Hi all,

I was wondering if anyone here had ever had a problem with using beta blockers or had some knowledge regarding beta blockers and severe edema. I'm not talking the swollen ankle thingy but dependent pitting edema to the tune of 4-5 lbs on a 100 lb frame.

Could this be the result of beta blockers? I've been on beta blockers for my hyperthyroidism since 1991 and not had any problems with more than slightly swollen ankles on a hot day until this last february. Since last September, I've had my beta blocker changed several times from 160mg inderal to 250mg atenolol to 240mg inderal to 100mg toprol and am currently taking 100mg atenolol. This current lower dose is not doing anything for the water, isn't controlling the weird heart thingys and isn't making my thyroid very happy either.

My pcp seems to want to deal with the problem by throwing lasix at me.

Any input would be appreciated.

I take 3 different meds for BP - 50 mg. atenolol, 5 mg. norvasc and 80 mg. Micardis Plus (water pill is the plus). So far, my BP is good and I don't feel poorly. A friend of mine has edema and is not taking a water pill, because he is allergic to the sulfa that some meds contain. I don't think lasix has any sulfa, but I told him to check with his doctor and get started on a diuretic. My Mom has been taking Lasix for years and is doing well on it. If your doctor is perscribing it, you can always start with a lower dose and see if your edema improves.

I have thyroid problems and gained 60+lbs of water. Caused by my thyroid making my heart have to work to hard- i have an enlarged heart now, with other problems, please make sure your doctor is sure that your heart is ok-- thats more important than pills to loose the water. Also the doc should make sure your thyroid is ok, as that can be part of the problem to.

Can somebody please tell me what EDEMA is, I'm starting to suspect it could be swollen feet and ankles from this thread. I've been on 50mg morning and night of Metoprolol for five years since my Triple bypass and assumed my swollen feet each night were from bad circulation. If I'm correct in my assumption, should I worry about my swollen feet or just carry on?

Thanks. I really appreciated the responses.

arlmon - lasix does contain sulfa but everything I read said it is not likely to cause an allergic reaction in someone who is allergic to sulfa. I checked cause I'm allergic to sulfa too and that kinda bothered me when I saw it. I have been taking the lasix since the end of march and not run into an allergy problem.

admace - Hypo or hyper? I'm a hyper with normal tsh and elevated hormones. Most likely secondary hyper but the docs don't seem to want to find out why. Been dealing with it for 48 years. Was put on betas and left to pretty much handle it on my own in 1994. The docs take one look at my labs and run. Was diagnosed with a heart murmur (he thought it was probably mvp) in 1983 and an ecg at the er in 1991 showed an enlarged right atrium. That's the closest I've ever had my heart looked at. I know neither of those was terribly significant at the time but having been hung out to dry on the thyroid issue, I'm not terribly fond of the idea of them ignoring this too. The thyroid is not ok. It's been acting terribly naughty for the last year. 3 endos later, and all they can do is shake their head and send me back to my pcp. He's clueless but he did run a creatinine clearance and since that came back "ok", I'm fine. I am to force fluids, take the lasix and call if the edema gets worse. He hasn't seen it. :rolleyes:

Jay Ar - Edema is the abnormal accumulation of fluid either under the skin or in a body organ. From what I've read Metoprolol is more likely to cause it than some of the other betas and swollen feet and ankles isn't real unusual. You should tell your doctor about it but in most cases, it's harmless. Mines quite a bit more than swollen feet and ankles.

access,

Your doctor is wise...LASIX is a VERY good idea.

Generally speaking, people who retain water and have hypertension are in the salt-sensitive minority...I consider myself squarely at the top of this pyramid.:dizzy: :cool:

We salt-sensitives respond beautifully to diuretics for our hypertension and almost not at all to ARB's or ACE inhibitors and only modestly to beta blockers (although they DO have some diuretic properties and thus are of some benefit.)

Mark my words, if your water retention bothers you, you will LOVE your furosemide (Lasix.) I have tried the last 3 days without it and ate Indian last evening and I am up 6 pounds, all my joints hurt, and I can barely make a filst. I am waiting til I eat something to take my 40 mg. Lasix and pee all this out...it works for about 3 hours. I will probably need tomorrow's dose to complete the job although I COULD take a second dose today///but that would cause me to be thirsty all night long.

AND it's cheap.

Honestly, with Lasix, you might find you are able to do without the 100mg. atenolol, which would be a blessing.
Give Lasix a try at 40 mg. (You MIGHT need a potassium supplement...I don't!)

Nicest drug I've ever taken...oh well, maybe after Demerol and Valium!

Hi lenin,

I don't have hypertension. I've always pretty much sat square on the perfect 120/80 except when the thyroid kicks into high gear and then I get the normal wide pulse pressure of a hyperthyroider at about 130/70 or something along those lines. My thyroid causes tachycardia, arrythmias and an increased cardiac output. Causes a lot of other problems with the increased metabolism for the rest of my body but the beta blockers pretty much control a lot of the symptoms.

I most likely will have to take beta blockers for the rest of my life. I don't have much choice there. The thyroid almost killed me once and I don't wish to ever go back there again.

Since I have succesfully taken beta blockers for 18 years, I can't understand why I am currently having this problem. My bp's been staying stable. Pulse is staying under 100 but I have been feeling quite ill ever since I started bloating last february. Nobody will look for the root of the problem. And besides, this lasix makes me wanna puke. Every day I've taken it, I spend the rest of the day trying to keep from losing my cookies and it also seems to be dropping my bp down to a max of 110/70. This is only 10mg, mind you.

I have trouble believing that after all this time that the betas may be the problem so that's why I asked if anyone else had problems with betas and this much water. I've got a strong feeling that it's something else going on entirely and I'm going to have to start jumping up and down on the pcp's head in order for him to take this seriously or to get him to do anything about it.

I'd very much like to hear that other's have had this same problem with betas. I really don't like some of the alternative possibilities very much.

To answer your question square on:
I really REALLY doubt that your beta-blocker is contributing to your edema. That would be antithetical to the way beta-blockers work.

Not exactly what I wanted to hear but pretty much what I expected. My pcp doesn't seem to know a whole bunch about betas. I've been trying to learn as much as I can about them after a little incident last september when he switched me from 160mg/day of inderal to 25mg atenolol and landed me in the er where I was told I could go as high as 400mg if needed. I went as high as 250mg. This 100mg just isn't doing it.

I gather I'd be pretty safe going back up again and not have to worry that it is contributing to the waterworks problem especially since dropping the dose doesn't seem to have any impact on it anyway?

Can't tell you how much I appreciate the input. :)

I feel that if a person isn.t responding well to a beta-blocker for any reason, then it's unlikely raising the dosage to sky-high limits is going to do much good, and probably a LOT of bad.
If 100 mg. atenolol, a very HIGH dose, doesn't deliver then I think the answer is to find another drug.


This current lower dose is not doing anything for the water, isn't controlling the weird heart thingys and isn't making my thyroid very happy either.

And of course, the perfect drug class for edema is a diuretic.

And besides, this lasix makes me wanna puke.
There are several other diuretics you can choose but that sounds like a funny reaction to Lasix. Have you ever tried taking 40 mg? Try it for 2 days and check out the effect on your edema.


Anyhoo,
It sounds like it might be time to tackle your thyroid directly. If it is furiously overactive then perhaps surgical or radioactive iodine reduction should be considered. A lifetime of megadosing with beta-blockers may not be the answer becasue of the all-over body effects. There are drugs that work directly to suppress the thyroid: check out methimazole and propylthiouracil (PTU).

What is your blood pressure now with the 100 mg. atenolol per day. What was it BEFORE you started beta-blockade? Why do they keep changing your beta blocker?

edit:

Let me correct my past statements...further research informs me that beta-blockers CAN INDEED cause edema. Live and learn! :D

So accessn, it seems time to find another treatment regimen...DO check the radioactive iodine because it is the most common treatment and safer than surgery.
Whatever you do, DON'T up to 200 or 400 mg. atenolol.

Hi lenin,

My frustration level is maxed out. It's a long, long story which I will not go into a lot of detail here. I have a very rare form of hyperthyroidism which is not caused by the thyroid itself. It is a form of inappropriate tsh secretion that simply put, just means that my pituitary is mucked up and doesn't know when to stop telling the thyroid to keep putting out.

I have done anti-thyroid meds in the past. PTU, methimazole and block and replace. 3 solid years of hell. Surgery is not an option. If they cut out the thyroid, it will grow back because it will not stop the excess tsh production. There have been people with this problem that have had their thyroid removed 5 times. I have been waiting since 1994 for rai when one brilliant endo diagnosed me as having "some form of atypical antibody negative graves". RAI is not supposed to be performed unless tsh levels are below normal. My tsh level never goes below normal. I have been shuffled from doctor to doctor and no one has ever been able to help much. I've been dealing with this for my entire life. Sometimes it doesn't bother me much, other times it's a real pain in the butt.

The treatment of choice is beta blockers to control symptoms. The root of the problem is not fixable.

People who are hyperthyroid are also blessed with many more beta receptors than a normal person and also have a tendency to metobolize drugs very fast. Therefore, higher doses and more frequent dosing is necessary.

I did pretty well for 12 years on the 80mg inderal la bid. Something unbalanced me last may (coincidently at the same time that I came down with shingles) and I've been having trouble ever since. Me and my thyroid hormones have been bouncing all over the place ever since.

I live in a very remote rural area. We have one doctor. I have been as far as 300 miles away to see 3 different endos since last september. They pretty much just shake their head and send me back to my pcp. Nobody ever checks to see if and what this is doing to the rest of my body. I get a cursory exam. A look at the labs, a feel of the thyroid, a quick listen to the heart and if I'm lucky, they check my reflexes. I haven't been lucky enough to have one stand right in front of me on that one yet. Came close on one of em though. :D Then I'm sent on my way with a different beta script to cope with it on my own.

But never mind me. I'm just an hysterical 48 year old female whose probably just going thru menopause that just isn't showing up in the labs yet. :eek:

Thanks for listening.

Helen

Ooops. I think I was a little cranky this morning. Sorry.

Any idea by what mechanism the betas do cause edema and whether or not it's dose dependent?

The main reason I ask is that I went so long without problems that it kinda scares me to just chalk it up to them without looking further for any other explanation. Especially since a reduction in dose doesn't seem to have any impact on the situation.

Thanks,
Helen

access,

I'm pretty sure the effect would be dosage dependent.
Basically beta blockers are vasodilators which process always causes some fluid leakage...have you developed a cough?

Your heart might be beating so weakly that you are chemically mimicing the effects of heart failure...and its attendant edema.

Why not go back to the 160 mg. propranolol and see what the effect is. There are big differences between a non-seelective like Inderal (propranolol)and a selective like Tenormin (atenolol.)

It sounds like IF you are going to continue the high beta-blockade route and you continue to get edematous, you really have no alternative but to couple it with a diuretic.

Have you had an MRI of your pituitary?...PAGING DOCTOR HOUSE! :D

<I have an underlying gut feeling that going to 200 or 400 mg. atenolol would be a DESPERATELY bad choice.>

What would your life be like if you went completely without a beta-blocker and let your "hyperthyroid" run full out? What symptoms would you expect? WHich did you have back in '94?

I found an interesting study: with selective beta-blockers the effect of adrenaline is "pure pressor" that is both systolic and diastolic rise, but with atenolol (selective) adrenaline cause systolic to rise and diastolic to fall: this lowered diastolic MIGHT mean more fluid leakage...not sure.

These mechanism are really tough to figure out though because the effects of thse hormones are so multivariate and effect almost every bodily function.

Yeah, developed a cough. Also got post nasal drip so I was kinda hoping it was that. Not keeping me awake or anything but the hubby's mentioned that I took up snoring in the last couple months.

Wouldn't a weak heart cause a drop in bp? I been running between 110/70 and 130/80 when I don't take the lasix. I took the lasix today cause I haven't for a couple days and a lot of the water is back.

I did find quite a difference between the selective and non-selective and to be perfectly honest and frank, I was enjoying the non-selective better cause it doesn't muck with the sex life so much. ;) I also noticed that when I originally switched from the inderal to the atenolol back in September, the slight puffiness that I had always had around my ankles disappeared. That made me think that the atenolol was less likely than the inderal to cause it. At some point in all this switching around I did go back to the 160mg inderal and didn't see any difference in the edema after a couple weeks. I do realize that a diuretic may be the only solution. I just wish someone would tell me why it's all of a sudden happening. I'm being brushed off and that makes me nervous.

Had a ct scan of the pituitary in 1991. No tumor. They did an mri of my neck the next day. Do not ask me why. I have never figured that one out. But it is typical of the medical care that I have received regarding this whole mess for the last 25 years.

Ok. I won't go up on the dose. I will ride this out for a little while and see what happens. Then if things don't get better I will try going back to the inderal.

Let me see. Without betas, I can expect my pulse to exceed 180. My metabolism shoots thru the roof and it really can be quite spectacular. It plays havoc with my head and my body. It has resulted in thyroid storm on two occassions. One real bad that required nine days hospitalization followed by home nursing care. The next one was following surgery but I felt it coming and got an increase in betas before it hit full force. My body runs itself into the ground until I collapse.

It wasn't difficult to deal with when I was young. Seems the older I get, the harder it gets. It's beginning to worry me about what it's done to me over all these years. Oh, did I mention I also have high cholesterol that does not respond to dietary measures? The docs have known about it for 25 years. Been told that since I'm a hyper, I don't have to worry about it. rotflol

I can expect my pulse to exceed 180.

I guess that quite effectively rules out the no medication route.
Try 40 mg. Lasix/day in a single dose and see what it does for your edema.
If you gag, you GAG...How's THAT for bedside manner.:jester: :D (Take it with food, it is better/faster absorbed in an alkaline environment.)

Ask your doctor point blank if he has any reason to suspect any heart remodelling or falling ejection fraction, or heart failure. What is your ejection fraction? Don't let him off the hook on this...you want PLAIN answers. Heck, you've paid them enough so far.

They did an mri of my neck the next day. Do not ask me why. I have never figured that one out.
Probably to ascertain thyroid size and look for any nodules.

Yeah, I don't dare not take the beta. Very rarely now do I exceed 90 bpm, whereas before, I never went under 100 until I started them.

I like your bedside manner. Direct, confident and caring. I imagine you don't hold and rub your face in your hands very often? That always seems so undoctorlike. lol

I weigh in at a whopping 99 lbs (lost 12 lbs over the last year) without the water. Think 40mgs is appropriate at that weight? I do find that about 4 days running on the 10mgs seems to make most of it go away but it only takes 2 days off to come back. I kinda stopped peeing very much back in february. For a while there, output was less than 400ml. They kept screwing up the metanephrine test jugs and I had to redo it 3 times over the course of a month. Oh yeah, another one of the endos' brill ideas. Test for pheochromocytoma 16 years into beta blocker treatment. :rolleyes: Squeezing out a little more on my own now but it still ain't my normal flow. I'll try buffering the lasix a little more. I been taking em with one of those high calorie shake drinks and a bowel of cheerios. I just hate walking around green. Everyone seems to notice.

Have no idea what my ejection fraction is. What is an ejection fraction? I've had 2 ecg's in my life. One in 1983 which shows some kind of weird flat top spikes that come in between some more normal looking spikes with a "1/2" hand written under one of em. I don't know how to read em. And then the er did one in 1991 that says right atrial enlargment but none of those weird flattened thingys. That's it. No other cardiac evaluations. I do have a copy of every single piece of my medical records going back to 1981. Even though I have had documented tachycardia, high cholesterol and am hyperthyroid, with a very strong family history of heart disease, no one has ever seemed to be concerned with my cardiovascular system. I guess that's cause I don't have high bp?????

>>"Probably to ascertain thyroid size and look for any nodules."<<

Guess again. They did a raiu and scan 3 days before that. They had a very pretty picture of my hot diffuse goiter with measurements and everything. They don't normally mri thyroids. The mri says "incidental note of diffuse goiter" and goes on to describe the spine. My guess is someone screwed up.

I do have an appointment with my pcp on the 31st. I made the appointment end of last month. He's not an easy man to get an appointment with. I can get an appointment with the fnp pretty easy but every time I've seen her, she huffs out of the room saying if I don't do rai, I'm going to end up with a pacemaker. She's got an absolutely wonderful bedside manner. I'd really like to punch her out.

You know what my most recent diagnosis is? "You aren't peeing enough." :eek: Give me strength.............

Was reading this thread tonight and hope you don't mind if I jump in here! I'm on metoprolol succ (Toprol-XL generic). Started taking it last summer when I starting having racing heart, etc., with hyperthyroid. I was diagnosed with Graves' and had the RAI, but I'm still on the beta blocker. I have HBP and had PVC's before the hyperthyroid and the beta blocker helps both. Can't take ACE anymore because of the cough I get with that! Now I'm having edema in my ankles and pitting edema on my legs! Today my PCP prescribed a diuretic and wants me to have a cardiolite stress test because of some funny feelings in my chest and the edema.

So, I've found a lot of interesting dialog here! One thing, I just developed a cough a few days ago and noticed someone here ask about coughing. Why? What significance does the cough have with the beta blocker?

Thanks! :)

access,

How's this scenario: Have the RAI and cut down on the size and functioning ability of your thyroid. Then you will be in the position that a lot of HYPOthyroids are in, lots of TSH floating around with nothing much to do? Taken to it's extreme, you could slow your thyroid to near nothing and even if your pituritary goes ATOMIC, there can't be a concomitant increase in thyroid hormones?

Hypergirl,

Beta-blockers cause pulmonary vasoconstriction and can cause an asthma-like cough or actual asthma. It's becasue adrenaline is blocked and adrenaline opens the airways and increases bloodflow.

The effect is worse for non-selective beta blockers like propranolol and nadolol and less with selective beta-blockers like metoprolol and atenolol which are more "cardio selective" to the heart.

But even the selective blockers aren't completely selective and thus metoprolol can cause a dry cough.

I've taken three different beta blockers and never coughed...but I coughed my HEAD off with my only ACE inhibitor.

Thank you, Lenin!

Hi lenin,

Both surgery and RAI are contraindicated when the pituitary is what's causing the problem. With surgery, the thyroid grows back and will keep growing back no matter how many times they remove it and if they don't get the whole thing with rai, it'll grow back too. If they go for total ablation with rai, not only does the pituitary go ballistic and often starts to grow but it ends up causing a whole bunch of other problems in other organ systems. It's a really complicated issue involving mutant receptors throughout every organ system and one of the reasons I'm considered so "atypical". I'm a mix of hyper, hypo and euthyroid with the hyper predominating. The only accepted treatment protocol is beta blockers and if you'll believe it, the addition of thyroid hormones or thyroid hormone analogs to supress the pituitary and lower the natural hormone production. My pcp has finally said to hell with the endos and is doing the research himself to see what we can do. I wish I had found this guy years ago. First doc I've ever run into who wants to take the time to help.

It's been a busy week and a half. I've seen my pcp twice. I have stage 2 kidney disease. I've had an abdominal ct and now have to go in for a scope and biopsy to see what is causing the thickened gastric wall. Perhaps why the lasix has been tearing up my tummy? Running into an insurance glitch on the scope so I don't know how long it's going to take to come up with the funds for that but somehow, I will have it done. I had an echo on wednesday and am now awaiting results on that. I hate techs that keep their mouths shut. "The cardiologist will read it and send the results to your pcp." :rolleyes:

The edema is somewhat better. Since I am no longer "dehydrated" I am no longer being told to force fluids so the lasix is now able to pull a lot of it off. Idiot nurse. :mad: She had ordered the wrong test on the kidneys, not the one that the pcp had put in the chart. Of course everything looked good cause the calculations hadn't been done. She ordered the test in individual pieces and then called to say everything was fine. It was one of those tests that size and a couple other things come very much into play and they hadn't been entered into the equation because the calculations were not ordered.

I'll let you know how the echo turned out. I'm keeping my fingers crossed on that one.

Hypergirl - The last endo I saw switched me to topral from inderal when I complained about the edema. Funny. When I looked it up, it is one of the betas that is most likely to cause edema. Even more so than inderal. I'm now back on atenolol.

I think we are still allowed to link to GOVERNMENT sites, so if you haven't stumbeld upon this give a read:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492817

Interesting read. I hadn't run across it cause I haven't looked too far into the option of surgery. My grandmother very likely had the same condition. She had her thyroid removed at 17. It grew back and she died of a cardiac embolism at the age of 23 back in the 1930's. My mother also probably has the same problem but hers doesn't manifest itself quite as much. She's always had bad hypertension and has been taking betas along with a whole slew of other meds to control that for years. If you're interested in what we are most likely dealing with try http://www.hotthyroidology.com/editorial_79.html (sites other than .gov can be posted too if they are preapproved). The articles a few years old and there are currently a lot more reported cases and it is now known to be much more common than orginally thought even just a couple years ago.

One of the things that the article you posted caught my eye on was the fact that inderal controls the tremor better than the metropolol or the other non-selective betas. It fails to mention that it's not just the tremor but some of the other weird stuff too. I saw you mention in another thread about the adrenaline rush. Being hyper is kinda like that, and most of the time it's to a lesser degree, only it lasts 24/7. Throw in a couple flutters or missed beats or a little too much stress and you can really be off and running.

I've always felt the inderal controls the symptoms better than the others. I don't like some of the side effects at the higher doses and if I go above 160mg, it starts to affect the conversion of t4 to t3. I also hate the way it makes me feel numb. The atenolol allows me to feel alive but doesn't control the annoying symptoms as well. The inderal actually does a good job controlling symptoms at a pretty low dose. It just doesn't keep the heart rate down low enough until you really crank it up. Have you ever run into anything in your research that says a selective beta cannot be combined with a non-selective to lessen the side effects and still achieve the desired results?

access,

I don't think that the RTR syndrome pertains to you at all. From my reading it is a condition where the BODY refuses to react to thyroid hormones and thus appears hypothyroid even in the presence of adequate or high thyroid hormones. Your body seems to react only too well to thyroid.

Yeah, that casueght my eye too about propranolol crossing the brain barrier where other beta-blockers won't. I have found it one of the "nicer" beta blockers...perhaps that CHS relaxation is the primary reason.

she huffs out of the room saying if I don't do rai, I'm going to end up with a pacemaker
If it were for myself, that RAI is the trreatment I would try...if it grows back, it grows back. But I think it stands the best chance of success (I avoid surgery WHEREVER possible...even with a tooth! :D:D)

I must freely admit though, what I DON'T know about the thyroid can fill books. :D

It's where parts of the body do not respond properly to the hormones. It's almost always partial and the majority of people who have it aren't even aware of it. A person can be hypo, hyper or completely euthyroid. That's one of the reasons they divide it into categories. It depends a lot on each individuals distribution of the various hormone receptors and the degree of resistance involved. When someone presents with the hyper side of things, they are hyper where the alpha receptors predominate (heart, brain, kidney, intestine, temperature, fertility and a few others), but they are hypo where the beta receptors predominate, primarly the pituitary, liver (high cholesterol is the norm), immune system and a few other organ systems.

I've been researching thyroids for 16 years. There is not one test result or clinical symptom or sign that points away from this diagnosis. There's a lot of test results that point away from every other possibility. Biggest problem is the endos I have seen have just glanced at the literature and are under the same assumption that you are. They refuse to look into it further and just label me "atypical" and then drop me like a hot rock. I disrupt their assembly line. My current gp finally is cause he's bothered to do more than just glance at it. I want a correct diagnosis and I want proper treatment. I don't want to end up in the same mess that over 50% of the people with this have ended up in.

One endo gave me a really good chance to see what rai would be like. He wanted to show me how much better I would feel if they would just go ahead and ablate it. They completely supressed the thyroid function with meds and then gave me thyroid hormones to try and make up for it. It was hell.

Oh, metropolol crosses the blood brain barrier too. I personally don't like too much cns depression. I like feeling alive!

But back to my original question. Is there any reason different beta blockers can't be mixed?

Finally got a copy of my echo report. It states that the clinical indication for study is short of breath(???). I thought we were investigating edema and long term hyperthyroid but nothing suprises me any more. There is a note on the report about the procedure/quality: The study is technically difficult but adequate for interpretation.

Estimated ejection fraction is 60%. It says there is mitral regurgitation and tricuspid regurgitation and "unable to accurately estimate the pulmonary artery systolic". Structurally normal aortic valve and aortic root is normal size. It's also got the chamber measurements for the left atrium and left ventricle which are all within normal values.

The pcp has written "ok no ef problem" on it which has always meant the matter is closed and put in the chart. In light of the erroneous "ok" on the incomplete kidney test, would I be safe in letting this one drop?

A little note to add - I've been poking around. Found a really good article called Understanding cardiac "echo" reports - Practical guide for referring physicians located at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1781094

The other thing that is really beginning to bother me is I was asked 3 questions. Height and weight, any hypertension, any diabetes? I was not asked if I had any other medical problems or whether I was taking any medications. Little oversights like that, coupled with an erroneous indication for the study often bother me a bit so I did some more poking. The use of atenolol results in a mean increase in EF of 8.6 EF units. The study was interpreted by a cardiologist somewhere way off in the "big city". He doesn't know the first thing about me.

I'm beginning to feel a little paranoid. Any reason why I shouldn't?