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Avatar universal

400mg of Metoprolol a day?

IWent to my cardiologist yesterday because my PVCs are still causing me great distress.  I guess I just haven't gotten used to them.  A little background:  I have had PVCs off and on for years but never really thought too much about them.  They would come and go and I would just barely notice them.  This last January my doctor took me off of Effexor XR for an anxiety condition I have.  As soon as she did the PVCs hit with a vengeance.  I don't get them like some (many 1000s a day or worse) but I get about 400-1000 a day, depending on the day.  One thing I have noticed is that I have good days and bad days and can't seem to figure out what causes one over the other.  I went to my doctor who told me that I was having PVCs and should see a cardiologist.  The cardiologist did all the normal tests and found that my heart was healthy.  They did a 24 holter about 3 months ago and found I was having PVCs but that they were benign and about 1100 a day.  The cardiologist put me on first 100mg a day, and then 200mg a day of Metropolol Tartrate, thinking that it would help the issue.  But, the PVCs kept coming.  So, yesterday, he switched me to 400mg of Metropolol Succinate ER a day and referred me to a guy that specializes in electrical problems of the heart.  He said this was due to the possibility of doing an ablation on me.  I have to say that the PVCs do cause me great distress but the thought of ablating my heart does not excite me.  I am also not sure if I should continue with beta blockers either.  I took a huge dose, 400mg, of my beta blocker last night and frankly my heart is womping even harder this morning.  Each hard beat feels like it is going to come out of my chest.  I am sorry to whine and I know a lot of people in here deal with PVCs much worse than I do but they really upset me.  I notice every one that I get and they do upset me.  I am working on this and I do see a therapist to deal with my stress in general.  I have seen many posts here that say just to grin and bear it.  But if there is hope out there should I seek it?  I see that ablations have a high success rate.  But the thought of "burning" tissue inside of my heart does not make me stand up and cheer.  I see there are some anti-arrhythmics that can significantly reduce the number of PVCs but that they can be toxic or even deadly.  Again, pardon me if I don't do cartwheels for that idea.  Should I taper myself off of this medicine and hope they eventually go into remission?  I see some talk about their PVC frequency and they talk about them hitting "every once and a while".  But mine are almost like contractions.  I can set a stopwatch and they will hit about few minutes, almost down to the second.  I want my life back and I feel like these little devils have taken over my life.  I am currently morbidly obese (450 pounds).  But I have been working hard to drop weight (have lost 50 pounds in the last three months) in hopes that will help reduce the frequency and strength of the PVCs.  I also attend group and private counseling to deal with my stress issues.  I feel like I am doing all that I can do short of anti-arrhythmics or surgery.  Any feedback would be appreciated.  Should I stay on the beta blockers?  Is there hope?  What would you do?    
3 Responses
Avatar universal
I feel for you my friend.  Let me read you my cardiologist report which may reassure you of the benign nature of these things and inform your decision about any future ablation. Please note that I  recently I posted my concerns about research potentially linking PVCs with cardiomyopathy-I am less concerned about this now..

"The 24 hour holter recording demonstrated frequent predominately unifocal ventricular ectopy with a count of approx 16,000 in a 24 hour period (104,000 beat in total) The morphology appears to be a left bunfdle block pattern whoch would suggest a right ventricular origin within the right ventricular outflow track. This is likely to be approachable by catheter ablation. I have emphasied to Mark that we are contemplating an ablation option solely because of his symptoms and not because of any medical perception or concern about risk. Mark is living testament and the benign significance of the ectopy in terms of risk of mortality".

What all this means from your perspective is the following:
(1) that pvcs in an oterwise normal heart are not harbingers to anything serious happening.  
(2) While ablation remains an option, given that you are only experiencing a relatively small number of PVCs, from a risk perspective I personally would be disinclined to proceed down this root.

(3) My cardiologist is very reluctant to use beta blockers for pvs because in his experience they can actually increase the frequency of them through slowing down the heart rate. In this context,  400 mg of metropolol seem an awfully high amount to me.

(4) PVCs have a habit of waxing and waning over the years- may be it is better to just put up with them and try to live as full a life as possible. Sometimes when I am experiencing trigeminy and go out and play tennis they go away, or at least I do not notice them.

Wishing you well

Avatar universal
One more questions for the forum.  I have read that using beta blockers can actually cause palpitations to sneak in.  Is it possible that by taking so much beta blocker on a daily basis that I am actually making my problems worse?  Since the beta blockers haven't made the PVCs disappear then is there any poitn to continuing them?  Thanks.
503607 tn?1275675179
400 is a big dose of toprol,  Have you tried any other beta blockers?  You may need to try a few, Toprol did not work for me pvc's broke through, I am on Atenolol and it works better for me,  I would definetily get a EP consult, they will not usually ablate PVC's.   It's worth going an discussing your options.     I would definetly try changing beta blockers,  I would not be able to get out of bed taking 400mg of a beta blocker per day.

Good Luck!
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