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Resting pulse rate

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Resting pulse rate

Post by mikenall on Sun May 19, 2013 6:52 pm

About 3 weeks ago I went to a routine followup appointment at my cardiologists preventive cardiology department. During the visit I was given an electrocardiogram. The nurse practitioner's only comment was that it was OK but was a little slow. They had cut my beta blocker (atenolol), from 75mg a day to 50 mg a year earlier due to a slow pulse. At that time it was 42. During the ekg a few weeks ago, I believe the pulse was 43.

Two weeks later I received a phone call and was told I should cut my beta blocker to 25 mg a day and come back in two weeks for a 48 hour holter monitor test. Last Tuesday I was hooked up and mailed the monitor back to them on Thursday. Friday afternoon I received a phone call and the first question I was asked was if I had been told to stop the beta blocker entirely. I told them it had been cut in half about two weeks before and they said to quit taking it entirely and I would need to come back in a month for another 48 hour holter test.

With some questioning I was able to find out that my resting pulse was as low as 33. I have seen many discussions with varying opinions on runners and beta blockers. Anybody else have any experience with this?
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Re: Resting pulse rate

Post by Marc Thayer on Sun May 19, 2013 7:47 pm

IMHO yer body has decided it doesn't require the modification...good for you!

I have a rather low opinion of BB's in regards to my own medical situation and found that questioning the purpose of such Rx to be more of a SOP call than a medical fact call...

To wit: One of the criteria to get discharged post-op was to have a BP over 100...I was consistently under..and yet I was forced to take a BB..a head scratcher fer sure. That Rx persisted until I proved it was causing more problems than it was preventing.

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Re: Resting pulse rate

Post by RoadKillBill on Sun May 19, 2013 8:57 pm

RHR sounds way too low. How is your BP? Really low HR can increase risk of clotting and infarct.

My doc tried to put me on an ACE inhibitor to reduce workload on my heart and lower my HR. I couldn't function. BP dropped so low I would almost pass out when I stood up. A co-worker said I was beyond pale to near transparent. Went back to a drug-free existence.

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Re: Resting pulse rate

Post by mikenall on Sun May 19, 2013 9:11 pm

BP is fine. I'm also on an ace inhibitor. I don't think they decrease heart rate
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Re: Resting pulse rate

Post by kodi30 on Sun May 19, 2013 10:31 pm

I've never been on beta blockers or blood thinners so I'm not sure how much I can help. However, for many, many years (at least 30 since I started checking my HR), my resting HR has been 40 +/- a couple beats depending on my previous day workout. In Nov I woke up feeling crappy and took my pulse, it was 30. I got up walked around took it again, it was 35. Unfortunately it was a Saturday and scheduled to run our local TT. Smart as I am, I decided it was a bad idea so I went & volunteered. All day I felt letharic and exhausted. Sunday was better but not much. Monday I went to see my card. He put me on a 24 hour 14 day monitoring system and pulled me off after 6 days. My HR would drop to 23 during the night. Not good for anyone especially an old guy like me. The results a PaceMaker in January. We have it set at 60 but I'm going to get it lowered. It seems to be fine except I get really shortwinded on hills. BTW after having it implanted I was off running and most other activities longer than I have been in 34 years, 8-10 weeks of nothing but walking.

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Re: Resting pulse rate

Post by Rachel August on Mon May 20, 2013 11:04 am

I was on BB right after my surgery but taken off maybe 5 days later because my blood pressure was too low (80/50) all the time! When my doctor heard that I was eating salty pretzels to try to get the BP up (and after a very scary episode when I experienced the room tilting AND spinning) – my doctor gave up and took me off that drug.

But my resting pulse rate after surgery was in the 90’s which is common after valve replacement.

Your pulse rate at 33 is low – my resting HR today ranges from 48-60

I’m not a fan of the BB – I think it could have helped me after my surgery but I was still fine without it. Of course I’m not a medical person at all, but I think there’s a time and place for it, and it does sound like you might not need it anymore.

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Re: Resting pulse rate

Post by RoadKillBill on Mon May 20, 2013 3:43 pm

mikenall wrote:BP is fine. I'm also on an ace inhibitor. I don't think they decrease heart rate

Yes, that is correct, Mike - ACE inhibitors reduce BP by decreasing peripheral vascular resistance, not by reducing HR. Thanks for clarifying, as I don't want to contribute mis-information to the site.

More accurately stated, my increased HR was thought by my doc to be a compensatory mechanism for my low ejection fraction, and he theorized that reducing workload on the heart would reduce heart rate and help with reverse remodeling (I had been in a slide toward heart failure prior to my surgery). There is anecdotal evidence that both ACE inhibitors and BB's contribute to reverse (favorable) cardiac remodeling in CHF patients.

I ended up without ever using any cardiac meds. My LV returned to normal dimensions, and I got a slight pickup in EF, but it's still low, and HR is still on the high side.
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Re: Resting pulse rate

Post by mikenall on Mon May 20, 2013 7:18 pm

Type 1 second degree heart block. Went off the beta blockers cold turkey Friday. When I tried exercising this morning my heart rate went crazy. 100 bpm walking at 4.0 mph. Going thru withdrawal - very unpleasant. Adrenaline receptors are telling me they haven't seen this in 13 years. Have a 10:00 AM appt. Wednesday with an electrophysiologist
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Re: Resting pulse rate

Post by Marc Thayer on Mon May 20, 2013 11:38 pm

Hang in there! Hopefully things will calm down a bit between now and then.

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Re: Resting pulse rate

Post by RoadKillBill on Tue May 21, 2013 11:58 am

mikenall wrote:Type 1 second degree heart block. Went off the beta blockers cold turkey Friday. When I tried exercising this morning my heart rate went crazy. 100 bpm walking at 4.0 mph. Going thru withdrawal - very unpleasant. Adrenaline receptors are telling me they haven't seen this in 13 years. Have a 10:00 AM appt. Wednesday with an electrophysiologist

Yikes! Sounds like maybe you needed more of a taper. I hope the EP visit has a good outcome.
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Re: Resting pulse rate

Post by mikenall on Tue May 21, 2013 12:25 pm

To say I am less than enthralled by how this was and is being handled would be a fair statement.

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Re: Resting pulse rate

Post by Dave Tuttle on Tue May 21, 2013 8:09 pm

mikenall wrote:To say I am less than enthralled by how this was and is being handled would be a fair statement.

Scary stuff... Good luck tomorrow!

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Re: Resting pulse rate

Post by trishb on Wed May 22, 2013 9:11 am

I agree with Bill...going off most any meds cold turkey is not a good idea.
But, ya'll never listen. Shocked

Good luck today with the EP. Keep us posted.





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Re: Resting pulse rate

Post by Rachel August on Wed May 22, 2013 10:46 am

Mike,

I really hope things go well at your appointment today.

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Re: Resting pulse rate

Post by mikenall on Wed May 22, 2013 4:46 pm

All is well - outside of beta blocker withdrawal - more later.
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Re: Resting pulse rate

Post by Dave Tuttle on Thu May 23, 2013 5:41 pm

mikenall wrote:All is well - outside of beta blocker withdrawal - more later.

Great news Mike! Good talking to you last night...

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Re: Resting pulse rate

Post by kcy1998 on Sat May 25, 2013 10:12 am

Mike,
I am reading your story with great interest. Have you always been on BB's and then after almost 15 years your RHR is really low?
Please keep us informed.
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Re: Resting pulse rate

Post by mikenall on Wed May 29, 2013 10:14 pm

Holter monitor summary report:

Sinus rhythm with sinus arrhythmia, sinus bradycardia and sinus tachycardia, with a first degree AV block, with second degree AV block wenckebach and 2:1 and 3:1 block, occurring at night. Minimum heart rate was 33bpm. Average heart rate was 61 bpm. Maximum heart rate was 147 bpm. Maximum R-R was 3.92 sec. Occasional ventricular ectopic singles, couplets, bigemy cycles and one VT run vs aberrancy up to 7 beats at 130 bpm. Rare supraventricular ectopic singles, couplets, one triplet and one SVT run up to 11 beats at 129 bpm.

This is the summary from the 48 hour holter test that prompted the phone call cutting off the beta blocker.

Kevin, I've had a slow pulse in the 30's pretty much ever since I've kept track. I've been on the beta blocker atenelol since July 2000. The dosage was 75mg a day until about a year ago. I never tried to get off of them because of PVC's. I know they slow you down but I just dealt with it. About a year ago in cardiology my pulse was 42 and I sat there and watched the nurse practitioner take my pulse manually for a full 2 minutes. On my way home from that visit I got a phone call from her telling me she had talked to the cardiologist and they wanted me to cut the beta blocker to 50mg day. OK. A year goes by and last month my pulse was 43. Nothing out of the ordinary for me. Two weeks after that visit I got a phone call telling me to cut the beta blocker to 25mg a day and come for a 48 hr holter in 2 weeks. It was the culmination of several events over the last few months. I passed out in early January for no apparent reason and that added to the decision for the holter. Fine.

I wore the holter for the 48 hours and it was received back by them late Friday morning. I received the phone call about the beta blocker that afternoon.

So I took 75mg of atelolol for basically 12 years, 50 mg for one year, 25 mg for 17 days and then none. My cardiologist told me the dose I was taking was equivalent to giving someone half an aspirin to treat a migraine. It was almost like not taking anything at all. The EP I saw told me the longer you take it the longer it takes the body to withdraw.
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Re: Resting pulse rate

Post by kodi30 on Thu May 30, 2013 10:50 am

Wow, those are things I hope I don't ever have to deal with. I don't know if I could keep track of when I change medication dosages, etc. I'm fortunate the only meds I'm on is Crestor for Cholesterol, baby aspirin and lasik, because I retain water....which I'm certainly not happy about.

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Re: Resting pulse rate

Post by Rachel August on Thu May 30, 2013 3:16 pm

Mike,

Sounds like there's a lot going on there with your heart. I had a holter monitor shortly after I was diagnosed (with what my cardio had originally thought was mitral valve prolapse) - they found two rare supraventricular ectopic singles - I never did find out if that was a problem or not.

I do know that passing out is never good!

So now is your cardiologist just watching what happens off the BB's? What’s the next step?

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Re: Resting pulse rate

Post by trishb on Thu May 30, 2013 7:34 pm

Curious also what the next step is, Mike.

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Re: Resting pulse rate

Post by mikenall on Fri May 31, 2013 9:30 pm

As I left it with the cardiologist on Tuesday, I already had an appointment for mid July. At that time I would expect possibly another holter test to see what's going on. As she commented, I have issues with slow pulse and fast pulse, and arrhythmias, and the solutions for one of them can exacerbate the other. She really didn't like the report on the holter at all. Being off the beta blocker has significantly increased the arrhythmias. Or, I am just very aware of them with everything that has been going on. I called and scheduled an appointment Monday AM with Dr. Blackburn, the Director of Cardiac Rehabilitation at Cleveland Clinic. I've been training for a July triathlon at the National Senior Games and that has entirely fallen apart in the last 2 weeks. My heart's reaction to exercise has totally changed. I'm afraid to swim at this point. I can go by perceived exertion running or on a bike, but I know I don't have enough swimming experience to feel comfortable right now in the water. My pulse is all over the place and I don't know if I would notice a problem while swimming. He's going to try and schedule a stress test for Monday, or I will probably have one soon after that. The question I need answered is if I should abandon the triathlon for now or if it is safe to continue training. I feel like I've been detrained overnight. I got my pulse up to 160 in 2 minutes this morning on a treadmill. I felt fine but, having been on the beta blocker for 13 years, this is totally foreign territory for me. Not to mention, if I can continue the training (this is primetime - the tri is 7 weeks from Sunday) I need to increase my WAF drastically (wife acceptance factor). I'll let you know how it goes.
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Re: Resting pulse rate

Post by trishb on Sat Jun 01, 2013 4:49 pm

Sorry for all that you are going thru, Mike.

I have similar issues with arrhythmias. The BBs just caused my blood pressure to plummet and made me dizzy contantly.
Since I really only have issues of tachy when exercising, my doc put me on short acting diltiazem 30mg. Normally would be taken every 6 hours, but I only take it about an hour before exercise. And it keeps my HR at 150 for max effort compared to 225+ without.

Not sure if this might be a temporary answer for you?

However in my case, I have a pacemaker to keep my HR from going too low.
But with since the drug effects would be out of your system quickly, it might not be too much of a factor.

Wishing you the best!!
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Re: Resting pulse rate

Post by Rachel August on Sat Jun 01, 2013 6:27 pm

Wow Mike, that's a lot to happen to your body all at once after stopping the BB's - I had no idea since I was never really on them for very long myself (I think for maybe 5 days after my surgery)

I'm really very sorry to hear all that you're having to go through - I'll be thinking of you in the next days!


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Re: Resting pulse rate

Post by Dave Tuttle on Sun Jun 02, 2013 7:24 am

Good luck tomorrow Mike... Hope you get the right answers.

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