Skipped Beats Gone, Replaced with Hard Beats

[johnnycake23]

Hi all,

For the last few months I’ve been feeling skipped heartbeats. When I was in my electrophysiologist’s office, naturally they weren’t happening then, so the EKG was negative. I then saw my cardiologist who said it’s not the bovine aortic valve—“the valve sounds fine.” (It’ll be 12 years next month, but that’s an Anniversary post.) He thought it might be a-fib and referred me back to the electro.

I took some readings off my Kardia device and sent them to my electro, who from the reading determined it’s not a-fib but rather PVCs. (Thank you, Kardia. Well worth the $100.) He said the Tambocor that fixed this problem for the past 6-7 years has now “lost its magic.” So he told me to continue taking the Tambocor (not sure why if it lost its efficacy) and added Mexiletine twice a day.

Well, that got rid of the skipped beats. However, now I find my heart beating harder than normal. It’s especially noticeable when I’m lying down. I put on a 24-hour monitor and returned it two days ago but have not yet heard back from electro about his findings. It should be any day now.

I’m hoping this whole episode is my just being overtired, as lately I’ve been working extra hours and not sleeping nearly long enough. But that seems too easy. My blood pressure and pulse have been fine, and I am always well hydrated. Plus I lost 25 pounds this year through better diet; I haven't been this light since before my second surgery.

I guess I’m writing to ask if anyone else has felt/feels this way, taken these meds, knows what’s happening to me, and/or what the fix is, if any? I’m still able to function—go to work, drive, take long walks. But it is an uneasy feeling, and not knowing what the hell is happening compounds the unease.
Thank you for reading and for your input.

Johnny

 

[Eva]

Johnny,

You seem you’re doing well in general.
Congratulations on losing weight..your heart and knees will love you for this!

You’re doing well by staying hydrated. When I don’t drink enough fluids, and drink coffee I feel those strong beats too. so, I cut down on my caffeinated drinks.

Pounding heartbeats, according to Mayo Clinic and others, are side effects of Tambocor. https://www.mayoclinic.org/drugs-supplements/flecainide-oral-route/description/drg-20063854

“Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:

More common

1. Difficult or labored breathing
2. dizziness, fainting, or lightheadedness
3. fast, irregular, pounding, or racing heartbeat or pulse

......”

Though Tambocor stopped working, your doctor may have kept you on it as he knows what’s best for your heart’s particular situation!

I take Metoprolol, and I won’t stop it any more. It’s saving me from Atrial Flutter/fibrillation!

Good luck and keep us posted.

 

[tom in MO]

I can't be of much help with anything other than sleep. Sleep deprivation has a profound effect on your cardiovascular system. I have sleep apnea and once I got it controlled, I was able to lower my blood pressure medications and the sexual side effects of our cardiovascular problems and associated drugs were eliminated. My highest blood pressure readings are usually when I have been sleep deprived for a few nights. Another thing, your need for sleep can increase as you get older so what used to be enough sleep can become not enough. The good thing is sleep is additive, skip an hour one night but sleep an extra hour the next.

 

[johnnycake23]

Tom and Eva, thank you for your replies. Very interesting information, especially how sleep affects the cardiovascular. That would explain a lot. Honestly, I hope that's all it is.

When I saw my electrophysiologist on Wednesday, he said my halter monitor showed actual SLOWING of the heart rate (bradycardia). This is surprising to me because I've usually had a fast pulse. That's why I started on Coreg 13 years ago and have been on it ever since, because of a consistently high resting heart rate. He told me that heart rates naturally slow down as we get older, and perhaps I'm overcompensating now.

So since the skips have stopped, he took me off the Mexiletine. He also told me to cut back on Coreg from 12.5 mg twice a day to 6.25. And my blood test came back all normal.

I hope this simple adjustment of meds and catching up on sleep will get me past this episode. Again, thank you for your concern and your input.

 

[Eva]

You’re welcome! The adjustment of Coreg will help!
My pulse went to under 50 beats during sleep on Metoprolol that caused me bradycardia that used to wake me up. Now, I feel much better since my electrophysiologist adjusted the dose (Twice).
keep us posted.

 

[johnnycake23]

My situation is not any better. The thing is, now I experience both: sometimes it’s skipped beats, other times it’s hard beats.

My electrophysiologist told me my magnesium levels were in the “low range of normal.” So he put me on magnesium, 400 mg twice a day. Been taking them for two days now, and doc wants another blood test in two weeks.

When I first experienced skipped beats 6-7 years ago, I was put on Tambocor and my problems were resolved almost immediately. My doc was a genius, I thought. When I went in for this latest episode, I was hoping he would work his same magic. Take this pill and you’ll be good as new. But it’s been weeks and my problems continue.

I take comfort in knowing my valve is OK, and this rhythm issue is supposedly nothing to worry about. Still it’s bothersome. I wonder if what I’m experiencing is “the new normal.”

I’m reluctant to ask for words of encouragement, as I know others are going through worse. I’m just wondering if anyone out there can relate to my situation. Anyone??

 

[Eva]

These skipped beats are very annoying. But doctors know best when they are serious. Magnesium works great for me. Hope it will help you too.

If your doctor is not worried about your skipped heart beats, then it could be due to anxiety, over stressed, etc.

From Harvard: https://www.health.harvard.edu/heart-disease-overview/skipping-a-beat--the-surprise-of-palpitations

”
Diagnosing heart palpitations

• When you have heart palpitations, check your pulse. Is your heart's rhythm fast or slow? Regular or irregular?
• When your heart skips a beat, do you feel lightheaded, dizzy, or out of breath, or do you have chest pain?
• Are you often doing the same thing when they occur?
• Do your heart palpitations start and stop suddenly, or fade in and out?
• ........ “

“How to stop heart palpitations
If you have unexplained palpitations, start with the simple things first:

• Don't smoke.
• Cut back on alcohol, or stop drinking it altogether.
• Make sure you eat regularly (low blood sugar can cause heart palpitations).
• Drink plenty of fluids.
• Get enough sleep.
• Have your doctor or pharmacist check all of your medications and supplements to make sure none cause palpitations. For example, decongestants that contain pseudoephedrine or phenylephrine can trigger palpitations.

..... “

Hope this helps.

 

[epstns]

Since your docs aren't worried, I would just stay the course with them. Do as they instruct and report the results back to them. As you found in the past, eventually they will figure it out. Fortunately, this problem is what I consider "an annoyance" rather than "a catastrophe." You can live with it until you get it sorted out.

I lived with brady/tachycardia for some years prior to my valve replacement. My resting heart rate would go down to the upper 40's, while under heavy exercise load (running) it would cruise along in the mid-160's. After valve surgery (you remember mine, you were here then), it all went wonky and I ended up with lots of rate and rhythm problems. Now, for the past 9 years, I have a pacemaker to ensure that my heart rate doesn't go too low (my escape rhythm is 48 BPM without the pacemaker, but the pacer keeps it at 60 or above), but also metoprolol to keep my heart rate from going way high. It took us months to work out the proper combination of meds and pacer parameters, but once we got it sorted, it has been a big non-issue. I haven't gotten any younger (have any of us?) - almost 72 now, but I still hit the gym 5 days a week, play volleyball, pickleball, ride a bicycle. . . all the things I want to do.

Keep after the docs. They can figure it out. Just don't let them off with some excuse. You've dealt with worse.

 

[johnnycake23]

Since your docs aren't worried, I would just stay the course with them. Do as they instruct and report the results back to them. As you found in the past, eventually they will figure it out. Fortunately, this problem is what I consider "an annoyance" rather than "a catastrophe." You can live with it until you get it sorted out.

I lived with brady/tachycardia for some years prior to my valve replacement. My resting heart rate would go down to the upper 40's, while under heavy exercise load (running) it would cruise along in the mid-160's. After valve surgery (you remember mine, you were here then), it all went wonky and I ended up with lots of rate and rhythm problems. Now, for the past 9 years, I have a pacemaker to ensure that my heart rate doesn't go too low (my escape rhythm is 48 BPM without the pacemaker, but the pacer keeps it at 60 or above), but also metoprolol to keep my heart rate from going way high. It took us months to work out the proper combination of meds and pacer parameters, but once we got it sorted, it has been a big non-issue. I haven't gotten any younger (have any of us?) - almost 72 now, but I still hit the gym 5 days a week, play volleyball, pickleball, ride a bicycle. . . all the things I want to do.

Keep after the docs. They can figure it out. Just don't let them off with some excuse. You've dealt with worse.

Thank you, Steve (and everyone else). I appreciate you taking the time to share your experiences and to allay my fears. I thought I'd give a brief update.

I had a pretty bad weekend of skipped beats, so on Monday morning I called my doc's office and was instructed to come in to get a heart monitor on for the second time. Monday night I read online about something called the Valsalva maneuver. Basically it's hold your breath and strain as if you're trying for a bowel movement. OK, sounds weird enough.

But I'll be damned if it didn't work!

Seriously, since then I have had only a minimal amount of skips, the fewest since this whole episode started. How can I attribute it to anything but this Valsalva thing. I mean, the only other explanation is that the new meds finally kicked in at the precise moment I tried this maneuver.

Look, I'm not trying to promote some kind of voodoo medicine. I'm only sharing my experience. The way I was feeling, I was open to suggestions. Like the general in War Games, "I'd piss on a spark plug if I thought it'd do any good."

I'm still gonna go get my blood drawn in a couple of weeks to see about my magnesium levels. And I may get the heart monitor on again too. But for now, [I say in a whisper] I may be past this. I sure hope I am anyway. Here's hoping it continues.

Thank you again for your concern and kind words.

 

[epstns]

I forgot - is the doc you're seeing an electrophysiologist or a cardio? If you need it, I can give you the name of the electrophysiologist I see at Northwestern. She has been very good with me.