Cardiologist doubled my metoprolol to treat PVC

Posted by shorisha @shorisha, May 14 4:03am

My cardiologist doubled my dose of metoprolol from 25mg to 50mg. Anyone else heard of this as an approach to address PVC's?

Mickey

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lindy9 | @lindy9 | 4 days ago

In reply to @ruthieann "I am glad to discover this site. A little history... In the spring of '22 started..." + (show)

I had severe episodes from age 14 to 19. Read in newspaper column that some people are SEVERELY sensitive to caffeine. After quitting coffee etc, I had NO problems for YEARS, until lately without thinking I was eating coffee ice cream from the US. Once I put 2 plus 2 together, I stopped the coffee ice cream and fine. That med you are taking has bad side effects. At age 75, I take NO meds for anything. I investigate the CAUSE of the problem.

ruthieann | @ruthieann | 2 days ago

Dana,
Thank your information. I have been referred to an EP who specializes in the lower chamber ablations. Now I am waiting for the call back and to see what my echo shows, etc. I didn't realize the medications for the lower and upper heart would be different, but it makes sense. You mentioned you were on different medications for the lower chambers. Do you recall what medications you were on at that time. That may be helpful for me to know. I appreciate your help. Thank you.

ruthieann | @ruthieann | 2 days ago

In reply to @gloaming "My posts get lengthy and have become burdensome to me about atrial fibrillation, arrhythmias, their progressive..." + (show)

@gloaming

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.

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Hi @gloaming,
Thank you so much for the information you shared. This issue is hard for me to make sense of and your explanation is helping to clarify the big picture. I also appreciate your comment on the doom-laden term 'heart failure'. And further input about living many years which I hope too at age 69, turning 70 this summer.
I am currently looking for an EP. And, yes I would drive two days away if I could get in to see the proper doctors! I am originally from WI. My husband and I were going to spend the month of July in Rochester, MN this summer to escape the TX heat. But because of my arrhythmia issue we canceled our plans. Currently, I am attempting to get an appointment with a different EP in Austin or Houston, but I am waiting for a call back. Maybe I should have kept the plans for Minnesota and tried to see a doctor there. Here, in TX it takes about a month to get an appointment.
I do have another question. How do you go about finding the best cardiologists and best EPs? I went to TCA (Texas Cardiac Arrhythmia, supposedly world renown) in Austin and had two ablations done and neither one worked more than two weeks. The doctor I had in Austin was highly recommended by several people I knew. (I guess that situation is similar to what happened to you. Sometimes they just don't work) Anyway, if you know how I can find out about a doctor who specializes in lower chamber ablations please let me know.
I do appreciate your sharing. Thanks for listening to my ongoing search for a remedy to this problem. It's complicated.
Thank you.
Ruthie

ruthieann | @ruthieann | 2 days ago

In reply to @lindy9 "I had severe episodes from age 14 to 19. Read in newspaper column that some people..." + (show)

Thank you for your comment.
I think it is remarkable to be 75 and take no medicines for anything!
You are very fortunate.

gloaming | @gloaming | 2 days ago

In reply to @ruthieann "Hi @Gloaming, Thank you so much for the information you shared. This issue is hard for..." + (show)

You have seen Dr. Natale, then? He is about the best there is. However, even he has his failures, regrettably. He often has to do a touchup ablation, and warns his patients when he sees them after his first crack at them in the surgery if he suspects they'll have to come back for a 'cleanup', or for a Watchman implant. I would suggest going back. He's extremely competent. The only other I know of is Dr, Santangeli at Cleveland Clinic, also a crackerjack EP. I don't know of others in the top drawer, but there must be some. The only other world-renowned EP, and he taught Natale, is Dr. Pierre Jais in Bordeaux, Fr.

It's not exactly a perfect plum or a warm peach to grasp at, but if worse comes to the worst, and nobody can fix your particular cardiology, you can always have a pacemaker implanted.

lindy9 | @lindy9 | 2 days ago

In reply to @ruthieann "Thank you for your comment. I think it is remarkable to be 75 and take no..." + (show)

I doubt I am remarkable. The reason I don't take meds is, the few times I went for treatment for a few valid concerns, I had read up on the problem and knew more than the doctors because they are mainly trained to give you meds that were worse or more scary than the original problem.
I have alleviated many health issues by decreasing sugar. Also, a chiropractor who uses the Gonstead method eliminated health issues I had that I didn't know he could help. I would go in for one problem and he would eliminate three. I wish he lived near me now.
But I have a list of 35 people that have died, many younger than me, The majority self destructed with unhealthy habits, and spent their time in and out of doctor's offices and hospitals, and unnecessary meds for things they could get rid of naturally. And then get cancer and spend the last year of their life getting chemo, radiation, etc. and losing their hair etc. Every one of them on their death bed stated they would not go the chemo route if they had to do it over again. My friend's aunt was diagnosed with stomach cancer at the age of 80. The docs told her she needed operation, and chemo, etc. Her response was NO!!! The docs told her she would doe if she didn't (well, we are all going to eventually.) She ended up living 12 more years to 92!!! A neighbor I had who was 8s, went in for a checkup, because her out of town daughter didn't want her to live alone. So she went to prove to her she was fine. She WAS fine, but one prescribed a med because a number was a little high, and had negative side effects, and after 6 months was taking a handful of meds. Her last symptom was depression, which she never had before, and lost her will to live. EVERY problem she had was from the meds. She stopped eating and died.
Remember the drug ad where a lady is sitting in doc's office because her med for depression was not doing anything. So the doc says, sometimes you need another. And then in the ad warn you to call you if you feel like committing SUICIDE! And people take these meds!!!

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