Recovery of Ejection Fraction post AVR

[pellicle]

Morning
a couple of interesting points here.

... Have been for 13 years now. One if the issues I read here is that people can’t push their heart rate high enough when exercising while on the drug. Thankfully I haven’t had that issue.

so my first question is are you on Metoprolol succinate (Ms) or tartrate (Mt)?

As you may know, I've started Mt as of about May this year due to some (I like to call them passive aggressive) ectopic beats which then progress to full blown tachycardia (more on that in a tic) and my HR just decides to hit 140 and stay there ... I tried cycling it out but when I got back it didn't settle ... and I can't do that 24/7 so I ended up getting the schitz with it and going to the hospital who diagnosed (agreed with mine actually) that I needed something and we settled on Mt (half a 50mg tablet twice daily).

This has a shorter half life (consult the two layer complex graph below)

as observed in Wikipedia:
The different salt versions of metoprolol – metoprolol tartrate and metoprolol succinate – are approved for different conditions and are not interchangeable

and shown above the interactions of each and the (bottom half of the graph) reduction in HR is more marked with tartrate but reduces in effect more quickly when at (something like) 12 hours succinate continues to provide a suppressing effect.

I've found that being on tartrate allows me to take Mt in the evening, get a proper restful sleep (without being shaken awake by passive aggressive ectopics) followed by unignorable high HR and a pounding headache if left ignored ... presumably by the blood not getting back into circulation properly (presumably because of my vascular occlusion gifted as a side effect in the last redo surgery - yah lets promote redos to infinity).

The benefit is that I can go on a cycle in the morning (when I typically do it in summer to avoid the heat, but catch more insects) and when I'm cooling down on return home pop half an M tablet and move on till dinner approaches in otherwise good shape.

So, perhaps this will help if anyone who's "unable to push through" their M effect when wanting to exersize and choosing Mt or Ms.

Of course consult your Dr, not just listen to some bozo on the internet who hasn't got a clue what he's talking about.

This leads me to my Qn for @Superman : what was causal in your move to M? Was it something like mine in a post surgery (like you've had fifty or something now right?) or was it something else?

As mine emerged some 10 years after my last OHS (or rapeNscrape debridement) {and someone sure took my bride a few months before!!} I would wonder if its actually (in my case) a symptom of COVID exposure (I was double vaxxed early) which I can't rule out (and some sites suggest is possible post C as a long C symptom) I found this site interesting

https://www.gosh.nhs.uk/conditions-...ons-we-treat/inappropriate-sinus-tachycardia/

What causes inappropriate sinus tachycardia?​

There are many theories as to the cause of inappropriate sinus tachycardia (IST) and more research is needed to confirm the cause(s). One theory is that the sinoatrial (SA) node is abnormal in some way, or that the person is over-sensitive to the hormone adrenaline, which causes the heart to beat faster. It could also be caused by a disturbance to the autonomic nervous system – the part of the nervous system responsible for ‘automatic’ functions such as heart rate and breathing.

[underline mine]

and given the anatomy

its a shoe in that after 3 surgeries that node is likely influenced into being abnormal in some way by scar tissue on my heart around that aortic valve (among other causes).

Or (in my case) its my bacteria come out from their polysaccharide biofilm hide to play the last part of hide and seek

dunno.

 

[DJ-Rae09]

you said you are on metoprolol 7.5 2x/day. I am on 25mg 2x/day six days out. I am hoping they reduce it. I feel pretty good but one thing is a lot of the day I feel my heart beating very strongly and a bit fast, like 75-80 bpm. I am wondering if this is just how it is in the early days or if it is the metoprolol. I am not on amiodarone. The strong beating is not the ticking sound, I can only hear that sometimes when it is dead quiet. i asked the nurses about it and they said it was normal. perhaps my heart is just pissed off about the unexpected daylight last week.

Yeah, like you initially after surgery I was put on 25mg twice a day (take morning and night). My resting HR in hospital was around like the 80s, the BB would drop it down to low 70s / high 60s.

I took metoprolol for 2 months post surgery and then started to wean off it and reduce dose.
When I started recovery at home my HR upon waking up was low 80s, I'd take the BB and it would knock it down to mid 60s / low 70s.

Below are some of my recent BP and HR (taken every morning) since being off metoprolol. I am 2 half months post surgery.
My HR pre surgery upon wake was generally around 70 and sometimes lower.
My BP pre surgery was a bit higher than it is now.

I'm seeing my surgeon next week and will ask if I need to continue the BB or not.

124/83	72
125/85	73
133/80	74
125/81	68

And yeah, my heartbeat was for sure stronger post surgery. but you get used to it.

And my INR test this morning

 

[Superman]

I take Ms. A recent change (about a year ago) as it’s a longer release and doesn’t seem to have the same peaks and valleys of Mt did for me. I couldn’t exercise well for about three hours after my morning dose. I did start after my last surgery then just stayed on it. Blood pressure remains at or below 120/80 (110/76 at my annual checkup yesterday) and it’s not causing me any trouble during exercise. I also haven’t been cardioverted since I started taking it. So I don’t make changes to what’s working.

 

[pellicle]

So I don’t make changes to what’s working.

a sound principle

 

[svAdagioME]

I doubt that metoprolol is something that you need to be on long-term unless there is a sustained medical condition that requires it. Only you and your doctors will know if that condition exists and what it is. My recommendation would be to begin discussion of weening off of metoprolol at a certain point (1 or 2 months after surgery). Just be quite upfront with your docs and ask when you can begin weening off of it. And if their response is no then ask why they believe you need to remain on it. There should be a clear clinical reason to remain on metoprolol. For some it is high blood pressure. For others it is tachycardia. For others it is something else. But you'll want to figure that out and fully understand the reason to be on it long-term. Almost all of us are on it short-term for the reasons mentioned previously.

Good approach. I will do that.

 

[svAdagioME]

Yeah, like you initially after surgery I was put on 25mg twice a day (take morning and night). My resting HR in hospital was around like the 80s, the BB would drop it down to low 70s / high 60s.

I took metoprolol for 2 months post surgery and then started to wean off it and reduce dose.
When I started recovery at home my HR upon waking up was low 80s, I'd take the BB and it would knock it down to mid 60s / low 70s.

Below are some of my recent BP and HR (taken every morning) since being off metoprolol. I am 2 half months post surgery.
My HR pre surgery upon wake was generally around 70 and sometimes lower.
My BP pre surgery was a bit higher than it is now.

I'm seeing my surgeon next week and will ask if I need to continue the BB or not.

124/83	72
125/85	73
133/80	74
125/81	68

And yeah, my heartbeat was for sure stronger post surgery. but you get used to it.

And my INR test this morning

View attachment 888842

Excellent data. Congrats on INR! My BP been rock steady every morning, 124/81 and morning BPM has gone 83 77 77 74 since I got home. Will see where we are in a few weeks but all good.

 

[Critter]

I had an almost immediate improvement in my left ventricular wall thickness in about 2 months as demonstrated by echo compared prior to surgery. My resting pulse is 58-60 and I only take 25 of metoprolol a day. Down from a 100 mg/day. I hade grade 1 diastolic dysfunction (beginnings of congestive heart failure). Valve gradient dropped from 80 to around 20 according to echo post ohs. Personally, I think they should put metoprolol in the water. It increases the ionotrophic and chrontropic effects on heart tissue. That’s all good. Also primary prevention for coronary artery disease.

 

[dornole]

Oh man don’t put metoprolol in the water. Someone like me will be doomed (puffy, obese and out of shape yet still have BP of 100/60 and a resting heart rate around 60). I felt like absolute crap on metoprolol. : )

 

[Deepak khanka]

Hi All
Need advise / any one has experianced this
I am 8 months post AVR. Now have an On-x valve. I did my echo in July 2022 , 3 months post surgery and by LVEF was 53% . Recent echo done on 01/12/22 showed EF 40-45%. Wondering why ef is going down. All the other measurements look fine and in range
I am currently on 2.5 mg ramipril for blood pressure ( I don’t have BP but given for helping the heart ) 75 mg aspirin, 1.25 beta blockers)
Any advise will be much appreciated. thanks

 

[Critter]

Make sure you are doing your rehab every day. Walking , anything you can muster to condition the heart. The heart usually has to remodel itself after AVR. You need to go over your meds with your cardiologist to see if you need to back off B blockers. Echo’s are not perfect and it depends on the examiner as well .

 

[Deepak khanka]

Thank you Critter

 

[BAV]

I had an almost immediate improvement in my left ventricular wall thickness in about 2 months as demonstrated by echo compared prior to surgery. My resting pulse is 58-60 and I only take 25 of metoprolol a day. Down from a 100 mg/day. I hade grade 1 diastolic dysfunction (beginnings of congestive heart failure). Valve gradient dropped from 80 to around 20 according to echo post ohs. Personally, I think they should put metoprolol in the water. It increases the ionotrophic and chrontropic effects on heart tissue. That’s all good. Also primary prevention for coronary artery disease.

Hi Critter, do you mind me asking if you're diastolic dysfunction reversed after surgery ?

 

[Critter]

Hi Critter, do you mind me asking if you're diastolic dysfunction reversed after surgery ?

Well I just recently had an aortagram and they noted I still have grade 1 diastolic dysfunction. My diameter is 4.6cm which is .1 less than 3 years ago. I doubled up my losartan to 50mg and doubled up metoprolol to 50mg. Losartan is supposed to stabilize the connective tissue of Aorta based on Marfan studies.