Question
My husband,who had a heart attack in July, has finally been given the green light to return to work. The only stipulation is that he see the Cardiologist once a year for a TMT. He is on Metoprolol 50 mg. twice daily. Since starting the medication, he has said that he is tired and has no energy. (His pulse is in the mid-40s) However, since being told he can go back to driving, his energy level seems to have increased and I now find myself wondering if maybe a little depression was the cause of the fatigue or if he has just gotten used to the way the medication makes him feel?
Answer
Pulse in the 40's? What is his BP like with that? Do you check his BP at home too? That may be why he is so tired all the time. He may not be able to tolerate such a low pulse or BP. If his BP is low and his pulse is like that be sure to tell his Cardiologist how tired and how much lack of energy he has. He may want to adjust his medication. Average pulse is 60-100. I have seen athletes in excellent shape have lower pulses. But they tolerated the low pulse better.
I cannot emphasize enough to call the Cardiologist about his symptoms. Some of the adverse effects of this drug that we know as Lopressor, is fatigue, depression and dizziness, bradycardia (low heart rate) and hypotension (low blood pressure). When used to treat someone with an MI or heart attack, it is contraindicated in persons with heart rate less than 45 beats/minute, second or third degree heart block and first degree heart block with a PR interval of greater than .24. First, second and third degree block can be seen on an EKG. Don't just stop taking the medicine--check with the Cardiologist first. Be sure to remind the doctor that your husband is driving a truck. Passing out behind the wheel because your brain is not getting enough perfusion would be a scary thing. So check. Please.
Answer
We did check with the Cardiologist. He said he is "well beta blocked" and that is how it should be. His BP. runs about 100/50 most of the time. I was also concerned about the low pulse so I asked both the internist and the cardiologist and got the same answer from both of them.
Answer
Well, then you will have to go with the Cardiologist decision because it depends on what happened to his heart when he had the heart attack--and your doctor is the best judge of that--how much heart muscle was damaged, if thrombolytics were used initially, if your husband had any irregular heart rhythms after his heart attack. I know they use this drug because it has been shown to reduce death during the first few hours after a heart attack, as well as after a completed infarct. And it should never be stopped suddenly. I think they feel like it reduces heart muscle damage by decreasing the hearts demand for oxygen through several different mechanisms.
Answer
Flobird,
So glad to hear things have gone well for your hubby.
I, too, was concerned about the low pulse rate and borderline low blood pressure. But if you have double checked with the physicians and they are comfortable with it, then so be it.
I agree that the increased energy is probably due to him getting back to work. Depression in any form can be very draining. I would like to think that the increased activity will increase his pulse rate ever so slightly as well.
Let your hubby know that if he begins to experience any problems with dizziness, or the fatigue worsens to take himself out of that truck immediately! I realize he may be hesitant to do that because he may lose his job, but better that than to risk his life or the lives of others.
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Keeping you safe, healthy, and on the road.
Nurse Red
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