PVCs, Inderal, low blood pressure

[jrizzuto]

Hello all. Had an ablation for AVNRT, SVT 2 years ago and it worked perfectly. However, I have had an increase in PVCs - bigeminal, trigeminal, couplets, the works.

The doc suggested Inderal 10mg one per day. I know that is a very low dose, and I can even cut the pill in half if I want to.

My issue is that my normal BP is 105/65 and a resting heartrate can sometimes be 58-65. Won't any beta blocker make these numbers even lower? The only time my BP gets higher is if I am very anxious, I've seen it 135/80 or even 150/90 - but this would be rare.

Also, very strange....that resting heartrate  of 65 will jump to 90 when I stand up. If I walk briskly it will stay steady in the 90's. Then, when I stop walking immediately it will raise to 100 - 105 - 110. It will level off a few minutes later with loads of PVCs thrown in there.

With symptoms like these, I cannot believe I would do well on Inderal or any beta blocker. Anyone agree/disagree?

[jrizzuto]

LOL - don't worry, I was born scared. I'm well aware smoking is bad, not easy to quit.
I'm curious - anyone else have what I explained in the last paragraph of my original post? I never heard of heartrate going up when you STOP walking. Re-read that one please.

Jim

[dmacd74]

You are wonderful, I understood what you meant... :-)

[bbxx]

I am sorry. I didnt mean to scare him. I was being sarcastic because I do worry about the fact smoking and strokes and heart disease goes together.
I really wasnt trying to be mean. Sorry. I hope you get things figured out and are feeling better soon. :)

[dmacd74]

You are not going to drop dead!!  bbxx is kidding, right?  You know a lot about yourself and seem on top of things.  But bbxx is correct, your lungs look good and veins are clear - but don't lull yourself into a false sense of security.  I am chubby (but less so than last year), but my PC always tells me that I am healthy - but I know in my heart I need to get this weight down or someday, maybe soon, who knows, my arteries will be clogged and I will get diabetes.  Look, you smoke, you shouldn't.  Your lungs are clear, but you can get a stage 1 lung cancer too.  And I don't think the constricting blood vessels you get from smoking is good for your pvcs.  Just my 3 cents...

[bbxx]

Ha ha.. well at least you know what you SHOULD be doing. lol
Personally I wouldnt put a lot of faith in the tests showing you are ok. I have heard so many people get tested  and cleared for this or that and then drop dead. Not trying to scare you, well, ok, maybe a little. lol Seriously though, smoking is the worst things in my opinion. To purposefully suck poison into your lungs....ugh...I really hope you quit.
Not a judgement, just a concern. However, I have never smoked but I hear it is the worst thing to overcome. I am cheering for you!

[jrizzuto]

Thanks all, I admit I'm a BIG baby when it comes to pills. At 54 I'm kinda proud that I don;t take anything on a regular basis.
SO I had my follow up after several weeks with an event monitor. It showed plenty of PVCs, trigeminal, couplets, and one SVT. The doc said she wouldn't really prescribe another ablation at this point. So she wants me to do the following...

1 - Start the Inderal, maybe try it at bedtime so I don't drag all day. My thoughts...if BP and HR are normally low during sleep, maybe I won't wake up ! Duh

2 - cut down the smoking since it could be causing coronary spasms. My thoughts....very possible but when I stopped smoking for a week my palps did NOT improve. And no one wanted to be on the same planet with me. My anxiety was so out of control I just had to go back. I only smoke about a half pack a day, light brand, and it makes me happy. I'm smoking from 13 and I'm 54. Angio results showed you can drive a truck through my veins, lungs are amazingly clear (good genes). But I'll try to quit anyway. No promises.

3 - cut out the evening wine. OK so why not just shoot me already- LOL? I drink 1-2 glasses of red wine almost every night. Every doc I told this to said it's good for you. My cholesterol is low, my BP is low, it works for me. But I will eliminate it sunday night thru thursday night, only have it fri/sat. Good compromise?

I guess it's hard for a doc to help such a stubborn know-it-all like me.

[tom_h]

It's interesting how one physician will favor one drug over another.  Yours apparently prefers Propranolol (Inderal).  If it isn't doing the job for you for whatever reason, there are plenty of other options that you can try.  Betablockers do have a tendancy to slow the heart rate, as well as lower blood pressure.  In recent years, they have been significantly downgraded for controlling hypertension, so are no longer front line.   In your case (and mine) it seems to do a pretty good job of doing that.  

Another thing to remember is dosage weight is different from BB to BB.  10mg. of Inderal might be small, but in another BB, it might be enough to drop an elephant.

I'm currently taking 50mg/day of Metoprolol, a dose which would be considered on the low side for this BB.  I'm coming off of 100mg/day.  The warmup time to get my heart of to operating speed is significantly longer while on this medicine.  There is definitely a lag before it gets up to speed, and during that time, the symptoms can be uncomfortable; a heavy feeling in chest, lethargy, and breathlessness.  Knowing this, I work up slowly and eventually I can get my heart rate in the target range for my age, and push significanly beyond that for short periods.

I think what you're experiencing is normal, but I'd calculate what the target heart rate should be for your age, and work to get it there during your walks to build some cardiac reserve

[dmacd74]

Give it a try.  Sometimes the initial reactions to the drugs, or annoying side effects subside.  I think it will steady your hr more....I've had good luck on it.  Please try it.

[bbxx]

I am not sure about the pulse, but...
I do believe that BB can lower bp, but everyone is different and will respond differently.
My bp is usually 90s, so to me, 105 is not low, although it is healthy.Sorry I dont have the answer, but I figured this would bump you up in case it was overlooked by someone that can answer you.