Atrial Fibrillation and long-term management with medication

@realitytest this happens to me with beta blockers. My bp and heart rate drop and I am weak, can't feel my arms, feel strange.

I will tell you two things. I use diltiazem (calcium channel blocker) but ONLY when needed. This is called the "pill in a pocket" approach.

You could also try the beta blocker ONLY when you have tachycardia.

I read once on another forum- sorry cannot cite- that beta blockers are sometimes not good for certain types of afib. Diltiazem also lowers blood pressure so when I have afib with heart rate of 180, the ER does a diltiazem drip and watches my vitals. I have only taken diltiazem three times n 5 years-while I wait for the ambulance!

Many thanks, windyshores!
Your suggestions about PRN beta blockers is certainly hopeful but I wonder if my doctor would approve it. Can I assume you are using your calcium blocker PRN with your doctor's approval?

I live in a rural, medically underserved area. I've long been unhappy about the paucity of quality medical care. May I ask what area you are in, and if you see a doctor in a highly qualified practice?

One thing I know is I'm not going to touch that Metoprolol again with a ten foot pole!

PS Is your blood pressure usually elevated?

My blood pressure is usually low, which probably explains my problems with beta blockers.

I have one cardiologist who wanted me to take blood thinners (based on a CHADS2 score for females over 65, and the female part of the score has now been removed so I was right in the first place!) and I declined. He prescribed a beta blocker (I told him I could not tolerate) and diltiazem (I told him I didn't want to take daily and asked if I could take it only as needed, and when he agreed, asked him to change it from extended release, which he also agreed to do).

I have another cardiologist from the hospital who is at the other end of the med spectrum and tells me to go home and forget about the episode!

My feeling is that doctors have no liability if they follow protocols. If they don't prescribe and something happens, they can be blamed. They don't mind if we decline what is offered because then if something happens, the record shows we declined the med.

The first doctor has now told me he agrees with what I decided several years ago and that they are "probably overmedicating people."

I only have afib once a year or so, so my situation is different from those who have it frequently or continuously. Meds are needed for many people of course and I will take them when that time comes. For you, perhaps diltiazem will be better than a beta blocker and perhaps- ask your doc- you can do pill in a pocket.

This is a forum I have used: https://www.afibbers.org/forum/index.php

That is where I saw discussion of beta blockers. I also take magnesium at night, and drink low sodium V-8 for potassium as recommended by someone on that site.

My blood pressure is usually low, which probably explains my problems with beta blockers.

I have one cardiologist who wanted me to take blood thinners (based on a CHADS2 score for females over 65, and the female part of the score has now been removed so I was right in the first place!) and I declined. He prescribed a beta blocker (I told him I could not tolerate) and diltiazem (I told him I didn't want to take daily and asked if I could take it only as needed, and when he agreed, asked him to change it from extended release, which he also agreed to do).

I have another cardiologist from the hospital who is at the other end of the med spectrum and tells me to go home and forget about the episode!

My feeling is that doctors have no liability if they follow protocols. If they don't prescribe and something happens, they can be blamed. They don't mind if we decline what is offered because then if something happens, the record shows we declined the med.

The first doctor has now told me he agrees with what I decided several years ago and that they are "probably overmedicating people."

I only have afib once a year or so, so my situation is different from those who have it frequently or continuously. Meds are needed for many people of course and I will take them when that time comes. For you, perhaps diltiazem will be better than a beta blocker and perhaps- ask your doc- you can do pill in a pocket.

This is a forum I have used: https://www.afibbers.org/forum/index.php

That is where I saw discussion of beta blockers. I also take magnesium at night, and drink low sodium V-8 for potassium as recommended by someone on that site.

Thank YOU for elaborating on your medical/medication history as pertains here.

I am about to see my cardiologist (first time in months, the way it works around here even in an emergency). Will also try to reach the out of town (Cleveland Clinic) office - doctor's PA - to report my med response, and concerns.

(Wondering about the difference between beta blockers and calcium blockers.)

PS I take potassium salt substitute (quite satisfactory for me, compared to sodium) and magnesium supplements - I really need it to combat my very painful nocturnal leg cramps.

I just reread your post. A doctor cannot really "insist" on you taking any medication. You always have the right to refuse. And it can stay friendly 🙂

The problem seems to be that you took the beta blocker when your pulse and blood pressure were normal, so it lowered both to below normal.

If you have tachycardia, it is a good med- while you have tachycardia. It seems you would have to monitor so that when the tachycardia stops, you also stop the med- BUT you have to taper it very very carefully.

If you can tolerate the tachycardia, then you can try foregoing medication and see if it stops.

Afib is different from tachycardia itself, because of the stroke risk from clots. I have asked for short term anticoagulation and instead they did an echocardiogram to make sure I had no clots. I read a study that suggested people like us should be able to do one month of anticoagulation to deal with an episode.

I do tai chi and Reiki and try to keep stress down. It looks like you follow some of the same approaches with Mg and Potassium.

I hope your problems do not recur. I don't know why many providers don't listen about the blood pressure.

I have a Kardia to do an EKG at home. It is the size of a credit card and you put two fingers on it and count to 30. Good luck!

I just reread your post. A doctor cannot really "insist" on you taking any medication. You always have the right to refuse. And it can stay friendly 🙂

The problem seems to be that you took the beta blocker when your pulse and blood pressure were normal, so it lowered both to below normal.

If you have tachycardia, it is a good med- while you have tachycardia. It seems you would have to monitor so that when the tachycardia stops, you also stop the med- BUT you have to taper it very very carefully.

If you can tolerate the tachycardia, then you can try foregoing medication and see if it stops.

Afib is different from tachycardia itself, because of the stroke risk from clots. I have asked for short term anticoagulation and instead they did an echocardiogram to make sure I had no clots. I read a study that suggested people like us should be able to do one month of anticoagulation to deal with an episode.

I do tai chi and Reiki and try to keep stress down. It looks like you follow some of the same approaches with Mg and Potassium.

I hope your problems do not recur. I don't know why many providers don't listen about the blood pressure.

I have a Kardia to do an EKG at home. It is the size of a credit card and you put two fingers on it and count to 30. Good luck!

Ha! Just saw my local cardiologist and he said I could reserve the Metoprolol for PRN usage, and even cut it in half if I thought my (.25) dosage was too strong.

I'll have you know I quoted you during the appointment (paraphrase) about "the pill in a pocket" usage.

Thank you!

Still don't know how the Cleveland Clinic doctor will react, but I'll reserve judgment until I speak.

Ohhhhh sorry I didn't catch the fact that you have frequent/daily afib. Different picture!

It is concerning that the doc didn't realize female gender had been dropped.

If I had afib often I would be thinking very differently. I guess it also depends on how long it lasts. Glad you have the Watchman.

I am so confused about aspirin. They tell us not to use it against clots, these days, though 7 years ago with my first episode that was the recommendation.