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 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. 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.