ICD implanted to treat my beta blocker?

When hospitalized in October, 2019 with CHF (EF of 23) my new cardiologist put me on a beta blocker and a direutic.  When I passed out on a Zoom call in April, 2020 with a heart rate of 22; it was suggested afterwards in the ER that I have a defribulator implanted and then get back to taking the meds.   Otherwise I am asymtomatic; no edema, no shortness of breath when walking 3 miles, no chest pains and no coronary blockages on my angiogrm.  63 year old male type 1 diabetic with a 25 BMI and high blood potassium (5.9).  Looking forward to getting back on the beta blocker shortly, now that I have an ICD.   But to this layman, it would almost seem that with the implant we are actually treating the side effects of the medicine.   But my retired RN wife reminds me my EF was still 23 during the June angiogram.   So there is that.  Thoughts?   


7 Comments

iDC + beta blocker?

by AgentX86 - 2020-08-16 00:43:48

With an LVEF of 23%, an ICD is called for. You don't say what the beta blocker is for but the most common reasons are arrhythmia (causing tachycardia) and hypertension. Either way, beta blockers work but, as you point out, also slow the heart (which is how they work).

So you're somewhat right. The beta blockers limit the highs and the ICD makes sure it doesn't do its job too well. Again, the ICD is needed for an LVEF that low, in case...

 

ICD implanted to treat my beta blocker?

by WIK - 2020-08-16 01:28:01

Thanks for the response.    I just found and joined this forum yesterday and am glad I did.   So many questions for this newbie!  I appreciate  your insight.

Beta-blockers improve survival in heart failure

by crustyg - 2020-08-16 03:36:06

It's counter-intuitive but it's true.

Turns out that beta-blockers restore a more normal calcium-channel control so that heart muscle fibres aren't flooded with excessive calcium ions, and that helps to restore a healthier contraction.  Odd, because beta-blockers definitely *reduce* the strength of heart muscle contraction in non-HF muscle.

Perhaps annoyingly your wife is correct - and there's a good chance that your %LVEF will increase over time.

Diabetes control

by Gemita - 2020-08-16 04:01:39

Hello WIK,

You clearly have a lot going on and I really hope that you are being well looked after by different specialists (particularly an endocrinologist for your diabetes, in addition to your cardiologist).  

My immediate thought is, is your diabetes under firm control??  Are you getting periods of hyperglycaemia or hypoglycaemia because either can certainly be very dangerous and quickly make you extremely unwell.  Unfortunately beta blockers can mask the symptoms of low blood glucose (hypoglycaemia) in some patients and in others, may even raise blood glucose levels (hyperglycaemia).  My husband suffers from diabetes and it can be difficult to manage sometimes particularly with multiple health conditions.  Treat one condition and it may worsen another.  I really feel for you.

I would be asking your cardiologist/endocrinologist:

. which beta blocker would be safer to take with type 1 diabetes, if you haven’t already done so, and maybe review all your medication including dosage of insulin.  

. I would want to know how well my kidneys are working to help eliminate the high potassium levels and what I can safely do to improve kidney function ?   

. I would want to know whether my levels of insulin are satisfactory (presumably you monitor your blood glucose frequently throughout the day to make sure your levels are stable?).  Insulin we were told is the hormone in the body that keeps the potassium level in the blood stable.  Poor insulin control can lead to problems like this.  

. I would ask whether you could work with a dietitian to make sure that your diet is working well for you.  Even with insulin, it is still necessary to watch what you eat for maximum control of your blood glucose levels.

I will leave your cardiologist to deal with your 💓!  Yes it seems crazy that we have to place a device in the chest sometimes because they want to hammer us with meds for other conditions which would result in a dramatic drop in heart rate.  But this was one of the reasons why my pacemaker went in too!  In your case though with a poor ejection fraction, an ICD is another level of protection to keep your heart beating.

There are different meds though for heart failure and if you do not feel well on one med, ask to try another, but work with your doctors until you find something suitable.  I hope they can get your ejection fraction up quickly through a combination of treatments.  It will be a balancing act but hopefully you can be stabilised and enjoy a good quality of life.

Finally, I presume your doctors are regularly checking your electrolytes since you are taking a diuretic ?  Electrolyte imbalances can quickly cause heart rhythm irregularities and you have more than enough to cope with without getting further problems.  I hope for the very best for you

 

Conditions and meds

by WIK - 2020-08-16 13:10:22

Gemita; great post, thank you very much.  I appreciate your concern.  The diabetes is well controlled, as evidenced by an A1c of 5.6-5.9 (last two lab tests).  My continuous glucose monitor from Abbott Labs has helped, compared to 40 years of finger sticks to draw blood.  
Kidney function has been somewhat impaired for 20 years, as my creatinine level was typically 1.5-1.7, but this year, after being treated with direutics (along with the beta blocker) by my new cardio specialist, is is up to 2.2, so the trend line is not good.  That and the potassium is up to 5.9.  Both are related to my electrolytes being out of balance due to my meds.  My nephrologist has last week prescribed a potassium binder, to help my body excrete excess potassium.  My wife and I suspect dialysis with the year.  My cardio physician has told us "one can live without kidneys, but not without a heart" which says a lot about his bedside manner.  I just want the nephrologist and the cardiologist to communicate, which is not happening.  My endocrinologist is not very helpful, but after 40 years as a type 1 I know what to do.  Such is life I suppose in my HMO environment with affordable care act coverage.   Having a retired RN as my life partner for 37 years has helped immensely through this health crisis.  I can truly say I married above me.

Your wife has a good patient

by Gemita - 2020-08-16 16:30:39

What a truly lovely thing to say about your wife.  Can you come here and tell my husband he is lucky to have me?  I am giving him a hard time trying to keep him on the straight and narrow, hiding the choc ices and orange juice while testing his blood 4 x day and giving him his insulin without fail.  He is not a good patient like you!!

Yes you need to treat one organ at a time now and your heart is a good place to start.  No our doctors don't always communicate with each other either and I have to take all test results and consultation letters with me to appointments.  It is extremely hard work trying to stay well in the present environment and we have had to fight to be seen sometimes.  Hubby is 82 now with multiple complex health problems but as long as he has a quality of life I shall be happy.  We both got our pacemakers in the same year (2018), so we can compare notes !

Thanks Gemita

by WIK - 2020-08-16 18:24:45

I truly appreciate your kind words and support.   I'm a realist and can only hope to be around at 72, let alone 82.  I look at the statistics but fully intend to be an outlier  I wish you and your husband well.   My father passed in 1999 at age 83 from a heart attack while he was sleeping. He was widowed but still working part time in the small business he owned for decades.    A good friend told me at the time, "Don't tell me how lucky a human being is in life until you tell me how he or she dies" - and that parable really hits home for me.  Then...and now. 

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