Low blood pressure and metoprolol

It's a measured assessment of risk. You CAN live with AF for a long time, just not long runs over 100 BPM. But you might not survive a stroke, and this is why your cardiologist would normally prescribe an anti-coagulant right away...as soon as AF is confirmed. But usually you are also prescribed diltiazem or metoprolol to keep the rate down if it looks like you're often in AF.

Many electrophysiologists (EP) will let you take an antiarrhythmic drug on demand, or what we commonly call 'pill in pocket' for when you're out an about and need to take something soon to stop or to manage AF, Typically, that is 200mg of (often) Flecainide if you're under 150 pounds weight, or 300 if you're upwards of 170 pounds. Always consult your physician about this before starting and stopping prescribed medications.

Metoprolol acts to make the heart beat less strenuously. It can be used to reduce mild hypertension, for example, but some people don't tolerate metoprolol when they're in NSR (normal sinus rhythm). Their heart rate falls below 45, and this is in the area called 'bradycardia'. You get lightheaded, you might get dizzy and take a fall...which is hardly ever a good thing...or you feel breathless and don't have any energy. If your pulse routinely shows a resting rate, while at the computer or at the table, that is below 50 BPM, I would recommend calling your EP/cardio and telling that person what's going on. More important, for medics, is how it makes you feel...the symptoms. They trust the symptoms a lot. If you don't know you're in AF or flutter, which is quite common, then you would not be treated much except to control the rate. An ablation might be indicated, just not so soon. But, if you complain of not feeling well, of knowing when your heart is in AF, of anxiety, poor sleep, poor balance and dizziness, they most assured do want to know that and they'll almost always do something about it, including discussing an ablation with you. Or, trying another medication.

FWIW, I had to quite metoprolol because I was presenting at the ER with an HR of 30. This number is what the AV node, the final safeguard electrically, is meant to put out to keep you alive. When/if the SA node quits or is blocked, the AV node will keep you alive...barely. So, I was taken off metoprolol forthwith, and placed on the biggest hammer there is for rhythm control....amiodarone. Thankfully it kept me in NSR for all but two days for the next eight weeks.

There are remedies or solutions. Just keep a diary, and use the information when it changes unfavorably, or worryingly, with your heart specialist.

I cannot tell you how much my symptoms align with yours. I have orthostatic BP (blood pressure). My BP fluctuates when I stand up, bend down and walk. My legs are wobbly, I get dizzy and I am so fatigued. I take Midodrine to elevate my BP. I have been so frustrated. I have not been able to drive. I have a pacemaker which is wonderful. I feel for you with all the side effects. Thank you for sharing this.

I have paroxysmal afib, which over the years has been relatively infrequent (except for recently). I have low blood pressure and beta blockers like metoprolol cause symptoms like loss of feeling in my arms. Can't tolerate them at all. When I have an episode, my pulse goes high (close to 200bpm) and I usually not always, call an ambulance. The main problem in that situation is that diltiazem also lowers blood pressure. I tell paramedics not to give me the full bolus because that once lowered my systolic blood pressure to 60. The hospital gives me a diltiazem drip and watches my blood pressure.

I am not on a blood thinner as yet. If your heart rate is below 100, I believe you are safe if on a blood thinner. What is your CHADS score (either of the two scoring systems?). Are you over 75? I am curious if your score requires anti-coagulation.

I am 77 year old man diagnosed with AFib nearly two years ago after a few hours-long episodes, separated by days and weeks, which involved wild and erratic rapid heart rate. After the first couple of episodes, I was prescribed 25 mg of metoprolol succinate daily which made me feel “safe,” but then came more episodes of AFib, so, after firm diagnosis of AFib from Holter monitor, I was prescribed 50 mg Flecainide twice daily. After about a year I grew weary of sometimes too-low BP, so cut my metoprolol in half which helped considerably. (When taking Flecainide, a beta blocker serves as protection from possible dangerous arrhythmia caused by the Flecainide.) So far, no more AFib episodes with no need to increase any meds. I have also significantly improved my diet and exercise practices since diagnosed. Because I am healthy and quite active and have had no breakthrough AFib episodes, I do not take an anticoagulant, with blessing of my cardiologist, even though my age puts my CHADS score up to strongly suggest I take it. My next step will be to cut Flecainide in half and see what happens. That’s because the downside of both these meds is that they make me feel like I have a mild case of the flu half the time. I strongly believe that the fewer drugs we take, the better, especially if we can improve our health with lifestyle and behavioral changes.

I also take metoprolol, twice daily. It's to keep heart regulated. I take mine for PVC's and PAC'S though. My heart would race when I got excited. My adrenaline pump wouldn't cut off and the metoprolol keeps it from doing that.

My EP has told me that beta blockers are not indicated for me because my blood pressure averages 110/66 and drops to 90/58 at times, my resting heart rate is 58 and it can drop to 35 before bouncing back up. I have a history of near fainting in the past. The standard of care for people taking Flecainide is to also take a beta blocker. I can't tolerate it.

The pill in the pocket approach to manage my asymptomatic AFib works best for me with Flecainide.

My Apple Watch alerts me of irregular heart rhythms, and my Omron Connect Series 7 wrist blood pressure device also displays a rhythm alert icon when it detects an irregular rhythm. My LookeeTech 2 lead ECG shows me if the rhythm is occasional PVCs or PACs, which are normal for me, if I am in AFib.

I live a normal life now and I carry an oximeter, Lookee Tech ECG, Omron Connect BP in my small purse when I go out. I wear my Apple Watch and I always have my meds with me. This has given me the confidence to live my life and manage my arrhythmias. I keep an eye on my Apple Watch during the day and I don't stress like I used to four years ago. I feel well most days.

Physical therapy has made a huge difference in how I feel. I am stronger from strength training, more flexible, improved balance, and I have less pain from osteoarthritis and osteopenia. I have a home program and I go every 3 months for follow up that it is covered by Original Medicare and my Medigap plan F.

Hello. Would love to know how you monitor afib on watch mine is apple8 and can’t make it monitor auto. Also would love to know your if you take bp cuff with you. I’m looking for that option. Too big. Also, your routine w Pt and exercise. My Medicare limit on Pt visits. I have osteoporosis and joint pain too!

@lkl

I have listed some links below on how to setup your Apple Watch. I have “Irregular Rhythm” setup on my watch because I get different arrhythmias. I set my High Heart Rate to 100 and Low Heart Rate to 50. This can be customized.

Irregular Rhythm Notifications
https://support.apple.com/en-us/HT20893

AFib History Setup
https://support.apple.com/en-us/HT212214

Apple Support For Questions
800-275-2273

Omron Connect Series 7 Wrist Blood Pressure.
I buy this online from Concord Health Supply. They have excellent customer service and guarantee.

Physical Therapy:
Original Medicare will pay for PT for a specific diagnosis within a 3 month period before it needs to be reevaluated for additional visits, however, if you are a Fall Risk or have balance issues, Medicare will pay for unlimited number of visits every 3 months Medicare Advantage Plans may have more limitations.

I see a Musculoskeletal Orthopedist at the Sports Medicine Clinic and he sends in PT orders for specific areas I need exercises for (lower back, shoulder, ankle, core, etc).

Make sure your therapist is aware of your heart diagnoses and is able to modify your program for your heart. Ask for a therapist who is trained in Cardiac Rehab, or is able to collaborate with a Cardiac Rehab PT. Medicare will only pay for Cardiac Rehab for a limited number of diagnoses.

I have heart failure ( HFPEF) and it is difficult for my heart to pump blood to the arms and legs moving at the same time. My therapists modify my strength training exercises to use hand weights and bands either sitting in a chair or on the side of my bed, or lying down to exercise individual muscle groups (arms, legs, shoulder, back, core). I am in now in great shape for my age. I pair my exercises to my daily activities and spread them out throughout the day. This makes them easy to do in short segments.

Please send me a private message if you need additional help.

Extremely helpful. My cardiologist recommended a Boston Scientific “loup recorder” implant in my chest to record and monitor my heart rate that has been referred to like the “NY stock exchange…. HR All over the place”… most concerning … SVTs running from 200 bpm to 300 bpm. Also some bradycardia with hr @ 30 while sleeping. Bp stays pretty low all the time…Arm movement is a definite trigger. Fast moving of any kind really just runs hr way up. I had two “acute coronary spasms” back to back(to me they might as well have been heart attacks(ekg stated myocardial infarction)…. But no damage to heart per ejection fraction. Wondering about the loup implants. Dr says they be can use for constant control of the meds until they “know what they are treating” and possibly it will be a pacemaker. Any thoughts welcome. Best wishes to all of you.