Bradycardia but blood pressure okay - one month after OHS

[jmb1997]

Hi - I had a mitral valve repair done exactly one month ago and after surgery was given a daily prescription of 81mg baby aspirin and 25mg of metoprolol. My blood pressure was pretty consistent of either 110/70 or 120/70 and my pulse was generally 80 while seated, 85 standing and 90 when walking moderately. Before surgery I was pretty much the same.

Starting last week I had some PACS and my cardiologist had my wear a heart monitor for a week, which ended yesterday. I haven't really had any rapid heartbeats at all. I told the visiting nurse about this, who is in touch with my surgeon and his office, and she seemed unconcerned and said this happens after surgery.

Beginning last night though I have had a steady but slow heart rate of around 55-65. This is consistent, whether or not I am laying down, sitting or standing. My blood pressure has almost remained constant at 120/70 or 110/70. I don't seem to be dehydrated at all either. To note, my blood oxygen has been 97-98% and my energy seems pretty much unaffected. I do sometimes think I'm dizzy for a few seconds when I stand up - but that might be in my head and not really happening.

I was really concerned to hear my heart beating this slowly, though I guess slightly encouraged that it's a steady beat. I contacted my cardiologist, who wants to drop my metoprolol dose in half, but the visiting nurse said so long as I have no other symptoms I should just keep an eye on it and not touch my dosage as this could lead to higher blood pressure.

I'm tempted to contact my PCP, but figure he'll just send me to the cardiologist. I was curious if anyone else had this sudden change in heart beats and rhythms this long after surgery, or while taking something like metoprolol and if you have any advice.

EDIT: I wound up speaking to a doctor in my surgeon's office and I was told to cut my Metoprolol in half. They said so long as my blood pressure, blood oxygen and breathing are fine for me not to worry. It's just weird to have your heart rate drop 25% suddenly. I'll see if this reduction changes anything. I am to see the surgeon in four days for my five week post-surgery follow-up.

 

[dornole]

Hope your visit went well. Metoprolol directly lowers your heart rate so it is not surprising that you had this decrease. I couldn’t get off it fast enough after my mitral repair! Unlike you my BP is naturally quite low (100/60) and my resting heart rate is about 58 (even though I definitely don’t have great cardiac fitness). When I was on it I thought I would keel over. Sounds like you’re tolerating it ok and it’s doing what it is supposed to do. Hope all is well.

 

[Chuck C]

Hi and welcome to the forum.

I contacted my cardiologist, who wants to drop my metoprolol dose in half, but the visiting nurse said so long as I have no other symptoms I should just keep an eye on it and not touch my dosage as this could lead to higher blood pressure.

Your cardiologist trumps the visiting nurse. I'd go with his recommendation. If she is right that your blood pressure goes up, you can always go back to the 25mg dosage, under the guidance of your cardiologist.

It is normal to reduce beta blockers and even wean off of them in the months following surgery. My metropolol dosage was quickly reduced in the weeks following surgery and I was completely taken off of it by about 3 months.

But you should also be aware that your current HR range of 55 to 65 is nothing to be alarmed about, especially since your other vitals, such as blood ox, are good and you're not having any symptoms. I just took my vitals and I'm 117/75 with a HR of 58.

They said so long as my blood pressure, blood oxygen and breathing are fine for me not to worry. It's just weird to have your heart rate drop 25% suddenly.

Just a thought as to what could be happening. Prior to surgery, with your mitral regurgitation, your heart had to work harder to get the cardiac output that your body needed. Now that you have had the repair it does not need to work has hard. Our hearts get used to operating in a high pressure and/or regurgitant state prior to surgery and it takes awhile for them to acclimate to the new situation. My HR dropped significantly following my valve surgery, although the drop was not as sudden as yours.

 

[jmb1997]

I wound up speaking to my cardiologist after my last post on this topic and she also said to cut my Metoprolol dose to 12.5mg. The reduction had no impact on my blood pressure but my heart rate actually went even lower, as in it dropped to the mid-40s while laying down and was around 50 or so while seated. I even ran a few hundred feet to catch the train one day and my heart rate very briefly went up to about 65 and then within a few short moments was back around 50.

A week after cutting my Metoprolol dose I reported back to my cardiologist with the latest news and her reply was that "25mg is already such a low dose it doesn't even matter if you reduce it to 12.5mg so you shouldn't have expected a change." Ummmm, okay. What about my heart rate being so low? She said nothing specific and seemed unconcerned.

A few days after talking to her I had my pre-scheduled follow-up with my surgeon. I first met with his PA and then with the surgery himself. I mentioned my heart rate and both separately said, "Some world class athletes have resting heart rates in the 40s." Yeah, maybe, but I'm no world class athlete! With all my other vitals being alright they seemed unconcerned and told me to follow-up if my heart rate dropped to the mid-30s. I guess they see these sudden drops enough after surgery to not be worried???

Interestingly, one day after seeing the surgeon I began my cardiac rehab class. On my first day they noticed that when I was working hard on the stationary bike and the treadmill that I had some PACs or PVCs (this didn't happen on lower-intensity equipment like the NuStep). Despite my low heart rate the cardiologist at the rehab clinic suggested that I increase my Metoprolol back to 25mg. My cardiologist concurred and said, "There's no difference between 12.5mg and 25mg since it's such a low dose anyway, so you can do it if you want." If I want?!?! Time for a new cardiologist....

I did go back to 25mg and, whether it's coincidental or incidental, about a week later my resting heart rate went back to around 80bpm despite being on a higher dosage. I don't get it. The PACs and PVCs also stopped and my heart rhythm has been steady even while on higher intensity equipment while at rehab.

So long as none of the "experts" seems concerned I'm just rolling along with it.

 

[dornole]

Wow that seems super weird. I was wondering if maybe your HR monitor was on the fritz, but it sounds like you had the same low HR on the cardiac rehab equipment?

But yeah sometimes "if you want" is not what a patient wants to hear. I remember when my newborn preemie twins projectile vomited all their feedings and were dx failure to thrive and my pediatrician "well maybe try thickening the formula, or making it thinner?" In retrospect I guess that was kinda reasonable but man with my kids starving to death I wanted a definitive freaking answer and plan! Called the NICU back for a referral and got a new pediatrician who was very much up to the task of handling my out-of-the-ordinary twins. Old one was a nice man and perfectly capable with my older kids but I needed more than well-child visits and boo-boo care for the twins.

I think you deserve a cardiologist who at least attempts to explain things to you. Hope everything stays stable for you.

 

[pellicle]

Hi and welcome

I had a look at your bio and your age is missing from that (don't need exact DoB, but to within a year or two would be helpful (if you feel the need to obfuscate your personal data)

Hi - I had a mitral valve repair done exactly one month ago and after surgery was given a daily prescription of 81mg baby aspirin and 25mg of metoprolol. My blood pressure was pretty consistent of either 110/70 or 120/70 and my pulse was generally 80 while seated, 85 standing and 90 when walking moderately. Before surgery I was pretty much the same.

ok ... that sounds pretty good for post surgery.

Starting last week I had some PACS and my cardiologist had my wear a heart monitor for a week, which ended yesterday. I haven't really had any rapid heartbeats at all.

excellent ...

Beginning last night though I have had a steady but slow heart rate of around 55-65. This is consistent, whether or not I am laying down, sitting or standing. My blood pressure has almost remained constant at 120/70 or 110/70.

seems ideal to me (but then knowing your age and fitness levels prior to surgery would be "not blinding me" to what is expectable for you).

I don't seem to be dehydrated at all either. To note, my blood oxygen has been 97-98% and my energy seems pretty much unaffected.

excellent ...

I do sometimes think I'm dizzy for a few seconds when I stand up - but that might be in my head and not really happening.

or it might be really happening and indeed happens to many and may have even happened to you before but you simply were not focusing on it?

I was really concerned to hear my heart beating this slowly, though I guess slightly encouraged that it's a steady beat.

ok, so you have data on what your beat was before? Say 10 years ago?

I know people who are fit, waaay fitter than me. I have gone walking (around hilly areas, not just doodling around suburbs) with them and noticed that I'm struggling talking while they're just talking. I asked their HR and found it was 70, meanwhile mine was 120.

Heikki for instance has a resting rate of 50, and in competition (endurance XC skiing) his HR goes up to 170 in peak and he spends most of his time at 140. I'd be dead or passed out of I tried to keep up with him. Hes not big but has fantastic cardiovascular fitness.

It's just weird to have your heart rate drop 25% suddenly. I'll see if this reduction changes anything. I am to see the surgeon in four days for my five week post-surgery follow-up.

right, some data I can work with finally ... so your previous HR was mid 60's?

but I'm still flying totally blind here (so please address all my questions for data if you desire anything more than "some guy at the pub whos' not really listening" sort of answers. You know ... like:

I wound up speaking to my cardiologist after my last post on this topic and she also said to cut my Metoprolol dose to 12.5mg.

sounds perfect

The reduction had no impact on my blood pressure but my heart rate actually went even lower, as in it dropped to the mid-40s while laying down and was around 50 or so while seated.

mid 40's is getting lower, but athletes go there.

I even ran a few hundred feet to catch the train one day and my heart rate very briefly went up to about 65 and then within a few short moments was back around 50.

ok, so what is your tolerance to exersize? What is your oxygen level like when doing measured energy exrsize (such as on a machine which measures that, stair master, stationary cycle, running treadmill ...)

A week after cutting my Metoprolol dose I reported back to my cardiologist with the latest news and her reply was that "25mg is already such a low dose it doesn't even matter if you reduce it to 12.5mg so you shouldn't have expected a change." Ummmm, okay.

indeed, Ummmm .... myself its time to change cardio. Your Cardio is an ******.
*(The truth about idiocy, which is that it is at once an ethical and a cognitive failure. The Greek idios means “private,” and an idiōtēs means a private person, as opposed to a person in their public role—for example your cardiologist.
Your cardiologist is idiotic because they fail to grasp their public role, which entails, or should, a relation of active concern to others, and to you. They are not involved. It is not their problem. Because they are an *****.
This still comes across in the related English words “idiomatic” and “idiosyncratic,” which similarly suggest self-enclosure. For example, when a foreigner asks him for directions, the ***** will reply idiomatically, rather than refer to a shared coordinate system.
At bottom, the ***** is a solipsist
)

I can assure you that many members here (including me) have had an ***** say "wow your dose of warfarin is too high" yet our INR is perfect and INR is the intention to treat and the measure of proper dose.

She seems to have no knowledge of pharmacokinetics ...

Interestingly, one day after seeing the surgeon I began my cardiac rehab class. On my first day they noticed that when I was working hard on the stationary bike and the treadmill that I had some PACs or PVCs (this didn't happen on lower-intensity equipment like the NuStep). Despite my low heart rate the cardiologist at the rehab clinic suggested that I increase my Metoprolol back to 25mg. My cardiologist concurred and said, "There's no difference between 12.5mg and 25mg since it's such a low dose anyway, so you can do it if you want." If I want?!?! Time for a new cardiologist....

I see you're in agreement ...

I did go back to 25mg and, whether it's coincidental or incidental, about a week later my resting heart rate went back to around 80bpm despite being on a higher dosage.

firstly I'm going to say that unless youre old and sick that 80 is not a good indicator.

I don't get it.

short answer: you're still in recovery ... keep an eye on things and if things are not settled at 3 months then it deserves greater attention.

The PACs and PVCs also stopped and my heart rhythm has been steady even while on higher intensity equipment while at rehab.

exactly what beta blockers are intended to do ...

Hope that helps

 

[jmb1997]

Oh yeah, that was my resting HR for sure. I checked with my finger on my neck and also my wrist, with my oximeter, through my blood pressure cuff, at cardiac rehab, at the surgeon's office, with my visiting nurse, etc. No idea why, but for three weeks I had the resting HR of a world class endurance athlete, and then it went right back to my normal. I actually just paused typing this paragraph, put on an oximeter and my HR was 81, which matches my blood pressure cuffs and cardiac rehab readings from earlier this week. My whole family are in good shape and everyone has a resting HR around 80, including my sister who was a competitive long-distance runner.

I did switch cardiologists recently. My PCP first sent me to her years ago gushing that "she is one of the leading cardiologists in the world!". I thought how lucky I was - until I met her. In my first appointment I mentioned how I had neither eaten or drank anything that whole day before our 2:00pm appointment and asked if that would temporarily send my blood pressure up or down. I figured she'd snap back an answer right away as this seems like Cardiology 101. Instead she sat with a thoughtful look on her face for maybe ten seconds as she tried to reason herself to an answer before she said, "It'd make your pressure go up. (wait five seconds) No wait. It'd go down." Yikes!!!! I'd also read in a lot of online forums that it you had mitral regurge to avoid The Three C's: chocolate, cheese, coffee. I asked her if there were any foods I should avoid as I wanted to see what she'd say. Instead of naming the Three C, she thought for a long time and said, "No... I don't think so." Then she told me I shouldn't get into body building. Uhh, what? She continued on by saying body building could put too much pressure on my valve and cause it to snap. She then told me that if my valve ever snapped I'd have extreme difficulty breathing and to call her office and ask to talk to her. Then she thought again and said, "Actually... If you can't breath, you should call 911 instead." Gee, thanks. I thought maybe she could be arrested for impersonating a cardiologist.

Also, in that first session she was collecting family history info from me and asked me how old my mother was. In a weak voice I mentioned that she had just died of cancer very recently after having been misdiagnosed. She immediately asked (while still looking down at the paper on which she was taking notes), "And how old was she?". Wow. Not even the standard, "Sorry to hear that", or, "What type of cancer did she have?". Nothing.

It's been all downhill since, and initially she refused to send me to a surgeon who did minimally invasive surgeries because she said "That might be the wave of the future, but we're not there yet." We were in Boston just two years ago with multiple hospitals performing minimally invasive MVR for over 20 years. I decided to ask once more and if she said no I'd switch cardiologists, and if she said yes, then I'd switch cardiologists after the surgery.

I think I stuck with her out of spite to show her how minimally invasive surgeries do work. I kid you not when she saw me at my follow-up she said, "You don't look like you just had heart surgery!". Our conversations post-surgery just reinforced it as time to switch and I "broke up" with her right at the end of my post-surgery EKG earlier this month.

 

[pellicle]

I think I stuck with her out of spite to show her how minimally invasive surgeries do work.

my most sincere advice is find someone else

Our conversations post-surgery just reinforced it as time to switch and I "broke up" with her right at the end of my post-surgery EKG earlier this month.

excellent ... and good timing really.

Best Wishes

 

[dornole]

I’m still stuck on no coffee, chocolate or cheese … what the heck ?? News to me!

 

[dornole]

Oh my gosh look what 2 marvelously named research studies come up if one googles “mitral regurgitation cheese”

 

[pellicle]

Oh my gosh look what 2 marvelously...

with a side of mac and cheese LOL
just ... thanks for sharing ... made my morning

 

[pellicle]

no coffee, chocolate

there comes a point where if you give up so much goodness you have to ask yourself what sort of life is it?

btw I usually eat 70% cocoa (to reduce the sugar)