Patient's Query
Hello doctor,
My sister had her aortic valve (tissue) replaced last week. The operation was uneventful, although she has been experiencing nausea and weakness. She is given beta-blockers each time to prevent atrial fibrillation. Before the operation, her heart rate was 100 beats per minute, which was attributed to the stenosis. After the surgery, her heart rate has remained around 100 beats per minute even without beta-blockers. The hospital staff has now reduced the beta-blocker dosage from 10 to 2.5 mg, but she still feels very weak. With beta-blockers, her heart rate has decreased 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 them to avoid weakness or nausea? Or would this be a bad decision?
Hello,
Welcome to icliniq.com.
I carefully considered your concern and would like to explain that several factors may be maintaining the patient's heart rate at those levels, such as pain from the surgery, local inflammation, potential fever, transient respiratory decreased capacity, relative anemia, relative hypovolemia, immobility, psychological conditions, etc. The causes mentioned above may at least partially contribute to her weakness and nausea. Beta-blockers may further exacerbate this clinical condition, especially in the case of relative hypotension and decreased overall cardiac performance.
I would recommend monitoring her blood pressure before administering her medications, and if the symptoms persist, consider gradually withdrawing the beta-blocker from her therapy. It is important to taper her daily beta-blocker dose progressively to avoid the rebound effect that could occur from stopping the beta-blocker abruptly. In such a case, the high heart rate may reappear. Therefore, I suggest discussing with her attending cardiologist the gradual discontinuation of the beta-blocker by reducing the daily dose step by step.
I hope this has been helpful.
If you have any further questions, feel free to ask me again.
Patient's Query
Hello doctor,
Thank you for the reply.
I appreciate the points you have made, though I now wonder if I was not entirely clear with my question. Please allow me to try again. Before the valve replacement surgery, my sister had tachycardia, with a heart rate of around 100 beats per minute. The doctors were unsure whether 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 dropped to a low systolic level.
Kindly help.
Hello,
Welcome back to icliniq.com.
Let me explain that a heart rate of 90 to 100 bpm, when the rhythm is normal sinus, is not considered pathological. So, if 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 those values even after a couple of weeks post-surgery, it would be necessary to investigate any underlying issues (for example, thyroid dysfunction, persistent anemia, etc.).
Let me know if you have any further questions.
Patient's Query
Hello doctor,
Thank you for the reply.
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 be able to wean herself off them entirely within the next few weeks. I am fine for now, but may reach out to you again tomorrow.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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