How Common are Heart Arrhythmias?

I'm closing in one my 1-year AVR anniversary and noticed that under stressful situations, I still have the occassional heart arrhythmia or skipped beat.

During my initial 12-week rehab, I had some heart arrhythmias that were noticed by the rehab nurses. After wearing a halter monitor, my cardio put me on some calcium blockers, then beta blockers and now I'm down to 12 MG of Toprol XL.

Over the past few weeks, my life has become pretty stressful due to some career demands, etc. I have noticed that during moments of higher anxiety, stress or exercise, I still have the occassional missed beat or heart arrhythmia. Upon researching this, I found out that the beta blocker (Toprol) might actually be contributing to this.

Has anyone else experienced anything similar to this? The last time this happened in late February, my cardio reduced my Toprol from 25Mg to 12Mg and the arrhythmias went away. I'm confused

Hi,
My boyfriend Jim(AVR early December) is taking 40mg twice daily of sotalol (an anti-arrhythmic beta-blocker) since going into SVT in January. He has kind of the opposite problem to yours - he's fine while he's doing anything, but when he's sitting/lying down, and his HR drops below 60bpm, he gets ectopic beats. There was a definite point around mid-April where this all started up, and at the same time his heart rate generally dropped by around 10-15 bpm both exercising and resting, and his blood pressure got a bit lower - both due to just getting better I imagine. Apparently sotalol does have proarrhythmic (ie it can cause other arrhythmias than the ones it's supposed to stop!) properties, particularly when there's bradycardia (low HR, which is usually below 60bpm) or various other things such as low magnesium and potassium levels. Not sure if this is exactly the same as the situation with toprol but it sounds kind of similar. It can apparently be dose-related.
Jim's rehab nurse and GP both think the sotalol may be working "too well", but he's on the lowest dose. Both have suggested changing to atenolol, which has equal success at maintaining sinus rhythm compared to sotalol, but the GP won't change it without the cardio's say-so. Bizarrely, he doesn't seem to have contacted Jim's cardio to ask his advice Then a few weeks later, he suggested upping the dose "just to see what happens" but Jim hasn't done it. Can't say I blame him - it's already making his heart slow enough and him tired enough, he sure doesn't need any more of that!
I'm not a doctor and this is purely my hypothesising, but I'm wondering if maybe both you and Jim could see what the docs think about weaning you off the beta-blockers. Maybe I'm over-optimistic? Or over-curious? I'd just like to know what would happen to Jim's heart rate/rhythm if he wasn't taking the sotalol - I'm not sure anyone can guarantee that he would have problems, but they'd rather keep him on the sotalol as that way they're sure to avoid a FAST arrhythmia. Talk about being stuck between a rock and a hard place. And we've got to wait until November to bring all this up with the cardio!!!
Hope you get this resolved - and please let us know how it's resolved - the more ammo we've got to convince Jim's doctors, the better
Gemma.

Arrhymias are very common, and I have found that stress is by far the most significant factor in causing them. I take 500mg of magnesium daily, which normally keeps them in check, other than for times of high stress. Then the uneven heart beat reminds me to sit down, take a rest, and stop stressing out over a situation I can't change anyway, whatever it happens to be at the moment.

Allen, you're normal. Stress is the big ugly monster that likes to use your heart as a soccer ball. I'm over 12 years post-op and I still get PAC's and PVC's when I'm stressed. Usually it's just for a day. But I went through a period last Fall (when our nest became empty) that lasted a good month or more.

I've taken 50 mg of Toprol since my surgery. The main reason is to slow my heart rate, but it also keeps most arrhytmia at bay. Unless I'm stressed or getting sick. I can usually tell when I'm getting a cold because my heart gets a little jumpy.

How common are arrhythmias?

VERY COMMON !!!

The chief contributors are STRESS, Sleep Deprivation, CAFFEINE, and something else which I have forgotten. Sounds like the ingredients of most high pressure work environments, right? How much COFFEE do you drink?
How much CHOCOLATE do you eat?

I finally felt like I had reached my full level of recovery at 18 months post op. Had a GREAT 6 months after that and then began having ARRHYTHMIAS, usually several hours after working/exercising. My cardio told me to increase my Toprol XL from 25 mg to 50 mg. While on a 30 day monitor, I accidently discovered that if I omitted my morning cup of Hot Chocolate (which has caffeine in it), the arrhythmias went away. If I over indulged in Chocolate, they came back.

Bottom Line: see if cutting back on Caffeine helps. Good luck on reducing your stress levels! REGULAR Exercise should help you increase your ability to handle stress. Good luck finding the time

My cardio checked my magnesium levels, said they were OK and told me not to take any supplements. I still wonder. There are SEVERAL VR.com members who report good results from taking 400? mg of magnesium daily. It's worth asking your cardio.

'AL'

I agree with Al. Everyone gets arrhythmias sometimes. I am about to be moved at work from an open cube into a closet, and every day since I found out, I've gotten arrhythmias in the morning at work. This is disheartening, as I've not really felt any since I came home.

Anyway, the point is that it is stress, not a heart problem, that's causing it for me. I'd been brutally physically active the week before with absolutely no symptoms. Tell me I'm going to have to report to work all day in a coffin, and I start getting chest rattles.

Everyone must do what he or she feels works for them. Unless it's continuous or threatening in some other way, my own approach is not going to be to run to the cardiologist, unless he can keep me in my open cube at work. All he can do is dump on more meds and say, "See how this works."

Best wishes,

Just to add...

From what I understand (from my cardiologist) the time to get worried is when either they persist for a long period of time (10 minutes or more) or you start to feel light-headed or faint...

Not actually fainting, just feel like it, sleepy like you might pass out or at least feel woosy.

But not the "woosy" my son describes, for that you jsut have some water, hell get it for you, quite funny actually. He usually feels "woosy" after walking near a drinking fountain or a room with a sink he can reach...

Anyways, the arrhythmias are inefficient heart rhythms and after time the supply of oxygen to the brain isn't enough to keep it going right so it starts getting "sleepy" which, of course, isn't a good thing for the brain to do...


I was advised WAY the heck before I had any heart related issues (not counting my CHD and OHS after birth) in high school that if I felt any abnormal heart rhythms that persisted longer than 10-15 minutes or started feeling light-heated or whatever, to get to the ER and tell them what's going on.

I guess they use adrenalin or something to kick start your heart some, but it's never gotten than serious in my experience so I don't really know.

Hey, on a related note:

Anyone have information experience to share on 24 holter (that's not what my cardiologist called it, but the same thing I'm pretty sure) monitors?


My thought is to get the initial appointment and "installation" set up on a Monday morning when I'm off work. I can shower before going to the hospital's cardiology department and get wired up then go about my day. The next morning (Tuesday) I can go back and get unplugged then go home and take a shower to get all the glue off...

I'm not keen on the glue they use for those leads.

Just wondered what kind of experience I might be getting myself into here...

Not worried or anything, just like to know what to expect and if there's any advice or hints on stuff to do or NOT to do while wired up. =)

Hey Harpoon,

The Holters aren't that bad. I had one a while ago and they told me to do everything as I would normally (..or as normally as one can with a car battery hooked up to them!! ..)

The only thing I hated was not being able to shower for 24hrs. Sleeping wasn't too bad - I kept the "car battery" in front of my stomach and slept on my side without too much incidence.

I went to work the next morning (sponge bath!) and almost missed my bus, so they got some very good readings while I was madly sprinting up the hill - then almost having a coronary afterward!!

The glue wasn't so bad, I just had some funky little marks on my skin for a few days after. Not sure how hairy your chest is, but that wasn't really an issue for me..!


Anyhoo.... after reading this thread, I was wondering how concerned I should be about the frequency of my PACs and PVCs. I seriously have these ALL the time, which is to say, I don't go 5 minutes a day without one or the other and this is a constant thing - day in, day out. My cardio doesn't seem to think they're anything to be worried about (.."most people get them"..), but if I'm having them THAT often, surely that can't be good for me? Would appreciate your thoughts (..and no, I don't drink coffee or soft drinks, eat very much chocolate at all, or have a great deal of stress going on..).

Cheers all
Anna : )

Not long ago I started a thread on the same topic. I am one year post op for aortic valve replacement. I though I was past the hump and have recently had some palpitations that felt like A-Fib. The last was concerning. My echoes and excellent and my coronaries are wide open. My doc thinks it may be anxiety induced and gave me some SSRIs and it has seemed to help.
I can go three weeks without palpitations and a Holter is only for 24 hours. He will be putting me on a long term event monitor that I will wear for approximately 30 days. The arrhythmia and electrical impulses are recorded on a chip and I dial into a data line when there is an event. It is in ingeious technology and my surgeon says the beauty is that they an see what is happening before the arrhythmia starts and that is good data to have.
Anyway arrhythmia is very common but we have to be careful as a certain (albeit low percentages) can be fatal. After I year I want get to the bottom of it and my docs think it is nothing to be alarmed about.
Anyway, the down side of a Holter is that is is 24 hours and if you don't have an event it ay or may not tell you much.

I didn't enjoy carrying the Holter monitor on a bandolier at my side in public, as it felt like I was carting around a cheap radio - and showing it off. Very humbling.

Don't worry about the glue sticking. They BIC-razor your chest where they put the sensors, so you look like you unsuccessfully tried to mate with a rabid Remington shaver. As I wore the monitor shortly after my operation, my chest hair was still growing back, and I was a little misty about losing parts of it again so soon.

Abbanabba did much better at sleeping with it than I did, I guess. I slept uncomfortably on my back, with it at my side, sandwiched between my arm and The Little Dog, who functions as a hyphen between my wife and me most nights. Sometime during the night, the cat decided to test out the new spaghetti-wire bed on my chest, but fortunately didn't stay long. I didn't dare throw her off, because I was afraid she'd attach herself to some part of the equipment during the ejection process.

I hooked the monitor up high on the other side of the shower curtain rod and took a shower anyway. The tech had said the sensors could get wet without damage, I felt the unit itself was protected dry, and I had no problems with it. Better check with your tech about the specific model you wear, though, as getting electrocuted in the shower may not be on your personal to-do list.

It's just one day. It's bearable.

Ya know, Anna, if you're really having PACs/PVCs all the time, as you describe, it sure would explain your SOB, sometimes tiredness, and loopy balance.

While a heart experiencing PACs and PVCs does move some blood, it doesn't move blood appropriately or efficiently. When that's happening, the blood doesn't get oxygenated to normal levels, and the blood that is oxygenated is not delivered at proper levels. If the arrhythmias continue, it can result in symptoms of SOB, fatigue, dizziness...

And a further thought, PACs and PVCs sometimes slow down or disappear when the individual focuses on physical activites. This can make them difficult to note properly on stress tests and similar active laboratory monitoring, where the patient is apt to be functioning at a more accellerated level.

Best wishes,

Say it isn?t so!!!

Say it isn?t so!!!

Allen,

You?re freakin? me out.

You said:
?Upon researching this, I found out that the beta blocker (Toprol) might actually be contributing to this.?

What research says that?

tobagotwo said:

And a further thought, PACs and PVCs sometimes slow down or disappear when the individual focuses on physical activites. This can make them difficult to note properly on stress tests and similar active laboratory monitoring, where the patient is apt to be functioning at a more accellerated level.

Click to expand...

Hmmmmm, that's very interesting, and now that you mention it they probably act up more just after I've been doing something active (..which is pretty much when they take all the leads off!..). It seems everyone is reluctant to give me anything to "smooth" these things out because my underlying HR is already quite low and they don't want to lower it any further. I wonder if a pacemaker would help things?

A : )

Before I had my surgery, my cardio warned me of the irregular heartbeats. He said that when you cut the chordae tendonae to take the old valve out, it does something (I can't remember what he called it) and causes rhythm problems. I have PACs almost constantly. I took Atenolol for awhile, but hated how tired it made me, and I still had the rhythm problems, so I convinced my doctor to take me off of it. Frankly, I don't even notice the extra beats anymore. Occasionally I have that sensation that makes me cough to get it back on track, but I think that is mild atrial fib.

I think everyone has skipped beats and extra beats occasionally, especially in those situations that were previously mentioned. It's just that when you valve is audible and you are so aware of your heart, you are much more likely to notice it.

Have you tried MAGNESIUM supplements?

Several VR.com contributors had indicated they take 400 or 500 mg of Magnesium daily and it solved their irregular heart beat problem. Just to be safe, check with your Cardiologist for his 'OK' beforehand.

You didn't say how much atenolol you were taking previously. I was on a medium-high dose (100 mg) of Toprol and also felt 'draggy'. My cardio had me cut the dose in half for two weeks. No problem and felt better. Cut the dose in half again. No problem. Went cold turkey after two more weeks. Sure enough, arrhythmias started back after several days. Back to small dose (25mg) of Toprol XL (extended release) which worked until my tolerance for Caffeine (actually Chocolate) took a dive. Now I don't knowingly take anything with caffeine and no more arrhythmias. I'm going to address the Magnesium approach again on my next Cardio appt.

'AL'

Rain said:

Allen,

You?re freakin? me out.

You said:
?Upon researching this, I found out that the beta blocker (Toprol) might actually be contributing to this.?

What research says that?

Click to expand...

Thanks for all the replies. Great information shared. Regarding the Toprol, I performed some internet research on heart arrhythmias and beta blockers. I read some articles that said the blockers (Toprol referenced) can actual cause some arrhythmias as the heart grows stronger post surgery.

I'm currently on 12MG per day of Toprol and I'm hoping to have that reduced to 6MG per day after my 4-month check up with my cardiologist. He knows I am anxious to get off all meds (besides Coumadin). I want to know how I really feel as I think the meds cause 90% of the symptoms.

Regarding the feedback on stress and anxiety being the main culprits, I agree 100%. Prior to my AVR last summer, I was living the corporate Type-A lifestyle. Between my cell phone, PDA, pager (now a Blackberry) and my laptop w/wireless access the VP I reported to could contact me anytime, anywhere. I averaged at least two Starbucks a day and my 3PM pick-up was a large bag of M&Ms. The good news was that I countered this stress and anxiety with consistent exercise and weight lifting.

Post AVR, I've had to take a step back and re-establish my priorities and my calendar. Although I'm still electronically connected (waiting for brain chip implant ) to my boss, I'm managing expectations better and I refuse to get into any type of electronic conversation while I'm driving 70 MPH down the highway.

I had to downsize (don't you love that term) two 17-year employees last month and I think the hidden anxiety associated with that had a lot to do with the heart arrhythmias.

P.S. - I've also cut way down on the coffee. One cup every morning and that's it.