Dr. Ilir Sharka
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My sister had her aortic valve (tissue) replaced last week. The operations were uneventful, though she has been suffering from nausea and weakness. Each time she is given Beta-blockers to prevent atrial fibrillation. Before the operation, her heart rate was 100 beats per minute, which attributed to the stenosis. After the surgery, her heart rate has remained around 100 beats per minute without Beta-blockers. The hospital staff has now reduced the Beta-blocker dosage from 10 to 2.5 mg, yet she still feels very weak. With Beta- blockers, her heart rate has descended to 86, but she feels terrible. My question is, if she feels fine without the Beta-blockers, could it be safe for her to discontinue using Beta-blockers to avoid the weakness or nausea? Or would this be a bad decision?
Hello,
Welcome to icliniq.com.
I passed carefully through your concern and would like to explain that several components may maintain the patient heart rate at those levels (like pain due to surgery, local inflammation, potential fever, transient respiratory decreased capacity, relative anemia, relative hypovolemia, body immobility, psychological conditions, etc.). The causes mentioned above may at least partially contribute to her weakness and nausea, Beta-blockers may further deteriorate this clinical condition, especially in the case of relative hypotension and decreased overall cardiac performance. I would recommend monitoring her blood pressure values before taking her medications, and if the symptoms persist in withdrawing her Beta-blocker from therapy gradually. It is necessary to taper her daily Beta-blocker dose progressively to avoid the rebound effect of stopping Beta-blocker cold turkey. In such a case, the high heart rate would reappear again. So, discuss with her attending cardiologist to gradually stop the Beta-blocker by reducing the daily dose step by step. I hope to have been helpful to you. In case of any further questions, feel free to ask me again.
Patient's Query
Thank you doctor,
I appreciate the points you have made, though I am now wondering if I was not entirely clear with my question. Please allow me to try again. Before the valve replacement operation, my sister had tachycardia in which she had a heart rate of around 100 beats per minute. The doctors were not sure whether or not this was due to her aortic stenosis. Immediately after the operation, when they administered 10 mg of Beta-blockers to prevent arrhythmia, her blood pressure fell to systolic. Kindly help.
Hello,
Welcome back to icliniq.com.
Let me explain heart rate of 90 to 100 bpm when the rhythm is normal sinus is not considered pathological. So, if the Beta-blocker use is associated with profound weakness, it is wise to stop it gradually as I explained to you. If the heart rate remains at that those values even after a couple of weeks in post-surgery, then it would be necessary to investigate for any further underlying problem (for example thyroid dysfunction, persistent anemia, etc.). Let me know in case of any further questions.
Patient's Query
Thank you doctor,
I have spoken to my sister, and she will continue to take 2.5 mg of Beta-blockers daily despite the slight weakness they continue to cause her. Her only hope is that she will wean herself off them entirely within the next few weeks. I am fine for now, but may reach out to you again tomorrow, shall I?
Hello,
Welcome back to icliniq.com.
I wish you have good health. Please let me know in case of any further questions.
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Cardiology
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