This has been scary

[Catie]

Probably I was remiss for not checking my heart rate for a few days, maybe a week, I dunno, and just trusting that my assigned medications were okay. But I have been doing so much doctoring for this, that and the other issue. Checking where incisions popped open a bit; following cellulitis and what turned out to be a small blood clot in my arm; got checked out after two nights of many palpitations. Wore 24 hour Holter monitor earlier in the week after another ER visit.

I wasn't mentally prepared when I pushed to be seen by my cardiologist and he said we had to change my beta blocker dose immediately. He cited several possibly catastrophic outcomes. I think my heart rate was 48 on his EKG, and he wanted me to dial back and skip doses of beta blocker if my HR was 50 or below. But since seeing him Thursday, it's been in the 30s every time I've measured it at home. I stopped by my GP today; it was 41 there. For sure, I haven't taken any more metoprolol!

These 30s are scaring me. And it's a weekend. Can't get back in touch with cardiologist till Monday. I wonder whether the amiodarone lowers heart rate, too. I don't have symptoms, no faintness, etc.

 

[Protimenow]

Most cardiologists DO have someone on call. You should be able to call your cardiologist's office and talk to an answering service -- or, if your cardiologist only has a machine, listen to the complete phone message and see if there's a number to call so that you can reach your doctor or an on call physician.

My heart rate is often in the 40s and 50s. I'm not sure how I'd feel if it was in the 30s. I won't say whether or not it's right to be concerned about that heart rate - if you can't reach your doctor (you shouldn't have to wait until Monday to be able to talk to him or her), and you have an Emergency Room nearby (or not), it may make sense to visit the E.R. if you're not feeling right or want to have this checked. A cardiac issue like yours may be enough reason for them to see you without much delay.

(How are you measuring your heart rate? The usual way is just feeling your pulse and counting beats per minute - this can be done without anything other than a something with a second hand. Some phone will even take your heart rate (my Android phone does) by shining a light through your fingertip and using the camera to detect your heartbeats).

I'll be back to see how this resolves. I won't say 'good luck' -- just because it's the weekend, you should be able to get some help or advice - and you should be okay. (If you see my posts, I usually use 'should,' rather than 'would,' so don't let my wording scare you)

 

[AZ Don]

After seeing your cardiologist and GP, I would think they would have advised you what to do if your heart rate stays low or goes lower, or at least how to reach someone. After my discharge I was given a lot of paperwork and it included numbers to call if I had problems. When I had Afib I was able to reach the cardiologist on call at the hospital relatively quickly - in the middle of the night. That you are not fainting or passing out is a good sign but I would call until you reach a Dr, or go to the ER if you are not able to reach anyone. My heart rate has dropped as low as 50 or so, but only when I'm cold.

 

[LondonAndy]

I am not familiar with that drug myself, but just looked up the patient information leaflet for the tablet version here and it says "Do not take Amiodarone Hydrochloride if you have a slower than usual heartbeat (called 'Sinus Bradycardia' or an illness called 'Sino-atrial heartblock'. So that drug could be a factor, but worth talking to a doctor of course.

Also, just read your profile and notice you are taking Lasix, a water tablet, and the leaflet says taking these two drugs together can increase the chance of side-effects.

 

[jwinter]

Catie, It sounds like you are going through some rough times. I agree with the others that you should be able to contact someone on the weekend. Use the ER if you have to and when you get in touch with your Cardio or GP ask them the weekend protocol if you need help. I was on Amiodarone after first valve replacement and also had very slow pulse and low blood pressure. It was a difficult time for me and I feel for you. Hope things level off soon.

 

[Catie]

Thanks, you guys. It really has been one complication after the other since my surgery. I had three ER visits between 10-10 and 10-17. Was hoping to avoid another one. Cardiologist Thursday seemed to think I might need to skip a dose or two of Metoprolol. He didn't instruct for this! I was just seen at my GP's office Friday afternoon, but we talked about 8-10 things. *sigh*

GP office is acute care this morning; I'll probably start there.

LondonAndy, I was off the Lasix, but my L ankle swelled after my shower, so they may put me back on it.

Discharge was from Cleveland, so I've tried to transition back to TX.

Protimenow, I've found it hard to measure my heart rate manually because the beats are weird. Arrhythmia is a known problem; on warfarin for having had afib. Have used blood pressure monitor and pulse oximeter more readily. Rate is bouncing around some, but certainly nothing on the too high end of things.

 

[Agian]

Well Catie, the beta blockers do reduce your heart rate. Mine is often in the 40s. These cardiologists have a way of freaking people out. What did he mean by 'catastrophic outcomes'? Bloody hell! Couldn't he just say the metoprolol was causing your pulse to be unnecessarily low: 'How about we stop it, lower the dose, or try something else?' I didn't like metoprolol btw. I'm on Atenolol. My heart rate fluctuates between 45 to 85. It's actually nice when it's low. Click... Click... Click... Zzzzzzzz

 

[carolinemc]

Catie, the biggest I see you have beside checking everything too much, you are so tensed up that is affected you and your body. You are worried sick from what the doctor said. Next you see him, ask question about what everything means in detail. Make him go slow if need be. You need to be proactive and need the doctor to explain everything in better, clear detail. That way it will calm your stress levels that is effecting you and your body. Please ask your doctor questions. Promise me that you will, it will calm you down some. Good luck, and welcome to this wonder spot in cyberspace. Hugs for today.

 

[Catie]

I called the post op nurse line in Cleveland. She said to dial 911 because having my heart rate parked in the 30s for a day and a half wasn't okay. ER reaffirmed this.

Caroline and Agian, I didn't type here the several things my cardiologist mentioned could be outcomes. Like the heart no longer beating. It is okay.

My heart rate rose.. We all surmised it must have been the metoprolol leaving. More afib and widely fluctuating rhythms. The ER reached the doc on call from my cardiology group. I was released home to take one 25mg metoprolol when I got home and to remain on a single dose a day for now.

 

[honeybunny]

Thank you for the update. Sending positive thoughts and prayers that everything settles down. It's difficult to live alone sometimes because there isn't anyone to watch over us during situations such as yours so you need to be more vigilant than someone who resides with a partner. I'm glad you are taking care of yourself. Hugs to you~

 

[AnnaK]

It's been rough sailing for you Catie- hope you hit smoother waters soon! The metoprolol is a bear, I just take 12.5 mg/ day & that small amount can really throw me sometimes. Taking it with a meal helps, also I find the brand name, toprol, to have fewer side effects.

 

[AZ Don]

Glad to hear that you are ok. As was discussed in another thread recently it is important to be involved and advocate for yourself. If the Dr's give you meds that cause problems you have to speak up and advocate for yourself - just as you did.

 

[epstns]

Unfortunately Catie, your current situation sounds a bit like mine immediately after surgery. As I've described my heart rhythm post-op, it tried everything. It went fast. It went slow. It skipped beats. It added beats. Then finally it got bored and would just plain stop for 20-30 seconds at a time. Let me tell you, it is no fun to watch your heart monitor go flat-line. You then wake up to find a circle of very concerned looking faces all around your bed. Not good at all.

After a few days of this routine, they told me that they could continue trying to get things under control with meds or they could implant a pacemaker. I went with the pacemaker and haven't looked back. I still take 25mg/day of metoprolol to keep my heart rate down within range, away from possible afib. My pacemaker would keep my heart rate at or above 60 BPM, but my atria are naturally paced 90% of the time. My issue is that my ventricles are sluggish. Without the second wire from the pacemaker, my "escape rhythm" (natural rate without pacemaker) will go down to 40-50 BPM and is out of synch with the atria. Hence I have a two-lead pacemaker.

Again, sorry for the drawn-put story, Catie, but if they suggest a pacemaker, it really is not a lifestyle issue for me at all. And with the newer generation pacemaker, I have remote monitoring, so I only have to go in to the clinic for interrogation once per year. If they see/sense anything amiss in the quarterly remote uploads, they will call me to come in.

 

[Catie]

I really appreciate that you guys have kept talking to me. And Steve, thanks so much for all you've shared with me about your pacemaker. That possibility was mentioned in the last few days for me.

So, I learn my cardiologist is on vacation all week. I've faxed a letter to his nurse and left her a message about what's been going on with me. I had a very brief conversation last night with the cardiologist on call from the group to ask if I could take a half dose of metoprolol once my rate comes up. It was clear that he didn't believe my heart rate was in the 40s. Probably because when the Cleveland Clinic nurse said to go to the ER on Saturday, my heart rate was on its way up, and they didn't "capture" it bouncing between 35-50 as it had been before it rebounded and I went into afib.

Heart rate just this hour finally came back up to 70 after being in the 40s for 46 hours. I shudder at taking another metoprolol. I'm going to wait another hour and see if I get a call. Maybe someone over there will read my letter and respond.

 

[Catie]

70 was a one-time reading today; HR has remained in the 40s; therefore still haven't been able to take beta blocker. And the cardiology office hasn't responded to my letter and phone message. I wish my own cardio hadn't left on vacation.

 

[HopefulHeart]

Hi Catie.......I'm so sorry to hear about all the trouble you are having. I am impressed by your courage and persistence in trying to get answers. I'm finding more and more with my own Cardio that he just wants to give me a textbook answer, sign off on my sheet and be done with me. I have to really press him and sometimes repeat myself when explaining something about my heart that concerns me. In other words, I am definitely my own advocate and sometimes with these doctors I feel like I'm the only ship sailing on the waters. As I have not had my surgery, there is no way I could possibly understand what you are going through. But keep on advocating for yourself and stay strong. I think you are doing a fantastic job and hopefully one of these days soon everything will level out for you.