Skipped Beats & Pregnancy

[wayupnorth]

42 yr old woman...5 weeks pregnant...(this will be my 4th child) I have been taking atenolol for approx. 8 yrs. - prescribed to reduce "skipped heartbeats" which caused anxiety/panic attacks.  When first given dose was 25mg each day. OB/GYN that I have scheduled an appointment with (have never been seen by him)  said that ideally he would like me off the atenolol since it is not for hypertension.  I have low blood pressure (averages 102/60 most of the time).  I did see a cardiologist 4 yrs ago (holter/ekg/echo)..all good...some pvcs...but nothing unusual.  Tried to stop the atenolol in the past...3/4 of a tablet for 1 week, 1/2 tab for a week, then 1/4 tab for a week. It went well but 6 weeks later the skipped beats came back, more flutters, feeling shaky afterward and of course anxiety about it all!  Started the atenolol again (1/2  tab) and things settled down(this has been about the last 3 yrs). Stopped the atenolol 2 days ago and today I  had episodes of skipped beats (10-20/hr)... don't get so panicky about it anymore since I visited an anxiety specialist (fyi, I never had an anxiety or panic attack until I had an episode of skipped beats and palpitations)
Also had the stomach flu yesterday with a fever ( 99-100)! My questions...
1.  Is there a good way to discontinue the atenolol?
2.  Is discontinuation the better choice while pregnant?
3.  Is there a better(safer) beta-blocker to use when pregnant?
4.  The increased skipped beats could be the result of being sick and pregnant rather than my stopping the atenolol, right?
5.  Should I request to re-visit the cardiologist when I see the OB/GYN so they are in sync?

Thanks in advance for any guidance!

[anacyde]

Hi there :)  Long time PAC sufferer (skipped beats) and have had two pregnancies; one with a heart problem and one normal.  Here's what I can tell you based on my own experience.  Hormones are a huge huge trigger for me - both during pregnancy and normally.  Reflux also aggravates my palpitations - so between reflux and hormones and pregnancy, I had plenty of palpitations!

A normal ejection fraction is 50-70%.  It will increase later in your pregnancy for most people, and normalize shortly after delivery.  In pregnancy, a low EF is what you worry more about...if it drops below 50 this is a serious problem.  Don't worry about your normal ejection fraction.  Mild regurgitation is not uncommon in pregnancy.

When beta blockers are necessary while pregnant, they discourage Coreg due to risks to the baby, but Toprol seems to be well tolerated with fewer risks.

Congratulations on your pregnancy!  Best wishes for a healthy and happy.  If you want more info on skipped beats from fellow sufferers, come on over to the heart rhythm support forum too :)  I think you'll feel very reassured in addition to what the doctor has said.

[Michael J. McWilliams, M.D.]

Congratuations on the pregnancy

1.  Is there a good way to discontinue the atenolol?

I think the taper you already tried is appropriate.  Cut it in half and then cut it in half again over 2-4 weeks.

2.  Is discontinuation the better choice while pregnant?

I would prefer to have pregnant people not on beta blockers.  The risk of being on a beta blocker are very low, but the goal is to reduce risks as much as possible.  There is almost no physical risk of the PVCs, albeit the emotional risks (panic attacks) should not be minimized.  If you think the beta blocker makes you feel that much better, then it might be reasonable.  Otherwise, I agree with trying to stop it.

3.  Is there a better(safer) beta-blocker to use when pregnant?

There is not data to suggest that one is safer than any others.

4.  The increased skipped beats could be the result of being sick and pregnant rather than my stopping the atenolol, right?

PVCs tend to increase with pregnancy.  It is likely that they are increasing from hormonal changes.


5.  Should I request to re-visit the cardiologist when I see the OB/GYN so they are in sync?

If you see a cardiologist, they will repeat the echo and holter.  If they are both normal, other than PVCs, they will give you a clean bill of health.  It kind of depends on what you want to do.  If you would feel better seeing a heart specialist, then do it.  If you have no significant changes in your symptoms and are comfortable with the previous work up, you don't have to see one.

I hope this helps.  Good luck and thanks for posting.

[wayupnorth]

Just a couple more things I remembered from the cardiologist visit...heart structure normal, mild regurgitation, and ejection refraction of 70%??  Also I do notice skipped beats a couple of days before my cycle and in the middle of my cycle (almost always accompanied by a headache)...over the years I have also noticed that if I feel full (like need to burp) or my stomach is sour/upset I get the skipped beats much more often (my brother in law was experiencing the same thing - (the beats with gas obviously!) and he was diagnosed with acid reflux - since treating the stomach issues he says he hasn't had the problem with the skipped beats...is this a correlation you have heard before?