How much do beta blockers lower resting heart rate?

[TrixieStix]

Last Saturday evening my heart was 52bpm at 7pm.

I'm on metroprolol.

that is quite a low heart rate. My ME/CFS specialist at OMI who prescribed me the Metoprolol told me to monitor my heart rate closely and to stop taking it if my heart rate goes below 59.

At first my doctor only prescribed it to me to take once daily, but at night when I was sleeping my body's "withdrawal" from the Metoprolol was triggering a fight or flight response that would wake me suddenly from my sleep with the sensation of an adrenaline rush. So I was told to try taking it twice daily, but to make sure my heart doesn't go below 59. So far so good and it's only hit 59 once and usually it never goes lower than 61.

 

[Kenjie]

that is quite a low heart rate. My ME/CFS specialist at OMI who prescribed me the Metoprolol told me to stop monitor my heart rate closely and to stop taking it if my heart rate goes below 59.

At first my doctor only prescribed it to me to take once daily, but at night when I was sleeping my body's "withdrawal" from the Metoprolol was triggering a fight or flight response that would wake me suddenly from my sleep with the sensation of an adrenaline rush. So I was told to try taking it twice daily, but to make sure my heart doesn't go below 59. So far so good and it's only hit 59 once and usually it never goes lower than 61.

Yeah I went to doctor on Tuesday and told him about the low heart rate... He wasn't concerned.. Told me its normal as that's what the beta blocker does is lower heart rate.. And he printed out a prescription for an anti depressant which I didn't think was the answer... And he sent me on my merry way home..so I think I just need to hang tight as best I can even though its the hardest thing to do and see specialists even though its a waiting list through the hospital.

Current doctor believes I will improve and get better on metroprolol. Told me too give it more time as I've only been on it couple weeks. I said I didn't doubt that he was trying to help but that I was still struggling in the meantime.

 

[Kenjie]

Current doctor also thinks I'll only need to be on beta blocker for 6-12 months and my body will have been healed by then.

My concern is that a beta blocker is a bandaid effect and even if over time things improve that coming off it could potentially return body to original symptoms..

 

[TrixieStix]

Current doctor also thinks I'll only need to be on beta blocker for 6-12 months and my body will have been healed by then.

My concern is that a beta blocker is a bandaid effect and even if over time things improve that coming off it could potentially return body to original symptoms..

Are you taking it once or twice daily? My ME/CFS specialist really only wanted me to take it once daily, because she is worried about it lowering my heart rate too much and thus causing symptoms due to that. Thus why she wants me to monitor my heart rate closely.

By what mechanism does your doctor think your body will heal within that specific time frame?

My primary doctor brought up the possibility that my the vasovagal nerve has also become deconditioned from laying down all the time due to my POTS like symptoms so my thought has been that perhaps using the Metoprolol to control the POTS like symptoms will help me to be able to spend more time sitting upright and in turn my vasovagal nerve will perhaps get more responsive and help my symptoms.

 

[Kenjie]

Are you taking it once or twice daily? My ME/CFS specialist really only wanted me to take it once daily, because she is worried about it lowering my heart rate too much and thus causing symptoms due to that. Thus why she wants me to monitor my heart rate closely.

By what mechanism does your doctor think your body will heal within that specific time frame?

My primary doctor brought up the possibility that my the vasovagal nerve has also become deconditioned from laying down all the time due to my POTS like symptoms so my thought has been that perhaps using the Metoprolol to control the POTS like symptoms will help me to be able to spend more time sitting upright and in turn my vasovagal nerve will perhaps get more responsive and help my symptoms.

I'm not sure.. He hasn't said much more.. I've changed doctors twice.. Had this doctor two weeks and straight away he did ECG and put me on metroprolol 23mg to test it out then a week later a week ago increased to 47.5mg both dosages have only been once a day..

What I am unsure of if its the right treatment without knowing the cause or without a definitive diagnosis... This doctor doesn't think there's a cause but has said this without reading back on my healrh records I assume.

And apparently coming to a diagnosis will take time and to give the metroprolol time and a chance.

 

[TrixieStix]

I'm not sure.. He hasn't said much more.. I've changed doctors twice.. Had this doctor two weeks and straight away he did ECG and put me on metroprolol 23mg to test it out then a week later a week ago increased to 47.5mg both dosages have only been once a day..

What I am unsure of if its the right treatment without knowing the cause or without a definitive diagnosis... This doctor doesn't think there's a cause but has said this without reading back on my healrh records I assume.

And apparently coming to a diagnosis will take time and to give the metroprolol time and a chance.

I'm not a doctor of course, but that sounds like a high dose to me for treating POTS. With POTS usually only small doses of beta blockers are used. Does this doctor have experience treating POTS?

I'm finding multiple medical sources online saying that higher doses of beta blockers can make POTS symptoms worse rather than better.

"A randomized, crossover, controlled study showed low-dose oral propranolol significantly benefited POTS patients by attenuating tachycardia and improving their symptoms. However, the same study showed no improvement in the symptoms of POTS patients with higher-dose propranolol and may even worsen them."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390096/

 

[Kenjie]

I'm not a doctor of course, but that sounds like a high dose to me for treating POTS. With POTS usually only small doses of beta blockers are used. Does this doctor have experience treating POTS?

I'm finding multiple medical sources online saying that higher doses of beta blockers can make POTS symptoms worse rather than better.

"A randomized, crossover, controlled study showed low-dose oral propranolol significantly benefited POTS patients by attenuating tachycardia and improving their symptoms. However, the same study showed no improvement in the symptoms of POTS patients with higher-dose propranolol and may even worsen them."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390096/

That's the thing I don't even know it it is pots.

Seems more like autonomic dysfunction to me but without being accurately and thoroughly tested its hard to know what it is. So far its been doctors with different theories.

I want definitive answers but getting that seems like the challenge.. Bit like finding a needle in a haystack..

I feel like I'm screaming out for help and answers but to no avail!

I experience.. Funny heart rate low or high.. Was high.. Now low since on metroprolol...since this started in december hot flashes with difficulty cooling off... Doing the slightest thing is exerting myself... When I get hot a dizzy spell can come on from combination of feeling hot and freaking out... Have had several near fainting spells... Mostly after being hot...can't regulate my body temp....haven't fainted yet thank goodness...few weeks ago had loss of appetite... Queasy and nausea comes n goes... Let me think what else...

 

[Kenjie]

Oh yes... Since it started I had low blood pressure although that's not so bad now since I started takes vitamin b12 and vitamin b...always felt like I'm on a boat and feeling of unsteadiness when walking...not quite as bad now but still there.. Still feel like I have to walk slow... Walking fast just exerts me makes me hot n dizzy etc.

This whatever it is has been like a roller coaster of symptoms. Also was sleeping fine til couple weeks ago started having bit of trouble sleeping.. Waking hot flush sometimes dizzy hard to get back to sleep... I'd get up to drink water or cordial to try cool off... Other times I'd wake with that night terror heart attack feeling... Ive also had day time dizzy spells which make me think I'm going to pass out...

 

[Kenjie]

I had strep and thrush in December and after those cleared my body was still out of sorts and I've been this way since..

 

[Valentijn]

@Kenjie - Have you had a Tilt Table Test (TTT)? It can help in determining what sort of autonomic disorder you have more specifically, which might indicate the best type of treatments to try. The TTT is usually done by the autonomic or cardiac department at a hospital.

The concern with beta blockers is that they may be suppressing a symptom which was actually helping you a bit by compensating for a deeper problem. Tachycardia can happen with no apparent cause, but it can also happen in response to low blood pressure (BP) or low pulse pressure (PP). If BP or PP is low, blood and oxygen aren't circulated efficiently enough, and the heart rate rises to help compensate and get the blood and oxygen moving better. In that case, simply slowing down the heart rate can be a bad idea.

Presumably your doctor checked your blood pressure before prescribing anything. But some don't know to look for low BP or especially low PP, so might have overlooked it. And office visits are often too short and active to allow low BP or PP to manifest while seeing the doctor. Hence a TTT or home testing could help a lot to see what's going on.

 

[Kenjie]

@Kenjie - Have you had a Tilt Table Test (TTT)? It can help in determining what sort of autonomic disorder you have more specifically, which might indicate the best type of treatments to try. The TTT is usually done by the autonomic or cardiac department at a hospital.

The concern with beta blockers is that they may be suppressing a symptom which was actually helping you a bit by compensating for a deeper problem. Tachycardia can happen with no apparent cause, but it can also happen in response to low blood pressure (BP) or low pulse pressure (PP). If BP or PP is low, blood and oxygen aren't circulated efficiently enough, and the heart rate rises to help compensate and get the blood and oxygen moving better. In that case, simply slowing down the heart rate can be a bad idea.

Presumably your doctor checked your blood pressure before prescribing anything. But some don't know to look for low BP or especially low PP, so might have overlooked it. And office visits are often too short and active to allow low BP or PP to manifest while seeing the doctor. Hence a TTT or home testing could help a lot to see what's going on.

Yeah I get a dull ache in my chest too on the left side although my mum reckons nothing to worry about... Shes not a doctor... The ache is there now...

And I had to wait 3-4 months from now to see the specialist at the hospital as there is a waiting list through the public health system.. I feel as though no one is concerned at all.. Whereas I am worried about my health

 

[Kenny Banya]

that is quite a low heart rate. My ME/CFS specialist at OMI who prescribed me the Metoprolol told me to monitor my heart rate closely and to stop taking it if my heart rate goes below 59.

At first my doctor only prescribed it to me to take once daily, but at night when I was sleeping my body's "withdrawal" from the Metoprolol was triggering a fight or flight response that would wake me suddenly from my sleep with the sensation of an adrenaline rush. So I was told to try taking it twice daily, but to make sure my heart doesn't go below 59. So far so good and it's only hit 59 once and usually it never goes lower than 61.

Crikey! My resting heart rate was 42-46 beats per minute before I started beta blockers (propanalol).
It drops to about 38 beats per minute.
The argument from my CFS Specialist is that beta blockers increase pulse pressure, so the heart doesn't need to beat as fast

 

[TrixieStix]

Crikey! My resting heart rate was 42-46 beats per minute before I started beta blockers (propanalol).
It drops to about 38 beats per minute.
The argument from my CFS Specialist is that beta blockers increase pulse pressure, so the heart doesn't need to beat as fast

my me/cfs doc is adamant that if mine goes below 59 then I stop taking it. Without a beta blocker my resting heart rate is between 70 - 80 bpm.


"What is Bradycardia?

Having bradycardia (say "bray-dee-KAR-dee-uh") means that your heart beats very slowly. For most people, a heart rate of 60 to 100 beats a minute while at rest is considered normal. If your heart beats less than 60 times a minute, it is slower than normal.

A slow heart rate can be normal and healthy. Or it could be a sign of a problem with the heart's electrical system

For some people, a slow heart rate does not cause any problems. It can be a sign of being very fit. Healthy young adults and athletes often have heart rates of less than 60 beats a minute.

In other people, bradycardia is a sign of a problem with the heart's electrical system. It means that the heart's natural pacemaker isn't working right or that the electrical pathways of the heart are disrupted. In severe forms of bradycardia, the heart beats so slowly that it doesn't pump enough blood to meet the body's needs. This can cause symptoms and can be life-threatening."

 

[Luther Blissett]

Yeah I get a dull ache in my chest too on the left side although my mum reckons nothing to worry about... Shes not a doctor... The ache is there now...

Without trying to belittle this symptom, are you aware if it is trapped gas? I was recently worried about an ache in my left side, sometimes dull, sometimes sharper and moving up into the armpit area, and it turned out to be trapped gas. It was also affecting my sleep (waking me up startled).

Do you sleep on your right side?

I also found that drinking some elctrolytes (sea salt and baking soda) helped me cope better last year with warm weather and feeling dizzy.

 

[Kenjie]

my me/cfs doc is adamant that if mine goes below 59 then I stop taking it. Without a beta blocker my resting heart rate is between 70 - 80 bpm.


"What is Bradycardia?

Having bradycardia (say "bray-dee-KAR-dee-uh") means that your heart beats very slowly. For most people, a heart rate of 60 to 100 beats a minute while at rest is considered normal. If your heart beats less than 60 times a minute, it is slower than normal.

A slow heart rate can be normal and healthy. Or it could be a sign of a problem with the heart's electrical system

For some people, a slow heart rate does not cause any problems. It can be a sign of being very fit. Healthy young adults and athletes often have heart rates of less than 60 beats a minute.

In other people, bradycardia is a sign of a problem with the heart's electrical system. It means that the heart's natural pacemaker isn't working right or that the electrical pathways of the heart are disrupted. In severe forms of bradycardia, the heart beats so slowly that it doesn't pump enough blood to meet the body's needs. This can cause symptoms and can be life-threatening."

I don't think my heart beat this slow before beta blockers.. It was little bit all over show but now frequently slow. Not very comfortable. Hard to know if on right path re beta blockers...

 

[Kenjie]

Without trying to belittle this symptom, are you aware if it is trapped gas? I was recently worried about an ache in my left side, sometimes dull, sometimes sharper and moving up into the armpit area, and it turned out to be trapped gas. It was also affecting my sleep (waking me up startled).

Do you sleep on your right side?

I also found that drinking some elctrolytes (sea salt and baking soda) helped me cope better last year with warm weather and feeling dizzy.

I sleep on my left or right side. Sometimes back too. Mostly side. Yes in the past before all these death like symptoms I would have the feeling of trapped air and try to release it and sometimes the trapped air was enough to cause heart palpitations. Not sure if that's what's happening now.

 

[Luther Blissett]

I sleep on my left or right side. Sometimes back too. Mostly side. Yes in the past before all these death like symptoms I would have the feeling of trapped air and try to release it and sometimes the trapped air was enough to cause heart palpitations. Not sure if that's what's happening now.

Sleeping on your left side causes much less trapped air than on your right side, as does sleeping on a slight incline using pillows, a special wedge pillow or raising the legs of the bed at the head end.

To find out if it is trapped gas I would suggest either a herbal tea, Fennel, Peppermint (unless you get gastric reflux), an indigestion/antacid medicine like Tums (or whatever you have there, Calcium Carbonate is the ingredient) Gaviscon, or even a mug of hot water.

If you are physically able, lying on your back and bringing one bent leg into your stomach and then swapping legs might help.

Or this one

It sounds a bit innocuous, but trapped air can be quite painful, distressing and cause anxiety, so hope this helps, at least it would be one less thing to worry about.

 

[Kenjie]

Sleeping on your left side causes much less trapped air than on your right side, as does sleeping on a slight incline using pillows, a special wedge pillow or raising the legs of the bed at the head end.

To find out if it is trapped gas I would suggest either a herbal tea, Fennel, Peppermint (unless you get gastric reflux), an indigestion/antacid medicine like Tums (or whatever you have there, Calcium Carbonate is the ingredient) Gaviscon, or even a mug of hot water.

If you are physically able, lying on your back and bringing one bent leg into your stomach and then swapping legs might help.

Or this one

It sounds a bit innocuous, but trapped air can be quite painful, distressing and cause anxiety, so hope this helps, at least it would be one less thing to worry about.

Great posting