Hello doctor, i am a doctor as well. I have an...

Dear Customer
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Our advice about your medical condition :

Dear customer , you have mentioned many informations about your medical condition , and which can discribe your heart rate weakness , and that medication are not effecient in your case , beside pre-existance other medical issues , you case cant be treated easily because its a little bit complication , so we will mention some advices and facts about your case , wishing you following it 

why is your heart rate low and medications arent effective any more :

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according to your medication condition ( ASD ) , this is one of the complication after long standing ASD defect without getting treated 
- medication as you mentioned you couldnt tolerate , but as a matter of fact , those medications are only to treat symptoms to avoid surgical treatment option , its not meant to treat your ASD , but only control your blood pressure to avoid the its complication 

is surgery is an option for you in this age and is it effective :

- your cardioligist can decide which if surgery can be helpful in your case or its risks may outweigh its benefits 
- surgical options such as open heart surgery or catheterization for repaid your heart defect (ASD) , and it can be done at your age , although it may have some risks , but studies shows its totally effective in this age and even older and have low morality rate 

what to do next :

1. stick to your medication
2. reconsult a doctor ( prefered to just keeping up with one doctor and follow only one doctor instructions )
3. consult with your doctor about chaning in medication plans , other options may be suitable 
4. cut smoking , its effects in this age and stage may be multiple harmful to normal healthy person 
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Kind Regards