Beta blocker pre-surgery?

[Guest]

I had my pre-op physical this week, and my internist prescribed a beta blocker, metoprolol 25mg. He said there is a tendency to have atrial fibrillation with valve surgery. I called the surgeon and he OK'd the prescription.

I have had leaky mitral and aortic valves for almost 12 years with no irregular heartbeats that I am aware of. I have been taking cozaar (which is in a different class and is used to reduce the "afterload" on the heart) for all that time. My blood pressure has never been a problem....and at the pre-op it was 114/66, HR 74. I am still on the cozaar.

The pharmacist said the metoprolol will reduce my heartrate and blood pressure and make me feel sluggish. My question is how low should the blood pressure go? Do you stay on the beta-blocker post surgery or is the threat of a-fib removed after everything is fixed?

I am 6 days before surgery and really just want to get it over with!
Pat

 

[Maryka]

I take metropolol now--since my heart surgery. (I had my first Afib in the days after heart surgery.) It must be hard for you to sort out what is caused by your deteriorating heart situation and the lethargy caused by your medications. Do you take your BP at home? That will help you know if your BP is getting much lower. Prescribing you metropolol does not sound like a bad idea to me.

 

[Adrienne]

About 30% to 40% of people who have valve surgery get A-Fib within the first couple of months after surgery, but it is usually temporary

I take 25 mg of Metoprolol (12½ mg twice a day) and that small amount does not cause any drowsiness. More than that amount definitely can!

 

[LisaD]

The threat of a-fib is greatest immediately following the surgery, but remains with all valve surgery patients because of the scar tissue formed in the heart from surgically opening the heart to fix the valve. Unfortunately, the place where they cut into the heart holds the electical control center and can make the heart irritable. Of course, it is better to chance this than heart failure resulting from the leaky valve.
Many people are placed on metoprolol to help control heart rate after surgery and in low dosages does not tend to effect the blood pressure. I have had to be on various medications since my surgery, and had side effects with many, so if there is a problem, I let the doctor know and they look for another solution. It doesn't hurt to try. I do not have a fib, but another heart rate issue. I am a nurse that has worked with a lot of heart patients as well as being a survivor. I was the same way prior to my surgery, just get it over with! Best wishes.

 

[traveler]

I've been on a beta blocker from 3 months before surgery and continuously since. Every time I ask about getting off the answer is no. My cardiologist would like to increase the dose but my blood pressure is too low (90/55). I think the beta blocker makes me tire too quickly. Before surgery I used to work 12 -14 hours a day and sleep less than 6. Now it seems like I really need 7 or 8 and would like 9 hours of sleep. Periodically I quit taking it so I can work longer hours -- I wouldn't recommend it, its just what I do.

 

[Dina]

my internist prescribed a beta blocker, metoprolol 25mg. He said there is a tendency to have atrial fibrillation with valve surgery.

I have had leaky mitral and aortic valves for almost 12 years with no irregular heartbeats that I am aware of. My blood pressure has never been a problem....and at the pre-op it was 114/66, HR 74.

. My question is how low should the blood pressure go? Do you stay on the beta-blocker post surgery or is the threat of a-fib removed after everything is fixed?

I had a totally open tricuspid valve for over 15 years and had no symptoms until that very last year--a flutter(like afib),that was when I was put on metoprolol and also scheduled for Surgery. My bp has always been on the low side and I was a little concerned when I was put on it but it never did affect
my bp but only slightly.And you are on the lowest dose,at one point I was taking 200 a day.
The low end for a safe bp is 90/60,and while 80/60 is not life threatening,you certainly do not want it going any lower than that. I have had my bp as low as 70/55 in the hospital(NOT as a result of BB's) and i think this is the number where the doctors become worried.
Regarding being kept on the BB post surgery- they like to keep you on it for a while,about 2-6 months, and depending on your keeping a normal rhythm, you will probably be weaned off of them slowly,you should never stop taking this med all at once. In most cases the major threat for arrhythmia is removed after surgery,the main worry is scar tissue and/or manipulation,etc causing a type of arrhythmic response which in most cases ends after healing has occurred.

 

[Doug]

I had been on Metoprolol until the end of Nov and my cardiologist switched me to coreg. I guess I am used to the low heart rate and bp from the beta blocker, I have been on them for 11 years. It is kind of funny watching the tech trying to increase my heart rate during a stress test, it just won't go over 120.
I did end up with A Fib in the hospital about 4 days after the surgery. They put me on 24 hours of Amiodarone drip IV and then swtiched me to pills; 3 a day for 1 week, 2 a day for another week and then 1 a day for 2.5 weeks. So far I have not had any more problems with the rhythm.
The hospital messed up my dosing one day and I ended up with a very low bp (75 over something). I was very dizzy until it wore off and they did keep a close eye on me for the next 24 hours. I was very good about making them explain what they were giving me and why, but I forgot to ask about that one pill that day.