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Beta Blockers and Palpitations
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Beta Blockers and Palpitations

Hello Again! I want to thank you so much for giving us the oppurtunity to ask questions here and somebody actually listens. I posted a question here recently how I started taking Toprol xl 25mg after having A-fib for the first time. I had a large increase in palps. from my normal of 1-10 a day(ocassionally more and sometimes none!), to 200-300 a day and one day I had 2000+. So they switched me to Atenol 25mg. I was ok with a small amount of palps. for 2 wks and then they started to get worse again. I had alot of them yesterday and they triggered tachycardia. I went to the ER and the Dr. there tells me that I would just like to think I would be better with no meds. but that I probably have just gotten worse over time. So I call my Dr. who is new to my case because of new insurance and he tells me "Beta- blockers will not do that." He told me to up my dose of Atenol to 50mg. I told him I was concerned because of all the palps and I think they will get worse. He says that can't happen. My resting heart rate at home is 60. How much lower can it go?
I've had palps for 6 1/2 yrs and they only got this bad after the a-fib incident and I started to take Toprol. I don't know whether to increase the dose and see what happens or stop the meds and see if they slow down again. I'm worried either way. He did say it doesn't look like I have WPW. They think my palps just coincidently got worse after the a-fib.
I see another Dr. next Thurs. as long as they don't cancel my appt. again.
Thanks so much! Sue
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Avatar_n_tn
Sue,

Thanks for the post.

First, some patients can develop worsening palpitations with beta-blockers, although this is uncommon.  The patients who develop this usually have vagally-mediated atrial fibrillation so that when the get a slower resting heart rate, it triggers afib.  One way to see if the beta-blockers are causing a real phenomenon is to up the dose as you were advised, but do so while wearing an event monitor.  This way, the doc can see what is happening when you are having symptoms.

Another possibility is that some people just feel their heart more when they are going slower.

A third possibility is that you have a baseline lowish blood pressure.  When you take the beta-blocker, your blood pressure drops further which leads to a compensatory increase in heart rate.  When you feel the relative tachycardia, then you develop anxiety which further speeds the heart rate, thus cauing a vicious cycle.  I see 2 or 3 patients per month that develop this type of syndrome.  The treatment is the combination of proper hydration and beta-blockers.

Don't worry too much about what is too slow.  You'll know that your rate is too slow when you begin to feel tired or run down.

Hope that helps.


27 Comments
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Avatar_n_tn
I forgot to mention that alot of these palps actually feel different than when I don't take meds. If that means anything.
Thanks
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Avatar_n_tn
Beta Blockers don't actually cause palpitations. However, they slow the heart rythm down to the point that palpitations are more noticeable. When we are Beta Blocker-free are hearts beat faster and that in itself supresses the palpitations. The heart's pacemaker does't have time to fire off a premature beat when the heart is beating fast enough. You'll probably notice that during Tachycardia you never feel these premature beats. But Beta Blockers and Calcium Channel Blockers will prevent some people from having an episode of A-Fib. I take both Toprol XL and Cardizem and I haven't had A-Fib in two years. Good luck to you.
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Avatar_n_tn
I was moved from CCB back to beta because my sleeping heart rate was down to 15bpm.  My resting heart rate is about 50.  The doctors don't seem to think that a low heart rate is a problem unless you pass out.  Because I have cronic (chronic) a-fib, it's also not a problem when my HR goes over 200.  It seems like, if they do the tests and there are no other heart problems, the rate really doesn't matter, unless it cause you to over focus on the problems.
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Avatar_n_tn
Thanks to everyone! It just feels good to just know you're not alone. Mo I don't feel any palps during tachycardia, but on the other hand, it was a strong palp that actually stopped the tachy. I just can't see how my number of palps went down the tubes after having a-fib. Can a-fib make everything worse suddenly, does anyone know?
Thanks, Sue
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Avatar_n_tn
How does your EP : cardiologist explain why and where your pvc's,pac's are occurring ?
Did they go over diet, exercise, heart tests ?
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Avatar_n_tn
My cardiologist that I had for 6 1/2 did all the tests: echo, treadmill, blood. Everything is normal. I don't drink, smoke, stay away from caffiene, etc. My BP is usually 106/56. I try to eat healthy. I drink a glass of Gatorade everyday to make sure my potassium and electrolytes stay ok. I'm a small person, I only weigh 103 and I'm 5'5". I've always been this weight. My heart problems started when I was 7 months pregnant for the first time. Never had any trouble before that.

Sue
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Avatar_n_tn
I am very thin and was a premature baby born with heart murmurs but symptoms began in my late 20's.
Have you had a tilt table test ?
I had this due to the b/p ?
Any heart disease in your family ?
Good for you following all the good heart tips.
Do you have mvp ?
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Avatar_n_tn
No, I never had a tilt table test, no heart disease in the family and no, I don't have MVP. I was told once by another cardio. that I feel every palp., even the ones that most people wouldn't. Lucky me!

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Avatar_f_tn
just wanted you all to know I am the queen of skips.  I've had every kind of skip you can imagine.  Pvc's, bigeminys and god knows what else for 25 years.  When I say beta blockers don't help, I mean it.  Was taking .50 mg atenolol twice a day, plus avapro for blood pressure 150mg.  Now I'm down 25mg twice a day.  Still get bigeminys like crazy.  I would have an ablation, but too many people don't get help from them either, besides they are dangerous.  Take care all.  Barbara
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Avatar_f_tn
Wow, this topic is very timely for me:  I have been "doing the rounds" this summer, interviewing various EP docs (I, like Barbara, am a major PVCer having experienced every ventricle nasty there is, with the occasional psvt and pac thrown in).  I had been on 25mg atenolol for several years with little or no effect on my pvcs.  When they got very bad this last June, I was told by my cardiologist to up it to 50mg and possibly higher, as most docs agree that 25mg dose in a 5'9" woman is "homeopathic" to quote one EP.   BUT here is the kicker:  my pvcs got worse on the higher dose, in fact, I had several pvc episodes at 50mg that I have never had before (nor since, as I have now gone off atenolol).  One  EP insists that it must be a coincidence because "beta blockers wouldn't do that".  But the other two do say that in some people it can do that.  I am really thinking I am one of the "unusual" ones in which it worsens the pvcs.  I did have a holter on when I upped the dose to 50mg and it came back w/ 10,000+ pvcs and several runs of vtach.  Fun stuff, eh?  And now, several months later I am sitting here at the end of the day (on zero medication) having felt maybe ONE or TWO pvcs!!!  I do want to emphasize, however, that it is stress and other triggers that cause these things to flare up the most, not the beta blockers.  In other words, my remission is much more due to the summer's lack of responsibilities and low stress than it is due to having quit atenolol.

By the way, all three EP docs diagnosed the same thing in my case:  RVOT (pvcs/and nonsustained vt arising from the right ventricle outflow tract).  It is very "ablatable" but all three docs say  this is a totally safe condition (can you believe that?!) even w/ so many pvcs.  So, although they will ablate any time I am ready, they would rather see me live with it if I can tolerate it because although there is a very low risk from ablation, there is no risk at all with my condition (my EF is high).  For me, having (finally) seen electrophysiologists (instead of the cardiologists who know less about these things) has been the reassurance I have been looking for.  I recommend being very proactive and finding doctors you feel comfortable with who will take the time to explore your concerns.  Then, I recommend major mental overhaul and re-evaluation of your life, your fears, etc.  Radical acceptance of pvcs is the best medicine.  (I am also going to give meditation a shot, what the heck)
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Avatar_n_tn
-Good for you!!!- ;-)
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Avatar_n_tn
I've been on a beta blocker for years to slow my heart down.  It works well for me, except that I swear my pac's/pvc's are worse since I've been on tenormin.  Just wanted to let you know.
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21064_tn?1309312333
What a group we are!! So many similar circumstances! I have had pvcs for many years and took beta blockers (Inderal) for a good portion of that time. Initially, they worked great, but eventually, I became MORE symptomatic. Over the last couple of years I was off of the RX except for major "storms", in which case the low dose beta blocker seemed to work beautifully.

In December, the pvc's raised some concerns that I did not expect. During my annual echo, my EF dropped to 40 (it had dropped earlier in the year also), and a number of doctors suspected the pvcs to be the culprit. Because of the test results, they were able to determine that my MVP/MR was ot the problem, which led them to the pvcs!  Hmmmm...."benign" just took on a whole new meaning for me. However, it is my under-standing that pvcs rarely cause this problem. To effectively assess their hypothesis, I was given flecainide and then rythmol (switched to rythmol because of side effects) to see if a decrease in pvcs would lead to an increase in EF...If not, I would need an ace inhibitor...UGH!!! After 3 months, the EF went up to 45 (~10%). Good news!! In July (6 months), I discussed the RX side effects with my EP and she reminded me that I could try an ablation (no guarantees). I asked about stopping the RX altogether and was told that was no longer an option (because of myopathic changes as a result of pvcs). WHOAH!! Long story short....Went for the RVOT ablation in August and so far, so good. It is wonderful to have more good days than bad! Although we are not certain if the procedure was entirely successful, it is wonderful to be less symptomatic. I do still have pvcs but they do not seem to be nearly as persistent. The doctor who performed the ablation said she noticed a remarkable drop in pvc frequency (EKG) immediately after she ablated the ROVT. She knows that I have other foci, but she was not able to trigger them at the precise moment that is necessary to ablate. I had really come to live with the pvcs (they were like my own shadow!!), but when it came to a change in the heart's pumping function, I got in line for the ablation. I was never really afraid of having a heart attack or anything, but I was scared when I heard about the persisten drop in EF! YIKES! For me, the ablation was the right decision. However, if someone can make the positive mind/body connection and deal with the pvcs in a less assertive manner, I say GO FOR IT!! I did that for a very long time, and I'm hear to tell everyone...once you know your situation is benign, relax and don't let your imagination run wild.  Remember, you are probably getting at least yearly checkups and the docs are watching...So, relax, trust your doctor (or find one you can trust)and enjoy life! Mind over matter can be exhausting....
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Avatar_n_tn
talk about exhausted.. I'm back on the event monitor and having irregular beats and runs of fast beats ( atrial runs, whatever that means) ... PACs, a few PVCs and sinus tachycardia.

I've had these symptoms for 20 year but NOTHING like this before... I was wondering if it is possible that going off a low dose of beta blockers that I only took for one month could have produced a rebound effect like this?? Anyone know?

I've been off them a week now and surely this should go away if the rebound sensitivity to adrenaline is causing this. I can't do anything -- eat, move, stand, much less walk , without having jumps, skips, fast heartbeats, over and over. I am so tired of being afraid
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21064_tn?1309312333
I don't know if rebound effect is truly what you are experiencing. What I do know is that I also had the irregular for 20 years and then SLAM!! There are a number of us who wonder about early pre-menopause and the hormonal effects on the pvcs/pacs. Try not to be afraid....The event monitor is great for capturing what you feel, when you feel it...It is good that you are having a "bad" arrythmia day while you have the monitor...That way you can transmit the activity and the doctors can evaluate it soon after it occurs. Stay cool and try to put your mind at ease. Even though the beats are occurring with great frequency, you should try and do what you normally do..It helps to go about business as usual and stay among friends...Don't know where you are located, but for me it is great to have power again and communicate with my buddies on the forum..... : )
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Avatar_f_tn
Just a note to thank you for the encouraging words.  It is one thing to hear "keep up the fight" from someone who has never felt a skipped beat, quite another to hear it from someone who has been "in the trenches" themselves.  

As Mark Twain put it:  "The key to longevity is to aquire a minor illness and to nurse it for a lifetime."
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Avatar_n_tn
Hi Hankstar
You seem very knowledgable in regards to the "heart" in general so I have a question for you.  People talk about a-fib.  I have read that some people don't even know they are in it.  I would like to know exactly what the symptoms are.  I have been woken up in the night with a very eratic heartbeat.  I've clocked it at 220.  It is very irregular, I mean all over the place.  So much that it is hard to count.  I can't believe that when I am feeling it that I'm not passed out.  The wierd thing is that I do not feel like I will pass out or anything.  It just beats like this for about 12 minutes or so, sometimes less.  It only happens about twice a year.  My doctor says it is probably a-fib but tells me not to worry.  (I have had all the test, but no ep study).  If that is a-fib how on earth to people not know they are in it?  It is not a fast heart rate that you can slow down with breathing.  It is "stuck" and just stops when it decides to stop.  Any comments?
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Avatar_n_tn
Thanks for responding.  That really fast eratic hearbeat really freaks me out too.  Ususally I feel a very long pause prior to it starting. A much longer pause than the pvc pause. That also freaks me out.  My doctor told me that because it happens so rarely that It doesn't warrant an ep study. The longest it has ever gone is about 15 minutes.  Most of the time it stops in less than 5 minutes.  Once or twice  year is enought of that type.  Thanks again.
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Avatar_n_tn
Hi, to everyone.  Where do I start.  I am a 33year old male and I have been extremely active my whole life.  I am very athletic and I have an extremely stressful job.  I have had PVC's for approximately 8 years.  I have had all the tests, EKG, stress tests, echos, holter monitor.  I have noticed in the last year that the PVCs seemed to increase.  I am an avid runner and weightlifter and after I work out I get a lot more of the "skipped heartbeats".  My doctor put me on TRoprol 50mg once a day and it doesnt really help. I have been really fighting not to start on any heart drugs but the skipped beats are driving me crazy so I tried it. Does anyone get skipped beats during a workout? I get them when lifting weights and during a run.  My doctor doesnt seem too concerned.  It bothers me tremendously.
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Avatar_n_tn
I get skipped beats whenever I bend over.  I'm quite active (I'm a walker) and the walking doesn't seem to cause the skipped beats. Don't know why I get them when I bend over, but they sure do scare me.  Have had this condition now for 8 and a half years; all heart tests have come back normal, thankfully.  Just wanted to let you know you're not alone in your fear!
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Avatar_n_tn
I'm also on tenormin (atenolol); have been for about 8 years now.  I used to get the pounding heart after I ate; not now, and what a relief!  I don't get the pounding sensation at all really, unless I'm very anxious.  However, my pac's seemed to INCREASE with tenormin!  I'm just taking it one day at a time; my heart tests have all been normal (thank God).  I can get obsessive about my heart.  Good luck!  Glad you're more comfortable.
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Avatar_n_tn
I have to wonder along with you...why are some of us so very aware of our hearts and others not?  I've heard many people say they can't feel their heartbeat at all.  Not so with me!  Perhaps we're just sensitized to it?
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Avatar_n_tn
So glad to see your feeling better! Wonder if taking 1/2 a med twice a day is better than once a day? My Dr. keeps telling me to take 1 once a day. I know how you would feel getting a pounding heart. I have gotten it a few times since taking beta-blockers. It sure can make a person uneasy.

For some reason my palps have slowed way down this past week. Yesterday I didn't have any until 5:30pm. Then I only got 7-8 the rest of the day. They did that when I was on Toprol too, and then the next week I got 2000-3000. So I'm not celebrating yet. However I did change one thing. I have taken a vitamin supp. for years that has 60mg of iron in it. I always have just over the anemia level in my bloodwork. But I thought maybe too much red blood cells might make the heart work harder. I don't know, just reaching for the stars on that one!

Hope you continue to feel better!
Sue
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Avatar_n_tn
Hi hank...I find your posts very comforting.  The atenolol slows my heartrate beautifully...but I swear it's causing my pac's.  I never got pac's before I took this med.  My doctor and cardiologist keep telling me not to worry about it.  Sometimes I can cope, but now my obsession is back and I'm freaking.  I get so scared!  Wish I could get my mind off my heart.  Good luck to you; you are a very helpful person.
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Avatar_n_tn
Hank, you're a wonderful guy and I love reading your posts!  You are such a comfort to me.  I'm convinced my pac's (pvc's, whatever) are caused by the tenormin, as I developed them soon after beginning this medication.  I've been on tenormin for 8 and a half years for rapid heartbeat.  Well, it slows my heart down, but now I have the pac's.  Don't know which is worse!  Actually, I guess the rapid heartbeat was worse (it was doing 120 at rest).  Now my heart rate is comfortable in the 80's range.  I'm 58 years old, have diabetes, but otherwise not in bad shape except for being overweight.  I'm also a walker which helps to slow down my heart rate.  I thank you for writing as I felt mucher better after reading your post.  I notice you've helped a LOT of people!  I wish you the best!
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Avatar_n_tn
That does make so much sense. My mother in law had her heart valve replaced and they recently changed her meds to 1/2 twice a day and she said she feels much better. So far I'm still doing much better than I was so I'm not going to rock the boat right now and change anything. I'm sure you know know how that is.

Thank you for all your help. With all the knowledge I've gotten from this forum, I think I found a very caring and understanding Dr. I knew the right questions to ask thanks to everyone here.

Thanks for your help and I hope you continue to do well!
Sue
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Avatar_f_tn
A related discussion, food triggers was started.
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A related discussion, beta blockers was started.
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