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On bisoprolol 5 mg for nervous rapid heartbeat, getting tachycardia episode. Should I increase the dose of medicine?

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Practicing since : 1981
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Hi! I've been on bisoprolol 5 mg a day for 8 years not for HBP but for nervous rapid heartbeat with sometimes tachycardia. But with this, my heart rate is sometimes too low (52bpm) and I am tired, don't sleep well and have insulin resistance that I didn't have before the betablocker treatment. So I asked mycardiologist if there wasn't a new generation of betablocker that was even more selective than the bisoprolol. He gave me nebivolol 5 mg and said that I had to take the same mg because bisoprolol and nebivolol are mg for mg alike. So I did and it's was great for 6 weeks. My heart rate was 62 bpm instead of 52, I was much less tired for sport, and my blood glucose level fasting was 70mg/dl instead of 115. And I got normal erction again. But after these 6 weeks, I had 2 tachycardia episodes in 3 days (about 150 bpm) with a bit of tight chest (just a bit) and this was both times about 20 hours after taking my dose and so about 4 hours before taking my new dose. So I took 4 hours earlier to stop the tachycardia and here also compared to bisoprolol, it took about 2 hours for my heart rate to go back to normal while in the past with bisoprolol, it took only 30 minutes. So I restarted the bisoprolol and didn't have any tachycardia problems anymore still 1 month later. But bloog glucose XXXXXXX again, fatigue also, less erection also and I'd love to go back to nebivolol but I am a bit afraid now. Should I take 10 mg of nebivolol instead of 5 mg or take 7.5 mg because I have the feeling that mg for mg, the bisoprolol is stronger and 5 mg of nebivolol act like 2.5 mg of bisoprolol. Thanks :)
Posted Mon, 3 Dec 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 6 hours later
Thanks for writing in.
I am a qualified and certified cardiologist. I read your question with diligence.
Though, I have not seen your EKG during tachycardia. But rate of 150 suggests supraventricular. Therefore, I have a feeling that you have Tachy XXXXXXX Syndrome. Tachy XXXXXXX syndrome is a collection of conditions which shows as slow and fast supraventricular rhythms in ECG. Tachy XXXXXXX syndrome us also known as ‘sick sinus syndrome’ or ‘sino atrial disease’. Your heart rate of 52 when your demand is far more only strenghten the suspicion.

Your history is not different from that of Tachy XXXXXXX Syndrome either.
Tachy XXXXXXX syndrome leads to abnormal functioning of the sinus code that regulates the impulse rates. It leads to sinus pause or arrest. This complication is associated with conduction system disease of the heart. It may also lead to a number of supraventricular tachyarrhythmias like atrial fibrillation and atrial flutter; though so far you have not had any documented episode of either. Is Tachy XXXXXXX Syndrome a common disease?
Research has shown that 1 out of 1600 elderly people is suffering from this disease globally. This is an alarming percentage that needs to be taken care of. Agreed your younger age and variation in your blood sugar which you have so vividly described can not be explained with this diagnosis.

The Tachy XXXXXXX Syndrome is a disease that can be in a person for a long time. However if early Tachy XXXXXXX syndrome treatments are not given, this disease may become debilitating. This is why it is recommendable that once the disease symptoms are noted, it should be given immediate attention.

A person suffering from Tachy XXXXXXX Syndrome is likely to have a fast heart beat rate, or a slow heart beat rate or an alternation of both too fast and too slow. The heart is a very crucial part of the body that helps in blood circulation. An alternation in the way the heart works may lead to very severe body effects in terms of health. What are the risk factors associated with Tachy XXXXXXX Syndrome?
Underlying disease are the major risk facors for Tachy XXXXXXX syndrome. The risk factors are high blood pressure, increased cholesterol, smoking, alcohol consumption etc..

What are the Symptoms of Tachy XXXXXXX Syndrome?

Some of the major symptoms of Tachy XXXXXXX syndrome are: Fatigue or tiredness which you have and Dizziness which you do not have.
Tachy XXXXXXX Syndrome Treatment
The most common treatment for tachy XXXXXXX syndrome is the use of medications and pacemaker therapy. These are the two major ways that will be used to treat this complication. The aim of the pacemaker therapy is to control the rate of heart beat. Please discuss with your cardiologist about this diagnosis. A test like Holter can confirm the diagnosis.

Coming back to your original about dosage of Nebivolol whether you can take 7.5 or 10 instead of prescribed 5 mg. My problem is what if you heart rate falls more rapidly? I would not recommend increase in dosage of the prescribed medicine specially a situation when your diagnosis has not been established.
If you have a followup question for me or you want to clarify some information, please write. I will be most happy to answer. Good Luck.

With Best Wishes:
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: On bisoprolol 5 mg for nervous rapid heartbeat, getting tachycardia episode. Should I increase the dose of medicine? 7 hours later

Thank you very much for your answer. Actually, my heart rate is 52 bpm only since I've been taking the beta blocker bisoprolol. My normal rest heart rate when I am not with beta blockers is about 72 bpm. My tachycardias episodes are very rare, I had only 4 the last 2 years. I've had a holster for 5 days some years ago and there was nothing alarming or XXXXXXX and my cardiologist said everything was fine. At this time, I had around 200 extrasystoles a day (during holter, and I could feel each one), all were atrial extrasystoles. Today, I have them only occasionally, sometimes 4 or 5 times a week and sometimes none for 6 months. I had a echograph of the heart 2 months ago and was said to have a 20 years old guy heart. Both my family doctor and my cardiologist said they think my problem is not the heart, it is the neurovegetative system that is unbalanced (my doctors are in Switzerland and me I am in the U.S. for some months, that's why I am asking online). I called my cardiologist and faxed him a copy of the ECG and he said it's fine, no heart problem.

Also with the bisoprolol, I didn't have any tachycardia episode anymore for at least 5 years, but then I had 2 episodes six weeks after switching from bisoprolol to nebivolol 1 month ago. So my question was more if it is possible that this was due because of the nebivolol but then why after 6 weeks only and not at once and then I switched again to bisoprolol (1 month ago) and didn't have any tachycardia anymore. So I was wondering if 5 mg of nebivolol are enough and if mg for mg, they have the same action as bisoprolol because I was watching online the test made with bisoprolol vs nebivolol on healthy people and while the top of mg used with bisoprolol was 10 mg, the top of mg used for nebivolol was 40 mg. When I contacted the nebivolol manufacturer, they told me that according the the tests made, both nebivolol and bisoprolol are given at a dose of 5 mg with about the same effect on lowering blood pressure BUT, they told me since my question was about tachycardia and not blood pressure, there's never been a test made of nebivolol or a comparison nebivolol/bisoprolol for tachycardia and here maybe the dosage for this purpose might be different from bisoprolol to nebivolol since nebivolol induce far less bradycardia than bisoprolol. So my cardiologist seems to say that reading the notice about nebivolol, they speak about 2.5 and 5 mg only. And when I told him I read they made tests (mostly on people with heart failure) and they started with 2.5mg to finally get to 40mg (that was confirmed to me by a family doctor in the U.S. according to what he could read in his compendium), he was amazed. And because nebivolol has so much less side effects on me, I'd love to switch again to nebivolol (my cardiologist said it's fine, he doesn't believe that the nebivolol has created these 2 tachycardias, and according to what I told him, he thinks what I had was more about a hypoglycemia). My only concern is if 10 mg of nebivolol are a reasonable amount and not an overdose.

Thank you very much Doctor, and sorry to be annoying you with such details.
Answered by Dr. Anil Grover 3 hours later
Thanks for writing back.
It is never annoying to get more details from the patient. Now I have clear idea of what you are suffering from, as you are having intrinsic heart rate (when no drug to stimulate or depress your natural pacemaker that is sinus node) is around 72. Therefore, obviously, you can not have bradycardia. In any case, for a moment it was suggested that you suffer from inherent structral or heart problem. You have problem with conduction system of heart (not structral but only being over sensitive to stimuli like hypoglycemia or drugs; the operative word being over). Well, by your detailed history I can make out that you have fairly good understanding of your own heart's response and you can competently make changes with help of the doctor who had been seeing you and adjusting your drugs. I stand corrected on that count. Nebivolol never creates tachycardia, did I suggest that? Then there must have been great miscommunication. Everything appears to be settled now, I am happy about this, these are limitations of online consultation. If any issue is unresolved and you feel I can be of help, you can write to me. It was pleasure interacting with you. Take Care. At least all of us learnt limitation of involving three continents in email communication without the benefit of asking each other! Good Luck.

With Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: On bisoprolol 5 mg for nervous rapid heartbeat, getting tachycardia episode. Should I increase the dose of medicine? 4 hours later

Thank you so much for your answers and advices! They are really appreciated and it's always nice to have the opinion of an expert! No, you didn't suggest Nebivolol could create tachycardia, it was just one of my questions to know if it was possible for a betablocker like it to create tachycardia and I thank you for your clear answer.
I enjoyed your professionalism and clarity in you answers and decided I will switch to Nebivolol again as discussed with my cardiologist.

Take care and I wish you the best!
Answered by Dr. Anil Grover 39 minutes later
Good luck and take care.
Thank you for the kind words you have for me. You may now close the query with your remarks and stars. It was pleasure interacting with such a knowlegeable person like you.

Regards with Best Wishes

Above answer was peer-reviewed by
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