Take the Beta Blocker or get second opinion? Feeling Rushed.

Dear Doctor,

  I am a 30 year old female who has been having palps.  Saw a cardiologist and he did a 24-hour monitor.  I have the palps worse the week before my period and I was drinking a lot of caffine.  The 24 hour monitor was done the week before my period.  It showed me to have about 40 pvc's an hour, 38 total couplets, and one 7 beat run of nsvt.  He ordered an echocardiogram, which showed everything to be perfectly normal.  He has gone ahead and referred me to an electrophysiologist, which I see later this week, but in the meantime wants me to take beta blockers, metoprolol.  
My question is:  I am very active, aerobics, weights, run...and my blood pressure is always a normal low 110/70.  I feel like the cardiologist, who has only seen me 3 times in my life, has jumped the gun on giving me these beta blockers and wants me out of his hair.  Should I wait to get a second opinion from the electrophysiologist Friday?  The cardiologist keeps mentioning ablation to cure me, since I am only 30.  He seems a little to gung ho to medicate and burn parts in my heart for me!  I am now trying to experiment with cutting out caffine and haven't felt palps as often.  Is it just me or does it seem that he is pushing the beta blocker too quickly?

Thanks!

[tom_h]

Metoprolol is an extremely common beta blocker.  Many of us are or have been on it.  I presently take 100mg/day.  For me, it helped a great deal with the PVC's along with easing and improving my ability to self convert SVT's, (episodes of rapid pulse >200bpm).  I have to say that again that for me the cessation of caffeine made the single greatest improvement in lowering my daily PVC tally.

Does the fact that your BP is a litle low concern you?  Metoprolol may cause it to drop a little along with slowing your pulse.  Many of the folks here are heavily involved in some kind of sport, be it running, cycling, or in the case of myself ,speed skating, but still suffer from bouts of PVC's or SVT's.  I've had 54 years of PSVT, but my EKG is pefectly normal with the exception for an almost undetectible marker typical of Wolff Parkinson White syndrome. The fact that your EKG looks normal doesn't necessarily mean that you don't have an underlying problem.

If my history was seemingly as short as yours, I be trying medication way before thinking of an electrophysiology study.  Remember though that it never hurts to get a second opinion.  Good luck!

[kd1980]

Hello and thanks for commenting on my question.  I was beginning to wonder if anyone was out there!  ;)

Yes, what concerns me the most about taking the meds is that my blood pressure is already a normal low.  The cardiologist told me that this could be a problem.  He gave me a 50 mg pill and told me to cut it in half and take half in the morning and half in the evening.  He said if I start to feel sluggish or dizzy to stop taking the med.  He gave me these on Monday, knowing that I see the EP doc on Friday.  I don't mind trying the med if I really need them, but if he is just giving them to me so I won't be pestered by pvc's, then I would rather just cut out my caffine and deal with the pvc's.  I exercise daily and am very active.  I do not want to feel sluggish or take med's if not necessary.  Also, I like my current weight and do not want to start packing on pounds.  I have heard that weight gain is a possible side effect of beta blockers.  Of course, my heart is more important, but if I am just taking them for pvc's not to pester me I would rather not take them.  

[BobRBob]

I take Metoprolol with Dronederone to control a-fib. I take only 25Mg a day of the Met but it does seem to help hold me in normal rhythm and it controls my rate when I go a-fib. I understand your issues with taking drugs but you really haven't got anything to lose by trying the Met to see if it helps. If it doesn't or you don't like the side effects you can just come off of it with nothing really lost.

[ocdish]

I'm pretty similar to you, 39, normal to slightly low BP with PVC's and PAC's. I'm healthy and exercise often. I also have SVT and inappropriate sinus taych. I've been told that since my heart is structurally normal, treatment is completely optional. I hate betablockers. They make me feel like I can't breath. I have not had any PVC's in a row, but I was told that even it I did, it would still be benign. I have had a lot of testing though, including an Echo, stress test, and EP study with an ablation for the SVT and inappropriate sinus taych.

If I were you, I would call your dr. and ask if he or she thinks that you need to take the medication to prevent anything dangerous of it's just being prescribed to alleviate symptoms.

That being said Beta blockers are safe!

good luck with the EP doctor. When you go, make sure you really discuss having an ablation if the doctor is leaning that way. I feel that my doctor pushed me into it without discussing the risks and benefits fully. (I'm fine now -- but it took me a few months to really recover.) I have a great doctor now that is much more conservative and really takes the time to explain things to me in a reassuring way. the more I learn about PVCs, the less scary they are. I just had one while typing this, and it didn't even slow me down.  :)

[chuparosa]

Just my opinion of course but I would wait until you see the ep. He might come to the same conclusion but who knows. Get as many opinions as make you feel comfortable. Sadly you may need to cut out all your caffeine for good.....

[kd1980]

Thanks guys for all your advice.  It is so nice and reassuring to talk to people experiencing similar things!  I have not tried the beta blocker yet.  I am going to wait until I talk to the EP guy tomorrow.  However, I have cut out caffine and have noticed that I do not have many pvc's at all without it.  I do have a headache though and miss all the energy it would give me!

[colleendawn813]

i am 30, have pvcs and pacs really bad the week bfore my period just like you. after all the tests coming out normal, i went on metoprolol.it made me dizzy, i couldnt tolerate even a small dose (although that isnt a common reaction, especially with only 25 mg that i was on once a day). so i started taking atenolol, another bb, but that lowered my already healthy bp, and honestly it didnt help all that much with the skipped beats. in my case, because my heart is healthy, the only reason my cardio put me on meds was to alleviate my symptoms. if your heart is healthy, you dont need them.but they DO help some people considerably. for me it has come down to not letting the pvcs bother me and trying to ignore them. its really hard to do! but the weird thing is that for 2 weeks out of every month i don't have even ONE skipped beat. its all centered around my cycle. i wish they would come up with something that would help pvcs caused by hormones...it would probably cure me!

[kd1980]

You sound so much like me!  I only really notice my pvc's the week before my period or when I get real anxious or drink a pot of coffee..;)  I kind of felt like the cardiologist was just giving me the beta blockers because he felt like the pvc's were pestering me.  I couldn't for sure tho, if that was the reason or if it was because my holter caught an episode of nsvt and he was giving me the beta blockers to control that.  I know this sounds crazy, but the day I wore my holter it was the week before my cycle and I drank a lot of coffee that day because I wanted it to catch everything I had felt.  I have had ekg's before and they would catch nothing.   I guess I succeeded in having several pvc's and a run of nsvt.  
My main concern however is....is the nsvt dangerous?  If so is he giving me beta blockers to control it or are the beta blockers just for me not to feel pvc's?

Thanks for your comment.