

Hello, Thank you for your question. I will try my best to help you with your questions. I need to ask few questions before first.

Dr .Saeed ahmed :

Are you taking some other medicine ?

Dr .Saeed ahmed :

Do you have high blood pressure ? diabetes ? history of stroke ?

JACUSTOMER-ugzmx9r0- : No other medication and only been on bisoprolol for 10 weeks, no other history just did bp and it was 93/61 pulse 96 felt ok though
Dr .Saeed ahmed :

Do you get episodes of dizziness ? blackouts ? or weakness ?

Dr .Saeed ahmed :

Did your doctor did a holter test ?

Dr .Saeed ahmed :

if yes what were the results ?

Dr .Saeed ahmed :

Are you taking asprin ?

JACUSTOMER-ugzmx9r0- : Sometimes dizzy no blackouts feeling just rubbish pain being the main factor not required to be on warfarin as low risk seemingly and allergic to aspirin
Dr .Saeed ahmed :

well, heart rate as low as 55/min with episodes of dizziness means that you need to lower bisoprolol dose.

Dr .Saeed ahmed :

Also your blood pressure is lower than 100 systolic which is also an indication to lower the bisoprolol dose.

Dr .Saeed ahmed :

At this stage your doctor needs to do a holter for 24-48 hours

Dr .Saeed ahmed :

to see how many episodes of AF you are having

Dr .Saeed ahmed :

because you may need a pacemaker with betablockers if the the heart rate is going low as 55 and also having AF episodes.

Dr .Saeed ahmed :

So a holter is first step if not already done.

Dr .Saeed ahmed :

You have questions ?

Dr .Saeed ahmed :

Regarding your chest pain.... Does it occurs with activity ? exercise ? at rest ?

Dr .Saeed ahmed :

does it increases with breathing ? cough ?

Dr .Saeed ahmed :

Or increases with pressure over the pain area ?

Dr .Saeed ahmed :

Please reply so that we can complete the chat, thanks

JACUSTOMER-ugzmx9r0- : Chest pain occurs with all of the above I could be free from pain and sitting and it comes, it comes after I sm walking I feel bad after eating I csn awaken and have chest pain it's not more painful when I breathe or cough it doesn't seem yo be any one thing it has vatious levels from niggling full and annoying to sharper .
JACUSTOMER-ugzmx9r0- : doctor just increased bisoprolol to 7mg from 5mg 4 days ago as at tea time I always feel worse like the medication is runningnoutnwhich is weird I wanted to get atenolol bd to see if that helped
JACUSTOMER-ugzmx9r0- : However GP just increased
JACUSTOMER-ugzmx9r0- : also I feel this is all worse pre menstrual can this affect things could it be hormonal. I am so tired of it all perhaps should get private consultation this is really affecting my quality of life
Dr .Saeed ahmed :

These symptoms are not due to hormonal changes.

Dr .Saeed ahmed :

Chest pain of unknown origin with AF means high chances of possible ischemic heart disease.

Dr .Saeed ahmed :

ECG can be normal in 40% of patients with ischemic heart disease.

Dr .Saeed ahmed :

So first thing that needs to be ruled out in your case is ischemic heart disease.

Dr .Saeed ahmed :

you need echocardiogram and stress tests.

Dr .Saeed ahmed :

at your age with no risk factors like obesity, smoking, family history of heart disease

Dr .Saeed ahmed :

chances of heart disease are less,

Dr .Saeed ahmed :

but if you have any of these risk factors this increases the chances of heart disease to high levels.

Dr .Saeed ahmed :

It is best that you see a cardiologist rather than a GP

Dr .Saeed ahmed :

In my opinion you should take asprin if allergic then other blood thinners like clopidogrel are the options.

Dr .Saeed ahmed :

you need a lower dose of bisoprolol so that heart rate can increase

Dr .Saeed ahmed :

if you have episodes of AF on this dose of 7mg then we have option to implant pacemaker

Dr .Saeed ahmed :

with pacemaker we can increase the dose of bisoprolol to max

Dr .Saeed ahmed :

because pacemaker will no allow bisoprolol to lower the heart rate below a fixed rate

Dr .Saeed ahmed :

in most cases 60 beats per minute

Dr .Saeed ahmed :

I hope this answers your question

Dr .Saeed ahmed :

you have queries ?

Dr .Saeed ahmed :

let me know if you have questions.

Dr .Saeed ahmed :

Rate the answer as excellent if you have received your answer.

Dr .Saeed ahmed :

If you have more questions or anything is left unexplained

Dr .Saeed ahmed :

simply use reply to post your questions. THanks

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