Fast heartbeats after CABG

[chrisr]

I have just had a 2nd CABG (5 bypasses including RIMA to replace LIMA)at CCF. All apparently went well except that I now have a HRT of 80-90 which was 60-70 prior to surgery. It is now 3+ weeks postop. Is such a fast HRT normal after such surgery?
I have unfavorable reactions to Betablockers so have been placed on Cardizem 240 now on 180. This has kept my BP at about 130/70 mostly but has not helped with the HRT problem. The Cardizem also tends to worsen swollen foot problem from which veins were harvested for CABG. Is there any other medication that I can try? I was prescribed Coreg 3.125mg prior to surgery but not postop. Is this a possibility since I was allergic to Atenolol the only BB I have tried? Appreciate any comments or assistance and thank you in advance.
ChrisR

[CCF-M.D.-MJM]

Hi Chris,

Sorry to hear you are concerned.  I heart of 80-90 a few weeks after surgery is not a big concern.  When you check your pulse is it a regular beating pattern or an irregular beating pattern.  A regular rhythm is likely sinus rhythm.  An irregular pattern could be anything from atrial fibrillation to frequent premature beats.  If it is irregular, I would recommend you call your local doctor and have an EKG to check your heart rhythm.

There are benefits to beta blockers that are not present for calcium channel blockers like diltiazem.  Clearly if you have an allergy or significant intolerance to beta blockers, they are not an option.  Coreg is a beta blocker, in fact it is a very good one.  If were able to tolerate a beta blocker, I would prefer to have you on coreg over diltizem --- but would leave this decision up to your cardiologist.  You can either call your Cleveland Clinic cardiologist or  your local one (depending on where you live and your preference).

The swelling in your legs should get better with time -- although you probably already know this since you are (too) experienced with bypass surgeries.

I hope this answers  your questions.  Please call you cardiologist to ask about changing to coreg, as long you tolerated it ok.  Also, unless you have contraindications,  you should also be taking an aspirin, statin (like zocor or lipator), and possibly an ACE inhibitor as well.

Hope this helps and thanks for posting.

[chrisr]

Hello Doc, Thanks for your prompt and informative reply. Yes I am in NSR although did have some PACs and to a lesser extent PVCs prior to surgery. Hope these continue to keep away. As regards the Coreg/Cardizem issue: I have had unfavorable reaction to atenolol about 5 yrs ago after my first CABG. At first Atenolol worked so well that I could not even hear my heart beat which was the norm after surgery (also involved AVR and aortic aneurysm repair). But after about 2 weeks I had a run of misbeats or PVCs which terminated after stopping the atenolol.All the doctors I have now talked to are also in favor of Coreg. However I am really scared to repeat my exp of 5yrs ago and initiate PVCs with the Coreg. My question to anyone in the forum is: Has anyone had a more favorable response to Coreg than any other BB including Atenolol? If so, could you kindly let me know as to what were your reactions, dosages taken and frequency?? Thanks again and appreciate any comments.
ChrisR

[chrisr]

Thanks for your post and concerns. Since I am also diabetic I expect a rough time with healing of the leg but its been doing fine so far. I myself cannot understand why the BB especially atenolol gave me those ectopics. Do you remember which was the more agreeable BB that your relative used? Just checking around to make sure I try the right one this time around. Thanks again.
ChrisR

[Momto3]

I have been on a few different BB's and could NOT take atenolol. I took ONE pill and about 20 minutes later I started shaking all over...scared the daylights outta me.  Called the doctor (at night) and he said to stop taking the RX and that it would just wear off.  He said it affected my central nervous system...Like I wasn't nervous enough!!!  Anyway, I have taken BB's on/off for many years and had no problem.  My dad takes Coreg (post CABG and I believe the doctor titrated it to the highest effective dose) and he has had no problem.  It's probably just a matter of finding the one that works best for you.  Personally, I will never take atenolol again, but others have had wonderful success with it. Good luck.

[MinnieM]

I am so happy to see you post and that you are back with us again.  I cannot take COREG.  This brought my rate higher and irractic.  He first gave me 12.5 which was way to high.  Then decreased it to 6.5 and I could not tolerate that.  Then he gave me 3.5 (lowest dose ) and told me not to complain.  (I am the one who asked for this after seeing an Intern here state how good it was)  The doc wants my BP low and HR in the sixties and low seventies after the severe A-FIB attack and now Dynamic LVOT obstruction due to SAM.  Never happened on the other meds, I had. i.e. Tenormin (atenol) or TopolXL.  I found a bottle of Zebeta (beta blocker)  in the house and started taking this 10 days ago. (have no idea how I got this as it was 9 months old and a full bottle)  I took Zebeta for 3 days, 5mg in the AM and 5mg in the PM.  (broke a 10mg in 1/2).  I could feel the calm. Three days later, my BP was 100/60 and heart rate was 67.  I screamed for joy. Well, the doctor called the other day as he thought i missed my appointment with him.  I told him what I had done. *^%&%$^$*#$ LOL. He said this is not the first drug of choice for me but if it is working, keep doing what I am doing. I continue monitoring my BP and HR at home and the highest my HR has been is 76.  Highest BP has been is 130/60.  Yesterday even with the nail biting Astro's Play off game, my BP was 90/60 and HR was 70.  I have never felt so calm.  Now, I am not saying this is for you but it is trial and error with all meds.   I am on an Ace Inhibitor and it is Avapro 150.  I use to be on Avalide 150/12.5 but I found one should not be on a diuretic with an LVOT obstruction so I asked him to switch me to Avapro and take a mild diuetic, separtely,if I need it.  Chris, I cannot tolerate Lipitor or Zocor but I do tolerate Crestor 5mg. well and this has done the job brining my lipids down well.  

Please talk this all over with your CC doctor first.  They are the experts and follow up with your Locals.  Again, I am glad to see you post.  God Bless.

[tickertock]

With drugs its all trial and error, its funny how the same line of drugs can works wonders for some and have such adverse effects in others. What works and with minimal side effects take, what doesn't avoid them all together, the key is finding an understanding doctor that is wiiling to work with you and find out the drug that is best in working for you.

[chrisr]

Thank you all for your comments and words of encouragement. This is the greatness of this site. I am due for a cardio visit next Monday and will discuss all the options you all have given. Strange thing is that I am in NSR even with the high HRT. Preop I maintained 60-70 HRT but also had PACs and some PVCs. So another reason why the hesitancy to take a BB. I would have to work hard to select one that lowers my HRT but also keeps me free of the irregular beats. Will keep you informed and hope to reach there soon. Thanks again.

[geno49]

i had a heart attack 8/5/05 still adjusting does Lopressor make you feel terrible or is it my imagination this stuff sucks and my BP is still eractic Pulse goes from 55 to 88 on a moments notice.  sleep is all i want to do.