Low BP dilemma

I had a Pulse Field ablation 17 days ago. When I was discharged from the hospital, my blood pressure was around 75/45, I felt fine so no one was really concerned.

Started 50mg Flecainide BID and 12.5 mg Metoprolol on day 1 post ablation. On day 10, my blood pressure dropped to 70/40 so PA reduced the Metoprolol to 6.25mg.

On day 14 (Monday) I felt very dizzy after dinner and had to lie down for an hour before I can get up. Called PA on Tuesday, she told me to stop Flec immediately and stop Metoprolol on Wednesday (yesterday).

Today after lunch, my resting HR suddenly increased from previous 60's to 80's. Could this possibly be a rebound caused by stop meds cold turkey? I did question PA when I spoke to her on Tuesday, but she said 6.25mg of Metoprolol and 2x50mg of Flec are such a minimum dose, it would do no harm.

I am afraid of getting into Afib for stopping meds so early after ablation. On the other hand, my BP may continually drop if I stay on meds. Should I call the PA tomorrow to restart Metoprolol, or should I wait?

If you are over 60 and have a diastolic pressure of low 80's, that's nothing to be concerned about. Personally, I take my BP first thing when I wake up. My Galaxy 4 watch must be calibrated with a proper cuff every three weeks, or the app won't let me register a reading. So, I feel it must be pretty close during any one three-week period. My own readings each morning run between 114-124 over 66-75. As I type, it reads 116/75. Three hours ago, returning from a noon-hour 5 km walk in the heat, it would have been 135/90 typically.

I think there's a balance between keeling over due to syncope, maybe breaking a hip to boot, and running between two extremes of systolic and diastolic. If you feel fine, can function, why second-guess those pros who counsel you to just fuggedabbadit and find happiness...as in losing the two drugs on which you'd been so dependent until a few days ago?

Oh, and my heart rate, five months post ablation, runs between 60 and 80 at rest...for some reason. I'm a life-long athlete, competitive runner and snowshoer, whose rest HR typically ran 40 BPM, maybe 45 if I were vexed about something or other. Now it's 60-75, and I'm a bit perplexed to see it as high as 80 at times for no apparent reason. I dwell on it for 1.66 seconds and move on to something else that interests me. Next I look, it's at 73. And I've been moving around a bit meanwhile.

I have stopped metoprolol cold turkey, but that was to begin taking Amiodarone right after a first ablation that went sour. My HR was in the low 30's when I presented at the ER. Stopping metoprolol was the first obvious remedy. In your case, you're advised to desist from taking either one. My advisor would have said to go off one, slowly (over maybe 8-10 days), see how it felt, and then to try limiting the other. You could try that on your own and see what it feels like. The only person who can live under your skin is you!

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Yuxi
Today after lunch, my resting HR suddenly increased from previous 60's to 80's. Could this possibly be a rebound caused by stop meds cold turkey? I did question PA when I spoke to her on Tuesday, but she said 6.25mg of Metoprolol and 2x50mg of Flec are such a minimum dose, it would do no harm.

I am afraid of getting into Afib for stopping meds so early after ablation. On the other hand, my BP may continually drop if I stay on meds. Should I call the PA tomorrow to restart Metoprolol, or should I wait?

Yes, the increase in your HR from 60s to 80s is because you stopped the metoprolol. That's fine and nothing to be concerned about. You can stop metoprolol cold turkey and don't need to wean off after being on it a short time.

You can't stay on the meds and remain safe. I wouldn't resume the metoprolol or flec if I were you. Afib won't hurt you, but passing out and falling or having a heart attack will, and with the BP numbers you've posted I'd say that's the next event lurking around the corner. 70/40 isn't a viable BP to keep you alive and well. Listen to the PA; they're doing right by you.

I concur with Carey. My daughter's father-in-law was diagnosed with afib & heart failure recently. At the beginning of July she and her family went to visit. He had an episode where he wasn't really "there" for a period of time ( 20-30 seconds ) . His BP was very low, but I don't recall the systolic ( maybe 60's ), the diastolic was in the very low 40's. She & I chatted about the meds ( BB ) causing the issue. No change in meds after. Fast forward to this week and he fell and cracked some vertebra. They've now taken him off all the meds.



Edited 1 time(s). Last edit at 07/28/2023 08:07AM by GeorgeN.

Gloaming, Carey, George, thanks for your good advice! Last night after reading your post I decided not to take meds, just read some novel, relaxed and went to bed early. I feel good this morning, my HR went down to 60-70 while I was asleep.

I was worried about increased HR because in the past flutter was always a prelude to Afib for me. The night before I had a bad dream that I went back in Afib and I was so scared it woke me up. I am PTSD'd by Afib lol.



Edited 1 time(s). Last edit at 07/28/2023 07:49AM by Yuxi.

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Yuxi
I was worried about increased HR because in the past flutter was always a prelude to Afib for me.

Though you just had an ablation and generally your HR will increase for a few months afterward--at least with RF ablations.

Yuxi - don't fall. Carey, George are right.

Daisy, PavanPharter, yes I need to constantly remind myself increased HR is not out of normal and I am doing just fine

Just want to give an update. I am 5 weeks post ablation. I stopped Flecainide and Metoprolol 3 weeks ago (2 weeks post ablation) per PA because of the concern of low blood pressure. 3 weeks past, my BP still remaining low, 75-85 over 45-55. This is frustrating as I thought once I stop the meds my BP would be recovered to my normal level (100-70).

Afraid of anemia, last week I had a blood work done in my GP office, the value of RBC, Ferritin, Iron, B12 all came out within normal range.

Not sure what to do, I searched online and came across this article. So could it be magnesium?? I take various forms of magnesium of daily total 550 mg. Should I stop Magnesium?

"A review of 11 randomized studies found that magnesium, taken at 365–450 mg per day over an average of 3.6 months, significantly reduced blood pressure in people with chronic medical conditions. "
"Another review of 10 studies in over 200,000 people suggested that greater dietary intake of magnesium may protect against high blood pressure in the first place. Every 100-mg daily increase in dietary magnesium was linked to a 5% reduction in high blood pressure risk "

[www.healthline.com] Here is the link to this article.

You might want to test RBC magnesium & serum magnesium to see if elevated. Or you could just stop and see if your BP changes.

In my case, I can take nearly 10x what you take without issue. I clearly waste a lot of magnesium in my urine. If you are accumulating the Mg, then that could be an issue.

George, thanks for reminding me this. I had a Mag RBC test done in February 3 month after I started taking Mag, had a 6.4mg/dl which is at the high end of the normal range. By now it could be even higher as I never stopped taking magnesium. I will stop it and see if my BP decreases.

Your Mag intake is crazily high