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Do I need a beta blocker to imrprove heart failure?

Was in hospital in January for a reaction to heart cath dye...went into congestive heart failure and my EF dropped from about 38% down to 22%....do have history of heart attack and valve replacement 5 yrs ago. At the present time taking 50mg cozaar...25mg aldactone and 25mg of Toprol XL but am finding my BP stays fairly low 105-125 over 60-70 but more bothered by heart rate that drops to mid 50's at rest and up walking around only goes to 60-63.  Tolerating the 60's but once I head down to mid 50's seem to develop headache and just not feeling right.  Might also mention that with this lowering of my EF found I needed 02 24/7 which is something I've never had previously.
What I'm trying to accomplish is to raise my EF back to mid 30's if possible and from all my reading seems a beta blocker is a med that should be used...(was on coreg years ago but taken off due to severed lung issues which went away once off coreg) My heart rate has never run really high so when I take the toprol I drop pretty low.....guess all I'm wondering if is this low mid 50's is acceptable in heart failure?  Could the lowered heart rate have anythng to do with my need for oxygen?  Lung dr while in hospital didn't seem to think I had any lung issues other then the CHF at that time.
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1884349 tn?1353818598
Hello and welcome to the forum.

First, you are correct that beta blockers (ie toprol or coreg) are very important medications to take for heart failure.  So, if you can tolerate them, I highly recommend them.  If indeed your lung issues are "resolved" (see below), you might see if low dose coreg has less of an effect on your heart rate than the topril.

Second, it is possible that the inability to increase your heart rate with exercise is contributing to your symptoms.  The beta blocker may be partly to blame (though you take a very low dose) but it is also possible that your heart simply is not increasing your heart rate to an appropriate level.  An interesting test for this would be either an exercise treadmill test or a holter monitor to observe how high your heart rate can get with exertion.

Third, I am HIGHLY suspicious for lung disease contributing to your need for oxygen.  Heart failure rarely ever causes low oxygen levels (unless your lungs are full of fluid and you would know it if they were because you wouldnt be able to breathe).  So I would consider a 2nd opinion from a lung doctor (and the heart rate will not cause this either).  In general, a slow heart rate is actually a good thing but on occasion, it can either get too low or cause a patient symptoms in which case steps sometimes need to be taken.

Hope you feel better and that your heart function continues to improve.


Dr. Rich

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