Quick info/advice on metoprolol B-blocker "cold turkey", pls!

[normofthenorth]

6.5 d post-op, generally very pleased, but I've got a puzzle with my metoprolol B-blocker:

1) My HR has been much higher than normal (and much higher than "symptomatic-defective", too!) since my surgery -- like 90-something resting, vs. ~60. I've also felt a lot of "my heart beating out of my chest".
2) Partly(?) in response to a ~2-hr episode of A-fib fairly early post-op, I was put on 12mg x 2x/d of metoprolol B-blocker.
2a) I've also had fairly frequent PVCs, averaging ~10/mins, which often corresponded to "my heart beating out of my chest".
3) A few hours after I popped the first tiny metoprolol pill, I awoke with neurological symptoms -- only time post-op, touch wood! Dysphasia and a bit of general IQ loss. An hour later, I awoke again and I was cured.
4) They ran a brain CT, found nothing. Most of the Docs suspected a TIA. One crusty-pushy post-op Cardiologist (and I, esp. initially) suspected the metoprolol B-blocker caused my episode.
5) While I was on the metoprolol, I still had 90-something resting HR (vs. ~60 pre-op) with quick trips up to 105-ish from very litle activity. (This is, admittedly, in the first week post-op.)
6) I was supposed to go home yesterday, with ~5-6 prescriptions, including one for metoprolol B-blocker. Instead, there was a SNAFU with my INR -- too much Vit. K before the wires came out, so it was still too low the next day to send me home -- and I had to stay another night.
7) Today I DID get sprung, with TWO prescriptions -- Coumadin and baby Aspirin only!
8) It turns out the crusty-pushy post-op Cardiologist had decided to wean me off the metoprolol B-blocker (just in case it raises my risk of neurological symptoms) -- AND TO WEAN ME OFF IT AS I WENT THROUGH THE EXIT!
9) I've got way less monitoring here at home than I had in the Cardiac ward, and I'm not sure I'd even notice if the w/d of the metoprolol caused me cardiac problems, unless they were emergency severe. I have a little $20 "Chinese toy" BP & HR monitor, and it says I'm 123/82 BP (high for me) and 105 HR (silly high), while sitting here in a comfy chair typing.

Basically, I'm looking for any info or reactions I can get. Anybody heard of this kind of "cold turkey" treatment, at the exit? Should I be worried? Should I be taking some of the spare metoprolol pills we have in the house from somebody else (tonight), then phoning my own Cardiologist for advice tomorrow?

 

[Duff Man]

I personally would not self medicate, because you can find yourself in a bind quickly. Say for example you take the spare pills you do have, but the cardiologist isn't available until xx days - you'll run out and this time you would not have been properly weaned under supervision of a doc. You won't be able to get a script from the cardiologist, and I do think you would find the rebound effect of immediate withdrawal unpleasant. More unpleasant than what's going on right now.

I would call your cardiologist's office first thing this morning to tell them your feelings about not being on the beta blocker, and perhaps speak to a nurse or even the doctor if they let you. Make an appointment, too.

Higher heart rates and blood pressures seem common after surgery. I can remember a couple members having resting heart rates of like... 120, 130, 140 even. That is not to say that it's normal or safe - only a doctor can make that call.

Docs have told me they start to worry about rapid heart rates when the muscle doesn't function well, and/or when the rate is so fast for so long that it begins to damage the heart muscle. I believe they mean a sustained heart rate of somewhere near my maximum for my age. Some people have a lifelong normal resting heart rate in the low 100's and it's perfectly fine for them... I'm one of those guys that, for a long time, had a resting heart rate above 90 - 95 for most of my life.

 

[kfay]

Norm, I wouldn't necessarily let the high heart rate be a concern. A lot of people have reported that on here after heart surgery (surgery had the opposite effect on my heart, after a "normal" pre-surgery heart rate in the 90's, mine was in the 50's-60's after surgery). You are really early post op and your heart is still in shock from such a major trauma. The beta blocker may have helped calm it down and if you had a weird "mental" side effect to that one, they can certainly switch you to another. I would not take someone else's medicine that is around your house, but rather give your cardio's office a call and let them know what is going on and see what they have to say.


Kim

 

[Sbullock]

Hi Norm- I was on 25 mg Metoprolol twice a day upon leaving the hospital- I was cold all the time and my heart rate was 85/68 ish with a heart rate of 60. I also had a pounding heart in the evenings (not fast but hard) and nightmares and restless legs to keep me company thru the night.
When I saw the surgeon at 6 weeks post-op I asked to go off the Metoprolol and he said to reduce to 12.5 once per day. This didn't help so I stopped the beta blocker on week 7 (Cardiologist agreed) and my heart rate went up to about 90 with BP 125/85 after my walking exercise.
All of the symptems described above disappeared after 2 weeks and my resting BP has settled down ro 98/72 with a heart rate around 72-75.
I am surprised that they took you off the Metoprolol because my understanding is they give it to you if you have had A-Fib. I didn't have any A-Fib but they gave it to me as standard care. I bought a good BP monitor and pretty much took my BP every 5 minutes until I got bored with it.
I think you'll find your heart rate and BP will improve a bit each day with continued exercise.
Good Luck

 

[Mentu]

Norm, in my limited experience it is too soon for you to see things stabilized. Your numbers before surgery are pretty much out the window as your heart is just beginning to adjust to its new circumstances. This adjustment will take months and at one year I am still seeing changes. That said, I began taking Metoprolol after leaving the hospital and it very effectively kept my pulse rate down in the 60s and 70 and when exercising in the 130s at the highest. Likewise, my blood pressure stayed around 120/70. During the first two month, I felt my heart beating like a big drum but, unlike the palpitations before surgery, this never left me feeling ill. As time passed, however, I began experiencing extremely low pulse rates sometimes near 40 which left me feeling drained of all energy. My Cardio finally let me go off the Beta-Blocker 7 months after surgery. I guess what I'm saying is that without the Beta-Blocker you probably have to expect higher numbers but in time they will begin to decline as your heart continues to adjust to its new situation. As for the the blood pressure cuff, a good one only costs about $50. If you have doubts about how effective your current one is, you should consider replacing it if for no other reason than to reduce the stress you may feel over the uncertainty of your device's numbers. One question I have for you is "how do you feel?" I know it is still very early in your recovery but do you feel well overall? I would suggest that it is too soon to worry about pulse and blood pressure unless they are making you feel less well. On the other hand, balancing your INR should probably be a greater concern and it is something that will respond more quickly. Give yourself time.

Larry

 

[normofthenorth]

Thanks, folks. I've got a call in to my Cardiologist for a phone 2nd opinion.I hope he calls.

Duff Man, I appreciate your warnings against "self-medication", except that you're scaring me about exactly what THEY did!! You're warning me about
"not have been properly weaned under supervision of a doc. You won't be able to get a script from the cardiologist, and I do think you would find the rebound effect of immediate withdrawal unpleasant. More unpleasant than what's going on right now."

Problem is, that scenario is EXACTLY "what's going on right now"!! There was no "weaning under supervision of a doc"! They kept giving me exactly the same dose, 2x/day, then took off my remote EKG monitors a day before discharge, then gave me my last little metoprolol pill, then discharged me! Any "weaning" of my blood metoprolol levels down toward zero was (a) done outside the Hospital, with no supervision, and (b) as "immediate" as that "withdrawal" could ever be, unless they administered a metoprolol-antagonist drug, or replaced my blood with a metoprolol-free transfusion! I went from a constant dose to NO dose, and I did it outside the Hospital exit.

THAT's what's got me concerned.

In reality, I think it happened because I was under the care of a team that includes one strong-willed cardiologist who isn't much of a team player. The rest of the folks (including the neurologists) suspect that my episode was a TIA, and she alone believes it was a reaction to metoprolol. So she withdrew the metoprolol on my way out, to eliminate the risk she was more concerned about (more reactions) than the other (tachycardia, maybe even A-Fib). I don't think a second MD knew (or knows) what she did, unless they routinely go back and double-check discharge records. (If they routinely did that, I think somebody would accuse them of having too much spare time!)

Like many interesting decisions, it's based on uncertainties, ignorance, and competing risks. I have no idea if the "consensus group" (which would have sent me home WITH metoprolol) is right, or if the pushy lone-wolf Cardiologist is right. But I'm PRETTY sure they didn't discuss it with each other.

 

[Greg a]

Norm, I have always followed the call of my GP ....he gets reports from alll my team and he is the head coach if you want to use a sports analogy. The batting coach may have an idea while the third base caoch differs from the first base coach but the COACH has the final say in my case my GP has almost 20yrs ER where he takes the facts in front of him and can call a specialist but he makes the final call Remember that in the states the patient hires the health team as individuals where we follow a more structure format with some choice but not as much as they have unless you want to go to the Toronto Clevland Clinic.

As to the heartrate ....you have pissed off the most important organ in the body and it is letting you know about it ,,,in time it will forget how mean you have been and will forgive you

 

[MarkG87]

I'm on 50 mg of metoprolol 3x/day out of the hospital. But, no coumidin, just aspirin and Plavix. Heart rate has been in the 110 range since I've been home. I hope that when I go back next week he'll start adjusting this down. Prior to surgery i was on Micardis HCT 80/12.5 for High BP.

 

[Duff Man]

It seems counter intuitive that a beta blocker could cause a TIA... but not impossible.

if what you're saying is correct and the neurologist didn't talk to the cardiologist on your way out and unilaterally cut you off the beta blocker, you need to see any cardiologist relatively quickly to let the cardiologist make the call.

If it were me, I admit I personally would probably continue taking a beta blocker (moreso if I had refills or some safety net) and make an appointment with my cardiologist as soon as humanly possible. I am a very aggressive patient with totally different circumstances though. In this situation I would consider the neurologist's actions in conflict with the health of my heart and it soiunds like the cardiologist's prescription of the drug.

If the neurologist is right and the metoprolol did cause the TIA, and you continue to take the medicine.... you are asking for trouble. So you really need to talk to a doctor about this, and depending upon your confidence with the neuro's call.. I might not take the BB until you do talk to your cardio.

 

[Lynlw]

It seems counter intuitive that a beta blocker could cause a TIA... but not impossible.

if what you're saying is correct and the neurologist didn't talk to the cardiologist on your way out and unilaterally cut you off the beta blocker, you need to see any cardiologist relatively quickly to let the cardiologist make the call.

If it were me, I admit I personally would probably continue taking a beta blocker (moreso if I had refills or some safety net) and make an appointment with my cardiologist as soon as humanly possible. I am a very aggressive patient with totally different circumstances though. In this situation I would consider the neurologist's actions in conflict with the health of my heart and it soiunds like the cardiologist's prescription of the drug.

If the neurologist is right and the metoprolol did cause the TIA, and you continue to take the medicine.... you are asking for trouble. So you really need to talk to a doctor about this, and depending upon your confidence with the neuro's call.. I might not take the BB until you do talk to your cardio.

I THINK a cardiologist, but not his card, stopped the med

 

[normofthenorth]

Yup, what Lyn said! Several neurologists, my Nurse Practitioner, and those of my surgeons who opined, all seemed to think I'd had a TIA from a little clot thrown by something probably totally unrelated to the drug, despite the ("post hoc ergo propter hoc" -- sorry!!) coincidence.

The one lone (wolf) cardiologist was the outlier, and I'm pretty sure she just unilaterally reversed everything pretty soon before discharge. Nobody said she thought metoprolol CAUSED a TIA, just that it caused a drug interaction or a side-effect that LOOKED LIKE a TIA.

One (admittedly weak) indication that the Nurse Practitioner REALLY disagreed and was bullied-and-outranked by the Cardiologist is the wording of my "Cardiovascular Surgery Discharge Summary". When it comes to the metoprolol (after a description of the "?TIA" and the CT scan), it says "His low dose metoprolol was dicsontinued by Dr. L____ (cardiologist) after the ?TIA episode."

Even that seriously understates what Dr. L____ (cardiologist) did, since THREE MORE NIGHTS passed after my ?TIA and before I was discharged -- still with a full blood-system load of metoprolol, but no script to maintain it. The wording implies that my metoprolol was d/c 3 nights earlier, which would have been a more defensible decision, and would have given them a chance to observe the effect on my heart stats, or to prescribe an alternative B-blocker.

But the simple fact that the Nurse Practitioner's summary mentions the cardiologist by name in this context, suggests to me (reading "bureaucratese code" between the lines) that the NP was distancing herself from the Cardio's decision. IMHO, anyway!

 

[normofthenorth]

A little update: I saw my GP today. Actually the new one I just met pre-op (after my previous GP retired) wasn't available, and I wanted to see a GP (and get my INR checked and interpreted), so the Clinic agreed to reassign me to a different one. She seems great, maybe more Sympatico than the first new one.

She listened, understood, and basically agreed: The "cold turkey" (w/d of metoproplol) seems silly and unimpressive. But I'm not suffering with higher tachycardia than before, so it could go either way.

But she'll call my Cardiogram (who hasn't gotten back to me) and try to squeeze a second opinion out of him. Sounds sensible and helpful.