Long QT, athletic puls (below 60) and about to take toprol

[soscared872]

I am turning 56 years old this month. I am an athlete, weight is normal, non-smoker, and moderate drinker. I eat very healthy food.  My total cholesterol in january was 183 and my LDL is low. Two months ago I fainted at work and was taken to emergency. I think it was from swimming in a hot pool and dehydration. I swam 4200 yards that morning. They found nothing except irregularities in the ekg. Previously the two months before fainting I started having head pressure and on afternoon walks felt like collapsing (but did not) - it was after starting lumigan for glaucoma (which I stopped taking after I fainted). I went to a cardiologist. He also saw irregularities in the ekg and recommended a 24 hour holter test, a stress test and a tilt table test. The 24 hour holter test result is normal, they told me. The stress test showed no blockages and the cardiologist said the heart looks good. Though it skips beats. Yesterday I did the tilt table test. He saw numbers in the 480 range on long qt and qtc. My pulse at 65 degrees was in the high 80s and when supine in the 60s. Now he wants me to take toprol. I dropped off the prescription last night then went home and did some research. Later last night I found my blood pressure was 135 over 85 and my pulse was 55. This morning about the same. Pulse in the 50s and blood pressure 135 over 85. I saw a site on metaprolol and they advised not taking it if the pulse is below 60. I think I have white coat anxiety. I am afraid of taking toprol because I commute 28 miles to and from work. I am afraid my dizzy spells will return and that I will be too tired. I am thinking of holding off, telling my doctor what my resting pulse and bp is (I already take quinapril, 5mg per day). I have business travel coming up over several weeks and I think I will ask for a 30 day heart monitor test. I wonder how a 24 hour holter shows "normal" but now the doctor wants me on toprol? He said I can continue swimming but my performance won't be as good. And that I might have to drop quinapril if my bp goes too low. I will be taking 30mg (the lowest dose).

[Ger57]

Good to hear that you are feeling much better.

8-9 miles a week? That is quite some distance to swim. Sound like a good cardio exercise!

Take care and all the best.
Ger

[soscared872]

Just a followup. I'm into my second week on the low dose metoprolol. I'm now back to longer distance swims. My cardiologist endorses it. I had maybe 3 evenings of being tired. My heart rate came down but it no longer scares me.

Still I need resolution on how at age 56 I suddenly developed long QT symptoms. I made another appointment with my cardiologist in July to discuss this. I think I do not have LQTS but I have acquired Long QT. Since I'm hypothyroid and on thyroid medicine and get blood tests every six months, I suspect my medicine is unbalanced. And if it needs rebalanced will I get the other side of the deal, short QT? That can be equally dangerous. My next thyroid checkup is in July also.

In the meantime I do not have the head pressure and my balance is better. My legs feel stronger. Swimming 8 or 9 miles a week is what I like to do.

[soscared872]

Okay so I took my first dose of metaprolol this evening. Yeah I feel tired - about 26 minutes after popping the pill. It's 25mg. But yeah also relaxed. It's 8:26 and I usually wake up very early to work out. but I'm very tired and will probably wake up at 6am. Hope I will not be like this for several weeks

[soscared872]

Thanks!

Okay I am still going to consult with my doctor and report my pulse rate these days before I start taking the metaprolol. I talked personally with a pharmacist yesterday and she also suggested I tell the doctor first about my pulse rate.

My cardiologist has a web site that reports test results and I have not been receiving them. I want to look at those too before taking this medicine.

I have been athletic for decades and have competed in 880 meter swimming (part of triathlons) and shorter interval races in masters swimming so I'm puzzled why I have not had a problem with long QT way back then. The doctor did say he is not 100% sure I have it.

[Ger57]

No, I was not. I felt great and hardly noticed any side effects (besides the lower heart rates in rest and at max).
You will be just fine. Enjoy your swimming :-)

[soscared872]

A max heart rate of 180 would be awesome. My stress test itself they put me up to 150 (90% of max). I normally have been doing anywhere from 120 to 137 for over 40 minutes.

I commute 28 miles and I am worried about dizziness and being tired. I am working still and can retire now if I want to but have not planned it.

One more question: Were you tired at first when you went on metaprolol?

[Ger57]

I started with a dose of retard 100 after I had a medium heart attack. Glad to be alive, so no discussion with my cardiologist at that time.

My resting pulse went from 50 to 33-35! That in itself was no problem for me, but my max heart rate went down from 180 to 145 which made it hard for me to exercise. I am a fanatic bicyclist.  
After discussion with my cardiologist, the dose went down to retard 50 which raised resting pulse to 40 and max heart rate to 165. This is acceptable for me. It seems as if my heart is more efficient now as I can output almost the same power level at 165hf as I used to do at 180hf! I only lost a bit of my short interval power.

Perhaps it differs from person to person, but if you take a dose of 30, I guess the impact for you will not be so big.

[soscared872]

Did you question the cardiologist about taking it with such a low heart rate? When first taking it, did you avoid being physically active? Are you physically active?

[soscared872]

I forgot to mention, I don't feel heart palpitations. Never have. I am not out of breath, have never had difficulty breathing except as a young man after I had wisdom teeth pulled. My official real faint/loss of consiousness was this year in my mid-50s, I'm aware long QT symptoms first show up anywhere up to age 40. And something does not really add up. My cardiologist thinks I had this problem all this time and I think he is ordering a genetic test for long QT.