Pacemaker and propranolol

Propranolol dose

by Rch - 2023-04-12 20:12:55

Hi

Glad that the PM implant was uneventful but sorry to hear you are now bothered by fluctuating HRs! Are you on extended release or short acting formulation? In any case, 5 mg of short -acting propranolol is a baby dose. It's a non-selective beta blocker! It can be safely titrated up if you have no contraindications. You are well protected from any downside risk with your pacemaker. Please consult your cardiologist before making any medication changes! I wish you well!!

GP

by Penguin - 2023-04-13 03:32:23

Hi, 

In your situation I'd give the GP a ring about the propranolol and ask how often you can take it and at which dose? Most GPs will do a call back without any need to try and book an appointment. This can avoid a long wait as you will know! 

Regarding fluctuating heart rates, your pacemaker may not recognise irregular, short lasting heart rhythms below 100 bpm as problematic tachycardia. PMs tend to recognise problematic tachycardia when h/rates are above 100 bpm or they occur above your max tracking rate (e.g. the maximum h/rate set on your device for atrial pacing.)   There are settings on pacemakers to stop the device tracking fast arrhythmia, but in my experience slower arrhythmic beats seem to be trickier even though they can cause symptoms. I have a similar issue. 

It's also worth knowing that tachycardia is generally defined as h/rates above 100 bpm. However, very unhelpfully, some types of problematic tachycardias and low rate AF can still occur below 100 bpm and yet are still named 'tachycardias'.  

At your first pacing check ask about your tachy-brady syndrome symptoms and report the discomfort caused by these choppy higher rate episodes. There may be some settings changes that can help your symptoms via your Medtronic device. ( I don't have a Medtronic device and can't suggest anything I'm afraid, but others with Medtronic devices and tachy-brady syndrome may be able to help.)

In the meantime keep a diary of the dates / times that symptoms occur.  This makes it easier for the techs to look up the episodes at your clinic appointment. This will then serve as evidence that your symptoms correlate with what you say is happening to your heart rate and this always helps when trying to get a problem resolved / identified. 

I hope this helps a little. 

Note: This post has been amended. 

Pacemaker and propranolol

by Roxy - 2023-04-13 04:29:32

Thanks for this help. Not sure if propranolol is slow or fast acting, must find out. Took 10 mg last night with advice from specialist nurse at London bridge and felt a little better. 

Blood pressure a bit high despite 2.5 Ramilpril daily but GP so hard to get hold of. Rang this morning and 3 week wait. 

Visiting Warfarin clinic today so will chat with them but no doctors around of course. 

Will feel happier that a higher dose of propranolol is not a problem now though but obviously will not overdo anything till I talk to the right people .

Thanks again so glad to find this forum

Roxy 

Warfarin Clinic

by Penguin - 2023-04-13 06:27:58

You may be pleasantly surprised by the presence of a consultant if your Warfarin clinic is in a hospital.  Consultants are stepping in for junior doctors during the strike. 

Obviously if your clinic is at the GP surgery this won't apply, but you could ask for someone to nip over and speak to the GP about your Ramipril if this is where it is. 

I'd also bear in mind that post surgery these arrhythmia often play up for a few weeks or longer and then begin to settle down again. Not nice in the interim, but worth knowing this as you don't want to end up on higher dose drugs / with poss side effects for a short term cause. 

Try some self help measures: e.g. try to distract from stress and avoid triggers like caffeine, acidic foods, large meals at night and alcohol which may trigger arrhythmia.  Sometimes you can settle the arrhythmia without extra meds.