Beta Blocker - stop or keep taking?

[Billvalpo]

I had a stent implanted and angioplasty in one artery about 6 months ago after initially reporting angina to my physician who confirmed multiple clogged arteries after an angiogram.  I am a 62 year old male and run regularly for exercise, completing several marathons in the last several years.  After the stent, I was placed on Crestor, Toprol, Plavix, and aspirin for medication.  My concern is the impact the Toprol is having on my exercise.  I do not have a blood pressure issue since my resting BP is 106/69 with a 44 pulse rate.  When I run I find my pulse rate climbs to 113 after 14 miles and my angina is then sufficiently severe I have to stop for an extended period to recover.  Since I do not have a blood pressure problem do I need to keep taking the Toprol which appears to be keeping my pulse so slow I cannot keep running?  As a point of comparison, the person I run with has a pulse above 160 at the same 14 mile point.

[ed34]

your beta blockers are actually protecting your heart. When you feel severe angina, believe me it will be much worse without beta blockers. Under no circumstances should you ever stop taking beta blockers without a GPs consent. You have to be weened off of
them gradually.

[Flycaster305]

ed34 is giving you lifesaving advice, check with your doctor first.  

You mentioned several blockages and only one stent.  I'm assuming other arteries were less than 70% blocked, or you would have had more stents.  It is very possible the angina is being caused by blockages that are increasing.  I'd suggest contacting your doctor with these symptoms.  I'd ask for a stress test.

[kenkeith]

Troprol is contraindicated for a slow heart rate and used to treat angina (chest pain) and hypertension.  Is your low bp with medication?  If you bp is normal, you may consult with your doctor to be treated with a nitrate.  I take a nitrate prior to going to the gym and have no angina...never discontinue any medication without a doctor's knowledge and consent.

You are correct aerobic exercise is to help maintain cardiac health, but you are not reaching the theraputical range (about 159 for your age group).  Raising your heart rate to only 113 does not or may not be very beneficial for your heart.

[Flycaster305]

I don't take Troprol but take a beta blocker (Coreg) and have taken other beta blockers as well, and I cannot get my heart rate above 115 even after 45 minutes of strong aerobic exercise.  Also, my Cardiologist suggested that the old formula to determine maximum heart rate (220 - age, and subtract 20% of that figure) doesn't apply when taking a beta blocker, and that has been confirmed during several physical rehab sessions after MI's.  I'm assured I'm getting a good aerobic exercise even though my heart rate stays below 115.  Based on the rate I'm sweating after 45 minutes, I know I am!  Like kenkeith I also take a daily nitrate, Imdur, 90mg daily, which lowers BP.  



  

[kenkeith]

What it boils done to then is you can't rely on your heart rate or on your pulse rate, to judge how hard you are working when on beta blockers. My understanding under the circumstances an exercise stress test is the best way to establish parameters for a new target heart rate on beta blockers.

[ed34]

But pulse must be related. When attempting to get my beta blockers running at the right
level I had to wear a pulse monitor and note the rates associated with angina or chest pain. If my pulse goes over 100 then I get angina. If it goes over 140 then I get chest pains. Beta blockers are limiting me to around 110 (2.5mg). What amazed me was how
quickly the rate increases/decreases. Sitting down it would hover at around 60 and as
soon as I stand up it rockets to 110 within two seconds. Then sitting down it goes back
to 60 in around 10 seconds.

[kenkeith]

New parameters from a stress test would include the theraputic heart rate (pulse) based on vital signs, etc. from a stress test.  The appropriate heart rate would be correlated to METS (physiological, metobolic equivalent for measurement of energy) and METS can be associated with any exercise and monitored accordingly (there are charts that relate METS to different exercise routines). For instance, my limit according to the stress test is 7 METS, and when on the treadmill that is equal to walking at a quick pace of about 4 miles an hour and a pulse of about 130.

I wouldn't be surprised Bilvalpo is exceeding more than 10 METs with his routine, and a stress test would determine how many METs (heart rate is determined) is safe and theraputic.