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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes low heart rate while on Bisoprolol?

Answered by
Dr.
Dr. Yogesh D

General & Family Physician

Practicing since :2009

Answered : 960 Questions

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Posted on Tue, 30 Aug 2016 in Internal Doctor Category
Question: my father had an episode of torsades which was self terminating...the doctor gave him bisoprolol 2.5 saying that its just to help his heart maintain a good rhythm.....now his bpm is 50...even after reducing the dose to 1.25 mg his bpm is still 50....what to do?
doctor
Answered by Dr. Yogesh D 14 hours later
Brief Answer:
50 beats per minute on Bisoprolol may not be worrisome.

Detailed Answer:
Hello Mr Saptarshi,

Thank you for writing in.

I have read the query carefully and understand the problem.

While on a beta blocker, a slower heart rate is expected, and if the heart rate remains at and above 50, I think it should be fine.

And it takes a while for the heart rate to increase when the dose is reduces, so wait and see for a few more days, if you do not see any change, or if the heart rate goes below 50, then please consult the cardiologist without fail.

In that case, the dosage might need to further reduced.

I hope this answers your query, feel free to write back if you have additional concerns.

Warm wishes.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Yogesh D 8 hours later
is an even lower dose of bisoprolol available?which beta bloccker is a better antiarrythmic metoprolol tartrate or bisoprolol fumarate
doctor
Answered by Dr. Yogesh D 4 hours later
Brief Answer:
Lower dose of Bisoprolol is not available, consult cardiologist.

Detailed Answer:
Hello Mr Saptarshi,

Thank you for writing back.

No, Lower than 1.25 mg of Bisoprolol is not available, you might have to cut the tablet into two halves, but before acting on my advise, you definitely need to consult with the cardiologist. We provide general information only so that you can understand things better.

Both metoprolol and Bisoprolol are good antiarrhythmics, in Torsades de pointes the mainstay of treatment is beta blockers, but the choice of beta blockers is up to the cardiologist.

The beta blockers at very low dose such as 1.25 mg or 2.5 mg act selectively on the heart and thus control arrhythmias, but a common side effect of beta blockers is bradycardia.

The risks and benefits must be weighed in each case, severe bradycardia would require stopping beta blocker.

The problem with this condition is, there are many variants of it, one form is congenital long QT syndrome, then there are acquired long QT syndrome that are secondary to some drugs or other disease processes or metabolic/electrolyte disturbances including hypokalemia, hypomagnesimia...

Otherwise, QT prolongation can occur after a myocardial infarction.

The exact cause needs to be identified, because the treatment primarily depends on the cause.

Propranolol is used to treat Torsedes de Pointes extensively but it is a non selective beta blocker, but well tolerated, and has the same side effects.

As I mentioned earlier, a heart rate that is constant and stays at or above 50 beats per minute is expected with beta blockers and should not cause any other problem.

Unless your father has syncope (fainting), severe fall in blood pressure etc due to beta blockers, this can be continued.

Please consult with the treating cardiologist and discuss the problem in detail.

Drug therapy requires proper monitoring and accurate diagnosis, so it is dangerous to change medication suddenly without the supervision of a cardiologist.

I hope this information will be useful to you.

Best regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Yogesh D 2 hours later
thank you so much sir for the info...i passed my mbbs two years back and am prepairing for my pg...my father had a head injury n there in the icu he was having severe XXXXXXX which i think led to the torsades there..otherwise his coronaries are normal n there is no history of any infarct and previously he didnt have any cardiac problem as such...when discharged he was prescribed metoprolol 25mg half tab twice daily...we consulted an electrophysiologist afterwards and he changed it to bisoprolol 2.5 and later 1.25 once daily....we come from a remote place and there are not many doctors leave alone cardiologists...sir do you think in my father's case a beta blocker is really necessary...cant we let the heart to work on its own...?thanking you again...await your reply
doctor
Answered by Dr. Yogesh D 7 hours later
Brief Answer:
Acquired long QT secondary to bradycardia induced by head injury.

Detailed Answer:
Hi doc,

Thank you so much for clarifying that you are a doctor.

Now that I know the background, I think it is pointless to continue Bisoprolol when the precipitating factor (head injury) has been effectively managed.

A secondary Torsedes de pointes does not need long term beta blocker therapy.

Make sure your father's head injury is now taken care of.

A high sympathetic tone may persist for some days following the head injury, and I think your father has passed through that phase hence continuing beta blocker therapy is not a wise decision.

I hope you can contact a cardiologist at the earliest and get his/her opinion as well.

Thank you again for using healthcaremagic, it is my privilege to be of service to another doctor.

Wishing your father a speedy recovery.

Best wishes.

Dr. Yogesh D
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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