Palpitations/change of medicine

[Art S.]

First of all, let me tell you what a joy it was to find this site. Reading the messages from others with the same symptoms that I was having was therapeutic in itself. I had a good cry for about 15 or 20 minutes. I am 48. Exercise regularly. Weight a bit high but coming down with 2K calorie diet. Started having symptoms (strong, noticeable pulse, irregular pulse, lightheadedness, mild chest pain) in February 2004. After a stress test, holter monitor, and two heart scans, I have been diagnosed with simple pvc's and pac's. Stress test showed blood flow was good, no blockages, heart otherwise normal. Yea! My symptoms increased greatly in Jan of this year and we redid the tests. I was put on Toprol. I take Diovan as well for BP issues (it's never been horrible, but it is consistently in "good ranges" now). After my last visit, however, my doctor (who I respect and trust) changed my medicine from Toprol to Cardizem. He indicated that the Cardizem, being a calcium channel blocker, would not slow down the "low end" of my pulse as much as Toprol. Apparently, the monitor picked up some pulse rates in the low 40's while I was sleeping, and I think he changed it in relation to that.

I didn't get to have a full discussion with my doctor during my visit last week. I will remedy this next time, but any insight you can share as to why the change would be helpful. My symptoms have returned with a vengeance while the Toprol is leaving the body and the Cardizem is kicking in, but I feel much better today. Your site has helped tremendously.

[CCF-M.D.-MJM]

Hi Art,

Glad to hear the cardiazem is kicking in.  I have patients that respond to calcium channel blockers and others to beta blockers -- then unfortunately some that do not respond to either.  If you symptoms were better on toprol (metoprolol) after a few weeks on cardiazem (diltizem), you could simply restart the metroprolol under the supervision of your doctor.

I would not worry about an asymptomatic heart rate in the 40's while sleeping.  Diltiazem and metoprolol both decrease the strength of contraction and make PVCs and PACs less noticeable, it all depends on how your body responds.

I am glad you found the site helpful and hope the information above helps.  Good luck.

[uptowngirl]

Just a quick note.  I have taken Cardizem in the past and found it to be a very good medicine for me.  I tried Toprol and did not like that at all.  I'm not a Dr., however, I thought a heartrate during the nighttime hours in the 40's was OK.  My rate even dipped down to 38-39, but the Dr. said that was alright.  Anyway, looking forward to the Dr. response here, and it sounds like your cardiac work-up so far has been pretty positive.
All the best,
Uptown

[macdoo]

My heartrate drops to 30 in my sleep(so the test a while ago said)..The doctor said that's a common thing we see in young people and brushed it off instantly.
Even when i wasn't on beta blockers, it dropped to 31 on some occasions.
40 is not that low.

[wingtip]

My doctor switched me from Cartia to metatropal because he though my heart rate was getting too low while I slept.  The holter showed five second pauses.

The beta blocker caused increased angina and asthma, and I had to beg an EP to get me back to Cartia.  

My EP felt five secong pauses (rate less than 30) was fine, because it was a vagel response.  He said the trick was not letting it drop like that when you are awake, because you might pass out.

Good luck

[Art S.]

Thanks, Doctor for the response and all the comments.

Some days I think I have this palp stuffed whipped and other days it gets me down. I understand this part of the drill is patient to patient only, but that's OK. I'd really like to hear from folks as to what they have found to help them relax on the "bad palp days". I exercised yesterday as I was feeling better and that helped a bit. But on the really bad days, I just don't feel like it. Any suggestions on things that have worked for you in the past?

Of course, drinking heavily is out at this time. :-)

Hopefully the cardizem will fully kick in and knock the palps out. But I don't know that yet. So any ideas would be appreciated.

Thanks,
Art S.

[Gaspipe]

Your story mimics mine very closely. Remember with PVC's you WILL have good and not so good days. But I've found that even on the worse days I trudge on; meaning do not change your daily routine... sitting on the couch and taking your pulse only makes it worse.The key is a positive attitude and keep on with your activities. Excersise ,stay rested, don,t overeat , stay well hydrated and remember many,many people have it much worse. Believe me it isn't always , if ever, easy but you can do it!I remain as always... Gaspipe

[Erik36]

I take both Cardizem and Toprol and it works great with the combo. My pulse gets down in the 30's when I sleep and the 50's when I am awake. I have no symptoms of a slow heart beat like fatigue or dizziness. My doctor says the heart rate is fine as long as it's not causing symptoms. My BP is 118/70. I tahe bothe these medicines for PVC's and A-Fib. I haven't had A-Fib since I started thiese medicines.

[pms_barbie]

I had a heart rate of 47 up walking around.  I fellt horrible like I would pass out. It was just awfule.  I was on sotalol 80mg twice a day and they droped me down to 40 mg twice a day.  I had to go off that stuff it was a wicked drug for me.  Now my heart rate drops down into the 40s when I sleep and my ep dr says no big deal.

[Art S.]

Well, I'm comfortable with heartrate issues. A rapid pulse has not been my problem. Just an irregular one. I don't ever remember a reading out of 70's even when the palps hit. I will cover this with the cardio doc next time I see him. What I'm curious about now, still, is why the change from toprol to cardizem when the toprol was clearly ameloriating the symptoms. The change in meds occurred early last week and I have been ATTACKED by the worst symptoms I've ever had in between. I sure as blazes don't want to change medicines again. The cardizem appears to be taking control. Yesterday and today (Th and F) have not been as bad as the week prior. It was getting tough to cope.

[wal44]

I am still amazed at how some doctors and other observers down play the exasperating effects of PVC. And although many say that beta blockers only "mask" symptoms by making them felt less - I can attest that the right beta blocker can lessen PVC occurance levels as well.
Atenolol did not do the job, and neither did Toprol XL. Someone on this board suggested Setral (Acebutolol) with the info that it was more particularly aimed at PVC sufferers (as opposed to just being for high blood pressure).
Anyway, that was the magic bullet here. My point is, if you are not happy with your current med, work with your doctor to find the one that works for you. As it turns out, I am only on half a dose (well, 200mg/day at supper), and it is all I need (when full doses of others did not work).

[cam4]

I agree that we should check into our meds. I have been on cardizem for the last 8 months since I had a coronary artery spasm. I have had the dosage upped 3 times in an effort to make my pvc's get under control. I actually had better results with atenelol, but since the spasm, they want a ca;lcium channel blocker. My thoughts are always if it is this bad with all of these meds, whats the poiint in taking them? I have a cardio appt. in 2 weeks and will ask about other meds. I was also prescribred paxil and found I had a horrible pvc reaction to it 2 days after beginning use. anyone else have that happen??
thanks
cam