Medication after Aortic Valve Replacement are you taking?

[Canton]

A couple of years ago I was diagnosed with BAV disease with an ascending aortic aneurism. After 6 months my aneurism grew from 5.0CM to 5.3CM and I was told by my surgeon that the time has come, and I would need the replacement. I had the surgery, and I went with a tissue valve... I was 53 years old at the time. And while initially I was told by the doctors after the surgery that it all went fine... after a day or so in the hospital I was informed that I developed "complete heart-block" and I couldn't leave the hospital until after they installed a pacemaker. I wasn't prepared for that nor happy about it. Now 2 years later I feel recovered to a large degree. I got my strength back, but I don't think I have fully recovered my stamina and I gained some weight. The weight is now something I've have recently been working on. Walks and some aerobic exercises and such. Prior to the surgery I was on the KETO diet and it did get me fit so I've also within the last 2 weeks went back to it...but lately I'm feeling unusually tired and getting dizzy at times. But I'm wondering if the meds that I take today are causing me tiredness and at times dizziness so I'm curious what meds other people that had the same surgery as myself.

I'm currently taking as prescribed by my doctors daily: 1 metoprolol succinate (50 MG), 1 rosuvastatin (5 MG), 1 Asprin (325 MG)

I'm now thinking that 325 MG of Asprin each day might be too much as I think I should be taking the baby Asprin with only 81 MG... but then that got me looking into the other two. Both the metoprolol and the statin cause tiredness and dizziness.

So, I'm just wondering what others who have gone through what I have are taking today... though I understand that a very small percentage actually end up with a pacemaker ... lucky me. I'm a couple of months away from regular cardio checkup so I'm just preparing for that with my question on this forum.

 

[pellicle]

Hi

and welcome

...Now 2 years later I feel recovered to a large degree. I got my strength back, but I don't think I have fully recovered my stamina and I gained some weight.

that can happen ... both rough rides in flight and hard landings.

the question in the title wasn't really the question was it ...

to answer the question asked: from post surgery I'm on warfarin, aspirin and a year later (after a surgical infection) antibiotics (ten years later) and now taking some metoprolol tartrate and playing around with doses. It varies and I'm ok with that because I like to have some level of control over myself.

I'm trying to get off the antibiotics (which may be a dangerous pick) and don't know if the metoprolol is permanent or ephemeral.

but stuff like this shows you're on the right road

The weight is now something I've have recently been working on. Walks and some aerobic exercises and such. Prior to the surgery I was on the KETO diet and it did get me fit so I've also within the last 2 weeks went back to it...but lately I'm feeling unusually tired and getting dizzy at times. But I'm wondering if the meds that I take today are causing me tiredness and at times dizziness

it could be that ....

I'm currently taking as prescribed by my doctors daily: 1 metoprolol succinate (50 MG), 1 rosuvastatin (5 MG), 1 Asprin (325 MG)

I'm now thinking that 325 MG of Asprin each day might be too much

I'd agree and think that the literature supports it being "a bit unclear" about benefits. Myself my last OHS was at 48, I remained on aspirin for a few months then went off it (discussed with surgeon at a meeting, he felt it worthy of one word "sure" then moved on to what he saw as important business.

as I think I should be taking the baby Asprin with only 81 MG

I'd perhaps go baby aspirin every second day (taking into account platelet half life and other things like necessity). I'd monitor and see if you get any effect.

For myself I found that at about 8 years post OHS I began taking half a 300mg tablet every second day because I would occasionally get strange events which were half way between a migraine and a dizzy spell which was caused by my vision. I suspected TIA's occuring and reached for the aspirin as the first line of treatment. Its been effective in stopping that.

... but then that got me looking into the other two. Both the metoprolol and the statin cause tiredness and dizziness.

well dizzy is a bit qualitative so I'm a bit uncertain there but it could be as you expect. I'd ask your Cardio or Gp to work with you on the metoprolol and consider moving to tartrate version instead. That may help because of the different nature of it to the succinate.

Eg

my own dose varies between 12mg daily and 50mg daily depending how I'm feeling (and I address it on symptom basis).

Now I don't know if you know how to read graphs (most people don't) so sing out if that graph is difficult to approach (the article it comes from is perhaps more so).

Hope this helps with a list of topics to discuss with your cardio on the next appointment.

 

[Lynn]

Welcome Canton. I also managed to draw the pacemaker card due to complete heart block following my AVR. My experience was similar to yours; it was a shock and it took me some time to accept the situation. Having said that, my post surgery experience has been positive. 18 months out, I have found the pacemaker works so well I seldom think of it. It doesn’t limit my ability to exercise or impact my lifestyle in any meaningful way.

In terms of medication, for my heart I presently take only Warfarin as my valve is mechanical. No beta blocker, no statin or blood pressure med. No baby aspirin as I am allergic to ASA. I am fortunate to have blood pressure in the normal range and have not experienced any AFIB. They did want me to take a beta blocker after surgery (sounds like it is routinley prescribed) but as I had a previous negative experience with them, I was hesitant. As I had no rhythm issues in the hospital the surgical team agreed with holding off on the beta blocker unless I had an issue.

I did find that when I had been prescribed a beta blocker by another doctor some time prior to surgery that it made me very tired, irritable, and spaced out. It also negatively impacted my ability to exercise, my heart rate and blood pressure were too low on it. To be fair, I was only on it for a couple weeks so I may have adjusted over time, had I needed to be on it.

As you are a couple of years out from surgery, reviewing all of your meds with your cardio to see what continues to be needed makes sense. If you need something, you need it. But if not why take it?

Wishing you the best of luck.

 

[LondonAndy]

Hi Canton, and yes, pacemaker here too after my mechanical aortic valve was inserted in 2014. In fact just coming up to its first replacement.

I didn't think much about the pacemaker - it was very much the "B movie" of my hospital experience, and frankly I didn't even think about it for several months, as I didn't notice any difference in life. I had no prior heart issues other than the aortic stenosis.

I am on a betablocker (5mg Nebivolol, as Metoprolol didn't agree with me); Lisinopril even though I had low blood pressure after the surgery, as they said it provided "protective benefits"; Rosuvastatin (been on a statin since I was about 20 years old, now 56, due to family cholesterol issues); Warfarin, a couple of different water tablets; an iron tablet as I am one of those for whom my mechanical valve damages blood cells. Also a baby aspirin and other meds for diabetes.

Dizziness is usually a sign of low blood pressure - do you have a meter at home? Have you checked your BP when the dizziness happens? I am a great believer in having facts for when I talk to the doctor. Also, if the dizziness occurs when standing up, for example, it could mean your pacemaker's rate response needs adjustment.

Finally, are you drinking plenty of fluids? Dehydration causes low blood pressure, and it is not always obvious that our fluid intake is not enough. When you feel thirsty is too late.

 

[70sdiver]

I face the same tiredness way before I got to the surgery side from the metoprolol .I ask my doctor to try going to 25 mg and it worked out very well for me.

 

[Canton]

Thank you ALL!!! Each of you have been very helpful to my questions.

I'm certainly going to have a good talk with my cardiologist about the meds I'm taking. The first being the Aspirin. What I didn't mention was that my father (86 years old) not long ago had to be rushed to the hospital for internal bleeding in his stomach and the root-cause of that issue turned out to be the daily aspirins he was taking.

With regards to feeling tired and dizzy... It only started a couple of weeks after being in the Keto diet and I know that when one goes into Ketosis there is an effect called the "Keto Flu" ... but I had already been in Keto for some time, and I know how to avoid that by taking the right supplements. And while being in a Keto diet you do have to keep track of carbs and stuff, what I was not tracking was how much fluid I was consuming because Keto does drain the body/cells/muscles etc of water ... and LondonAndy... you reminded me of that fact, so again thank you! My dizziness does occur whenever I have been sitting or lying down for at least several minutes. I'm not sure if its dehydration or not... but I'll keep track of my fluid intake and make sure I take enough fluids so I can rule that out as a possibility.

Lynn, you're correct... I did get over the pacemaker over time. There are even days I forget that I even have it. Until the bills comes from the pace-maker monitoring service then the hospital who reviews the monitoring to the annual checks and their costs...then I get annoyed all over again...LOL!!! But yes, it not as terrible as I thought it was when they told me that I would need one.

Pellicle... the information you provided and your experience on the metoprolol I found really interesting... including maybe switching to tartrate. I will also investigate that further myself prior to my next cardio visit including reduction as needed.

Again, thank you all!!!

 

[Protimenow]

I'll apologize in advance. I didn't read the whole thread, but picked up many of the points (I think).

I got my mechanical valve in 1992. I've been taking warfarin ever since.

In 2020, my cardiac rhythm when crazy - multiple DIFFERENT simultaneous arrhythmias.

My heart rate sometimes dropped below 40.

I had a pacemaker implanted - the whole thing took about six hours - from the time I called my cardiologist at home until the time I was discharged. My time in the E.R., where they did the pre-op was a matter of minutes. I was in surgery about an hour after I arrived. Most of the time was spent in recovery. I don't think about the pacemaker very much.

I left what a 'parting gift' - a monitor for the pacemaker. I don't know if it's even working, although the light is on.

I take Verapamil - primarily to help regulate the rhythm (and probably the blood pressure, too). I take a really small dose of Atenolol, again for blood pressure. I also take a calcium/magnesium//zinc supplement K2 and D3, and 1000 mg of Vitamin C.

I sometimes take Life Extension Bone Restore - more calcium, boron, D3 and K2.

So far things seem to be going pretty well.

As far as what medications to be taken, some of this (especially the warfarin) may be entirely different for a tissue valver.

 

[skier]

I'm on metoprolol after my aortic valve replacement (mechanical) three and a half months ago. I don't have high blood pressure, so I'm wondering if I will need to continue and will discuss it with my cardiologist at my next visit.

Searching around, I found this article I wanted to share on beta blockers improving survival after AVR:
https://www.jacc.org/doi/abs/10.1016/s0735-1097(14)61971-9

 

[AZATADINE]

I had AVR (Magna Ease bovine tissue) last November. For three months post op, I was on Warfarin, 2.5mg Bisoprolol, 75mg Aspirin and 40mg Atorvastatin daily.

10 months on and now taking 75mg Aspirin and 10mg Atorvastatin.

 

[Paleowoman]

I was not tracking was how much fluid I was consuming because Keto does drain the body/cells/muscles etc of water ...

I keep the Keto way of eating - I know we have to have a bit of extra salt due to loss of it with fluids. If you're too low in sodium that can make you feel a bit dizzy. Just an idea.

 

[Canton]

That's an interesting article and certainly gives food for thought with regards to the statins I'm taking. Thank you for sharing it.

 

[Canton]

I keep the Keto way of eating - I know we have to have a bit of extra salt due to loss of it with fluids. If you're too low in sodium that can make you feel a bit dizzy. Just an idea.

Yes, and not just salt but also Magnesium and Potassium... I learned that the hard way when I started the Keto diet and felt the effects of the dreaded "keto flu"... which actually was a good thing for me because at the time I didn't know what the keto flu was, and I told my primary doctor about the effects I was having... he then ran some test and discovered my BAV issue with my heart. In any case, to combat that I drink sugar-free power-aid with meals as it contains electrolytes and I eat half an avocado every day which is rich in potassium, good oils and other benefits. That has helped me in keeping the correct nutrients.

 

[ATHENS1964]

I would like to know how big they were before and after the aortic valve surgery Left ventricular internal diameter in diastole (LVIDd)
Left ventricular internal diameter in systole (LVIDs) anyone who has information from his file would be interested in me .
I had 65 mm and 45 mm before the surgery and now I have 55 mm and 41 mm I think I am at the upper limits

I take b-blocker BISOPROLOL and acenocoumarol

 

[Stevebav]

I'm on metoprolol after my aortic valve replacement (mechanical) three and a half months ago. I don't have high blood pressure, so I'm wondering if I will need to continue and will discuss it with my cardiologist at my next visit.

Searching around, I found this article I wanted to share on beta blockers improving survival after AVR:
https://www.jacc.org/doi/abs/10.1016/s0735-1097(14)61971-9

I am 2 years post AVR and take 1.25mg Bisoprolol, low dose statin + aspirin. My surgeon said that although primary need for beta-blocker was to protect 'his embroidery' while healing he believed it be of long-term benefit.

 

[Sim]

A couple of years ago I was diagnosed with BAV disease with an ascending aortic aneurism. After 6 months my aneurism grew from 5.0CM to 5.3CM and I was told by my surgeon that the time has come, and I would need the replacement. I had the surgery, and I went with a tissue valve... I was 53 years old at the time. And while initially I was told by the doctors after the surgery that it all went fine... after a day or so in the hospital I was informed that I developed "complete heart-block" and I couldn't leave the hospital until after they installed a pacemaker. I wasn't prepared for that nor happy about it. Now 2 years later I feel recovered to a large degree. I got my strength back, but I don't think I have fully recovered my stamina and I gained some weight. The weight is now something I've have recently been working on. Walks and some aerobic exercises and such. Prior to the surgery I was on the KETO diet and it did get me fit so I've also within the last 2 weeks went back to it...but lately I'm feeling unusually tired and getting dizzy at times. But I'm wondering if the meds that I take today are causing me tiredness and at times dizziness so I'm curious what meds other people that had the same surgery as myself.

I'm currently taking as prescribed by my doctors daily: 1 metoprolol succinate (50 MG), 1 rosuvastatin (5 MG), 1 Asprin (325 MG)

I'm now thinking that 325 MG of Asprin each day might be too much as I think I should be taking the baby Asprin with only 81 MG... but then that got me looking into the other two. Both the metoprolol and the statin cause tiredness and dizziness.

So, I'm just wondering what others who have gone through what I have are taking today... though I understand that a very small percentage actually end up with a pacemaker ... lucky me. I'm a couple of months away from regular cardio checkup so I'm just preparing for that with my question on this forum.

I was on Atenolol for over 20 years. At 34 when I had my aortic valve replaced the second time I was put on Metropolol. I was feeling tired and depressed for 3 months and I told my cardiologist about it and asked to be changed back to Atenolol. After the second day on Atenolol I started feeling normal again, had a lot of energy and never felt depressed since that time. The cardiologist explained to me that metropolol crosses the brain-blood barrier (lipophilic agent) but Atenolol doesn't (hydrophobic agent), so that explained my symptoms.

 

[newarrior]

I am 2 years post AVR and take 1.25mg Bisoprolol, low dose statin + aspirin. My surgeon said that although primary need for beta-blocker was to protect 'his embroidery' while healing he believed it be of long-term benefit.

Bisoprolol I took it for a few months in 2019--pre surgery--hated it..hope you do ok w it

 

[AZATADINE]

Bisoprolol I took it for a few months in 2019--pre surgery--hated it..hope you do ok w it

I took it for 3 months post op but I dont recall having any particular feelings about it. I didn't notice anything when I came off it?

 

[Stevebav]

Bisoprolol definitely effects circulation in extremities - even on 1.25Mg. cold feet in bed, cold hands as soon as seasons change to autumn/winter - oh yes, don't forget that sniffy nose!....I imagine side effects vary according to dosage and ones size (I'm average build, average hieght, average weight).

 

[DJ-Rae09]

I'm currently taking after AVR:

7.5mg of metoprolol
16mg of candesartan
7mg of Wafarin
Cardiac aspirin

I'm hoping I'm able to step metoprolol soon, but I'm only 2 months out of AVR surgery.

Cheers

 

[tom in MO]

A couple of years ago I was diagnosed with BAV disease with an ascending aortic aneurism. After 6 months my aneurism grew from 5.0CM to 5.3CM and I was told by my surgeon that the time has come, and I would need the replacement. I had the surgery, and I went with a tissue valve... I was 53 years old at the time. And while initially I was told by the doctors after the surgery that it all went fine... after a day or so in the hospital I was informed that I developed "complete heart-block" and I couldn't leave the hospital until after they installed a pacemaker. I wasn't prepared for that nor happy about it. Now 2 years later I feel recovered to a large degree. I got my strength back, but I don't think I have fully recovered my stamina and I gained some weight. The weight is now something I've have recently been working on. Walks and some aerobic exercises and such. Prior to the surgery I was on the KETO diet and it did get me fit so I've also within the last 2 weeks went back to it...but lately I'm feeling unusually tired and getting dizzy at times. But I'm wondering if the meds that I take today are causing me tiredness and at times dizziness so I'm curious what meds other people that had the same surgery as myself.

I'm currently taking as prescribed by my doctors daily: 1 metoprolol succinate (50 MG), 1 rosuvastatin (5 MG), 1 Asprin (325 MG)

I'm now thinking that 325 MG of Asprin each day might be too much as I think I should be taking the baby Asprin with only 81 MG... but then that got me looking into the other two. Both the metoprolol and the statin cause tiredness and dizziness.

So, I'm just wondering what others who have gone through what I have are taking today... though I understand that a very small percentage actually end up with a pacemaker ... lucky me. I'm a couple of months away from regular cardio checkup so I'm just preparing for that with my question on this forum.

I didn't like metoprolol it affected my sex life. It did however make me very calm during family "discussions" They prescribed it after surgery. I asked my cardio if I still needed it and since I was on lisinopril for blood pressure he took me off. No problems.