I am 66 years old Caucasian male, 6 foot high, 165 lb weight. I quit smoking 20 years ago and my alcohol intake is limited to a total of 150 ml daily of red wine distributed evenly between my lunch and dinner. I am retired, living a comfortable life with almost no stress and for the last 20 years I have been following a healthy diet as recommended by the AHA and regularly exercising for a minimum of one hour at least four days every week. In 2003 I had an ischemia (80% obstruction in the LAD artery) and two stents were fitted. In 2013 I had a myocardial infarction (significant stenosis in rear CX) and two more stents were fitted. The previous stenting was found to be completely permeable with no signs of any restenosis. After this and according to the hospital protocol I was put on a medication plan with: Clopidogrel (discontinued after 12 months), Atorvastatin 20mg, Xarelto 20mg and Bisoprolol 2.5mg. The only other health issue I have is GERD for which I am taking 20mg of Nexium daily. Since the infarction, I have been undergoing regular checks (cardiac MRI, US, yearly stress tests, one SPECT test) and two months ago had a coronarography that confirmed a perfect state of all arteries and the four stents.
Before and after my cardiac incidents my heart frequency has always been on the low side (50-60 at rest and 45-50 when sleeping) and my BP similarly has always been on the low side (around 100-110/65-75 at rest). Why do I need to take the beta-blocker (Bisoprolol)? What are exactly its benefits in my case? My heart rate is now below 50 at rest and during sleep it drops below 40. For about a year now I am having daily spells of feeling cold even at high temperatures, and I also have a feeling similar to nausea sometimes accompanied by a discomfort in my chest. These come very frequently and are not related to any sort of behaviour pattern. The only thing I have noticed is that they go away during physical activity or exercise. Extensive study covering cardiology, gastroenterology, neurology and rheumatology reported that everything was in perfect order. I am wondering, could this cold, nausea and chest discomfort be caused by the insufficient blood flow caused by the beta-blocker? I have asked two cardiologists and two GPs, but I got the standard answer, which basically boils down to "that is the protocol, you should follow it, the meds are good for you".
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Jerry_D
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It sounds as though you are having Goldstar treatment .As to your meds. I would not be taking anything without knowing why I was taking it. So do not accept negative or placatory replies to your request from your doctor as to why you are taking your meds. .
Thanks for your kind response. Negative/placatory/boilerplate responses is something I am fighting against. Not very successfully so far, I'm afraid 🙂.
Hello
If you are taking a blood thinning medication that can make you feel cold
I believe you are in Spain and maybe your system works differently but the medication that you have listed I would ask for a review if you can and explain how you are feeling as well as asking why you are on each medication and if they feel you still need to be on them all x
Thanks for your kind response. As with arteries narrowed or blocked by plaque, chest pain, or angina, is a common symptom of non-obstructive coronary artery disease. This chest pain will usually occur during physical activity or with emotional stress. In my case, all three of my symptoms (chills, chest discomfort and nausea) totally disappear with physical activity. Also, other possible symptoms of NOCAD (pain in the back, arms, or jaw, shortness of breath, fatigue, light-headedness, palpitations) have never appeared. And finally, the NOCAD affects more women than men. For all this, personally I never had it on the top of my suspects list, but now that you point it out, I will definitely bring it up with my cardiologist.
Non obstructive coronary artery disease is an umbrella term for angina without obstructed coronary arteries.
The main causes are microvascular or vasospastic angina. They are similar however different types of bon obstructive angina.
Vasospastic angina is caused by the temporary, transient, constrictions of the coronary arteries. Some people also have these vasospasms in the small blood vessels too.
Microvascular angina is usually caused by microvascular dysfunction, when the small blood vessels fail to dilate or stay dilated in response, to extra demands such as exercise.
I have coronary vasospastic angina which effects men and women equally. I have vasospasms in both my coronary arteries and small vessels.
Microvascular angina probably effects more men than realised.
I experience my symptoms at rest usually in the night.
These are the classic symptoms of vasospastic angina.
I can exercise, however I experience my symptoms after exercising. The cold, emotional or mental stress will trigger my angina promptly.
Most people living with microvascular angina experience their symptoms with exercise sometimes at rest.
These are complex conditions often overlooked.
I hope you are successful in finding the answers to your particular issues.
I would definitely contact your GP or Cardiac helpline to tell them your symptoms and remind them of your low blood pressure and heart rate results and question whether it could be being caused by one of your meducations .Nausea , Feeling cold and minor chest discomfort , heaviness in the limbs , tiredness , fatigue and cold sweating can all be symptoms of a low blood pressure or low heart rate.
You need to establish if you are suffering from some new condition or whether your drug regime might need altering to your current needs.
You mention that you are on a blood pressure medication.
Were you put on that for high blood pressure sometime ago before you had your treatments and stents ?
Or , is it for an "off book" reason ( not prescribed for blood pressure but necessary for another symptom you have that the drug wasn't originally created for this often happens with heart related conditions)?
If any of your drugs were originally prescribed for high blood pressure but now yours is low it could be the cause of your symptoms .
Or , you may need to ask them to review your medications in general to see if changing to a different make or version will get rid if these side effects.
I was put on beta blockers after the heart attack, as part of the standard protocol. I never had, before or after, high blood pressure. I have asked my GP and three different cardiologists about the medication, however neither of them considered the meds as a possible culprit for my issues.
I'm surprised , a beta blocker can definitely cause the symptoms you have mentioned , even if it is still required but the dose is too high.It might be worth mentioning again with these new symptoms , I know I had them on both propanolol and bisoprolol , beta blockers just weren't right for me and sent my blood pressure to the floor giving me the symptoms you described yet , in my case , it made my tachycardia worse.
Have they given you an alternative diagnosis for the low bp and heart rate?
No. They considered it as "normal". I was sent to the gastroenterologist regarding my chest discomfort and nausea. He did an extensive blood test, an ultrasonic examination and a gastroscopy and concluded that the GI tract was not causing my symptoms.
The fact that you give your weight in pounds suggest you may be from the USA a place where they are even more keen on pharmacuticals than even the UK. My GP tried to start me on betablockers 2 years after my HA and after checking with a good cardiologist didn't take them. They have a large number of side effects and given your stats don't know why you are taking them. BP is just a number and is not at all a constant among individuals.
Be warned that GPs have a very limited knowledge of health, they are trained and kept informed by big pharma and as such slaves to them.
I did a lot a research after my HA and stents and would suggest everyone does the same, I recently saw my GP following a stomach endoscopy exam to find that they had lost the biopsy report. So she gave me an antibiotic for a "possible" bacterial infection, the probable cause of my gastrocardiac syndrome. She had my medical records in front of her but gave me penacilin (2,000mg.day), which I am alergic too. As a result of my not checking, I have had a torrid 2 weeks of painful genitals, swollen hands and feet and all over red and itching body, not to mention the stress and insomnia.
A lesson to me in the future, ALWAYS CHECK!! even though I have never trusted GPs. I know it is on my records but she didn't bother to look..and that could have costed me my life.
So my advice is to keep an eye on you BP and stop the betablockers, after checking with your cardiologist.
Thanks for your kind response. Indeed, one must be very careful and control/complement the doctors' conclusions with one's own investigation and, when important, also seek a second opinion (which is in a way what I'm doing here). After all, doctors are just human, and we all make mistakes. Furthermore, the western medicine in my humble opinion systematically makes two conceptual mistakes: 1) mostly focuses on isolated sub-systems, often just one at a time, and rarely takes a holistic approach, and 2) exaggerates in its confidence and dependence on pharmaceuticals.
Absolutely and most drugs treat symptoms, which is rarely the right approach. The main problem with GPs apart from their training, is that they are "General Practitioners" a "Jack of all trades" and medicine is a highly complex subject. What makes matters worse is the short amount of time allowed for each patient, when mistakes can be and are often made.
So again you are absolutely correct "trust but verify" a mistake I made to my cost.
I'm not a doctor, but the whole idea of Bisoprolol is to slow the heart, and in doing so it often reduces blood pressure. Could possibly cause your symptomsAfter my MI I was put on 2.5mg of Bisoprolol amongst most of the other drugs you are on. My heart rate reduced to 60 at rest and less at night. It was also difficult to exercise because it seemed like pushing against an immovable object. The cardiologist said that the beta blocker was effectively limiting my heart rate.
The cardiologist stopped the bisoprolol after a year. He said not to stop it immediately, but to withdraw gradually. My BP stayed pretty much the same (120/75) but heart rate increased to 75 at rest.
He also changed the PPI from Lansoprazole to Famotidine which is not a PPI. Apparently long term use of Lansoprazole can actually cause nausea. Not sure about the PPI you are on.
He also reduced the dosage of Atorvastatin from 80 to 40. But you are on a very low dosage anyway.
The result was wholely positive. I no longer feel sick, and am more able to exercise. I do feel cold from time to time, and it's usually after exercise.
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Chest pain / discomfort 
Strange feeling in my chest, could it be Angina.
Medication and nausea 
Heart Stent - feeling unwell when l get cold
Side effects of medications nausea
