Beta blockers and palpitations

[RobHemsley]

Hi guys,

For a number of years I've had prolonged bouts of palpitations (months) and then prolonged bouts without. I got this checked out by a cardio specialist last year, had all the tests, 24hr holter, ecg, exercising ecg, ultrasound etc and nothing dangerous was found. Cost me a lot of money. I had my medical taken off me whilst the results were being checked but no problems were found, just put down as ectopic beats, got my medical back a couple of weeks later.

This problem is annoying, worrysome and I'd really like to do something about it. I'm wondering if getting prescribed beta blockers might be a short term answer, it can't be doing my heart any good, flapping about like a wet fish in a bucket as it is...Would this be a problem for a class 1 medical (or even a class 2 for that matter??). Further to that, would it be an issue for any potential employer??

Cheers
H

[HEATHROW DIRECTOR]

I've had them for 50 years. Don't worry - only makes them worse!

[Cornish Jack]

On a purely personal note, Beta Blockers are to be avoided. Was prescribed for symptoms similar to yours. Did little to alleviate the problem but caused distinct circulation problems. Eventually had some excellent advice from a medic who suggested antacid tablets - yes, really. They worked!! the palpitations were being caused by gas pressure on the diaphragm brought on mainly by unrecognised stress and associated adrenaline production. In other words, RELAX!!!
As the Station Doc said -"There's nowt wrong with your heart - if there was, it couldn't do what it is doing!!"

[Pace]

Sure I read somewhere probably the daily mail :rolleyes:that latest studies show beta blockers actually increase your chances of heart failure or strokes.

Pace

[gingernut]

Encouraging news that the test's were okay. "Palpitations" is quite a subjective term. Shame about the grounding.

Sounds like that you have got some excessive nor-adrenaline that might need mopping up.

I reckon (GP allowing) if you did some aerobic exercise (swimming, walking fast, whatever takes ya'fancy), anything that makes you a little bit breathless, hot, and sweaty, for at least 20 minutes, 5 times a week, you will probably feel better.


Try it, if it doesn't work, let us know:)

[Pace]

Here are two links on beta blockers the one on heart attack and stroke increases the other on Diabetes increases by 50% using beta blockers.

Beta-blockers can lead to heart attacks, strokes and heart failure, new research shows | Mail Online (http://www.dailymail.co.uk/health/article-1080632/Beta-blockers-lead-heart-problems-new-research-shows.html)

Beta-blockers 'increase diabetes risk by 50 per cent' | Mail Online (http://www.dailymail.co.uk/health/article-403973/Beta-blockers-increase-diabetes-risk-50-cent.html)

[Fly380]

So many drugs warn of possible heart attack or stroke. Just the drugs companies covering their backsides. Check out anti inflammatories and one very popular painkiller.
Ibuprofen Information from Drugs.com (http://www.drugs.com/ibuprofen.html)

[Pace]

Fly380

Probably Gingernuts advice is the best as if all his tests were normal then its likely to be a stress thing / lifestyle thing!

I totally agree with you that most drugs have adverse reactions some more serious than others hence the less pill popping we do the better.

More de stressing has to be a better option than pill popping?

Pace

[RobHemsley]

Hey guys! Thanks so much for all your replies. Great to know I'm not alone with this. I'll have a bash with the antacids (any particular brand?), I do have a huge amount of gas (ask my ex!) ;-). When the condition is at it's worst I can feel a burst of adrenaline accompanying or preceeding a delayed beat followed by a real thumper!

It really is an unpleasant condition, it interrupts sleep etc at it's worst, making the problem even worse. And as you say, worrying about it makes it so much worse.

I've always avoided pills etc whenever possible and I get regular exercise, 20 mile bike ride a couple of times a week, aerobic exercise in the gym, walking etc, I have a good balanced diet and drink plenty of water. I do like a beer and the odd cig though :-\. Oddly I feel the condition is much improved for a couple of pints in the pub, stress relief?? Alcohol and nicotine are supposed to exaggerate symptoms, surely?

My doctor is loathe to prescribe BBs anyway, I have an occasional, mild, night time asthma problem which he says will be exaggerated by BBs. I also have a titanium hip - I'm a bit of a disaster really :-\ LOL

Cheers
H!

[Pace]

Rob

Reading your last post it really sounds like this is an anxiety thing, being too heart aware, scared that something is wrong and being tuned in to every beat.

If your heart races at night let it, you will soon ignore it and fall off to sleep.
"""IT""" is you not some affliction.

It will go when your concerns and attention towards it goes. Try taking up some sort of relaxation regime maybe yoga or one of the other eastern methods. Try Hypnosis, breathing exercises (I bet thats fast too)
Above all forget it and enjoy yourself.

Pace

[one dot right]

Try Hypnosis, breathing exercises (I bet thats fast too)
Above all forget it and enjoy yourself.


A little harsh,and, if I may say, patronising!

Some people (i'm one of them) are more aware of their heart beating than others. I went for months with 'palpitations' dismissed by doctors as ectopics before I had an episode of Atrial Fibrillation that got my heart going at a recorded ventricular rate of 280 BPM.:eek:

This resulted in an ablation procedure, a follow up two months later, and ongoing evaluation.

The 'it's all in your head' brigade drive me nuts. If it hasn't happened to you then you don't understand!:mad:

Rob, it may be worth a longer ECG holter, i.e 48-72 hrs to see what's really happening when you get these periods of abherrant behaviour. It is concerning when they happen and in my case nearly caused lasting muscle damage.

Not to mention it was bloody frightening!

[RobHemsley]

Crikey! Sounds like you're lucky to still be here One dot right.

I am tempted to go back to my specialist and ask him to do some more tests whilst I'm having problems. It had all but cleared up by the time the tests were done last time. It's nice to get a 'clean bill of health' but I think I'd rather it was checked out at its worst...It's an expensive problem to get checked out tho, especially considering I'm not actually flying for a living at the moment.

I gave the antacids a try but the results were not encouraging.

Cheers!

[one dot right]

Yes Rob I think i am. Think the ambulance crew thought I was lucky to still be here too.

Please get it checked thoroughly, I'd hate anyone to go through what I did unnecessarily.

Funnily enough, despite months of checks, various holters, AND me telling them something was wrong, NOTHING was picked up until I felt it go 'out of rhythm' one morning and not go back in, then followed the previously mentioned Atrial Fib episode.

Good Luck.

[air pig]

Hi Rob

Check your pm's

Regards

Air pig

[Thomas coupling]

Robhemsley:
Palps - get them tested by a cardiac consultant. No-one else will do. They know whats what and whether certain medicines are effective and their side effects.
I have/had an ATPL and after 30yrs of flying they found abnormal arrythmia. Did all the tests including nuclear stress test - decided the heart is fine mechanically but misfires occasionally. He put it down to certain triggers: alcohol, coffee (big time), coke! stress, etc etc. But because I had a lot of them he decided to put me on BB's. Transformed them. 99% gone!.
No mention of side effects??? There aren't any.
However - unless you are twin pilot, your flying days are over, I'm afraid. You need a class 1 and BB's and class 1 don't mix.

[one dot right]

No mention of side effects??? There aren't any.


Er, actually they have a huge effect on your exercise tolerance, and in my case at least make me feel very 'flat'.

However - unless you are twin pilot, your flying days are over, I'm afraid. You need a class 1 and BB's and class 1 don't mix.

Actually, certain beta blockers are permitted and compatible with class one.

[RobHemsley]

I have spoken to my GP about BBs before and was actually on them for a short while about 8 or 9 years ago (before I started flying). They usually have an effect on your lung function and as I suffer from very mild night time asthma on occasion my GP is loathe to presecribe any for what he is convinced are simple ectopics.

I did have my tests performed by a private cardio specialist, he seemed to be very thorough and found nothing of concern.

I wish I could blame stimulants but I don't drink coffee, only drink decaf tea, don't do drugs. I do smoke a small amount and I like a drink at the weekend. I'm probably underweight if anything for my height (6'2" 76Kg), exercise regularly and sensibly, have perfect cholesterol level etc. Stress is looking like the most likely culprit.

Anyway, thanks again for all your replies, I promise I will get it checked out again - even though it'll have to be private (god bless the NHS!) and will no doubt break the bank (again).

Cheers

RobH

[Thomas coupling]

onedotright: If you are on BB's you can't fly SPIFR. The end. If you are commercial transport twin pilot - that's fine.

Two: I run/gym/cycle weekly and have done for years - absolutely no impact whatsoever on my lung capacity or stamina.

Try again

[one dot right]

onedotright: If you are on BB's you can't fly SPIFR. The end. If you are commercial transport twin pilot - that's fine.


Well I have a letter from the Belgrano stating the opposite.:eek:

Two: I run/gym/cycle weekly and have done for years - absolutely no impact whatsoever on my lung capacity or stamina.


So do I. They have a massive effect on me, and are recognised for doing so. But I guess we're all different.

You try again.

[Thomas coupling]

Onedot: I have a letter stating that they are happy to consider me flying with a restricted class 1: twin pilot only. I'm on Bisoprolol.
But I've moved on since then.

What are you on? And for how long.
I've also asked my Cardiac specialist/AME (same guy) about this latest observation on BB's.

[one dot right]

Thomas, I'd rather not get into a public p1$$ing contest, but if you'd like to PM me i'd be happy to give you the details.:)

[Pace]

A little harsh,and, if I may say, patronising!

One Dot right

The only thing i was trying to say is that palpitations will be made more severe by fear. No way was I trying to say not to be checked out. Infact I would go further and say be checked out until you are convinced that your heart is healthy. Even if you have the slightest grain in your mind that the docs may be wrong the condition will be worse as many anxiety/stress conditions are generated by fear of the symptoms themselves.
There would be nothing worse fear wise than lying in bed thinking you are about to depart this world at any second with heart failure!

But having done that forget it as turning your thoughts inwards will not help at all.

Sorry you have a real "problem" but most dont.

Pace

[Bus429]

See my post on endoscopy; I too have had palpitations and been prescribed BBs.
I'm beginning to see a pattern...:uhoh:

[one dot right]

Pace.

Make your mind up!

[RobHemsley]

LOL - ok guys, play nice, this is stressing me out and yes, you guessed it - giving me an irregular heartbeat!

Seriously, thanks for the posts and advice. I think I have a bit of both, I am affected by stress, my personal and work life is generally a bit of a mess - not a happy time, but I do think there is also a bit of a chemical imbalance somewhere. Probably my own doing from years of smoking and binge drinking, I'm not getting any younger.

A bit of an odd coincidence perhaps, this only started after I had a hip resurfaced about 7 years ago, I had something like an epidural and there was obviously massive physical trauma. There was talk of the metal particles, which are bound to enter the bloodstream in small quantities, being potentially carcinogenic but I just wonder if they may affect anything else - particularly electrical impulses...?

Cheers and good health.

RobH

[nohumbug]

hey Rob,

Ive been battling the ectopics as well. I had them 10 years ago before i was a pilot and they went away only to reappear about 2 weeks before my last class 1 renewal. (timing is everything :ugh:) I had been through an extremely stressful time and my guess is that it was the stress that brought them on again. Anyway , the ecg was flagged as abnornmal; re sinus rhythm and frequent ventricular ectopic beats. I was allowed to continue to fly by the Dame , but it was a anxious month long wait for CASA to send me the letter instructing me to see a cardio. This time with the career on the line they only worsened.
The cardio was ok with my echo and stress ecg and didnt bother with the holter. The paper work is still on the snail train at CASA , so my fate is still undecided, the wait only making it worse.
However, i have recently found a couple of breathing and relaxation exercises which i purchased on line. Being a skeptic i wasnt exactly confident that they would help, but they are. Even if its just placebo or because im taking some control of the situation, they are helping.

I would be happy to pass them onto a fellow pilot (free of course:)) with a problem i well understand.

pm me if youre interested or you just want to talk about it.

[Loose rivets]

It's the funniest thing, but since stress-testing my increasingly arrhythmic heart, I've not had a problem.

I wrote what was intended to be a funny thread on JetBlast, but in hindsight, I wonder just what my suicidal attempt at testing my heart did.

I'd been months with what would have been a medical-losing arrhythmia, when I put it to the test.

Have a look at the funny thread.......and then don't do anything. I really don't want to be responsible for one of you keeling over.


http://www.pprune.org/jet-blast/417814-i-dont-beleeeeeeeeeeeve-me-hearts-playing-up.html

[RobHemsley]

Haha, that is a highly amusing thread LR, I guess you must have cleared some pipes somehow. Hope your health continues to be 'good'.

H

[aviate1138]

Same age as LR and had atrial fibrillation diagnosed and an enlarged heart [viral infection from flu ] with mitral regurgitation and a stage 3 kidney problem. I had been feeling all was not well within my overweight frame.

Cardiologist at Royal Surrey said I would need a pacemaker but he wanted to give me some drugs first. I had to lose weight and no exercise! Not easy I can tell you.

So I was given digoxin, ramipril, bisoprolol, warfarin and furosemide. Doses were increased gradually and after my last echocardiogram [9 months later] my heart had returned to normal size and my cardiologist scrubbed the pacemaker op. My kidneys somehow recovered more of their function and small amounts of wine can be consumed. Still on the pills but reductions are about to be made.

Side effects are complete loss of libido!, very itchy skin at times, variable bowel movements.

Anyone who feels something is not right with their heart is usually correct as I am sure one's central nervous system knows when things are out of order. For me the uncomfortable feeling of impending disaster has faded as my heart function has improved.

[HEATHROW DIRECTOR]

aviate1138... So do I understand that your AF has reached the stage that medication might be reduced? My wife has Lone AF and has been told she will be on drugs (Verapamil, Digoxin and Warfarin) for ever. Warfarin is causing serious hair loss, but none of the other problems you mention! We're hoping that she may be offered Pradaxa, which will remove the requirement for regular INR testing and hopefully get her hair back..

[aviate1138]

HD
Everybody who has AF seems to have a different version than mine. Most AF people I meet have paroxsmal AF and that causes fainting and rushes to the hospital, mine seems more benign [thank goodness] and I note that with Warfarin, Grapefruit is not recommended as are lots of Dark Greens and Cranberry Juice and Garlic! The trick seems to be a little of everything and that is where self checking ones INR [the coagulating rate] seems to give peace of mind over invariably inconvenient visits to the surgery.

My hair is falling out now and that is a bind. I expect to be on some medication - warfarin for sure but I am going to get my own INR tester and try natural foods to control the level - my target level is 2.5 and at present I vary between 2.2 and 2.5. The NHS will supply the little [expensive and non reusable] strips that gather the blood and allow the results to be shown.

CoaguChek |PT/INR Patient self-testing |CoaguChek XS System (http://www.poc.roche.com/coaguchek/rewrite/content/en_PT/10.30:30/article/POC_general_article_147.htm)

PS My surgery managed to give me 6 times the required daily dose of Digoxin and after 2 months I thought I was fading away. I now check every change in dosage and ask as many questions as I think reasonable. Second opinions are a right btw.

Good luck with SWMBO and her Pradaxa - I must check out that too! :)

[Seven44]

Hi Rob
Please check your PM

[LoneWanderer]

My heart really goes out to those suffering Palpitations/AF/PAF/Ectopic beats. I had suffered with a heart condition that was never really diagnosed properly from the age of 13.

Every clinician I met told me to rub my eyelids, don't drink caffiene, don't stress out etc etc. No one believed I had real problem!

At the age of 19, I had a cardiologist say I had AF and he prescribed various different beta blockers until my face went red and I couldn't step out in daylight, not to mention the other problems these drugs cause in a young mans life.

I gave up asking for help until I found a cardiologist working out of Leicester. He referred me to a cardiologist whom he thought could actually help. It took a while for an appointment to come through but he actually offered me a diagnosis. What I suffered from was re-entrant tachycardia triggered by ectopic beats.

Within 2 years I had EP studies and ablation therapy. Cured the problem and I could get on with my life.

The biggest relief I must say was being taken seriously.

[aviate1138]

HD "So do I understand that your AF has reached the stage that medication might be reduced?"

Until this week - yes. Now my surgery has told me that despite my cholesterol level being on the low side of average, they want me to take statins as well - because their garbage in/garbage out computer says so. I have said no and I am getting a second opinion as I feel I take enough pills now and statins have unpleasant side effects - on top of the itchy skin - no libido - hair loss i get at present! :rolleyes:

aviate

[WIDN62]

Rob,
There is so much conflicting information here because there are so many different forms of palpitations. I started with paroxysmal atrial fibrillation a few years ago. Because they were only there for a few hours at a time, I could have a medical and nothing would show. However, as they got more frequent, I decided to have them checked out. They could find nothing until one day I got to the doctors whilst in AF and had an ECG. I eventually got referred to a surgeon at Papworth who tried an ablation procedure but could not fix me. Flecainide was prescribed to me and after a period of grounding I got a multi-crew medical. Some years later the AF gradually got worse and I went back to Papworth. This time with medical science having moved on I had a pulmonary vein isolation operation and have been hugely better since.
The AF I had was never debilitating (a colleague of mine had it so badly, he could not get up out of a chair!) and I could cope with it pretty well – just felt generally shabby and under the weather. I was told by the Papworth surgeon a number of very interesting things. For example they have never found any connection between stress or caffeine and the sort of AF I experienced. Interestingly, along the lines of another poster, my AF only ever came on when I was resting – even mental stimulus seemed to keep it at bay – but sometimes physical pressure on my heart, such as leaning forward after a large meal or even turning on to my left side whilst in bed, would set it off.
I am sure that there are many different variations, but from the advice I have been given over the years, AF is definitely not good for your heart – it is not working efficiently when you are in non-sinus rhythm and there is an increased risk of blood clotting – hence why some people are on warfarin.
My advice would be to get an ECG whilst you are in AF and get those results to a real expert. My heart appeared perfect when I was not in AF, so they could find nothing to work on until I got there at the “right” time and they slapped an ECG machine on me. I have had numerous 24/ 48/72 hour halters since which have showed nothing except the odd ectopic beat, however on 2 occasions I have gone into AF whilst wearing the halter and that allowed them to move forward with my diagnosis and treatment. The surgeon at Papworth was very supportive and after all the tests were done on me initially, he said that AF would not be the cause of my demise, because basically my heart was in good condition and could cope with it. His advice in the years before my operation were to try all things in moderation – if anything brought the AF on, cut back on it!
By the way, I have heard that ventricular fibrillation is far more serious!
AF can be a very worrying condition, but the right drugs can help a lot, and in my case surgery was extremely beneficial.

[FlyingVisit]

I've suffered from SVT's (SupraVentricularTachycardia) all my life. It wasn't until I was 18 that the hospital actally confirmed it; until then everyone thought it was all in my head! It does annoy me when people say it's brought on by stress or caffeine - it isn't at all. Stress and stimulants can cause palpitations (ectopic beats) and a racing heart, but SVT's are totally different. I suspect the OP is suffering from SVT by the way he described the whooshing feeling he sometimes gets preceded by a thumping beat - that is how my SVT's start. They will come on for no reason whatsoever, and are very alarming. The heart will beat at 180 bpm and you can even see it thumping in your chest. There are various techniques you can do to stop them; holding your nose and mouth closed and blowing as hard as possible; pressing your eyelids gently; massaging ONE side of your neck along the artery (the pulse) but you have to be shown how to do this as it can be dangerous - and NEVER massage both sides as that can cause cardiac arrest.

Ectopic beats (flutters) are particularly horrible too. Some people swear by brisk walking to stop them, but if they do persist for hours you should go to A&E where they will re-set your heart rhythm. When my SVT's used to suddenly come on I couldn't do much as I felt giddy and faint. Usually, they would stop as suddenly as they started, but if they went on for too long, or I began getting a dull pain in my neck I would call an ambulance, and A&E would connect me to a heart moniter and put a butterfly in my hand, then slowly inject a drug to slow my heart down. They usually try to use other methods before doing that (I'm not sure why they only do that as a last resort) but it will slow the heart down eventually. They have to slow it down otherwise your heart would pack up - or you'd develop a bloodclot.

They eventually prescribed me Betablockers, though with me being young they weren't keen at first. But I insisted as the attacks were ruining my life. I've been lucky in that I've had no adverse effects through taking them, and they have stopped the attacks. I have been on them now for over 25 years.

I am still monitored every few years at the cardiac clinic, and a few years back was offered ablation therapy (same as what Tony Blair had) but felt a tad nervous having an op - and as the BB's have been so good in treating it I declined. However, we have left it open to review, in case my condition worsens, say, or the BB's started to cause issues. I'd also want the op whilst relatively young, not just to reap the benefits, but because I'd probably be in better health.

I found a link to the ablation therapy:

Cardiac Ablation (http://www.hrspatients.org/patients/treatments/cardiac_ablation.asp)

I'm actually not sure which SVT I have after reading that little lot, I only know it's Supra Ventricular Tachycardia - so when I read that Ventricular Tachycardia was the most dangerous I've decided to see my GP and ask him to look on my notes. If I do have that one I think I'll get the op down yesterday!:eek: