Question for you...

[Jason]

This past weekend, I started feeling a bit 'off', almost like I was having a hangover or something. It was kind of that 2-seconds-behind feeling. Along the same times my heart rate was lower than it had been before, dipping down to 45-47 bpm for extended times and averaging low fifties. My 'normal' since the surgery has been 55-60 so this isn't much lower than normal, but it was a new low for me in bpm. I am on 75mg of metoprolol, 2X daily. This happened Saturday evening, on and off through the day Sunday, and then today after cardiac rehab again with the 'off' feeling.

I called my cardio's nurse and explained this to her, along with the fact that my heart seems to be beating harder and my eyes seem a bit slow to focus at these times. I did say that the last two of these might just be because I am watching and listening to my heart more with the 'off' feeling. I told her that I haven't been sleeping well either, as I need something to help me sleep most night. (I am getting 5-7 hours a night, with Ambien) I said it may be that my body is just really tired, but I wanted to check in and see if the heart beat in the 40's was something to be concerned about. Again, it has only been for the last three days.

She talked the cardio and called me back, and they took me down to 50mg metoprolol 2X daily starting now. She seemed overly concerned on the phone and told me to watch heart rate, blood pressure, etc. and call back right away if the symptoms don't go away. She actually said that three times, and sounded quite concerned.

My assumption is that I am over-reading her concern, but thought I would ask all of you; do these sound like something of more concern than just backing off my metoprolol? In other words, should I be concerned about something else? Or am I just being a hypochondriac?

 

[EclipseDS]

Jason, I can tell you that when I did my CTA, they gave me 35mg of metoprolol to bring my heart rate down. I'm usually in the low 70s but they wanted it to be near 60 and it made me dizzy -feeling off for quite a bit.

In previous research, the normal heart rate (at rest) for an adult is 60~100. For athletes, it can be as low as 40s. Going back to metoprolol, it was my first time to take it, and only for CTA, so I don't know what the usual dosage is, but compared to what I downed to get my heart rate to 60s, I would assume, at 150mg daily, I would easily hit 40s too. Again, please be noted that i don't have much experience with metoprolol, so take this for what it is. Consult your doctor to put your mind at ease. Check and post your heart rate again tomorrow to see the effect of going 2x50mg.

-Eli

 

[dick0236]

You may be trying to "read in something that is not there" and that would be a normal reaction soon after surgery. Your cardio has made an adjustment in the meds based on her education and experience. My experience has been that nurses know how to nurse, but they are often not good doctors. My docs nurses are often concerned because my BP is always 140 to 150 over 80 to 90. My docs want it there and would be more concerned if it were 120/80. The nurses are also concerned that my INR is 3+, although me and my docs are very comfortable at that level. Remember that most PCPs and even Cardios don't have a lot of valve patients and nurses try to put us in the same pigeon hole with all the other cardio-vascular patients....and before someone takes me to the woodshed for being critical of nurses....my wife is a retired RN.

My heart rate is normally 50-60 and I may have experienced some of your symtons from time to time. Stay on top of your BP and HR and write down time, place and activities when symptoms appear....and keep your cardio informed........and remember, I am not a doctor.

 

[Jason]

Thanks, Dick and Eli. I was pretty sure I was being a hypochondriac, looking for something that wasn't there as you say. However, once the idea got planted in my mind, I thought I should bounce it off of the experienced folks here to see if anything else shook out. I think I just needed to hear from someone (other than my wife!) that things are fine. After thinking about it some more, if the doc was concerned with the symptoms being something bigger, they would have just had me come in or go to the ER. Just an overactive mind soon after surgery, I am sure. Thanks again.

 

[New Guy]

Jason,

I had a heart rate to low problem too at about your point in recovery. I was taking 25mg metoprolol twice a day and it was reduced several times to my current dosage 12.5mg extended release per day. For me it seemed that as I recovered and got stronger and began to exercise my heart rate just tended to want to beat slower so I needed less beta blockers. I hope to get off it totally but both my cardios want me to stay on it indefinitely.

You may need to adjust the dose down again. I hope so for you.

 

[Bryan B]

IMO a heart rate in the mid 40's is too low. With 60-100 being the normal range your heart rate was ~15 bpm below normal. If you had a resting heart rate of 115 (~15 bpm above normal) you probably wouldn't feel too good either. I think they did the right thing by lowering your Metoprolol and if it doesn't come up to at least 60bpm I wouldn't be surprised if they didn't lower it again.

When I was in the hospital they made a medication mistake while I was in A-Flutter. I had already taken my daily dose of Diltiazem CD 360mg before being admitted (that is a pretty large dose) and they gave me another 360mg that evening. I wasn't really paying attention to what they were giving me but upon being admitted I had told them what I had taken so far that day...they simply screwed up. I had most of the nurses on the unit and the cardiologist on duty rush into my room that night because my heart rate had dropped down into the mid 40's (I saw one reading of 41 recorded on the monitor). Granted my heart rate was in the 120's when I got there because of A-Flutter so it was probably a bigger deal, but it kind of freaked me out since I was sleeping soundly when it happened. BTW I personally think my heart enjoyed the rest...lol. But 40's is too low....again IMO even for a conditioned athlete...maybe mid 50's for them. But your heart rate needs to be high enough to pump blood sufficiently to everywhere in your body and I'm not sure mid 40's will do that, especially when even you are only mildly active.

 

[WandaW]

Dear Jason, I hate how every different feeling can get my anxiety up. I have had some serious changes and some not so serious changes. I agree that we just need to keep in touch with the MDs until they figure out what is the new normal for us. My Heart and Vascular clinic and their staff are very used to patients calling with questions and encourage the calls if we have questions, even on the weekend. Won't it be nice to be a few years down the road of recovery from our OHS's and this anxiety will be hopefully a vague memory. I too really appreciate the good info and great caring from those on this forum to calm me down and send me back to my MD when I feel weird.

 

[Jason]

Thanks everyone. I have been much more active, going to cardiac rehab 3 days a week and the Y or riding bike the other days of the week since I was allowed to start exercising, about 2 weeks after surgery. For comparison, I went maybe twice a week before surgery, for much less time. And several times in the dead of winter I would skip even these times of exercise. The folks at cardiac rehab have pointed out that my resting heart rate and recovery heart rate time have both dropped some since I started (not drastically, but it has been dropping), so it makes sense that my heart is healing and getting more conditioned. FWIW, my heart rate this morning is 57 which isn't much different than previous days, but I only cut my dose back last night.

Wanda, I know exactly how you feel. Not only does every little thing get me wondering what might be going on, I am listening or feeling for those little things a lot of the time. It does bother me, but I think it is wearing my wife down more so! She is the one that has to listen to all my explanations and descriptions. I agree, I hope this passes soon! The good news is that I am back to work part-time this week and full-time next week, and while at work I don't listen and feel for issues hardly at all. I get caught up in other things and my mind stays off of it.

 

[WandaW]

Jason that is great to be starting back to work!!!! I go back after Memorial Day and suddenly I wonder if I still have enough time to get better. I know I will be fine but this has been such a strange journey. I think I have too miuch time to think when I am not working. It is great to hear that your life is moving back towards normal, hopefully mine will move that direction too.

 

[epstns]

Jason - It sounds like you're on the right track, discussing your observations with your cardio and adjusting meds. I wouldn't worry so much about what your resting heart rate is, but about how you feel. Prior to surgery, my resting heart rate would settle into the high 40's as I neared sleep (like during econ's, etc.) but would easily run into the 150's during exercise. As I neared surgery time, the range narrowed, with resting heart rate in the low 60's and being comfortable only up to the 130 range during exercise. I am waiting to see where things fall after surgery. My pacemaker is currently set to a range of 60 to 130 BPM, but I am paced only about half the time, so who knows how high it could go. I'm not pushing it, until I start rehab and can be monitored and advised.

Keep up the good work. The exercise will help you not only heal but improve beyond where you were prior to surgery.

 

[Jason]

I went for a bike ride with my son this afternoon and finally broke through the 100 bpm barrier! I only got up to 112 bpm, but was regularly bumping up past 100. I haven't seen that since I had surgery. That felt good, although not sure if it means anything. I will watch my blood pressure and resting heart rate for any changes, but so far it doesn't seem to have affected those at all. My 'foggy' feeling is still there, although it seems to be less and less today. Time will tell.