Beta blockers for for healthy individuals

[Mikedabike]

I will try to be brief. 62 year old male, extremely fit. Diagnosed with congenital bicuspid aortic valve in March 2019. Over next few months no symptoms other than an increasing shortage of breath. Blood pressure fine, no pain, no medication. Told I would need to be monitored every 12 months. Late August 2019 went sick from work as breathlessness was increasing. All tests other than a CT scan (which I didn’t have) showed I was fine. I had an aortic aneurysm of 2.5 cm. Informed again that I was fine and that I just needed monitoring. In an attempt to be taken seriously I attended local A & E who arranged a CT scan. As soon as CT scan completed, kept in hospital and had a mechanical aortic valve replacement and hemiarch graft.

Since operation my fitness has helped me heal extremely quickly. Post op I have been on no pain killers at all other than paracetamol early on to deal with muscle soreness on my back and shoulders. I have had no pain whatsoever from chest wound.

6 weeks post op I have been signed off by cardiologist, cardiac rehab team. Just commenced my cardiac rehab physio. The only medication I am no taking is 1.25mg of bisoprolol in the morning and warfarin in the evening.

It has been apparent to me, that as I have kept myself very fit, I present a healthy picture to the medical profession, and I have struggled getting staff to understand my plight prior to my operation.

My concern now is that 3 days after returning home I had a suspected TIA. As they could not do an MRI scan it could not be 100% confirmed. Since then, although generally feeling very well, and very fit I have had a further 3 episodes of the early symptoms of a TIA. Each time I have come out of it, though each occasion is very frightening for me, (and even more terrifying for my wife).

I am concerned about the beta blocker I am taking. I believe this is to lower blood pressure and pulse rate.

Up until 9-12 months ago my resting pulse rate had been 52/54bpm for years (at my peak fitness it was in the mid forties when younger). As my breathlessness increased my resting pulse rate settled at around 60bpm in the months prior to my operation.

Starting the cardiac rehab physio has now given me the confidence to slowly and safely start to exercise and gently increase my fitness. Within just a few days of starting a gentle exercise regime, my resting pulse rate is already beginning to return to the mid to low 50’s.

My concern is that as I already have a naturally low pulse rate, and post surgery I am already healthier and fitter than most (please note - not a boast - just an observation) should I still be taking the bisoprolol beta-blocker? I am concerned that as my resting heart rate is normally lower than the general public anyway, should I continue using a beta-blocker whose main aim will be to lower blood pressure and pulse rate.

I forgot to add that pre-op my blood pressure was only very slightly higher than normal, post op it has been well within the normal range.

Apologies for a lengthy initial post and I welcome any observations.

[sherwood123]

I have asked the question to my cardiologist, surgeon , doctor and other medical professionals regarding taking medication for high blood pressure, which I don’t have. I had a double heart pass due to blockage on l/h side of heart, no pain , but slightly out of breath on exertion. The answer I can give you to your question, is , these medications protect your heart and are required to prevent overload on your heart. I have asked is there not any medication that protects your heart but does not lower your blood pressure, NO , is the answer. Bisoprolol is the best medication for heart conditions.

[Mikedabike in reply to sherwood123]

Hi, and thanks for prompt reply.

[MichaelJH Heart Star]

Hello and welcome to the forum! It is good to hear how well your surgery and recovery went. With TIAs the biggest risk factors are smoking (I assume you do not) and high BP. Bisoporol reduces the load on the heart post-surgery, and BP and HR long term. You are on the minimum dose. Unless you have had a 24-hour BP monitor it is hard to know how it moves it the day. For instance some people's HR and BP increase markedly when driving! Lower BP also reduces risk of any Warfarin related bleeds. I would get your GP to chase up an MRI.

Regarding your TIAs - a colleague had one. After a TIA or suspected TIA you should not drive for a minimum of one month and then only with your GP's go-ahead. There is more information on the DVLA website.

[Mikedabike in reply to MichaelJH]

Hello and thanks for prompt reply, You are correct I have never smoked. I am now 8 weeks post op and the TIA was over 6 weeks ago. My BP stays pretty stable all the time (even when driving), it tends to only increase when training or extreme stress (highly unusual). My main concern is my naturally low heart rate and the possibility of the beta-blocker lowering my heart rate even further.

[Lezzers in reply to Mikedabike]

Just out of interest, how do you know your blood pressure is stable whilst driving?

[Mikedabike in reply to Lezzers]

It may sound corny but I actually had it measured whilst driving (nothing fancy just an Omron device). I used to be an advanced driver in a previous life and was curious to see how my BP changed when driving under extreme stress at high speed to generally normal driving. Although it did rise, the rise was only minimal.

[Lezzers in reply to Mikedabike]

Was this a wrist monitor of some sort?

You're 8 weeks post op & 6 weeks post TIA?

[Mikedabike in reply to Lezzers]

It was the Omron BP monitor that fits around the upper arm. I am 8 weeks post op and 6 weeks post TIA.

[NorthantsSteve]

Hi Mikedabike. I’ve always had low BP and heart rate. Had a heart attack over 3 years ago (no other indicators/co morbidities etc) and put on BBs etc. This has put my heart rate lower and into mid to high 40s at rest. I can feel a bit light headed if I get up quickly but my doc says I’m ok and it’s best to try and keep my heart as slow as possible and to protect it from adrenaline surges. I’m happy to continue - but might look to decreasing dose as my general level of fitness is improving (currently on 2.5 Mg). So from your heart’s perspective I can see the rationale. In terms of BBs preventing a future TIA - more research is needed but that which there currently is shows there is no benefit in taking BBs to reduce risk of further cardiac events for those who have had a TIA only. I haven’t seen anything that suggests that taking BBs increases the chance of TIA.

[Mikedabike in reply to NorthantsSteve]

Thanks for the info and update. I have never been on any sort of forum before and I am amazed and heartened (no pun intended) at the rapid replies from everyone.

[magih in reply to NorthantsSteve]

Not meaning to derail but my GP just does not get it when I mention the adrenaline surges...could you explain to me what they are?

I found out in the summer that I have what the cardiologist describes as inherited young person’s hypertension and have missed & extra beats. On amlodipine & bisoprolol 1.25.

The surges are less but I still get them...in that bit between being awake & falling asleep at night!

[NorthantsSteve in reply to magih]

Hi magih. I think I probably mean something different. Like when your heart is racing because of a stressful situation.

[magih in reply to NorthantsSteve]

Ah, ok. I get these huge lurches, like when your stomach flips when on a rollercoaster!

[NorthantsSteve in reply to magih]

That could well be gastric. Your stomach might not like your meds. Is it at the same time each day or just random?

[magih in reply to NorthantsSteve]

Lightbulb 💡 moment!

I am also taking PPIs for severe reflux and the surges happen when I lie down! Maybe I’ll try taking the Lansoprazole mid evening rather than on going to bed, so I am getting the full effect.

Thanks!

[NorthantsSteve in reply to magih]

Try taking them 30 mins before you eat 😄

[magih in reply to NorthantsSteve]

I’m trying everything 🤪

[onadiet in reply to magih]

I was on Lanzoprazone as have Hernia and now GORD .I get the stomach surges as well. Straight after I get warm flush and anxiety and Palps. The Vagus nerve is near stomach so I wonder if there is connection there ?

[magih in reply to onadiet]

Thats an interesting thought.

[onadiet in reply to onadiet]

Well post Hernia Op. All OK.but still getting strange surges.Still think it's Omeprazole based. Waiting now for a other Endoscopy at Guys in Jan.25.I asked G P to refer me for Surgery such as LYNX or Fundoplasty or the newest one.Think my Spyncter is lax. Then hope to come off of Omeprazole.

[NorthantsSteve]

Hi Mike. Should also say that an MRI won’t rule out a TIA - only ruling it in. It’s also usual to go on Clopidogrel/Aspirin when you’ve had a TIA to inhibit future clotting. What other meds are you on?

[Mikedabike in reply to NorthantsSteve]

Literally only on 1.25 mg of Bisoprolol in the morning and my warfarin in the evening. I have very rarely taken medication my whole life other than the occasional paracetamol or ibuprofen (I guess I have been lucky).

[NorthantsSteve in reply to Mikedabike]

I guess the Warfarin is doing the ‘thinning’ job required to prevent further events.

[13allit]

Hi I had my mitral valve repaired in 2018 and took part in some research which involved several long detailed MRI scans before and immediately after my op. Apparently it’s not uncommon to have small bleeds in the brain when your heart isn’t functioning properly and also during the op. I’d had a few in the head scan which was done 5 days post op. I was told it wasn’t a problem and they should heal leaving no long term problems. I’ve had some periods when I get migraine type auras without the headache but over time these have got less frequent. Hopefully the same will happen with you. All my heart medication was stopped at try first annual check at the heart valve clinic and they’ll. keep checking me annually. Hope you continue getting fitter and stay healthy.

[Mikedabike in reply to 13allit]

Hello 13allit, this is very interesting. Since my apparent TIA I have had 3 other episodes where I have had a thick, heavy head and the migraine type auras (no pain at all). These were all very worrying at the time, and took varying lengths of time to clear. (The longest episode other than my TIA was a couple of hours). When I look back now I realise that each episode was possibly brought on by my not eating and drinking regularly. The problem has been that I have felt so good after the surgery that I keep having to remind myself that I have had major heart surgery. Without realising I kept drifting back into my old lifestyle of breakfast, very little food in the day, then a good healthy meal in the evening. I have taken it that these ‘episodes’ have been my body’s way of saying - don’t be stupid, you have had major surgery, you need to keep eating and drinking regularly. Hindsight is a wonderful thing, I even think my TIA was my own stupid fault. I was only 10 days post op, and 3 days since hospital release. I was going for my first anti-coag appointment and was in a rush. I missed breakfast, my wife drove me to the hospital, I even said we would grab a bite in the coffee shop at the hospital. However the appointment was that quick that once finished I said - oh we might as well get home and eat there. Cue the possible TIA just as we got back home. It was only as I came around much later that I could have kicked myself. In reality I hadn’t eaten since the evening before, so in effect I probably hadn’t eaten for over 12 hours. You can imagine how stupid and angry I felt with myself. Thank you again for your reply.

[NorthantsSteve in reply to Mikedabike]

For what it’s worth I’d be surprised if your not eating caused the TIA. Don’t beat yourself up, Mike 😄

[Sunnie2day in reply to NorthantsSteve]

Very low blood sugar actually can present as an apparent TIA; it's not a well-known cause of TIA symptoms but it does happen.

[NorthantsSteve in reply to Sunnie2day]

Thanks, Sunnie. Live and learn.

[Sunnie2day in reply to Mikedabike]

Please remember I am not medically trained. But I have 'been there-done that' - whilst carrying my second child I had what seemed to be a 'slight stroke' later deemed a TIA in the hospital but then changed to severe hypoglycaemia after the bloods results were in the next morning. Hypoglycaemia can present with symptoms of a TIA and it can be confusing to A&E/Casualty/Emergency Room medics who've not got much experience with the condition - but a good neurologist will 'see' it in a half-second.

In my case, a subsequent scan showed no evidence of any sort of stroke. But an eight-hour glucose tolerance test (GTT) a few days later told them I had gestational hypoglycaemia and when the wee man was one, two and three years old, repeat 8hr GTTs showed I had 'plain old' hypoglycaemia.

The wee man is now coming up on 38 years old. I still have low blood sugar - but I've never had another TIA as I manage my blood sugar carefully.

[Mikedabike in reply to Sunnie2day]

Thanks Sunnie2day. You echo my immediate thoughts as I came around from my apparent TIA episode. Like yourself I am not a medically trained person, but as I have always kept myself in shape, I tend to have what I suppose you would call a good body awareness (it was this that led me to push for a heart CT scan when the cardiologists were dismissing my heart problem prior to surgery). I instinctively felt that my TIA episode was actually caused by low blood sugar. I am currently exploring this avenue with my GP.

[Sunnie2day in reply to Mikedabike]

Hopefully your GP will order the longer glucose tolerance test (GTT) as the shorter 2-3hr ones are not as good diagnostically - 4-8hrs is much more definitive. Not pleasant but if the reason for the testing is owing to TIA symptoms, the longer GTT test is 'the gold standard'.

I was diagnosed in late (at Christmas) 1981 with the next three years tests confirming the diagnosis - at first I was upset, seeing it as a precursor to diabetes (doesn't run in my family and for most hypoglycaemics apparently it is not a sign of looming diabetes) but it's so easily (usually) manageable that 37 years on I'm so used to it I don't even think about it.

It's just habit now to make sure I have sugars-levelling nibbles on hand (fridge, cupboard, day bag, etc). If you're diagnosed, you'll find several good publications to help you manage it including knowing the warning signs your blood sugar is dropping and you need to eat something appropriate to your needs. I keep cheese cubes and apple slices in a Lock&Lock container, for example, for those times. You'll find your 'quick fix' as you go on - IF low blood sugar is the problem.

Please update us as you go on. When I was diagnosed with the hypoglycaemia the medics all went into mini-panics owing to my rheumatic heart - sugar levels can make heart conditions even more important to be monitored carefully.

[Prada47 in reply to 13allit]

Hi

Due to a previous brain bleed ( Leaking AVM ) and follow up Gamma Knife Treatment the Heart Surgeon would not book me in for By pass Surgery until the Neuro Surgeon agreed and only after I had a current MRI !!

He actually said he wanted it in Writing before he would agree to surgery reason being is the Heparin (spelling ) used to thin the blood during the surgery. It is also used to thin the blood during stenting.

In fact I can clearly remember a Nurse calling out administering Heparin Now when I was being stented !! Also had a hand full of Clopi dog rel prior to stenting.

Regards

[Prada47]

The current evidence for protective effect is that it's useful for the first 6 to 12 months after an event but, beyond that, there's no real evidence of benefit (if your unmedicated figures are good, of course!).

Hi can you clarify the bit about useful for the first 6 to 12 months ? I don't think I would risk stopping my 7.5mg Bisoprolol to find out lol and I have been on Biso for a few years now !!

I do note (if your unmedicated figures are good), I don't know if it is possible to know what your figures would be without the medication !! as I said I have been on Bisoprolol for a few years now. and I daren't miss my daily dose,

[Hidden in reply to Prada47]

I agree, in my mind bisopronol is a key medication in de- stressing the heart long term after the damage of a heart attack.

[Mikedabike]

Thank you, I really appreciate the detailed reply. All of what you say makes sense now. I can now imagine that I will be in a similar situation in 6 to 12 months time. The number of replies I have been getting has helped me not only understand but see the sense in continuing taking the bisoprolol in the short term.

[Prada47]

Thanks for that I do have Heart Failure so looks like my 7.5mg is for life !!!

Regards

[Mikedabike]

👍

[Prada47]

Maybe just maybe the Entresto will improve my heart so much that I will be able to dump everything else !!!

[Lezzers]

Sorry, I'm having a dim moment but that's nothing new for me!!!

"The current NICE guidelines are for beta blockers for "at least" 12 months after a heart attack if LVEF is normal"

Doesn't the "at least 12 months" mean that 12 months is the minimum to be taking but longer term is preferable?

My husband has HF & he takes them for vt's so hes in another ball game!

[Milkfairy Heart Star in reply to Lezzers]

My husband is on beta blockers to manage his arrthymias and high blood pressure.

[cjbroon]

I was diagnosed with a Thoracic Ascending Aortic Aneurysm in April 2017 at 4.9mm, like yourself I was fit and healthy and had absolutely no symptoms and was put on medication. Had OHS twice last April to repair it and left Hospital after a month on a load of tablets including Amiodorone for a couple Afib episodes due to the surgery. Managed to whittle the tablets right down but took a couple of infections, the first in May where the infection caused Afib and whilst in Hospital i got put on 2.5mg of Bisoprolol per day. Now I've only had the Afib one more time again due to an infection in November when I was in hospital for 4 days. Other than infections I've never had any other issues causing Afib. Got taken of the Amiodorone by the surgeon in July. Now I'm still in good shape and have been back to the gym at work and like yourself am an Advanced Driver and would like to come off the Bisoprolol now. I just think it causes a disruption to my sleep pattern and don't see any need to be on it. Last time I was in with the infection the consultant there said if I had infection again I should temporarily stop it and the losartan I'm on as it along with the infection caused my blood pressure to plummet. I actually feel really good now and don't see a need for the bisoprolol any more.

[Mikedabike in reply to cjbroon]

Hi, I understand your thoughts. It’s difficult to come to terms with taking medication when you have never been used to it. I have been grateful for many replies, and I feel more confident now in taking the bisoprolol in the short term. I am hoping as I start to get fitter that the hopefully within 6 to 12 months I will be able to stop taking it.

[NorthantsSteve]

Thanks TWU. I’d be interested to read the research. Have you got references please. Ta.