#bisoprolol

If you're managing severe heart failure (LVSD/EF 20%), you likely take Bisoprolol. This is Lesson 1 in our "Know Your Meds" series!

Why are you taking a pill to slow your heart down when you already feel tired? 🤔

Bisoprolol is a Beta-Blocker.

It protects your heart from the damaging effects of stress hormones (adrenaline).

It gives your heart muscle vital time to rest, heal, and recover.

This drug is a foundation of heart failure recovery!

⚠️ WARNING: Never stop taking it suddenly.

Introduction

Bisoprolol is a medication that belongs to a class of drugs known as beta-blockers, which are primarily used to manage cardiovascular conditions. This drug is often prescribed for patients with hypertension (high blood pressure) and heart-related issues, such as angina (chest pain) and heart failure. By understanding how bisoprolol works, its benefits, and potential side effects, patients can be better informed about their treatment options.

Mechanism of Action

Beta-blockers like bisoprolol work by blocking the effects of adrenaline (epinephrine) on the beta-1 receptors in the heart. This action results in a reduction of heart rate, decreased cardiac output, and lowered blood pressure. By slowing down the heart rate and reducing the force of contraction, bisoprolol helps the heart work more efficiently and reduces its oxygen demand, making it particularly useful in managing conditions like angina.

Uses of Bisoprolol

Hypertension: High blood pressure is a major risk factor for cardiovascular diseases, including heart attack and stroke. Bisoprolol helps to lower blood pressure, thereby reducing the risk of these serious health events.

Heart Failure: In patients with chronic heart failure, bisoprolol is used to improve survival, reduce hospitalization, and alleviate symptoms. It helps the heart pump more effectively and reduces the overall workload on the heart.

Angina: Bisoprolol is effective in preventing episodes of angina by decreasing the heart's oxygen demand. This is achieved by reducing the heart rate and the force of heart muscle contraction.

Arrhythmias: Bisoprolol is also used to manage certain types of irregular heartbeats (arrhythmias), such as atrial fibrillation, by helping to maintain a regular heart rhythm.

Dosage and Administration

The dosage of bisoprolol varies based on the condition being treated and the patient's response to the medication. It is typically taken once daily, with or without food. It's important for patients to follow their doctor's instructions precisely to achieve the best outcomes. Starting doses are generally low and may be gradually increased based on the patient's response and tolerance to the medication.

Side Effects

Like all medications, bisoprolol can cause side effects. Some common side effects include:

Fatigue: Patients may feel unusually tired or weak.

Bradycardia: A slower than normal heart rate.

Hypotension: Low blood pressure, which may cause dizziness or lightheadedness.

Cold Extremities: Some patients may experience cold hands and feet.

Gastrointestinal Issues: Nausea, vomiting, and diarrhea can occur in some individuals.

More serious but less common side effects include worsening heart failure, severe bradycardia, and bronchospasm, especially in patients with asthma or other respiratory conditions. Patients should report any unusual or severe side effects to their healthcare provider promptly.

Precautions and Contraindications

Before starting bisoprolol, patients should inform their healthcare provider about any other medical conditions they have, especially respiratory issues, diabetes, and thyroid disorders. Bisoprolol can mask the symptoms of low blood sugar and hyperthyroidism, making these conditions harder to manage.

Bisoprolol is contraindicated in patients with severe bradycardia, severe asthma or chronic obstructive pulmonary disease (COPD), and certain types of heart block. It should be used with caution in patients with a history of severe allergic reactions, as beta-blockers can increase sensitivity to allergens.

Conclusion

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So my Cardiac Ablation (this video explains that it is) has been set for the 8th November. Following consultation with my cardiologist, we discussed the 2 main options that remained with regards to treating and controlling my Atrial FIbrillation.

The first option was to remain on my medication (Flecainide (anti-arrhythmia agent) and Bisoprolol (beta-blocker)).

The second option was to have the ablation.

Because my artrial fibrillation is not caused through any chronic illness my cardiologist believed that whilst both methods were valid approaches towards the treatment of the afib, the ablation probably tipped the scale in terms of risk/reward. There are some risks associated with the medication (for example if I developed a blood clot) which apparently tipped the ablation in my favour, in addition to the fact that it has been like caused through the development of an athletic heart, caused by endurance exercise.

There are obviously some risks with the procedure but again these risks outweighed the option of remaining on the medication. 

10 months ago I went into Atrial Fibrillation which I wrote about at the time and my subsequent MRI scan and my subsequent lifestyle changes which I had to follow.

All has been going fine and 4 weeks ago I visited the cardiologist again having worn a 24/7 heart monitor which I wore on my London to Paris in 24 hours ride and for the week preceding my appointment.

The heart monitor picked up about 2000 instances of an ectopic beat (a little additional beat to the normal rhythm) which given that my heart had beaten over 780000 times during that period gave no cause for concern.

As a result, I was keen to progress things because I felt so good and well that instead of just keeping on the Flecainide (anti-arrhythmia agent) and Bisoprolol (beta blocker) - which is not a long-term solution due to side effects as you get older - the cardiologist agreed that I could taper myself off the drugs, the Flecainide first, and then the Bisoprolol, and have the Flecainide as a pill in the pocket in case the need arises to use it.

So I dropped immediately down to 1 dose (50mg) instead of 2 a day, and then today I finished with the Flecainide entirely. In 4 weeks I will stop with the Bisoprolol and hopefully be (and remain) drug-free. I have no idea whether my heart will maintain the normal sinus rhythm of its own accord (it’s been in sinus rhythm for the last 10 months) but I feel that I had to give this a try. The conclusion may be that if I revert back into AF that I need to undergo Ablation, but unless I try this I feel we’d never know.

The biggest change to my lifestyle in this period has been to give up alcohol completely which seems to have caused my friends and loved ones more of an issue to get their head around than it has myself, although it must be noted that my daughter is using her “permanently available taxi service” with liberal abandon, which actually I really don’t mind.

The cycling is going well, I have more energy, and save for a sore back at times I believe I am sleeping better. My ride distances are definitely up (long may it continue) although I’m not pushing myself so hard. My heart rate seems to top out at about 85% of max these days, which I think is down to the Bisoprolol, so it will be interesting when I come off that to see if my heart rate goes higher, or whether somehow I am subconsciously tapering my top limit as a way of self-preservation. Ironically, it doesn't seem to affect my overall performance as I have achieved a considerable number of PR’s etc. on Strava through the year.

It does make me think though. In recent times I have had an increasingly poor relationship with alcohol. It would definitely change my mood and for whatever reason I could feel myself getting angrier when I had a drink, so I am actually very blessed in a way that I have had a pretty good reason to give it up, which has made the whole process all the more bearable. I’d even go as far as to say that it has been easy, for me anyway.

So touch wood, the next 4 weeks things carry on as normal and then I’ll come off the Bisoprolol , go drug-free and see again where things end up. If coming off the alcohol turns out to be the answer then it might be a viable option for others who suffer from AF, to come off the booze and see if it helps to regulate matters once again. 

Believe me when I say that if you have a pretty decent reason (and I think AF is) to give up the booze, then it does make that process all the more achievable.