Cardiologist doubled my metoprolol to treat PVC

My cardiologist did the same thing from 25 to 50..I do not like taking it but my heart rate is high 90 to 100 and the flipping of my heart drives me crazy. Frustrated and they are scary

Hi there! Yep! I'm on 200 mg a day, but it still doesn't help.

Couldn’t take metoprolol, gave me a pain in the middle of my chest, very short of breath and didn’t work. My Cardiologist recommended nebivolol, which helped and keeps my blood pressure down. It is also a vascular dilater.so good for the heart.pay a little out of pocket but worth it.

My electrophysiologist also doubled my Metoprolol ER after reviewing my 24-hour Holter monitor results. I was averaging around 6-8 PVC’s in a 30-second ECG recording on my Kardia Mobile card for no obvious reason. The increase in Metoprolol ER helped me quite a bit.

Don’t be too concerned with now many milligrams you are taking, or how much other people take. It’s more important just to find the optimal amount that provides you relief. And more important than the amount, do your diligence to find out what’s triggering your PVC’s. I was finally able to trace my PVC episodes to longterm use of proton pump inhibitors.

This is true, just above. The idea is for you to be able to function and to be free from anxiety, to be able to sleep, and to live with freedom from dread and anger. While the dosage of metoprolol is high, if it works, it works! If/when it ceases to be sufficient, listen to your doctor, but ask him/her if there is some other drug that could work. Maybe diltiazem, maybe an anti-arrhythmic in a mild dose.

Metoprolol 100 mg 2X day was not working for me. The addition of Diltiazem 240 mg in the morning worked well.

I have PAC's and PVC's. had them since I was 26. I'm 73 now. Still hate how they feel. Still scares the crap out of me. As I age I wonder if they will become worse. My BP is good, my heartrate is only in the 60's during the day but it can drop into the 50's at rest. I am only on 12.5 mg of metoprolol ER and a low dose amlodipine. I have an extremely stressful life and I'm sure that makes a difference. I just wish I couldnt feel the skips and flutters.

I am glad to discover this site. A little history...

In the spring of '22 started having SVTs in my upper chamber. I had 2 ablations that summer neither one worked for more than two weeks. In November 2022 I had a pacemaker implanted and my 3rd ablation for SVTs. That solved issue until last summer when I began to have minor arrhythmias in my lower chamber and they have increased. After the pacemaker I was prescribed metoprolol succ 25 mg per day. My cardiologist increased my metoprolol succ ER twice within the past month to 50 mg twice a day, to 100 mg per day. Yesterday, I was at my EP and he said I should either treat have this problem treated with medicine or have an ablation. Has anyone else had an issue similar to this? Are these arrhythmia issues just persistent and continuous.

I apologize for the length of this post.

My posts get lengthy and have become burdensome to me about atrial fibrillation, arrhythmias, their progressive nature, and that the real risk lies in either stroke or heart failure, with the latter term an unfortunately doom-laden one that sounds worse than it really is. However, as I just stated, most disordered hearts electrically tend to progress toward worse states or levels, and eventually all that's left is a pacemaker if nothing else is done to control the arrythmia...whichever one it is. The problem really is that the one chamber must bulk up its mass of myocytes in order to keep up. In the case of atrial fibrillation, the left atrium enlarges and thickens its muscular wall. This has the effect of causing stretching inside which causes fibrosis, or scarring. This encourages yet more fibrillation. Or, the stretching causes the mitral valve between the left atrium and ventricle to prolapse, which also tends to encourage arrythmia and wall-thickening. The point of all this is that the wall-thickening is only helpful to an upper limit after which the muscle thickness actually begins to hinder itself, and the heart loses efficiency in pumping. This insufficiency is called 'heart failure'.

Please note that people can live many years with either condition, the heart failure and/or arrythmias....except for ventricular tachycardia...you do not want that...at all...at all. It's just that there will be a gradual decline, and that is what all of us would want to avoid if possible. So, you take a DOAC (Direct Oral Anti-Coagulant) daily to minimize the risk of stroke from improper circulation in the heart (chiefly the left atrial appendage), you take a beta or a calcium channel blocker to reduce heart output (don't make the heart beat so strenuously, even at rest), but the blockers also slow the heart rate when you are in arrhythmia, and you may need an anti-arrhythmic drug like Multaq, Flecainide, Sotolol, propafenone, Diltiazem, or others...several others...and whatever you tolerate that helps you at the same time.

Unfortunately, there seems to be a wide disparity between the quality of training, and also in the experience, of all the electrophysiologists out there. The top tier ones are very busy, highly sought, and are exceptional with an exceptional record of success. However, even they frankly tell their first-time ablatees that they will probably be back for more work. And they do come back, whether in months or years. I had two ablations months apart because the index failed inside of six days.

To conclude, and to answer your question, yes, left unmanaged, or left improperly treated by drugs or by surgery, the tendency over time is for arrythmias to become persistent and then permanent. I strongly suggest you consider looking further afield for another, better, electrophysiologist. Find the best two days' drive away if necessary.

Hi @ruthieann , I have myself had many ablations some lasted a while, and others were not as successful. The fact that you EP Physican is using both procedures and or medication I found, during my arrythmias days, was necessary. What I'm saying is an EP that knows how to use both is a valuable physician. My first EP Cardiologist and my most successful was very versed with both and under His care i went the longest without major shocks. My problems became worse when one EP i had was I thought a bit too aggressive and did an unsuccessful ablation to try and eliminate medication. It only made my problem worse when I was taken off the meds that were working and my heart had a massive arrythmia, which I can't prove, but my problems went downhill from there. I never went back to him, and I did find a great EP but the damage was done. That led to my Heart transplant but please know I'm happy with the outcome. So it sounds like you have one of those EP's that is looking at all options to best decide a plan.

One other thing you mentioned upper heart which in my experience is the source of AFIB and now you have a lower chamber or the Ventricles. My problems were with the lower chambers and the EP doctors who handle AFIB are not usually the same ones that handle the lower. I once went to an AFIB EP doctor who told me that and referred me to a collogue of his who was that one I mentioned as one of my best EP doctors. So, something to check on. maybe ask about whether he is experienced with the lower chambers and if you should see a different EP for that issue. The type of medications are different also. I was not on the meds you mentioned. Hope that helps let me know if I can answer any other questions.
Blessings