Lightheadedness When Standing

[The Thief]

Hey everybody,

I am doing great, and feeling fine at 8 weeks post AVR; ON-x Valve & ascending aorta repair. I'm on 25mg Metoprolol & 2.5mg lisinopril, and warfarin of course. Oh yeah, baby asprin too. Recent echo came back with positive results. With all my success in recovery, the only thing that is bothersome is the lightheadedness when I stand up from sitting or squatting. I know that this is attributed to the blood pressure/ heart rate meds.

My question(s) for the those of you who have experienced this; how long did this last for you? Did it stop after you were taken off the meds, or before? Has anyone actually fainted or blacked out?

Thanks!

 

[Jason]

I did have the lightheaded feeling when standing, etc. just after surgery. My heart rate and blood pressure were too low at the time, and my metoprolol dose was shifted downward. I still had the lightheaded feeling, which eventually went away with no other changes to my meds. Based on that, I would say that mine may have been exacerbated by the high dose of metoprolol, but also was just an effect of the surgery. It did go away eventually, but I don't really remember how long after surgery it was. Maybe 6 months?

 

[epstns]

Anthony,

A couple of things to consider. Firstly, although you have been released from the hospital, your heart is still healing. Because of this, it may not have its normal response to changes in body posture - when you stand rapidly it may not be able to raise blood pressure as rapidly as usual. So, for a while, you may have momentary light-headedness upon standing. I had this for a while, and learned to just stand up a bit more slowly and ensure that I was steady before letting go of any nearby support. Also, use handrails on stairs, as the added effort may require more of your heart than you are ready for. This, for me, decreased over time so that by about 12-14 weeks I no longer noticed it.

Also, metolrolol is known to cause reactions of this type. While many cardio's (mine included) like to send valve patients home with heavy doses of metoprolol, over time you may not need such a large dose. I would discuss this med and the possible dizziness side effect with your cardio and see if you are in line to reduce the dosage. I started out at 100 mg/day of metoprolol succinate (timed-release), but was able to reduce that, in steps, so that I now take only 25 mg/day. Feels a lot better.

 

[neil]

hi anthony, yea hopefully will get better in time, i still get lightheaded sometimes on standing now and blame it on the bp tablets, hey steve hows it goin hope your leaving the bacon alone lol

 

[tom in MO]

Same thing happened to me at about the same time in recovery. They took away the metprolol and dropped the lisinopril dose. Fixed it.

 

[T in YVR]

I have the same issues with Metoprolol (25mg) and Coversyl (ACE Inhibitor). They say it will go away when I come off these (esp. Meto). I am stopping Coversyl in the next few weeks. I am on Meto until April (for now - hopefully that will be it). I will have been on Coversyl for 3 months post op and Metoprolol since shortly after surgery while still in the hospital.

In the meantime, you just have to deal with it. Not much you can do. I don't squat as often, and if I do squat or am bent down, I get up very slowly - almost in a few steps.

I have had 2 instances where I almost blacked out (occurred in stores while shopping. It was a bit scary, especially if you have never experienced it before. Lasted about 30 seconds. I just held on tight until it passed, to avoid falling over).

T

 

[The Thief]

Thanks everyone for your feedback. I'm dealing with it okay, I just wanted to gauge when it got better for others. Other than that, I am doing quite well. I hope others are doing well too!
-anthony

 

[Freddie]

Had the same problem when I was on Metoprolol. I taught myself to take a deep breath 'in' before getting up from a sitting position and slowly exhaling on the way "up", then taking another breath "in" before I took my first step - it helped me, maybe this can help you too.

 

[epstns]

T brings up a good reminder. I also take metoprolol and if I am squatting down for any reason (like rooting around on the bottom shelves in my workshop or peering into the lowest shelves in a store), the longer I am in the squatting position, the more likely I am to encounter light-headedness when I rise. Someone once told me it was because the vascular system adjusts to the needs of the body when squatting down - in which position the knees tend to restrict blood flow to the lower legs, etc. Then when we stand up, all the blood flow is enabled. With so much more volume needed to supply the legs, the overall system pressure drops, causing the light-headedness. So, rising slowly allows the body time to adjust better.

 

[tom in MO]

Don't deal with it...stop it instead. Call your cardio, he may switch your meds right now.

I got lightheaded once or twice and had my 6-week cardio appointment within a week. He changed my meds right away.

 

[TheGymGuy]

Goes away after you are off metoprolol.

 

[epstns]

"Don't deal with it...stop it instead. Call your cardio, he may switch your meds right now."

Yes, but sometimes you're better off with the devil you know versus the devil you don't. I negotiated a reduced dosage of metoprolol, and that worked out for me. My cardio feels that the effect of metoprolol on my heart is what I need to ensure that my heart, with its past issues, continues to work effectively. If we could not reach an agreement that worked for me, then I would have asked to switch meds.

 

[T in YVR]

I agree with Steve. If the only symptom you have is lightheadedness when you stand up after squatting down for some length of time, that's pretty minor in the big picture. I wouldn't (and didn't) switch drugs so soon after OHS - especially since my echo results were so positive. Short term issue/long term gain.
T

 

[The Thief]

Good insight from all. I can stick it out especially since Ill be going off Metoprolol in 4 weeks after i meet with my cardio for our 3month followup visit. Thanks again everyone!

 

[epstns]

Anthony, I hope you can get away from metoprolol as originally planned, but things don't always go as planned. Don't be surprised if you are told to take it for longer, or at a lower dosage, until your heart completes its remodeling. You know how remodeling projects often go -- late. Not saying that this will happen to you, but be prepared to deal with it if you need to continue. At my current lower dosage, I don't experience the light-headedness. My cardio would like to keep me on some level of metoprolol long-term to reduce the chance that my post-op tachycardia and afib might return.

 

[tom in MO]

What my cardio told me was the lightheadedness was a sign I did not need the metoprolol, thus no need to continue. I did not ask to be taken off.

 

[epstns]

Good outcome!

Sometimes we need the meds for other reasons. My cardio, I think, wants to limit my heart rate, as I had brady-tachycardia prior to surgery. My resting heart rate would go down into the low 40's, but under exercise it would go up to the high 160's. He wants to keep me in a narrower range, like 60-160 BPM. My pacemaker keeps me at or above 60, and the small dose of metoprolol keeps me under about 160 or so.

 

[JUST-WAITING]

I am 2 1/2 years out from last surgery- and still light headed at times particularly when I move head sideways or go around acorner. Current dose of 25mg Metoprolol & 5mg Lisinopril-
I have cut dose of metoprolol in half with a little relief. Just taking day at a time- Doctors visit and echo once a year.