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Heart Disease  (Expert Forum)
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Beta blockers, MVP and palpitations
Answered by
Cleveland Clinic -
Cleveland - OH
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MedHelp Member's Question

Beta blockers, MVP and palpitations

by fearfactor, Sep 09, 2005 12:00AM
Thanks for taking my question.  I know there are many on this board regarding palpitations, but I feel very anxious about mine and just need some reassurance.  I am a 33 year old woman, in very good health.  I exercise and eat well and am of normal weight.  I take 12.5 mg of Toprol XL per day for heart palpitations.  I have mild MVP with trace tricuspid and mitral valve regurge.  I've heard that palpitations don't need treatment unless you have a structurally abnormal heart.  I'm wondering if my heart is structurally abnormal because of the MVP and regurge.  Also, do beta blockers really cause weight gain?  I'm afraid I"m going to gain weight though I have not yet.  I'm really scared about my palpitations and am trying to deal with them without letting them ruin my life but it's hard.  I'd also like to ask if Xanax can worsen palpitations because I take that for anxiety.  Thank you.

Stacy
Doctor's Answer

by Cleveland Clinic, Sep 09, 2005 12:00AM
fearfactor,



Nice name. It is within the normal range to have mitral prolapse and trace regurgitation. There would be no other treatment indicated for palpitations.



Beta blockers decrease energy in some. If this leads to less exercise, it could lead to weight gain, but beta blockers themselves do not cause weight gain.



Xanax can be very addicting but doesnt cause palpitations. Unless you are predisposed to disabling episodes of anxiety I generally treat with longer acting antianxiety medications and would look more into the root of your anxiety.



good luck
Member Comments (16)

by tickertock, Sep 09, 2005 12:00AM
To: fearfactor


Hope you feel better soon, as far as i know regarding PVCs and palps, mild MVP with trace regurgitation would still qualify as an essentially normal echo and would not alter the prognosis of PVCs and palpitations unless it progressed, my understanding only , I am not a medical doctor. I'm also wondering what guidelines the Cleveland Clinic use regarding ejection fraction, do they consider 50-70% as normal or 55-75% as normal, I have read much conflicting disagreements on the numbers though they dont appear to have a real significance difference, but I think most cardiologist regard 50-65% as normal, I am hoping the doctor might be able to chime to clarify this.

by hambone, Sep 09, 2005 12:00AM
Dear fear,

I have the exact same MVP.  

I can't take a Beta-blocker due to a low heart rate. It is possible to live with out meds if you want to.I think bb's will not completly get rid of the papitations.

I'm 52 and have been at this for awhile. My symptoms are under control most of the time, but I will get a "flare up" maybe every year to 18 months or so. It's no fun.The paps are very scarey & uncomfortable. Hang in there.

by Momto3, Sep 09, 2005 12:00AM
To: fearfactor
Hi Stacy,



I took beta blockers for about 12 years and never gained a pound while taking it.  I chose to stop taking them because they weren't medically necessary, only for symptomatic relief.  After awhile, it seemed that taking the BB's weren't working anyway.  Doctor agreed that I didn't really "need" them and that they were only for the symptoms.  



I really understand the anxiety that can come on as a result of having pvcs....oh boy, can I.  However, it will serve you best now that you have been thoroughly checked out, to figure out the best way for you to cope (RX, meditation, relaxation, therapy, etc) with the anxiety.  



I am not a doctor but have been watched for a leaky valve for years.  It is my understanding that physiologic or trace regurg. are medically insignificant.  Mild regurgitation MAY require some follow-up, and a doctor would be able to let someone know if/when a regurg valve should be watched.  You may want to visit the  American College of Cardiology website for more information on MVP and MR. Lots of info out there.



In 1998, my GP prescribed Xanax b/c he thought it might help with the anxiety (aka, palps!)  I never experienced an increase in palps after taking it, and used it very sparingly. I'm always worried about taking medications, so I only resorted to using it when the palps were driving me crazy.  It did NOT supress the pvcs, but it did help with the anxiety.



good luck and hope you find some relief : )



Connie



by upbeat63, Sep 10, 2005 12:00AM
Xanax did the best at reducing my anxiety and I've been on many other anti-anxiety drugs. Yes, xanax can be addicting and that's why other medications are usually tried first, but nothing did as good a job as the xanax for me, some others made me feel worse. But you've got to listen and talk with your doctor.



Knowing that xanax can be addicting I followed my doctors recommendations on it very closely. She and I also trusted myself to know if dependance was ever happening. I think knowing the potential made me more strict with it, and I started using it "as needed" .12mg only for the really bad episodes.



I don't think xanax causes PVCs, but palpitations are one of the many "possible" side effects if you read the drug information. It's there in black and white, but it's a long list! It doesn't mean you are going to get palpitations from taking xanax. I certainly had my PVCs long before I took xanax, and never experienced increased PVCs while on xanax. But I know one thing for sure, I worry about everything when I have anxiety attacks, so the word palpitations probably jumped off the page at me when I read it. Please understand it doesn't mean it's going to happen to you. And it's not going to stop me from taking xanax for anxiety if I have to. And weight gain is not on the toperol drug information, thank goodness! That's one less thing for me to worry about,,,,,smiles.

by Momto3, Sep 10, 2005 12:00AM
To: upbeat63
I loved your response...I am exactly the same way.  I was prescribed 25mg Xanax, but even after 7 years, I usually only take 12.5 mg b/c I worry, worry, worry.  It definitely works to stave off some of the anxiety and curb the panic over pvcs and life's stressors.  For the most part, my pvcs are nearly non-existent, but every now and again when life throws me a big curve ball, I have a mini episode.  Recently, we moved out of state and the night before, I was having tons of incessant palps....  I ended up taking Inderal and a Xanax to slow down the palps and curb the anxiety.  Fortunately, those days are very rare and the medicine is very effective.



Hope you are well : 0



Connie

by 1212debmar, Sep 11, 2005 12:00AM
To: fear factor
I believe that taking beta blockers actually increased my awareness of PVC's.

They slow down your heart rate and you don't feel the skipped heartbeat with a PVC...you feel the next beat. Now logically if your heart is beating at a rate of 60 as opposed to 75 it has that much more time to fill with more blood and therefore feel more intense.I've reduced my intake from 50mg. a day to less than 12.5mg every other day.I still have PVCs but they are so very much less intense that they don't start my adrenaline flowing and produce the panic I experienced on the higher dose of Atenol.

PVCs can be ablated if they occur regularly....problem is they have to be occuring while the procedure is in progress as they cannot be induced in the way A-Fib can be.If you have them all the time they may be able to catch where they originate from and ablate that point.In my case they are not common enough....an attempt was made to catch them while I was being ablated for A-Fib but none occured while I was on the operating table.The A-Fib was corrected though.

One person wrote of having over 20,000 PVCs daily....I think that person should investigate ablation as it seems that would be often enough to occur while on the operating table.

by Momto3, Sep 11, 2005 12:00AM
To: 1212debmar
I was one of the people with over 20,000 pvcs per day.  The doctors weren't crazy about trying an ablation until I ended up with a cardiomyopathy and did not want to be on anti-arrythmics for the rest of my life.  Turns out the CM was a direct result of continuous, persistent pvcs....Fortunately, my doctor left no stone unturned and it was caught before there was permanent damage.  My EF went from 40% (pre-ablation) to 60% over the next 18 months.



I was multi-focal and the doctor wanted to ablate very conservatively, so I had two RFA's.  The day before the 2nd procedure, my pvcs calmed way down and I was concerned that they would not be able to "find" the irritable foci.  I called the doctor to see if ablation could still be succesful.  She said as long as we see "some" activity, we will do our best to ablate.  It worked ; 0



Glad to hear your A-fib ablation was successful.  It is incredible what can be done to the heart.  Who would have thought they could "burn" foci to stop the odd beats?  It's probably only a matter of time before more can be done for those suffering with chronic and acute pvcs and pacs.



by upbeat63, Sep 11, 2005 12:00AM
To: 1212debmar
I also have 24,000PVC/day, but ablation is not recommended for me because my heart is otherwise "normal". I've been recommended toperol and take it very conservatively, at 12.5mg "as needed", it helped to stop the constant bigeminy and some short runs of nsvt, but to take it more than a couple of days in a row wipes me out. Luckily my PVCs are for the most part unifocal so ablation should be an easy fix, but it is not without risks. I guess if I pushed for it they might oblige me. But gee, I don't even want to get Lasik surgery done because I know there is a 5% chance my eyesight could become worse. My eyes and my heart, two things I don't want to mess with unless I absolutely have to. Guess I'm not at that point yet. Just some days feel that way.



And it's curious that some medical doctors would recommend it, and others would not. What are the criteria they use to proceed versus waiting? I think the doctors at Clevland Clinic only recommend ablation for PVCs if they are "debilitating". Anyone who has ever had even one knows how much they suck :-)

by wal44, Sep 14, 2005 12:00AM
I would disagree that ventricular ectopics cannot be induced. See a quote from a patient guide for RF ablations at Munson Medical in Michigan...



"Controlled impulses will then be delivered through one of the