Considering PM and want advice

OK, I'm new to this. I've been following the site for a while and find that many of the posts sound like me. I am 42 years old and have had significant bradycardia for the past 3 years (probably longer than that but have been diagnosed now). I also have PVC's. My heart rate is usually in the low 40's but it has gone down to 37 one time when I went to ER. I am an active person, when I have the energy, but my endurance has been pretty poor for quite some time now. I have had every test under the sun, they put me on a a beta blocker (metoprolol) to see about regulating my rhythm but a very low dose as before I was on 25 mg and my HR went down to 30. I could not function that way. So now they want to try half that dose and if not effective I could get a pacemaker. I am concerned about being on a beta blocker with my really low HR. Has anyone else been prescribed a beta blocker with significant bradycardia/low blood pressure/PVC's? Was it effective? I want to give it a chance to work but I am soooo tired I just want to sleep : (

11 Comments

second opinion

by Tracey_E - 2014-10-07 09:10:58

Is pvc the only thing wrong with your rhythm? Because 1) they're annoying but harmless and 2) meds don't help them. What beta blockers will do, however, is slow down your heart! If it was slow before, imo it was irresponsible to give you meds that would make it slower. If it was ok before, get off them because that could be the cause of your slow rate. I'm not an expert, just a lifetime cardiac patient, but your dr's approach seems scary to me. You have no business on beta blockers when your rate is that low.

Oh! And bb's also lower bp. You have to be really careful taking them if your bp was already low. Really, I would go get another opinion asap.

If you have other rhythm problems like afib, sometimes they will give a pm in order to safely increase the meds high enough to control the afib.

Tired no more

by justice - 2014-10-08 10:10:29

My pacemaker is now 8 weeks old and I feel great. Never fatigued, can walk for hours and exercise as well as keep up my usual business habits of working till 10:00 pm
Prior to the installation I was always tired and would fall asleep in front of the TV. Now I sleep well and honestly forget that its there,
Other than the initial bout with pericarditis I have not looked back.
Going for my first check up with my cardiologist tomorrow and I really want to give her a big hug.

I am truly blessed and would recommend this to anyone.

I also believe that a good diet and exercise is absolutely vital to thriving with a pacemaker.

Good luck

question?

by Gotrhythm - 2014-10-08 10:10:37

When you tried the 25mg dosage, even though your heart rate went to 30bpm, was there reduction in the number (or percentage) of PVCs?

Re: Tired no more...

by rjsully - 2014-10-08 10:10:39

Thank you for that! I makes me feel a little more at ease about doing this. I am a runner and do hot yoga, though this has been pretty limited as of late. So I am hoping I can resume these activities and feel like I used to. Staying up until 10pm? What's that like : ) I am hopeful.

re: question?

by rjsully - 2014-10-08 12:10:20

I guess I'm not sure if there was a reduction in PVC's. I have noticed that in the past few days of taking the lower dose of metoprolol that I haven't noticed the "fluttering". I have been checking my pulse with an oximeter and I have been between 36 and 41 for a couple of days now. I feel very tired/dizzy I put a call into EP's office and they said to dc the medication and will get back to me on next step, which I think is the pacemaker. So now I guess I'm waiting...

How do you feel?

by Gotrhythm - 2014-10-09 01:10:30

I was prescribed metoprolol for PVCs. I don't know if it helped the PVCs or not--but the issue with PVCs is quality of life. In themselves the PVCs are not dangerous. But PVCs make you feel bad, tired, no energy, light-headed. The metoprolol didn't make me feel better, it made me feel worse i.e. more tired, lightheaded, etc.

What I"m trying to say is that the only reason that someone with PVCs would take metoprolol would be to feel better. Do you feel better?

About pacemakers. They will not fix the PVCs. They will raise your heart rate to something closer to normal, and help your heart to speed up when a faster heartbeat is called for--like climbing stairs--and that will help with endurance.

I certainly felt better with a pacemaker.

Re: Tired no more

by rjsully - 2014-10-09 01:10:37

I have had a very low heart rate for several years now (in the 40's and sometimes lower). I tried the metroprolol one time last year (25 mg for only 3 days and my rate dropped to 30) and then 12.5 for only 3 days recently and again my heart rate dropped. So the low heart rate isn't r/t the medication. The EP put me on it to try to regulate my rhythm, but obviously it dropped my rate too much. His explanation was that when I am pushinig myself physically I am experiencing a vagal response that makes my blood pressure drop/get out of rhythm and that could be why I'm SOB/dizzy. Though I have been experiencing these sx's even when I'm not exerting myself. Never again!!! I won't take the stuff unless I have PM in place prior. I have just been functioning in a tired state with my low rate, but recently have had more problems when running and that's why I went back to cardiology. No endurance after a few months of trying to increase distance running, dizzy, SOB, almost fainting after exertion. I have run a few full marathons and several half marathons with the low rate, but then would sleep for pretty much the whole day following long training runs or the marathon itself. I didn't know that this was because of my low HR. I just thought I was really tired from running. Do you think the PM would solve the problems I am experiencing? EP wants to now try me on florinef in the hopes of raising my blood pressure, but it still doesn't solve the problem of my low heart rate, which I think is why I'm so damn tired all of the time. I've tried lots of other interventions prior to running (salt tablets/increased hydration/slowing down, all with no improvement).If a PM is the solution, I wish I could just go ahead with it instead of taking all of these medications.

What TraceyE said

by Gotrhythm - 2014-10-09 04:10:01

Having read your response "Re: Tired No More," I second TraceyE's suggestion that a consult with another doctor is in order.

Re: Tired no more

by rjsully - 2014-10-09 09:10:23

Thanks for all of your responses. I feel more empowered just by being able to ask questions and throw some things out there. I think a second opinion is a good idea and I will pursue that before any big decisions. This is my body and I should have a say, too.

before and after

by Tracey_E - 2014-10-09 09:10:23

My hr was low 40's before. I slept most of the day away, was always dizzy, sports were out of the question. After, I could feel the difference as soon as I woke up in recovery. That night the nurses got on my case for pacing the halls but it felt like I'd been mainlining coffee and I couldn't sit still. I still feel great, am healthy and active 20 years later. Not everyone feels such a profound difference but if the low rate is the only reason for your symptoms, chances are excellent you'll feel great after.

How long have you been on the metoprolol? I could not tolerate the stuff. I napped every day, was dizzy enough that in hindsight I probably shouldn't have been driving. The doc kept telling me to give it 6 weeks to adjust but the last straw was stumbling over nothing in my kitchen and breaking my foot. I threw the bottle away and changed to atenolol. I do better on it, though being on any beta blocker makes it harder to work out because it keeps the hr down. I still do it, but I am slow and some days I really struggle to get through.

Was your hr that low before the metoprolol? Because if it was not, I would question the need for the pm. Before you have the surgery, make sure the problems aren't from the meds.

Ah, PVC's....

by donr - 2014-10-11 10:10:53

...the bane of all Brady sufferers! And - very difficult to detect by the Newbie to "enjoying" them.

The worst part of PVC's is their randomness of occurring and the percentage of them in your HR it takes to make you feel groggy & lifeless.

I have had them on & off - mainly on - for a bunch of years.

Let me give you the Bottom Line Up Front (BLUF): it takes ABOUT 33% PVC's before you really feel wrung out - that is based on my experience. That requires continual runs of Trigeminy - meaning triplets of a single PVC followed by two regular beats for a fairly long period. There have been periods when I've run 10-15% w/o any significant tiredness, but felt that something was wrong. Down in the 5 % range they have an insignificant effect, AFTER you adapt to them & accept the fact that they won't kill you. At that point, you cease to even recognize their occurrence.

Have you learned how to feel them while checking your pulse at the wrist? The Newbie usually has trouble sensing the weak beat of the premature contraction, leading to thinking the beat is not even there.A good Oximeter will show the weak contraction, & will visually indicate that something happens early & give you a change in displayed HR.

As to the PM - it can fix Brady right up by increasing your HR. It cannot, alone, fix up PVC's because they are a phenomenon that occurs early, not late. The PM cannot predict the future & cannot slow things down. At least they can administer a med that fights PVC's & simultaneously reduces HR - like some Beta Blockers. The PM then keeps your HR at a comfy level.

In my case, I take Acebutolol (200mg, 3X per day) & Flecainide (50 mg 2X per day) & that reduces my PVC rate to about 3 every two minutes on the average.

My cardio wanted me to take the Acebutolol 4 X per day & the Flecainide 3 X per day - but that combo turned me into a zombie. Where I am now is a comfortable compromise between side effects & reduction of primary problem.

BTW: I'm paced at 75 BPM lower rate against a pre-PM intrinsic rate of about 72 BPM.

IF PVC's are the primary problem - as opposed to Brady - you can expect to take meds along w/ the PM. Also, do not take as a goal ZERO PVC's. Expect & accept a lower rate that does nor affect quality of life.

I forgot to ask up front - What is your PVC rate right now? Anywhere near the magic number I suggested as
minimum for causing you to have your functionality affected (33%)?

Donr

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