Connect
CABG, Beta Blocker Rebound and Running?
Hi, new member here with my first post. I'm 57 years old, and had cabg x6 in March 2018. In 2017, I was running 5k's, then developed stable angina in February 2018. After my surgery, I was prescribed Crestor, Plavix, metoprolol tartarate (25 mg 2x/day), and low dose aspirin. In addition, I have been taking Wellbutrin for around 6 years for an unrelated condition. My concern is with the metoprolol and some adverse effects that I am having.
My recovery went very well, probably due to my overall physical condition. I started running again in April and noticed the following: substantial effort where rate of perceived exertion (RPE) was high, dizziness when standing, weight gain, bradycardia, hypotension, and winded when climbing hills and stairs. My cardiologist reduced my medication to 12.5 2x/day and some of the symptoms subsided. I also found that my runs were improved if I ran *before* taking the half-tablet. (RPE) was improved, heart rate increase slightly but would I would still struggle with longer runs.
After discussion with my cardiologist, he decided to have me stop taking the metoprolol since it was such a small dose. Three days later, my easy run pace improved by 1 minute/mile with a much improved RPE. However my heart rate was near my maximum. I also noticed irregular heart beat, my blood pressure was ca. 160/105, palpitations, feelings of anxiety. The concern that I have is whether or not the Wellbutrin caused the "low dose" metoprolol to have more of an effect on blood concentration, thus making the sudden stop in medication causing a rebound effect.
I discussed the interaction between metoprolol and Wellbutrin with my cardiologist and he seemed convinced that 12.5 mg 2x/day was a very small dosage and did not appear to be concerned with the rebound effect. If my heart rate is near maximum when running *easy*, then should I be concerned with running harder? Also, should I be following a tapering protocol? Any guidance would be helpful, and I do realize that before doing anything, I should consult my cardiologist or other health care provider.
Additional stats: male, 5'10", 148 lbs, thin/average frame. Not obese, not type 2 diabetic, history of high cholesterol w/ HDL >70. Family history of heart-related issues. Ejection fraction 55% prior to surgery.
Like
Helpful
HugInterested in more discussions like this? Go to the Heart & Blood Health Support Group.
Connect
@whiteblaze2026 Hi Welcome to connect we have alot of good people here ,give the treatments that have helped them for there problems I think with that kind of blood pressure you should consult your Dr. Till others join in that is my suggestion.
@lioness Thanks for the nice welcome. I am very much looking forward to any thoughts that come from this forum. Have a great day!
Joe
-
Like -
Helpful -
Hug
1 ReactionWelcome! Your being here is giving others (me 🙂 ) ideas too! When all ideas are shared, then the discussion with our doc can be much more meaningful maybe... So, my two cents: As an engineer, when troubleshooting why something is wrong, I MAKE ONE CHANGE AT A TIME. Check the results, then, if not result I wanted to see, PUT IT BACK THE WAY IT WAS and try a different change. Repeat.
I say this because you are taking more medicines than just the Lopressor; can either of the other 2 medicines for cholesterol cause your issues?
10 years ago when I started on BP medicine, I took a beta blocker. But it had to be changed to an Alpha blocker instead as it made me so dizzy I couldnt even drive... Now back to Lopressor like you and yep, dizzy, but I did get A-fib out of my aortic surgery 4 weeks ago... I wonder if there isn't a different medicine that a) reduces heart rate, b) reduces BP, and maybe helps reduce A-fib? I was on a water pill for a week after surgery; it stated it could reduce A-fib IIRC...
@yorlik Thanks for the reply. I'm also an engineer (electrical) and have been looking at data lol.
My concern was the rebound effect from stopping Lopressor suddenly, because my heart rate and blood pressure seemed to have spiked. I went back to my running logs and compared my runs' average heart rates and when I started and stopped the Lopressor. Without performing a null hypothesis test, it looks like there is a difference between before and after heart rates.
After my first posting, my cardiologist put me on a holter monitor for a weekend and I'm awaiting the results of that. The rebound effect seems to have subsided and no longer dizzy when standing, resting heart rate is normal (ca. 62 bpm), climbing stairs does not cause me to get winded, but I still do have some irregular heartbeats. My average heart rate while running is higher but perceived exertion is lower for the same running pace with and without Lopressor.
Google is a dangerous thing- you can find what you want lol... but I have seen some apparently reputable sites (mostly targeted to an athletic audience) that suggest ARB's, ACE inhibitors, or a calcium channel blocker may be viable options. Diuretics are not suggested as the can lead to easy dehydration for those who sweat a lot during workouts. By the way, sweat reduced after I stopped the Lopressor. While I was on it, after a run, it looked like I was sprayed down with a garden hose and I lost 5% of body weight in sweat, compared to ca. 2% without Lopressor.
Stay tuned for further developments. Thanks again for the reply.
Joe
Excellent analysis! BSEE here too! I have a hard time determining 'bpm' with my A-fib; do you count the real faint ones out of rythm? And how many of them? My Samsung phone as heart rate monitor built in; a red lite you put finger over - it then scopes out the heartbeats. 15% of the time mine is so crazy it can't count BPM number; other times it will count 40bpm and 30 sec later it counts 135. It just can't decide which to count! The few times I am not in A-fib, the rythm is mesmorizing, each pulse identical, evenly spaced and come in around 65bbpm. Losartan says it tries to correct the irregular beats... wonder if maybe your doc would cut your to the lower dosage and do it once per day instead of 2x?
The heart rate that I was referring to was while running, so my Garmin Forerunner 235 counts it. When in cardiac rehab, I never had any irregularities while running- ekg was textbook. It happens only at rest, but I do count bpm only when the blood pressure monitor does not indicate an irregular beat.
Regarding my dosage, I was on 12.5 mg (one half the smallest tablet) once a day. My theory is that Lopressor and Wellbutrin (the other medication I'm on) has an interaction which increases blood concentration of the Lopressor. One site stated that concentration increases ca. 4x to 6x, but I don't know how reliable that is. We started with Lopressor slow release 50 mg? x 1x and that slowed my hearbeat down to around 40. Then went to normal release 25 mg x 2x, then 12.5 x 2x, then 1x. This was immediately after cabg over the course of a week or two. I was on 12.5 mg for around 4 months.
I have a Samsung also, and tried the heart rate monitor pre-cabg and it worked ok. That was before I wore the Garmin. It hiccups occasionally because of the sensor on the backside of the watch doesn't always mate up well with my wrist.
Have you ever had this symptom? Hard to explain, but have you ever had a muscle twitch from time to time? I had that happen in my neck where my carotid artery resides. I didn't think much of it, thinking it was just a twitch, until I was taking my pulse and noticed that the "twitch" occurred when my heart skipped. I wonder if my "pump" is pulling a vacuum?
Whew! I just looked up cabg - complex! with the various ways they can bypass, I would say making a vacuum is as good a guess as any! interesting that it happened when a beat was missed.. even when I miss beats there is a bunch of shaking around activity, it is not just dead time. could be some of them are 180 degrees out of synch with the real forward pump and thus causing a reversal. Bet your cardiologist loves talking to you - asuming he has time and does so.