Atenolol and CHF Symptoms

[Mark__0]

Posted by Mark on May 09, 1999 at 01:20:46
Doing searches and checking previous postings I found answers to some of my questions, but nothing quite what I was looking for.
I'm 33, 5/11, 280 lbs, white male.  I do not smoke or drink, do not like salty foods, and try to avoid sugar/sweets.  I try to watch fat intake, but need to eat more fruits and vegies. I am not diabetic, but both parents became Type II diabetics in thier 70s.  My latest cholestrol was 181, and my uncontrolled BP is about 155/95, pulse 85.  My controlled BP is about 135/75, pulse 60.  My father is in his 80s and has had by-pass surgery, value replacement/repair, pacemaker, and currently has severe CHF.  He developed heart disease (chest pain) in his 60s.
Since 1996 I have been on Atenolol.  Dosage started at 50mg a day. Over the past few years, I have had success exercising and losing weight, however due to switching jobs (into more a sedentary role) I gained back the weight I had lost back up to 280 (I was down to around 235).  Last winter, during a Dr visit for an ear infection, the Dr saw an elevation in office visit BP and was concerned and increased Atenolol to 100mg, once daily around 7AM.  My BP is normally significantly higher during office visits, but I take my readings at home and at various drug stores to make sure it is under 140/90.  But, since I am part of an HMO system, each time I visit the Dr's office I see a new Dr, and the message (that I monitor my own BP) seems to get lost/ignored in my chart.
A year ago (when I was around 235) I was experiencing a high amount of work related stress, and noticed that I was feeling "pinches" all around my upper chest.  The pinch would last about 1/2 second, liked being stuck with a tiny needle.  These were centered generally in the heart region, but I would also feel them on my right upper chest, upper abdomen, my back, and even on the left side of my torso (under arm / down the rib cage).  I went to the ER thinking I was having heart attack chest pains, and they basically laughed at me and told me to go home.  The attending Dr said it was most likely skeletol/muscular stress...which made sense because I was under stress and I also favor sleeping on my left side (being heavy it puts alot of pressure on my rib cage there).
The next week, I had an EKG done in my Dr's office and everything was normal.  To date, these pinches continue, a couple times a day, and most notably during times of stress, and I still like sleeping on my left side.  I sometimes experience the pinch taking a deep breath or even on a sudden laugh...I can not repeat the pinch if I repeat the same action that caused it.  The pinches are most noted when I am in a sitting position, particuarly for a long period of time.  Since the ER visit, I am now in a much better job, and am able to better control my diet, lifestyle, and exercise.  Unfortunately, the "pinches" are a source of anxiety for me not knowing what is causing them.
In general, I am a pretty active person despite my weight and enjoy exercising, just need to do it more often.  I have never really been fatigued, have no dizziness, chest pain, or shortness of breath.  I have noticed since going on Atenolol 100mg, that my sex drive has diminished, and I also that I am seeing slight swelling in my legs, particularly my left leg.  At the end of the day, I will notice a ring from the band of my socks, and there is some redness too in the tissue in that area.  I also have noticed toward the end of the day, I have a slight dry cough and can feel some tickling im my lungs.  I have also noticed, that these symptoms are not present (or hardly present) if my day has been very active with me walking around alot at work...but if I sit most of the day (which is usually the case) the symptoms always appear by mid-morning.
During the day, especially mid-morning, I notice my heart function is much lower.  I have seen my BP at 111/64 and pulse around 50.  By the late evening hours, it is back up around 135/75 pulse 60.  I have been exercising almost every day the past month on a treadmill at home.  I get my heart rate up around a constant 120 bpm for 30 mins, and at the very end for the last 3 minutes I run as fast as I can seeing my heart rate hit around 165 bpm.  I experience no pain or discomfort and only stop because my shins are starting to hurt.  After my workout, any evidence of leg swelling or lung tickling are virtually gone...and I feel VERY good, refreshed, and sleep well usually waking around 5AM without an alarm clock (on 6-7 hours sleep).  Pinches almost never occur in the hours following my workouts.  If I were to go to bed with some swelling in my legs or tickling in my lungs, when I wake up in the morning, the swelling is gone and lungs totally clear.  I do notice that when I wake up in the mornings, my feet and legs are quite cold.
Last Friday I visited the Dr's office again.  Unfortunately, I saw yet another Dr (the last 3 office visits I saw 3 different Drs).  I shared with her all this information, and in addition I shared with her that I have been doing some research on Atenolol and found out that beta blockers can cause symptoms of CHF, and overtime, actually physically damage your heart by continued weakening of your body's natural heart function.  She listened to my heart in 3 places (twice in upper chest, and once under my left arm) and also listened to my lungs in four places on my back having me breath deeply.  She examined my legs too.  She said my heart and lungs sound very good, and the swelling is probably being caused by sitting too much and being over-weight.  Continued activity and weight loss should correct that problem she said.
My 8:30 AM office visit BP was high again (around 160/100, pulse 76).  I shared with her a log of BPs that I had taken over the prior 48 hours, from various machines, showing a regular BP of 125-135/70-75 throughout the day, pulse around 55-60.
I asked to be taken off Atenolol and she was relucant to do that.  We comprimised and she gave my 2 Rxs for Atenolol 100mg and Hydrochlorothiazide 25mg.  I am to start taking 1/2 tablet of each, once daily in the morning.  I am free to adjust my dosages gradually until I find a combination that works well for me, as long as I promise to keep monitoring my BP so that it does not go over 140/90 and I return in a month for BP and med check.
So...now that you have some good/verbose history, here are my questions:
1)  Could the 100mg dose of Atenolol be causing those symptoms?  Is a drop
from uncontrolled 155/95 pulse 85 to a mid-morning 111/64 pulse 50 just too low for my heart to effectively service a body of my size?
2)  Reading the drug company literature on Atenolol, it indicates that it takes about 2 weeks for the full effect of the dose to hit your system.  Is the reverse true?  Ie, if I were to drop down to 25mg (or none at all in favor of the diruetic) will it take that long for my natural heart function to return?
3)  Taking the diruetic is suppose to deplete my body of sodium, magnesium, and potasium.  If I take a potasium supplement of 99mg and magnesium of 200mg daily, will that be sufficient?
Any other advise/suggestions would be appreciated.  It difficult to keep going over all these facts with each new Dr I see, and I am not so sure that the HMO will allow a referral to a Cardiologist and/or a stress test at this point.

Posted by CCF CARDIO MD-APS on May 11, 1999 at 16:31:51
Dear Mark,
1.Atenolol is most likely the culprit/cause of your decreased libido, especially if this coincided with the increase dosage.  It is not in any way damaging to the normal heart, however it can cause CHF in patients with abnormal hearts.  It is more likely that your excessive weight is causing you to not breathe well at night (obstructive sleep apnea or OSA) that is then causing undue pressure on the right side of your heart (which can lead to the swelling) than is the atenolol causing the swelling.
NO, if the blood pressure of 111/xx was not enough for your body, you would pass out, if not lose function eventually of the organs that were being starved of blood- IT IS A NORMAL BLOOD PRESSURE.   To be frank, the majority of your weight is fat which does not require much in the way of blood pressure like the brain, heart and muscle do.
2.YES, it takes time for the drug to leave your system, i.e.stop having the effect.   YOU SEEM TO THINK THAT YOUR HEART FUNCTION IS DEPRESSED, DO YOU HAVE AN ECHO THAT SAYS SO?  IF NOT, YOU SHOULDN'T BELIEVE EVERYTHING YOU READ ESPECIALLY SINCE YOU SEEM TO HAVE TAKEN THE BETA BLOCKER THING OUT OF CONTEXT- MARK, BETA BLOCKERS ARE ACTUALLY INDICATED TREATMENT FOR THOSE WITH DEPRESSED LEFT VENTRICULAR EJECTION!!!!!  If you have right sided heart dysfunction, it is possible that the beta blockers are not the right treatment for you.
3.Low doses of such a diuretic usually do not require any supplementation and the only way to be sure of any of this is to have the levels checked with a blood test some time after starting the medication.
My best advice is to concentrate on blood pressure control(as you are), WEIGHT LOSS + EXERCISE(so you too do not develop diabetes), and MAKE SURE THAT  your excessive weight is not leading to OSA and right heart damage.
I hope you find this information useful. Information provided in the heart forum is for general
purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to
write back with additional questions. Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call
1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that
can be used to select the physician best suited to address your cardiac pr