Saturday, July 5, 2008

Beta-blockers and ICDs

Here’s a question that just came in from Australia. It's about beta-blockers and ICDs.

Hi, I’m in Australia and looking for information about beta-blockers and adverse effects.

The hospital is considering me for a pace-maker/defibrillator if the drugs don’t work. At the moment the beta-blockers are actually killing me and I can’t find anyone else with my symptoms. I thought I would be able to get off the beta-blockers if I had an implant but one of the nurses said that's not true.

I can’t continue with the beta-blockers because I have had several near death experiences on them. On one occasion the ambulance guy said he only just arrived in time, a couple of minutes more and I’d have been dead. I end up in the ER almost weekly with this reaction. Do you have any advice or know where I can look for advice?

Let me preface this by saying that I’m neither a doctor nor we have doctors in our group. I, and others in the Bay Area ICD User Group, are recipients of ICDs with a panoply of heart conditions (dilated cardiomyopathy, HCM, Brugada Syndrome, etc). I write to you from my experience as a patient, and not as a doctor.

Having said that, I believe that the key to your answer is in your underlying heart condition (which you don’t mention). Has your cardiologist given you a diagnosis?

ICDs are usually prescribed as treatment for abnormal heart rhythms. Depending on your heart condition, this could mean a rhythm that's abnormally slow (bradycardia) or a rhythm that’s too fast (tachycardia).

You say that the hospital is considering you for "a pace-maker/defibrillator if the drugs don’t work." This "either-or" approach sounds unusual to me. An ICD is not a substitute for pharmacological therapy. In fact, it is more commonly used in conjunction with a drug or drugs. Look at it as just one of the tools doctors have in their toolboxes to manage your heart disease.

Beta-blockers, on the other hand, are used to help control your heart rate. They are there to slow down your heart, to lower your blood pressure and are often used in combination with diuretics, digoxin and ACE inhibitors.

Again, I don’t know what disease afflicts your heart. But I believe your nurse is right in saying that the ICD implant will likely not get you off beta-blockers. I, for example, am on beta-blockers and have an implant.

You also say that the beta-blockers are "killing" you and you can’t find anyone else with your symptoms and mention near death experiences as a reason to stop the beta-blockers.

Keep in mind that when you just start taking beta-blockers, your symptoms often become worse while your heart adjusts to the medication. This can take up as long as two and a half months.

However, there’s also a possibility that the beta-blockers are slowing your heart too much. Beta-blockers can be harmful if you have extremely low blood pressure or a slow pulse. It can cause you to feel dizzy or light-headed.

You should not stop taking your beta-blocker without speaking to your doctor first. Even if you feel that it is not working. Beta-blockers should not be stopped abruptly or your symptoms might worsen.

If you still feel you’re not getting the answers you seek regarding your medical care, I’d suggest you get a second opinion from a different cardiologist. Remember, as a patient, YOU are your own best advocate!

Best of luck to you.
Hugo.

1 comment:

Julia Lloyd said...

Wow, that is an unusual situation. I have heard of people have unintended side affects with the beta-blockers, but not of them being deadly. I have to agree with everything that Hugo has said and will add, talk to your doctor and if that isn't working, find another to ask.