over-medicated?

[jdd]

First of all, I would like to thank you for this forum.  You are true public servants.  :)  OK, I am an 22 year old of average weight and low blood pressure.  I do not drink or smoke, and exersize regularly.  Summer of 2002 I went in for a check up due to light-headedness in the mornings, family history of dilated cardiomyopathy, and a steady increase of palpitations over the past 4 years.  (You couldn't take my pulse for 10 seconds without feeling many ectopic beats.)  The doctor ordered an echo and found an EF of ~30%.  I was titrated up to 150 mg Toprol XL and 10 mg of Lisinopril.  Every test possible (EKG, holter, blood tests) was performed to rule out other causes of the decreased heart function.  I was banned from strenuous activity (although the only time I didn't experience palpitations was during exersize, and I was running ~25 mi./week).  January of 2003 I went for a second opinion and my EF was found to be 54%, which is what my EF was previous to Summer 2003.  (I had been followed for years b/c of my palpitations).  It is noteworthy that my resting pulse was around 85 up to 100 mg of Toprol XL, and I had frequent palpitations.  However, once put on 150 mg my resting pulse dropped to 40, but I am no longer experiencing palpitations.  My doctor is concerned that I am over-medicated and is considering lowering my medication.  I am also concerned about being over-medicated, but I am also afraid my EF will decrease again if my palpitations return.  Do you have any ideas of what the cause of my EF could be, and how would you deal with a low HR in a patient like myself?

[Shroom]

Hi, you have every reason to worry about being over medicated. I've been in the hospital twice this past month due to overmedication with Beta blockers. It turns out I have a genetic slow metabolism (CYP2D6) for a large group of medication including beta blockers. Thus, a tiny dose for most people can lead to an overdose after time in me b/c it builds.  More info on that at http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?124030

[Momto3]

Hi...I had the ablation for pvcs done on August 1st.  I am multifocal, but the doctors were able to ablate the main "culprit". I am a big chicken, but I decided that I did not want to take the RX and did not want to be skipping my life away : )

As far as the procedure goes, I was in a "twilight" state and don't remember much of anything. There was an anesthesiologist with me througout the entire procedure. I did feel the IV (no surprise there..hahaha), but not the catheters or the ablation.....The entire team was fabulous...and so far, so good. After dealing with THOUSANDS of pvc's per day, it feels wonderful to feel only a flutter here and there.....The doctors say that it generally takes 2-6 weeks to know how successful the procedure was (or was not). So far, so good! I do still get pvcs which is no surprise since I know that they only ablated one foci (RVOT). Although I still get pvcs, they do not seem NEARLY as frequent.  For now, I can take a beta blocker IF I get uncomfortable, but no more mandatory daily doses or medicine...YEAH!!! I am getting an event monitor over the weekend to try and capture some "different" beats I have been experiencing...Again, they are nowhere near as often....It's great to be RX-free!! Good luck!!

[PAT65]

Hello. I was wondering if you had the ablation, and how was it? If I remember correctly you had PVCs in the thousands like I do. I'm wondering at what point I should try something like that. The meds I have tried ( beta blockers and calcium channel blockers) either do not seem to help or the side effects are terrible. Please let me know how it went.

[jdd]

Well, believe me, I prayed that my low EF was a fluke but I have had three different cardiologists reveiw the echo and they all agreed that I had a significant decrease in heart function followed by a return to normal.  I didn't realize there was that much research going on concerning familial dilated cardiomyopathy, but it definitely sounds interesting, though I am hoping that my case isn't familial, b/c wouldn't that warrent an increased risk for a return of my symptoms?

[Dr. Erik]

Very interesting that pvc's can lower EF.

[Dr. Erik]

It is possible that the EF of 30% was a fluke as you EF's from the past had always been normal. I'm hardpressed to believe that an EF could chang that drastically.Good luck!!

[Momto3]

I am also curious as to the cause of the drop in EF, as I have  experienced a similar situation.  TEE in October 2002 showed EF to be 55%. In December, 2002 EF dropped to 40% and echo showed signs of myopathic changes (test was repeated to confirm). The drop in EF has been attributed to frequent and consistent pvcs. I was started on antiarrythmics and scheduled for a 3 month follow up. Fortunately, my EF has already improved by nearly 10%. In August, 2003 I agreed to an ablation to try and lessen or eliminate the need for medication. In September, I'll go for a follow up to try and quantify the actual success of the procedure. Would love to hear from others in similar situations.....

[Cleveland Clinic]

jdd, Thanks for the post. You've had quite an ordeal.

First, if you are asking the specific cause of your low ejection fraction to begin with, I'm not going to have a great answer...but it most likely is in your genes. There are a large number of causes of familial cardiomyopathy. Given the family history and your condition, your illness would be classified as a familial case. Most of the known mutations causing this condition are associated with the proteins that involve the muscle structure of the heart.   There are several large studies including a very large one at the Cleveland Clinic that are looking into the cause of a variety of heart conditions including cardiomyopathy.  Right now, a lot of research is focused on understanding the abnormalities, but there are other studies trying to look at therapies including new medications and even stem cell based therapy.

As for your heart rate. I wouldn't deal with it at all, as long as you are not having symtoms. Alot of time over medication with beta-blockers can cause significant fatigue, as many on this forum can attest.  

You've been fortunate with your good response to beta blockers and your improved ejection fraction.  

good luck