Remodeling the heart vs. beta-blockers

[Der Biermeister]

I think the goal for most of us post-VR is to get our hearts back in tip-top shape. The word I see banted about here the most is "remodeling".

I have a question: Assuming a healthy heart, I've always been told that cardio workouts are the best thing you can do. Aerobics. Getting your heart rate way up there.

Well - I supposedly have a pretty good heart now. The minor heart attack I had due to losing half my blood did NOT do any noticeable damage to the muscle or what now appears on the EKG. I have great blood supply to the heart now AND I have this wonderful marvel of modern medicine - the new valve.

I am walking up a storm. Doing 3-4 miles per day - and at least every other day, i am doing an extra 3 miles. I also have picked up my pace now (11 weeks post-op) to around a 15 min. mile. BUT - they have me on a hefty dose of Toprol, among other bp meds, which prevents my HR from getting anywhere near "aerobic".

So --- isn't this like a catch-22? Am I fooling myself by thinking I can remodel the heart when the drugs I take work against it?

 

[Superbob]

I also walk but I take a different approach. I don't measure distances and I don't check the heart rate. I walk with my dog and we explore nature. I stop when I'm tired -- or okay, actually I usually stop before I'm fatigued. I don't worry about what's aerobic (though I do some exercise biking to supplement the walking). I didn't go through the OHS ordeal just to obsess about numbers. I stop and smell the roses.

But this is just me.

 

[musician2k]

Actually I noticed the same thing, and even tho I'm pre-op I didn't KNOW my heart was in the shape it's in now so I was doing aerobic workouts on treadmills at my gym. Sure enough, I'd notice my HR increasing, but then Verapamil would kick in & it'd go back down. I suppose if post-op I'm not experiencing high blood pressure then why would the cardio keep me on Verapamil? Is there a reason you are still on the Toprol? A good thought, perhaps you could be, at the very least, on a much lower dose.

 

[Georgia]

Patience, dear DB. You're only 11 weeks about. Your heart isn't just remodelling, it's HEALING. These meds are primarily to support your heart as it heals.

My LV was quite enlarged; it didn't remodel completely until more than a year out. But total success!

 

[Superbob]

The Virtue of Patience

The Virtue of Patience

Georgia said this much more gracefully than I did.

In a word: patience. That's what she advises. Good advice.

It takes time to heal, and if the beta-blocker is slowing down your heart rate, that may well be part of what it needs to heal.

In retrospect, my response sounds sort of snippy. I didn't mean it that way. I just meant that there are different approaches to the same end. I didn't mean my way is best -- my message is that relaxation is part of the healing process, too, not just exertion.

Along the way to a remodeled heart, there are times when we need to be patient with ourselves.

 

[Marguerite53]

Ditto everything Bob and Georgia said!! Give it a little more time. Then present your querry to a doctor of similar mind-set to yours and get some answers. Persist. Find a different doctor who will address your goal orientation, if the current one will not. OR go out on your sailboat and enjoy the wind and the way you can control your boat and let your body rejoice on its own.

Marguerite

 

[Der Biermeister]

Patience, dear DB. You're only 11 weeks about. Your heart isn't just remodelling, it's HEALING. These meds are primarily to support your heart as it heals.

My LV was quite enlarged; it didn't remodel completely until more than a year out. But total success!

Good points Georgia and Bob -- I keep forgetting I am only in the early stages of healing. However - I've been told I'll probably be on beta-blockers for life. So I am still curious about the negative effects of beta-blockers when a person is trying to get an "aerobic" workout. OR is it that stressing the heart with aerobics really isn't all it is cracked up to be? Maybe it is better to keep your heart calm and quiet and just don't clog up the arteries.

 

[Der Biermeister]

My LV was quite enlarged; it didn't remodel completely until more than a year out. But total success!

THAT is real encouraging - thanks

 

[seand]

Toprol!

Toprol!

Toprol is the bane of my exercise existence!

If you've seen my other posts, you'll know that I am a competitive bicycle racer. I've been back racing since 6 months post-op (I'm at 10 months now), and my cardiologist refuses to let me stop the Toprol, although my surgeon was okay with me stopping at my 6-WEEK post-op check! She (regular cardio) knows how hard I ride, and she wants my heart to have a buffer against that. So, no, I can't reach my max, but yes, as others have said, we need to be patient. I am the most guilty of this! But as everyone keeps reminding me . . . 10 months is not fully recovered/repaired!

When I first climbed onto my indoor trainer at 3 weeks post-op, I could barely reach 130bpm. Now I can occasionally get 170bpm, and that's still on 25mg of Toprol . . . just do what you can do, and ramp things up gradually! Your heart is getting stronger, even if the bpm seem too low to be doing you any good.

seand

 

[Jkm7]

I'm on 25mg coreg twice a day. Recently my cardio was present when I had a nuclear stress. While on the treadmill, he was pleased when my heart rate got to what I thought was not nearly high enough for aerobic workout. He said that is WHY he keeps me on the coreg. He knows how much I walk and wants to keep my heart rate from going too high during my walks. He stressed he wants me to continue the walking but he'll keep my heart rate lowered.

 

[OldManEmu]

Beta Blockers

Beta Blockers

Beta Blockers while inhibiting the maximum heart rate that can be attained during training allow the heart to slow down and rest the balance of the time. While you may exercise vigorously for an hour a day the beta blockers assist the heart in slowing down for the other 23 hours, this is how they assist the remodelling. My heart was grossly enlarged and in class IV CHF at the time of surgery with the assistance of beta blockers and exercise it was able to remodel back to normal in 12 months and I now no longer take beta blockers. I certainly noticed the difference in my heart rate during exercise after I came of the beta blockers it was much higher. The added bonus of no longer taking Metoprolol is that I was able to discontinue diuretics as one of the common side effects of Metoprolol is fluid retention. Der Biermeister you?re not far out from surgery these things take time.

 

[Der Biermeister]

You guys are great -- your explanations are slowly sinking in and I hope I can remember all this good advice and just stick this away in the archives.

I am kind of like in a catch 22 with having to take so many meds - all of which have fluid retention as a side effect. So that means heavy doses of diuretics, which means potassium supplements, etc., etc. BUT I am greatly encouraged by your accounts -- especially for what to expect at a year out. I am almost 12 weeks now and I feel fantastic. Really -- probably better than I've felt in 5 years. So .. I know my heart is going to remodel just fine, because you guys have told me so!

 

[Mb]

Hello:

We were at my husband's surgeons on Friday afternoon. The subject of heart rate came up. He said the valves do not work properly or efficiently at a heart rate over 110 BMP, so he did not like to see the rate over that. He actually had told us that 4-5 years ago, post surgery, but I had forgotten.

Mb