Mitral Valve Repair

[Asghar]

Hi All!
I am a 44-year-old male. First of all, please excuse any mistakes in my English; I just want to share my story.

In March 2024, I underwent mitral valve repair and left atrium (LA) reduction surgery. After the surgery, my ejection fraction (EF) was 45%, and I had a dilated left ventricle (LV) with septal hypertrophy. Fortunately, after remodeling, my EF improved to 65%, and the dilation and septal hypertrophy have resolved.

Two months after surgery, I experienced atrial fibrillation (AFib). A 24-hour Holter monitor recorded a minimum heart rate of 73 bpm and a maximum of 144 bpm.

My current medications are:

• Ramipril 1.25 mg once daily
• Loprin/Asprin 75 mg once daily
• Metoprolol 25 mg twice daily
• Warfarin 5 mg once daily

Since starting Metoprolol, my resting heart rate hasn’t gone above 87 bpm. However, in the evenings around 7:00 PM, I often feel unwell, and my heart rate drops to the low 60s, sometimes reaching as low as 58 bpm.

 

[3mm]

Hello, Asghar - Your English is excellent! I am glad you are doing well overall.

Do you take Metoprolol Tartrate or Metoprolol Succinate? What time of the day do you take it?

Metoprolol Tartrate is an immediate release drug whose effects last for 6 to 12 hours.

Metoprolol Succinate is an extended release drug whose effects last for about 24 hours.

I suggest you track the time at which you take your Metoprolol and the time when you feel unwell, and then talk with your cardiologist about this. Perhaps you need to adjust your Metoprolol dose?

 

[tjay]

I am a 44-year-old male. First of all, please excuse any mistakes in my English; I just want to share my story.

In March 2024, I underwent mitral valve repair and left atrium (LA) reduction surgery. After the surgery, my ejection fraction (EF) was 45%, and I had a dilated left ventricle (LV) with septal hypertrophy. Fortunately, after remodeling, my EF improved to 65%, and the dilation and septal hypertrophy have resolved.

Two months after surgery, I experienced atrial fibrillation (AFib). A 24-hour Holter monitor recorded a minimum heart rate of 73 bpm and a maximum of 144 bpm.

My current medications are:

• Ramipril 1.25 mg once daily
• Loprin/Asprin 75 mg once daily
• Metoprolol 25 mg twice daily
• Warfarin 5 mg once daily

Since starting Metoprolol, my resting heart rate hasn’t gone above 87 bpm. However, in the evenings around 7:00 PM, I often feel unwell, and my heart rate drops to the low 60s, sometimes reaching as low as 58 bpm.

Looks like you're doing much better since surgery, your EF is much better and hypertrophy is resolved. So what's the issue? You feeling a bit unwell (shortness of breath, lethargic/lack of energy etc) around the same time every evening may have to do with the timing when certain drug(s) (e.g. beta blocker) are taken, and/or its dosage. I'm sure talking to your cardiologist will help resolve that.

Then AFib isn't uncommon after the surgery, but then again please discuss with your cardiologist. Feel free to post using a fresh thread on this forum for wider reach so that others may be able to provide their feedback on any specific questions you may have.

Your English is great ...

 

[Asghar]

Hello, Asghar - Your English is excellent! I am glad you are doing well overall.

Thank you 3mm.

Do you take Metoprolol Tartrate or Metoprolol Succinate? What time of the day do you take it?

Sorry i didn't mentioned that it's Metoprolol tartrate

I suggest you track the time at which you take your Metoprolol and the time when you feel unwell, and then talk with your cardiologist about this. Perhaps you need to adjust your Metoprolol dose?

I take it 7:00 AM in the morning and 6:00 PM in the evening. Yeh I am scheduled to meet with my electrophysiologist next week to discuss this.
.

 

[pellicle]

I take it 7:00 AM in the morning and 6:00 PM in the evening.

I vary mine a bit (its not a clock) and fit it in with my personal routine. I like to do some weights in the morning and know that by just taking it near the end of my session it'll start to kick in as my HR should be settling back down (but may not). This way I can train and keep my (self aware) pace.

If I feel my HR is going too high (for my personal comfort) and not recovering appropriately in breaks then I'll pop it earlier and "tone it down a bit"

I'm also on Tartrate.

Best Wishes