Sotalol quesiton, was this right

[palladin968]

I had an episode of tachicardia, but by the time I got to the doctor, it had passed. (Event though they did not see ANYTHING, they gave me metoprol)  I was told the next time it happens to goto urgent care right away, so they could get an EKG.

I went in, and they took and EKG, it came and went and they got thier EKG, afterwards the Doctor gave me some Sotalol and asked me to walk around.  It didn't really help and I had to sit down.  Eventually they said it was not settlign down and they said it could either stay or wait for it too settle. (Since I had been there like 3 hours and it was approachign 10PM, I decided to leave).

Since then I have felt awful, mostly the chest not feeling right.  I spoke to my family doctor (a few days later) and he said I was just suffering form stress.  (Meanwhile I'm way out of breath, my chest does not feel right, and I'm feelign miserable).

I finally got into the appt to see the Cardiologist, he informed me that even when I was not having the tachycardia, I was having an irregular heart beat.  (Before except when I was experiencing the tachycardia, they saw NOTHING wrong).  I finally persuaded him not to give me more sotalol, instead he moved me back to Metopol (sp?) at a higher dosage and Digoxin.

Today, the first day on the metopol, I feel SO MUCH better.  I'm wondering if the Sotolol is actually when caused the irregular HB the cardiologist was seeing yesterday, and if they should have been more thorough about checking for it actually being effective, when they gave me the Sotalol.    (Unfortunately there aren't many cardiologists available, so I had to wait a couple of week while taking the Sotalol, before the cardio could see me).

[palladin968]

Met with the surgeon, and he gave me the information on the procedure.  He told me the hospital's web site has information on the procedure, but it is in Dutch, so difficult for me to read.

He thought it would be a 2 week wait for the procedure to be scheduled, but they called today and the soonest they can give me is 1 month.

Have a CT scheduled the 29th.

(Not happy about having to wait so long).

The doctor more talked about ventral fibulation, than tachycardia as the main issue.

[palladin968]

Have an initial appt with the surgeon next Monday.  

[tom_h]

I was administered Heparin, a fast acting anti-coagulant which has a very short half life.  By the time I left the hospital several hours after the procedure, its strength had diminished to a quarter of the dose.

[DeltaDawn23]

I believe it takes 21 days for Coumadin (generic Warfarin) to become therapeutic.  There is an injectible bridge drug  -- Lovenox.  Good luck and keep us posted on your journey.

[palladin968]

Yeah I wondered about that also, he said something about needing to be on the blood thinner for a few weeks before the procedure.

[tom_h]

Interesting... In the US blood thinners are administered during the procedure if the left side of the heart is accessed.  Good luck and keep in touch if you get set up for an EP procedure.  Hopefully, we can answer any question you may have about what to expect.

[palladin968]

Dr moved me to verapamil today (on account of the side affects I was having).  

Also did an echo and everything looked ok.

They've put me a blood thiner, as a prep in case they do an ablation.

[palladin968]

I guess the edit is  "right now"

[palladin968]

I don't sem to have so much tachycardia, but I  feels so uncomfortable. (right now my heart rate is 60 BPM, but my chest just feels uncomfortable).

[tom_h]

It's good that you're off the Digoxin.  I've heard of the Metoprolol/Flecainide combination before.  It's administered here in the US as well.

I've been on as high a dose as 200mg of Metoprolol.  I had a really hard time with it.  My heart just didn't want to get up to speed if I did anything strenuous.  I dialed it back to 100mg, and I was fine.  After my ablation I continue to take 75mg/day, 50 in the evening, and 25 the following morning.

How are you doing with converting the episodes?  Has anyone shown you how to do it?  I was very successful converting mine, and I had literally hundreds and hundres of them over the course of 54 years.

[palladin968]

They switched me off of the Digoxin and on Flecainide (keeping the Metoprolol)

[palladin968]

Originally it was 100mg, but i was getting tachycardia in the afternoon/evening.

Now it is 150mg

[tom_h]

Metoprolol is a class II beta blocker while Sotolol is a class III agent that kind of straddles the fence between a beta blocker and a potassium channel blocker.  I think of Metoprolol as the Tic-Tac of blocking agents.  It's easily tolerated by most people.  When Sotolol is first administered, patients are often monitored in a hospital for a few days to make sure it doesn't do anything "funny".  It's a serious antiarrhythmic that can actually cause arrhythmia in some circumstances.  

Now.. your cardiologist put you on Metoprolol and Digoxin.  The latter drug is very old.  I took it back in 1957 when my SVT first appeared.  It's toxic and can buildup in you body.  I'd ask with all of the possible anti-arrhythmic drugs available, why were you put on Digoxin?


Question:  What strength Metoprolol were you prescribed?


When you get these episodes, there are several ways that you can convert them on your own.  Has anyone shown you how to perform Valsalva?  This is probably the most widely used method to convert an episode.  I used it for 54 years until my ablation 2 years ago.