The Metoprolol Affect

It's amazing how such a small amount of a substance can have such a strong effect on you.
Currently I'm only taking 25mg BID which many doctors have told me is really nothing and rarely have complaints from patients experiencing low energy and such.

My script ran out so I've been without it for about 4 days now and it's really amazing how much better I feel. Not really noticable for regular every day stuff but tonight on the bike was a different story.

My heart's response when needed was spot on. High cadence and extended efforts felt normal. With metoprolol I have a hard time getting my HR up to 150. And once I do get it there I'm already spent.

I'm still making a conscious effort to keep my max HR to 150bpm but tonight I did hit 162bpm. Haven't seen that in quite some time.

Yeah, beta blockers are excellent rate limiters, and limiting your heart rate is an excellent way to make even modest exercise much more difficult. I'm impressed that you were able to get your HR to 150 at all. Metoprolol limited my HR to 105. I could do nothing whatsoever to raise it higher than that, and even just climbing a flight of stairs felt like a chore. When I was taking it, my wife would have to wait for me at the top of hills on hikes, and normally I'm the stronger climber. It felt like it just sucked the life right out of me.

For those reasons I utterly despise beta blockers. I tried a couple of others, including Bystolic, which is a beta 1 blocker rather than beta 2 like metoprolol and isn't supposed to have the same fatigue effects, but they all have the same effect on me. If I had to take a rate limiter, I would definitely opt for diltiazem.

Metopropol has what I can tell has zero effect on me physically but I rarely push my body to max cardio levels, not my thing. My exercise is hobby farming i.e bailing hay, digging, hauling and gardening etc. Is there long term concerns if metopropol has no visible side effects.

My bike rides are ridiculous now. Diltiazem keeps me pegged at about 133 regardless of how hard I go, uphill, downhill, head wind, tail wind... 133 + or 1 a few but mainly 133.

My power and speed are also 2/3 of what they were before the ablation but there are some other factors affecting that.

I have a meter to check blood lactate and I should see if despite the constant HR to see if I am accumulating lactic while staying at this rate.

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Kleinkp
My exercise is hobby farming i.e bailing hay, digging, hauling and gardening etc. Is there long term concerns if metopropol has no visible side effects.

I don't know. My experience with bailing hay. Hooking bales off the bailer and throwing into the back of the trailer all in a singular motion. Then stacking it. All by my lonesome. Was a pretty strenuous workout.

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Kleinkp
Metopropol has what I can tell has zero effect on me physically but I rarely push my body to max cardio levels, not my thing. My exercise is hobby farming i.e bailing hay, digging, hauling and gardening etc. Is there long term concerns if metopropol has no visible side effects.

That's the weird thing about it. Many people take BBs with no noticeable effects while it almost disables other people. I felt it strongly just walking up hills or stairs, never mind max cardio levels, but I know people who run marathons on metoprolol and have no problem with it at all.

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NotLyingAboutMyAfib
My bike rides are ridiculous now. Diltiazem keeps me pegged at about 133 regardless of how hard I go, uphill, downhill, head wind, tail wind... 133 + or 1 a few but mainly 133.

My power and speed are also 2/3 of what they were before the ablation but there are some other factors affecting that.

I have a meter to check blood lactate and I should see if despite the constant HR to see if I am accumulating lactic while staying at this rate.

You bike while in af? My regular cardiologist asked me if my AT (atrial tachy) triggers my AF. Maybe it triggers yours as well. Just a thought worth asking your NP. You are lucky you can bike. Dragging a hose to water each morning puts me in tachy since my ablation. Wears me out. You are doing pretty well if you can bike hard.

I'm in the league of people heavily disabled by BB or rhythm drugs having a BB property (like sotalol).
Even a very small dose of bisoprolol has for me the kind of effect Carey described : out of breath and a HR barely reaching 100 BPM.

I was on Toprol XL for 6 years (before my first ablation) and never felt any effect while doing anything, including pretty strenuous exercise as well as skiing, scuba diving, windsurfing, hiking, jogging, etc. However, IF it did reduce my maximum HR, I wasn't aware because I didn't notice anything and wasn't checking. This was all 15-20 years ago.

Now after two ablations, and not on any meds, my maximum heart rate is definitely lower than pre ablations.

Yeah Ken - I figure my racing days are over - but probably were anyway. Just content with being normal and in NSR

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susan.d

You bike while in af?

I could tell you some stories about afib and racing bicycles. However, this is a public forum and the things I did in the early days would not be advisable.

I will say this. When you go into afib the lactic acid being produced by your legs likes to just stay there. That is until your heart decides convert back to NSR.

You can't imagine the havoc that lactic acid in your legs does when it starts coursing through your entire body. If you can imagine it. Imagine it happening twice in one race.

Carey.....

I am able to get my HR up to 150bpm on metoprolol but it takes a long drawn out effort like climbing a long hill. The further into a ride and if it's hilly is when I get to that level. And in all actuality I'm trying not to get it there when on the meds in the first place. It's too exhausting.

Like I've mentioned here before there are days it won't go over the low to mid 130's no matter what when on metoprolol.



Edited 1 time(s). Last edit at 10/02/2020 12:37PM by rocketritch.

That's the weird thing I mentioned above. It just doesn't seem to affect some people much at all, while nearly disabling others.



Edited 1 time(s). Last edit at 10/06/2020 12:54AM by Carey.

While at the OTC we were often tested for VO2 max and lactic acid. While some people clear lactate efficiently (Lance Armstrong was noted as a clearer and kept below 6 mmol but it's hard to rely on any Armstrong data as all of it was faked and due to PEDs.) To the point - most cyclists hit AT and LT at around 6mmol of accumulation with a few going to 9ish . Maybe it's bad genetics or masochism or just wanting to try so hard but I frequently tested at 16-18mmol. Way beyond where most people just shut down or give in.

Fair to say these levels weren't normal and were only taken after supra max efforts like VO2 max test or 5x 2km repeats on the velodrome.

Fair to say a lot of damage done by this even in my 20s.

Also fair to say that most of the damage I've done to myself was diet and exercise neglect from age 45 to 55.

Had I maintained the lifestyle I had from 20-45 I wouldn't have any issues most likely.

I've read BB can cause weight gain. I think Metropolol may have played a role in my gaining about five pounds despite my continued active lifestyle and healthy eating habits. It's not a lot of weight, but for what I do and how much (and what) I consume, I think its had an effect. Others?

Keefer —I gained 70 pounds from 1987 when starting Tenormin to 2004. I lost the weight through sheer willpower over the next few years because extra weight is not AF friendly. It does affect ones metabolism—it was a long diet battle to compensate for the effects of a BB. I only weigh 4 pounds more than 1987 when I was very slim and started Tenormin. Currently while on multaq I had to stop Tenormin so I can eat more but since the ablation my PVCs have caused swollen ankles which has increased my water retention and weight about two pounds.



Edited 1 time(s). Last edit at 10/02/2020 05:10PM by susan.d.

I am one of the ones for whom BBs were a boat anchor. I gained 25 lbs in a matter of weeks even while exercising. Jogging became a really just “shuffling feet”. It was awful.

A few data points from a couple rides with and without metoprolol. 4 rides with elevation gains between 3600-5600.

With Metoprolol....
Avg 122 bpm / Max HR 145-154bpm

Without Metoprolol....
Avg 144 bpm / Max HR 160-170 bpm

Rich - what percent of pre-ablation fitness do you feel you have now? Thanks.

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NotLyingAboutMyAfib
Rich - what percent of pre-ablation fitness do you feel you have now? Thanks.

To give a good answer to your question I would have to refer back to my ablation in 2009.

Ablation was done in August 2009. My EP at the time wanted me to take it easy for the first 3 months. I started back to spin classes in November and was back to teaching in December.

I would say that my fitness level was around 60%. As the year progressed it came back pretty quickly. The major difference was how my heart actually reacted to exercise. It was not as reactive to efforts as it was before. I could still get my rate up and sustain efforts but it took longer to get it elevated.

Looking back to that time I probably should have taken my EP's advice and not gone back to my old ways of always pushing myself.

That helps a lot. I'll keep just doing easy rides and not worrying about results for a few more months. Just a lot of LSD.

It's truly something that is hard to gauge. And it's also going to be individualized.

I knew I was having an ablation up front so I increased my training. What also increased as I trained more and harder were my episodes of Afib.

It got to the point where I had to phone my wife to come pick me up because I would no longer convert back to NSR quick enough to continue on. This deliberate attempt to be in excellent shape leading up to my ablation also lead me to be in permanent Afib up until the day of my procedure. Which was the better part of a month.

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NotLyingAboutMyAfib
Fair to say these levels weren't normal and were only taken after supra max efforts like VO2 max test or 5x 2km repeats on the velodrome.

I scored a 42 during a VO2 max test several months before my first ablation in full blown afib. I was my own worst enemy.