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

 

[Asghar]

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

Thanks for sharing your approach! I like the idea of timing it around your heart rate, and best wishes to you as well!

 

[Asghar]

I had a check-up with my electrophysiologist. He thinks it's quite normal to feel this way after mitral valve repair. It will take time to resolve—it's already been 8 months, and I’m not sure how many more months it might take. Fingers crossed!

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

In addition to above he also prescribed Aldactone (Spironolactone) 25mg.

BP was 120/80. I also did a INR, lipid profile and uric acid test with the following results:

• INR: 1.8
• Total Cholesterol: 194
• Serum Triglyceride: 142
• HDL-Cholesterol: 45
• LDL-Cholesterol: 110
• Uric Acid: 5.4

Hoping these numbers keep heading in the right direction!

Edit:

The following graph shows the minimum and maximum resting heart rates throughout the day over the past three months.

 

[pellicle]

Hi

INR: 1.8

I'm not sure what they've set for you nor do I know what guidelines are for mitral repairs, however that's got to be better than 1 if you have any history of thrombosis

The following graph shows the minimum and maximum resting heart rates throughout the day over the past three months.

looks good to me steady as she goes I'd say

 

[Asghar]

My INR was set to 2 for six months after surgery with an annuloplasty ring, but they kept me on warfarin due to AFib. Because of this, I still try to keep my INR close to 2, although it has crossed 2 a few times.

 

[dornole]

Isn’t the range for afib usually more like 2.0 to 3.0? What is the range they gave you for afib specifically ?

 

[Asghar]

They mostly recommend keeping it around 2.0, but during this entire period, it was observed as low as 1.3 and at a maximum of 2.8

 

[pellicle]

They mostly recommend keeping it around 2.0, but during this entire period, it was observed as low as 1.3 and at a maximum of 2.8

warfarin or acitrom?

 

[Asghar]

warfarin or acitrom?

It's warfarin.

 

[pellicle]

It's warfarin.

in that case what I was going to suggest won't be the case ;-)