Metoprolol vision changes? Or is this something else? Graying out of vision in one eye only

[dornole]

I do have a call in to cardiology about this stuff, but just curious what any of you have experienced with metoprolol / Lopressor esp vision changes.

My new rhythm cardiologist put me on Flecainide (rhythm med) and metoprolol (beta blocker) because I have paroxysmal afib now (episodes of about 4 hours a couple times a week before tx). Took off Flecainide after a couple weeks due to fatigue, dizziness and vision changes. Better but I am still experiencing the following:

--Fatigue, like I feel like I only got 5 hours of sleep -- tired, no energy, trouble focusing, low mood - I had this post surgery on beta blockers so not surprised

--Vision changes. There are two types.

1) Shimmering around the edges of both eyes that lasts for about 15 mins. That I have had since high school but usually only 1-2 a month, now it's 2-4 times a week. Docs assumed its migraine in the past (even though I don't get headaches, never really tested)
2) more opaque gray-out out of between 1/4 and up to almost all my vision in my left eye (only peephole in the center left) that lasts about 2 minutes, receding in a more area-based way (for example going up like a window shade) This has happened 3x in the past week and maybe before then, but I wasn't recognizing this as something different from the shimmer. The peephole experience freaked me out.

My blood pressure has always been on the low side of normal; on the beta blocker top number ranges from 86-95 and lower number 57-65.

Like I said, I am medically following up on this with my main question being primary care, cardiology, or emergency, but I do appreciate any experiences or helpful questions anyone has to share.

Deb

 

[pellicle]

Hi

--Fatigue, like I feel like I only got 5 hours of sleep -- tired, no energy, trouble focusing, low mood - I had this post surgery on beta blockers so not surprised

possibly a symptom of beta-blockers .. are you on metoprolol succinate or metoprolol tartrate. My first suggestion would be move to tartrate if on succinate

next, I'd ask to change to bisoprolol:

Cardioselective beta blockers, e.g. bisoprolol, metoprolol, atenolol, have a greater affinity for beta1-adrenoceptors. Bisoprolol is reported to be more cardioselective than metoprolol and atenolol. There is, however, potential at higher doses for cardioselective beta blockers to also block beta2-adrenoceptors.
(ref)

--Vision changes. There are two types.

1) Shimmering around the edges of both eyes that lasts for about 15 mins. That I have had since high school but usually only 1-2 a month, now it's 2-4 times a week. Docs assumed its migraine in the past (even though I don't get headaches, never really tested)
2) more opaque gray-out out of between 1/4 and up to almost all my vision in my left eye (only peephole in the center left) that lasts about 2 minutes, receding in a more area-based way (for example going up like a window shade) This has happened 3x in the past week and maybe before then, but I wasn't recognizing this as something different from the shimmer. The peephole experience freaked me out.

sounds more like classic migraine or (in 2) ) prhaps TIA .. I've almost never got headaches. Some good links out of this post (here)

I personally have found chiropracter helps with migraines, as well as doing my own regime of stretching and exercise daily (with a focus on posture)

HTH

Best Wishes

 

[dornole]

Thanks, helpful to get some beta blocker options that might work. I also may just go for an ablation and treat the afib that way vs the meds.

I'm not too worried about the migrainish vision changes but the opaque gray stuff is concerning.

 

[DebraB]

I have been on Metoprolol since my surgery in 2022. One day I decided to look up the side effects. Well, guess what? I had nearly 90% of the symptoms! Extreme lethargy, could fall asleep at work in the middle of the day. watery eyes, confusion, ear issues, zero interest in sex or anything for that matter, and the one that freaked me out the most was the shortness of breath. The medicine suppresses the adrenaline in you lungs (not a Dr, not sure how else to explain it!) so that makes you short of breath.
I could go on and on. See if you can change meds. I weaned myself off of it but keep some handy if I feel my heart racing.
Good luck!

 

[vitdoc]

lethargy = beta blockers most likely, to find out they need to be stopped with Dr’s ok
Classic migraine with scintillating scotoma often without headache.
Temporary partial blackouts in one eye strongly suggestive of TIA can be permanent.
If you are going in and out of A Fib or staying in A Fib you can throw clots from the left atrium which can lead to stroke or a retinal artery occlusion. Should be on anti coagulation with warfarin or something like Eliquis.

Check with the cardiologist ASAP.

 

[pellicle]

to find out they need to be stopped with Dr’s ok

or perhaps substituted, of course with Dr's ok ...

 

[pellicle]

I weaned myself off of it but keep some handy if I feel my heart racing.

not generally a good idea, however I'm not going to say you shouldn't but if you aren't on ACT (as VitDoc mentioned) you run risks.

I've been on metoprolol tartrate since 2022 without undue effects (actually, only with really good control of my tachycardia). Note I said tartrate, not succinate. They are different and they have different side effect profiles.

 

[Croooser]

Vision issues. Has anyone mentioned ocular migraines? If you do an image search, there are some examples of how they appear for some people. Just a thought, not a conclusion by any means.

 

[pellicle]

Vision issues. Has anyone mentioned ocular migraines?

yep ...

sounds more like classic migraine or (in 2) ) prhaps TIA .. I've almost never got headaches. Some good links out of this post (here)

but good call, even if I do say so myself.

;-)

 

[dornole]

Thanks all, just got back from the ER to read this. Cardiology sent me to ophthalmology, unsurprisingly they agreed with vitdoc:

Classic migraine with scintillating scotoma often without headache - no bigs, doc not super concerned esp since of long standing
temporary partial blackouts in one eye strongly suggestive of TIA - aka amaurosis fugax, red flag
Eyes looked healthy

Sent me straight to the ER for an MRI of my head and neck to look for evidence of strokes, any clots, plaques or vegetation roaming around up there, and any plaque / blockages / stenosis in the brain or carotid arteries.

They didn't see any active problems that could be causing the transient vision loss today on MRI today, so still not clear what is causing these but MRI was judged reassuring. (They DID find an old lacunar infarct in the right cerebellum indicating a past stroke, likely years ago).

Referred for follow-up to neurology and in the opinion of the ER will likely need another echo to double check for a clot or vegetation on valves. I am already on Eliquis since I developed paroxysmal afib a couple of months ago so I have that coverage at least.

Thanks again for the input. It's always good for us all to learn and document our experiences for others.

 

[BrokenHearted<3]

I have been on Metoprolol since my surgery in 2022. One day I decided to look up the side effects. Well, guess what? I had nearly 90% of the symptoms! Extreme lethargy, could fall asleep at work in the middle of the day. watery eyes, confusion, ear issues, zero interest in sex or anything for that matter, and the one that freaked me out the most was the shortness of breath. The medicine suppresses the adrenaline in you lungs (not a Dr, not sure how else to explain it!) so that makes you short of breath.
I could go on and on. See if you can change meds. I weaned myself off of it but keep some handy if I feel my heart racing.
Good luck!

Thanks DebraB. I had my open-heart sx in 2022 also! I had a valve replacement and aneurysm repair. Are you on metoprolol for a valve or afib or other? I’ve am extremely short of breath and thought it would resolve as I get physically stronger and increase cardio.

 

[Nelle]

Hi Deb,

You and I have much in common on valvuloplasty and afib. I am taking sotalol and felt as you describe for approx 4 weeks. I started it in Mid April 2024.

Re Fatigue: It gave me lower blood pressure and pulse that went to 47. I felt a little bit in a fog but is has improved a lot. My Cardiologist PA told me, as long as I keep my heart beat under 120 I will feel fine. In an exercise class, I watched my pulse and Yes I really did need to slow down at 120.

Re Vision Changes: Recently I am also having more ocular migraine, "QuarterMoon Kaleidoscope-y" images. Typically I have a few per year and other years with none at all. After my April hospital stay they came on more than usual but now again, getting fewer and farther between.
Many years ago I had "1/4 eye gray out" for about 1 minute, but didn't have it again and didn't get anywhere when I looked into it with the doctors at that time.

I'm very interested that you can go for an ablation-My Electro Physiologist told me I am not a candidate for ablation due to mitral valve disease. This gives me hope.

Wishing you the best.

 

[DebraB]

Thanks DebraB. I had my open-heart sx in 2022 also! I had a valve replacement and aneurysm repair. Are you on metoprolol for a valve or afib or other? I’ve am extremely short of breath and thought it would resolve as I get physically stronger and increase cardio.

Mine was May 27th 2022 I was put on it in the hospital after surgery. I assume that is protocol? I had it increased because at each visit to the cardio, my heart rate was 100-116. It always calmed down during the visit. I did not do cardio rehab so I'm not sure if that would have helped me with the shortness of breath etc.
Over the last 4 years I have had a major car accident, hit by a drunk driver 3 broken ribs. I found my best friend dead in his bed, and a few moths later found out I needed AVR surgery. I have not taken very good care of myself during this time and have gained a lot of weight. I am pushing 230lbs on a 5'2" frame, so I am sure that adds to my problems.
But since I have stopped the Metoprolol I have had a significant decline in side effects.

not generally a good idea, however I'm not going to say you shouldn't but if you aren't on ACT (as VitDoc mentioned) you run risks.

I've been on metoprolol tartrate since 2022 without undue effects (actually, only with really good control of my tachycardia). Note I said tartrate, not succinate. They are different and they have different side effect profiles.

I understand, and I wouldn't suggest that anyone do that. I just took it really slowly. A month for each decline in dosage and watched my heart rate closely.
This is NOT an endorsement for anyone to do the same! Always check with your Dr.

 

[Suckyvalvegurl]

The shimmering is an occular migraine. I have had them since I turned 40. Definitely worsened after surgery, but 5 years later down to just the normal amount that I had before surgery.

 

[dornole]

Hi Deb,

You and I have much in common on valvuloplasty and afib. I am taking sotalol and felt as you describe for approx 4 weeks. I started it in Mid April 2024.

Re Fatigue: It gave me lower blood pressure and pulse that went to 47. I felt a little bit in a fog but is has improved a lot. My Cardiologist PA told me, as long as I keep my heart beat under 120 I will feel fine. In an exercise class, I watched my pulse and Yes I really did need to slow down at 120.

Re Vision Changes: Recently I am also having more ocular migraine, "QuarterMoon Kaleidoscope-y" images. Typically I have a few per year and other years with none at all. After my April hospital stay they came on more than usual but now again, getting fewer and farther between.
Many years ago I had "1/4 eye gray out" for about 1 minute, but didn't have it again and didn't get anywhere when I looked into it with the doctors at that time.

I'm very interested that you can go for an ablation-My Electro Physiologist told me I am not a candidate for ablation due to mitral valve disease. This gives me hope.

Wishing you the best.

Honestly, I think the right hand is not talking to the left with my two cardiologists. There are just not that many people with rheumatic mitral stenosis in the US and I feel like I am getting "usually" answers when I am not a "usually."