Changed meds and reduced dosage Not sure where I stand

[akenclark]

Was originally on Metoprolol 50mg twice per day. Had SERIOUS depression side effects so we changed to Carvedilol 12.5 mg 2x/day. Over time the dizziness, fatigue and breathlessness climbing stairs got worse and worse. Looked at the COREG 24 hr 12.5mg But it is still on patent and costs $300 per month, not covered by insurance.

So we are trying the 24 hr version of 50mg Metoprolol (so the dose is half as much per day.) And I am now forewarned and on the lookout for possible depression. I take it at dinner time so one hopes the worst of the side effects have all night to subside.

So far. I can now climb stairs and arise from my couch without dizziness and only slight breathlessness. Even better, I am able to (cautiously) do a morning walk of about 3/4 mile with hills. Was in total couch potato mode on the Carvedilol.

My walk is gentle downhill for first half. I take a Kardia ekg pic and it is always beautiful--regular sinus. Then I start back uphill towards home. Kardia pics are varied on the way up and at the top. Sometimes the ap deems it as "Normal" but the line appears rougher and I can see a few instances of spikes right on top of one another which I assume is a double-beat. Occasionally it warns of "Possible AFIB" I always take another immediately and it reverts to "Normal" very quickly. Sometimes it says it cannot be interpreted and says my pulse is too high. (It seems to be indecisive if pulse exceeds 100)

The issue I have is that , of course , I do not have any ekg pics from before my arrythmia was diagnosed for comparison. I am asymptomatic, so maybe my heart has acted this way for years. I feel so much better and more energetic after this latest change I am reluctant to conclude we need to increase the dose (something my cardiologist seems always eager to do--He must own stock in Big Pharma or something) in some quest for the perfect ekg picture.

During the past month,I have cut back alcohol from 4 drinks per day to 4 drinks per week with many AFD's (previously unknown). I have cut out coffee from 3 -4 cups per day to decaf, hot cocoa, and green tea.

Hope it is not too boring. Any comments or shared experiences would be really welcome. (ideally I would have had Kardia pics from when I was on the Carvedilol but the Kardia is a new device to me.)

[akenclark]

Sorry to add a thought. I have no idea, given the Kardia readings, whether I am doing a good thing with the walks or damaging myself when it says "Possible AFIB". Thoughts on that?

Regards

[Arveno in reply to akenclark]

You can improve your health and condition by changes of your life style. Walking is VERY GOOD to you, but be careful, take it step by step with uphills. Be sufficiently hydrated. Probably you may drink little cofee. Chockolad is OK but NO SUGAR. green tee is god. Did your MD check your Potasium level and other electrolytes? You may improve your condition with some supplements (Magnesium taurat) but AWAYS check with your MD and google for interaction with your medication. Mayo clinic has excellent source of information. Seek knowledge, google on your condition, ask your doctor and try to be positiv. You can manage long good life.

I have some experience from my life. My 77 years husband had heart kollaps at 2016, had unbalanced diabetes, overweight, high blood pressure. Very bad prognosis. We ourself did following: management of his diabetes by LCHF diet, life style changes, total stop with alcohol. Walking, some supplements, checking with MD decreasing or avoiding some of number of his medications. Today he has normal blood pressure, mostly normal blood glucose, lost 24 kg, has normal weight. His medication was decreased, walking 40 min nearly each day. Changed from zombie to his normal personality. We are still extremely careful with his medication (Sotalol 40 mg 2x day, Apixaban 2x day. Very careful with harder work (sailing, working with house etc). If you have family let them be involved and support you. With wishes of all good!

[akenclark in reply to Arveno]

Thank you very much. Your story is encouraging. I am 68 and would prefer to not be doing "end of life" planning just yet. I shall be into the doc in a few weeks and will ask about the electrolytes. I have been sweetening my cocoa with Truvia but there is sugar in so many other foods. Is it the diabetes the prompts your strong recommendation against sugar? Or are there heart issues with it? Thanks

[Polski in reply to akenclark]

High AFib when resting is to be avoided, especially for long periods, and could damage the heart in the long run.

If yours is for a short time only when walking uphill, then it is probably just the Kardia trying to make sense of what it is receiving when your body is working hard. I suggest you just take the uphill bit very slowly, and then check the Kardia when you are sitting down again at home. If the reading is 'Normal' then, then you are fine.

[akenclark in reply to Polski]

Thanks. I am not competent to take the Kardia reading while still moving. I either stop and lean against a post or find a rock to sit upon. Your comment triggers an observation of something I found odd. After climbing the hill (it is merely a residential street so not insanely steep-like the foot paths in New Zealand!!!) I will often take three ekg's right after one another. Often, the first one is deemed "normal" (although to my untrained eye it is not as beautifully smooth as it is at the bottom of the hill.) Sometimes a very scattered pattern shows up with a "Possible AFIB" warning on the second ekg, so this occurs after I have been sitting approx a minute and it is clearly settling down on the graph towards the end of the 30 second sample period. A third ekg ,taken immediately, is almost always "Normal"-although occasionally the third one is deemed "unreadable". The scattered pattern, on the second graph, is never longer than a 15 second duration.

I shall definitely work on slowing down the uphill, as you advise, to find the sweet spot where I can pace myself to not trigger a problem but still not take the rest of the day to get up it. It is tricky when I do not feel anything going on when Kardia says my pulse is scrambled.

Thanks for your thoughts- I take them seriously.

[Polski in reply to akenclark]

My impression is that our hearts will jump around when we are working them hard, and also that some of those squiggles are simply caused by not holding the Kardia still. It is the reading when we are at rest that matters. The exercise is basically good for us, providing we are not pushing ourselves too hard - so take it very, very gently and you'll be fine. it is when it goes into AF and stays there that we have a problem.

Dr John Mandrola has written a book 'The Haywire Heart' all about exercise and AF (he is a cyclist and EP, and has some experience of AF) You may find it interesting if you are interested in better understanding how exercise and AF relate.

[akenclark in reply to Polski]

Thank you very much. Will check out the book.

[Enjoy]

Are you asthmatic as beta blockers are not recommended for us. Just a thought. Hope things improve soon.

[akenclark in reply to Enjoy]

Had asthma as a child. Not for many years now. Thanks

[IssyM]

I have been on Carvedilol for over 20 years. I am 61 years of age now and as far as I know I have not suffered too many side effects. I do get depression but I also take Glaucoma drops and this has made it worse at times if they get into my system.

They seem to work for me, so we have never changed them, I prefer to stay with what I know.

I did have a bad spell last year with irregular heart beats but my medication stayed the same. I underwent some tests at the hospital and my Doctor and the consulting Heart Specialist decided to leave things as they were. The tests did show that my heart misses beats but the muscle is still strong and no damage.

Periodically I feel panicky and my heart seems jump around but I find that a walk seems to help this, but I do not over stress my heart. More a sedate walk and if I feel up to more then I will increase my speed and walk up a few rises, about 1 hour in total, but I find that 40 minutes is usually enough to help.

I am not sure if this is any help, if you have other questions I am happy to tell you my experience.

[akenclark in reply to IssyM]

Thank you for your thoughts. It was exceedingly strange to me that over time the side effects of the Carveilol got worse and worse and became quite extreme. Usually they say "you will adapt".

It is interesting that you find walking settles things down for you, while in my case it seems to be a trigger. Similarly, on this site, I have read about some folks who have problems while in bed asleep--which is quite different from my experience.

[IssyM in reply to akenclark]

I can't remember having any trouble in bed with it. I find that worry seems to bring on an attack and then if there are any other stresses this seems to make it worse. I have glaucoma as well, so I did wonder if my eye drops were causing some of my attacks as one is a beta blocker. I also take magnesium tablets from time to time, but found that during an attack if I rub magnesium oil on my arms, legs and chest it seems to help. You can also buy a magnesium cream and I keep all on hand.

However my brother in law has had a different experience to me but he too started taking magnesium tablets.