I have been taking Carvedilol for 21 years and had to stop abruptly.
I am 53 year old male. I had an aortic valve replacement surgery when I was 32 years old. Shortly after they put me on Carvedilol (alpha/beta blocker). The dose was gradually increased up to 25 MG twice a day. I handled it fine and up to four months ago I was doing well. I changed my diet 6 months ago. I stopped eating red meat, and cut out fries and soda. At first I just felt better. A few months ago I started noticing what I called skipping heart beats. I think they are called PVCs, but it just feels like the heart pauses and starts beating again. I didn't think much of it at the time. I have had them before, just not as frequent. It wasn't until I woke up and they continued off and on for about 20 minutes that I thought to take my blood pressure. I sat at my desk for an hour to let my body purge any adrenaline or Cortisol from waking. My blood pressures were fine, but my heart rate was in the low to mid 40s. I called my heart clinic and was instructed not to take my Carvedilol that day. The next day I was instructed to take 12.5 MG. This too dropped my heart rate back into the mid 40s. I called the following day to let them know I was back in the 40s for my heart rate, and was instructed to hold my Carvedilol. They said if my resting heart rate climbs to over 60 I should take my Carvedilol. My resting heart rates have been the low to upper 50s. I went from 25 MG twice a day to zero Carvedilol in a couple of days. The aftermath has been tough. It has only been a little over a week since my last pill. I get frequent 'heart skips' or PVC, mainly after eating, or when walking around. I have read up on this. Carvedilol has suppressed the adrenaline receptors in my heart for 21 years. Right now they are hyper sensitive. Any release of adrenaline, or morning Cortisol, will cause my heart to react. Luckily my heart isn't jumping into unsafe heart rates, but the feeling of the skipping is unsettling. I have had several panic attacks while driving and just sitting in a chair. From what I have read the heart will start to tone down the receptors and the skipping will fade away, but it make take months. Just to explain why I needed the medicine a little more. After my heart valve surgery my heart was enlarged due to a leaky bicuspid valve. I was told the medicine would take the strain off the heart and keep the blood pressures down. I found out later that the overworked heart had also created a 4.3 cm aneurysm. It has not changed size in 21 years. I am set to wear a heart monitor for two weeks starting next week. After my current experience I see why they need to step down the medication, but I guess in my case that wasn't option with low heart rates. Has anyone else experienced similar symptoms when forced to stop Carvedilol? Will it improve with time?
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I cannot answer you directly as my arrhythmia is different, but are you sure it's PVCs and not simple PACs? Have you a formal diagnosis? The heart monitor will tell.
Secondly, and I'm not in a position at all to question your advice from a professional (I am untrained), but the normal range for hearts in sinus rhythm is between 60 and 100 BPM. Yes, all the way up to 100 BPM is considered within the 'normal' range when at rest. It's bizarre, I know....but that's what the literature says.
https://my.clevelandclinic.org/health/diagnostics/heart-rate
So why do you suppose you have instructions to monitor and to squawk when your rate exceeds a mere 60 BPM?
Not any advise but congratulations that the aneurysm has not gotten any bigger.
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1 Reaction@gloaming Maybe I should clarify. Taking the Carvedilol if the resting heart rate was in the 60s, That was the initial information from the Nurse. She later called back after hearing form the doctor who said to suspend the medication. They wanted my heart rate to be in the 50s, but not to exceed 100. I can only assume she was being cautious. My Carvedilol has turned volume control down on adrenaline spikes for 21 years. I think, but do not know, they didn't want my heart to freak out now the volume control is turned way up. I am assuming they PVCs, but not sure. From what I have learned online, PVCs can show as a downward spike after an upward spike on my Apple Watch's ECG app. That is what I see if I run it while having them. Also what I found on a google search "PVC causes a long pause followed by a very noticeable, heavy thump or empty "skip" sensation in your chest". That is what I am feeling. Like you said I will know more once I have the heart monitor.
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1 Reaction@gloaming and heartvalve2
Regarding normal sinus rhythm (NSR), normal heart rate, and what might be normal for an individual:
1. Talk to your doctor?
2. NSR, with normal EKG including pqrs electric waves might be 60 to 100 at rest, however a "normal " resting rate of 90 or 100 might be unusual (high) and perhaps your doctor will have an explanation if/when 90 or greater is the usual rate at rest? Normal for a resting healthy athlete might be 50 beats per minute, as long as the PQRS on EKG shows normal electrical activity.
3. Your normal and clinically acceptable rate might be a function of your heart, rhythm, and physical health - again perhaps something to discuss with your cardiologist if you are fortunate to be able to do so.
Best wishes
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1 Reaction@heartvalve2
I was going to mentioned a few things since I have been on Carvedilol (Coreg) since 2006. I am on Coreg and Entresto. Together they lowered my pulse rate into low 40s. I have a pacemaker so they raised my pulsing up until the PVCs got lessor. For me that was at 70 bpm.
Your medication can be the cause of the low pulse rate as mine did but just a comparison. I was told by my cardiologist that when heart rate gets this low PVCs increase are very common and troublesome. The heart rate is very low. Some athletes I have been told have very low pulse rates from fitness and many have had pacemakers.
A side affect (again from my cardiologist not my opinion) from increase PVCs is increased chances of tachycardia.
Again what was told by my cardiologist and PCP. When you eat the brain talks to vagus nerve. It send a signal to have more blood flow to digestion. Thus more symptoms can occur. I was told to eat small and more often. To sit straight up and try to walk after a small meal also. Not sure of all the medical connection of this but just passing on my instructions for my cardiologist trying to reduce my PVCs and runs of tachycardia.
Again not a medical opinion only passing on what information I learned from dealing with similar symptoms, same medication and what was told to me not that it applies to others.
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1 Reaction@heartvalve2 There ya go...not to exceed 100. And that meshes with the instructions I was given after my ablations for AF: only get urgent treatment if your HR exceeds 100 BPM, and in my instructions, for 24 hours! Even a few days after an ablation, the instructions said not to sweat it if my HR rose to 120, but fell to normal again under 24 hrs. That sounds horrendous, to me, but fortunately I didn't have that experience. I was in the ER on doctor's orders as soon as he felt my wrist and raised an eyebrow, telling me I was in AF at the moment.
I hope you continue to improve.
@gloaming
To clarify, HR of 100 - 120 was a red line, but what if any guidelines for exercise?
Thank you for your information
Best wishes
@heartvalve2
Per my heart failure (HF) doctor. Reference your post below:
"PVC causes a long pause followed by a very noticeable, heavy thump or empty "skip" sensation in your chest"
I feel the same and described to my HF cardiologist. His explanation was the erratic PVCs does not result in a full (EF fraction) pump of blood out of left ventricle (LV). Thus when it does contract normally there is more blood in the heart and you get that heavy thump because heart is full of more blood after the PVC.
This help me understand what I was feeling. My electrophysiologist (EP) also told me every single cell in the heart is capable of sending an electrical shock to heart. Thus he said you can see how this can happened and be so prevalent. He went on to say "our role is to find out where and treat it with medication and or applicable and ablation.
I hope that helped as I experienced the same feeling. And when I do it get on going PVCs (and it happens a lot) I become even more heart focused and more stress/anxiety contributing to (My EP) more PVCs.
@tallbackhip I'm not clear on your question. Are you asking if a person wishes to do aerobic or HIIT exercise while in obvious, measured, AF, what should the rate be, or what upper limit would be appropriate? I can't answer that as the individual's symptoms would govern the limits. I was at the end of a 10 km run when I had my first bout of AF. I was at the time retired, and had a history of training for running races. My resting HR was 45 BPM, up from 38 when I was in my 30's. My typical training when I was diagnosed comprised 10 runs up to 20 km, sometimes running quickly, sometimes just plodding. My HR would rise to 170 BPM if running up a hill, of which there were plenty locally, or back off to 140 if just running at a 'maintenance' pace, say 8'/mile. It turns out that my running was not the initiator of my AF. It was late-diagnosed 'severe obstructive sleep apnea.'
When I was experiencing AF, seated and watching TV, my rate would exceed 138 BPM typically, sometimes rising to 180. That is not a dangerous state, especially for a healthy and fit heart used to sustained effort. But it can't be maintained indefinitely as it can lead to cardiomyopathy and eventually to the 'remodelling' that we are warned to avoid. So, my instructions, and what we routinely counsel newcomers to afibbers.org forum, is that AF is not a dangerous disorder unless it is sustained beyond 24 hrs at a rate above 100 BPM, is accompanied with RVR (rapid ventricular response), and is highly symptomatic (shortness of breath, fainting, excessive anxiety, etc).
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1 ReactionYes, that's the sort of information I was wondering about, when is a HR above 100 a concern, and in particular in relation to advice about HR and exercise.
Thanks for your information.