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Old 08-25-2008, 01:39 PM   #1
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Stopping carvedilol for today, stress test tomorrow

Hi all. I'm going in for a stress test tomorrow afternoon and I have stopped my medicine like the itinerary has instructed. Anything with -lol at the end pretty much has to be stopped for 24 hours before the test. I'm somewhat worried because it's a beta-blocker (obviously) and anytime I've missed a dose or was late taking it, I felt jittery and shaky all over. I think I even ended up having a panic attack one time and made my bf drive me to the hospital.

I'm also on maxzide for HBP. I'm really just nervous that my bp is going to skyrocket so I'm wondering if the Maxzide is enough to keep it down until after the test. It should be over around 2 pm. If some think it won't be enough, what can I do to keep it down?
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Old 08-25-2008, 10:47 PM   #2
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Re: Stopping carvedilol for today, stress test tomorrow

Ok as if a few minutes ago, my heart rate went through the roof at just over 100 bpm. I couldn't take it anymore and went ahead and took my medicine. I'll never stop my medicine like that again.
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Old 08-26-2008, 08:29 PM   #3
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Re: Stopping carvedilol for today, stress test tomorrow

Hi Storm,

Sorry to hear about your dilemma. How important is it to you to take the test? Is it a routine test? A heart rate of 100 bpm is considered borderline normal.

I find that staying off the beta blocker for 24 hours does not pose a problem for me. This could be due to the fact that I am on other blood pressure medications, my dose of the beta blocker is not a high one, and the selectivity of my beta blocker.

My suggestion would be to call your doctor's office and inquire about what action (if any) on your part would be appropriate. Make sure to mention your concerns about the increased heart rate.

We are told to stop taking the beta blocker 24 hours prior to the test and given no further instructions. I think it is assumed that enough of the residual drug will remain in the system to get us through the 24 hours. Beta blockers are not usually used as first-line treatment in hypertension (except where otherwise indicated), which means that most hypertensive patients who take beta blockers are also on other medication. This helps keep the blood pressure in check. I think that cardiac patients who may be endangered by withholding the beta blocker are given specific instructions and observed more cautiously during the stress test. Stopping the beta blocker for 24 hours does not seem to affect my blood pressure much, though it affects the heart rate significantly. An increase in heart rate is taken into consideration when the baseline measurements are taken before the test commences.

If I were concerned about a drop in my blood pressure as a result of withholding the beta blocker prior to the test, I'd take a higher dose of one of my other blood pressure medications. Luckily, my blood pressure does not seem to react negatively in these circumstances. Never take such steps without checking with your doctor first. Let us know how your test goes. Good luck!

flowergirl

Last edited by flowergirl2day; 08-26-2008 at 09:16 PM.

 
Old 08-26-2008, 09:22 PM   #4
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Re: Stopping carvedilol for today, stress test tomorrow

Thanks for your reply I really was supposed to have this done back in March but I ran out of money and couldn't go. I get these episodes where I get weird chest pains right around my sternum and ribs on both sides and it's kind of difficult to breathe at times. Every EKG I've had was normal, as well as chest x-rays and bloodwork. It really feels like chest wall pain but they want to make sure nothing is going on.

When I did stop the coreg, it didn't seem to affect my BP too much. It seemed to hold right around 130/90 or so. But later last night around 1:30 am or so, my heart just started to beat real funny, not like skipping but a hard beating sensation in my chest. I do get this normally, but this seemed to be more amplified. When I got up and moved around it increased to I think 102 BPM. Really I just felt uncomfortable and couldn't sleep for most of the night, so I rescheduled my test for Sept 11. I think maybe I should talk to my doctor about an alternative to the beta blocker, and maybe just go on something else. I am on a diuretic in addition to my medicine, Maxzide. Now all day today I've just felt a little weird all over. BP is staying right around 130/90.

What other BP meds do you take? I may consider a calcium-channel blocker again, if it doesn't make my legs swell again.
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HBP, 3/2004, Rheumatoid Arthritis, 8/2007
Coreg, 6.25mg x2 daily, Maxzide 37.5/25 mg x1 daily, Claritin 10mg x1 daily

Last edited by Storm Moon; 08-26-2008 at 09:23 PM.

 
Old 08-26-2008, 10:23 PM   #5
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Re: Stopping carvedilol for today, stress test tomorrow

Hi Storm,

I typed a reply to your post and my CAT has lost it. He hit the keyboard with his paw before I could post my reply. Oh well. I'll re-type most of it and watch the cat this time. He appears to be sleeping directly above the keyboard.

The withholding of beta blockers prior to stress testing of any kind - pharmacological- thalium or dobutamine, or exercise stress testing, remains controversial.
Most doctors prefer to stop beta blocker therapy prior to the test. 24 hours is the norm for propranolol, while the longer lasting drugs such as metoprolol and atenolol may require longer periods of withdrawal of therapy of up to several days. This is because besides the effect these drugs usually have on the heart rate, there often are other prolonged effects on cardiac function.

The reasoning behind stopping the medication is that if the patients are stable enough to undergo the test, they should be able to tolerate short periods of beta blocker withdrawal. This does not uniformly apply to people with CHD or CAD, who are given specific instructions if their beta blocker therapy is withdrawn prior to the test. In people who are on beta blockers at the time of the test, there is a higher false negative rate. It has been shown that other long-acting drugs, such as calcium channel blockers and long-acting nitrates- can also impair the test outcome. I've had mine done both ways, while on beta blockers (dobutamine), and without (exercise).
I wish you luck. The fact that all your other tests showed nothing is a very good news. A good stress test result will be the icing on the cake. Let us know how it goes.

flowergirl

Last edited by flowergirl2day; 08-26-2008 at 10:23 PM.

 
Old 08-27-2008, 06:42 AM   #6
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Re: Stopping carvedilol for today, stress test tomorrow

Quote:
Originally Posted by Storm Moon View Post
... I get these episodes where I get weird chest pains right around my sternum and ribs on both sides and it's kind of difficult to breathe at times....
I've been doing some reading on nutrition due to the connection with hypertension. From what I understand, these symptoms can occur when a magnesium deficiency is present. Mag deficiencies don't show up readily in lab tests...and diuretics can be contributing factors to mag/electrolyte imbalances, but other factors can impact mag imbalances as well (calcium intake, genetics, etc.).

I haven't pursued this information in depth, but I thought I'd mention the possibility. It is something I believe I experienced when on hct...not the chest discomfort, but just about every other symptom.

The other thing I thought I'd mention is that I've never had heart concerns but I did experience chest pains around the time I was on a beta blocker. I do think there was a correlation.

Bethsheba

Last edited by bethsheba; 08-27-2008 at 06:43 AM.

 
Old 08-28-2008, 05:21 PM   #7
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Re: Stopping carvedilol for today, stress test tomorrow

Quote:
Hi Storm,

I typed a reply to your post and my CAT has lost it. He hit the keyboard with his paw before I could post my reply. Oh well. I'll re-type most of it and watch the cat this time. He appears to be sleeping directly above the keyboard.

The withholding of beta blockers prior to stress testing of any kind - pharmacological- thalium or dobutamine, or exercise stress testing, remains controversial.
Most doctors prefer to stop beta blocker therapy prior to the test. 24 hours is the norm for propranolol, while the longer lasting drugs such as metoprolol and atenolol may require longer periods of withdrawal of therapy of up to several days. This is because besides the effect these drugs usually have on the heart rate, there often are other prolonged effects on cardiac function.

The reasoning behind stopping the medication is that if the patients are stable enough to undergo the test, they should be able to tolerate short periods of beta blocker withdrawal. This does not uniformly apply to people with CHD or CAD, who are given specific instructions if their beta blocker therapy is withdrawn prior to the test. In people who are on beta blockers at the time of the test, there is a higher false negative rate. It has been shown that other long-acting drugs, such as calcium channel blockers and long-acting nitrates- can also impair the test outcome. I've had mine done both ways, while on beta blockers (dobutamine), and without (exercise).
I wish you luck. The fact that all your other tests showed nothing is a very good news. A good stress test result will be the icing on the cake. Let us know how it goes.

flowergirl
Thanks again for more information Now I wonder if Coreg is needed to taper down as well as atenolol and metoprolol. I've been on atenolol before and can attest to its withdrawal affects. I see on some drug sites that Carvedilol/Coreg is an alpha/beta blocker, but others do not. I wonder which it really is? It seems pretty strong.

Quote:
I've been doing some reading on nutrition due to the connection with hypertension. From what I understand, these symptoms can occur when a magnesium deficiency is present. Mag deficiencies don't show up readily in lab tests...and diuretics can be contributing factors to mag/electrolyte imbalances, but other factors can impact mag imbalances as well (calcium intake, genetics, etc.).

I haven't pursued this information in depth, but I thought I'd mention the possibility. It is something I believe I experienced when on hct...not the chest discomfort, but just about every other symptom.

The other thing I thought I'd mention is that I've never had heart concerns but I did experience chest pains around the time I was on a beta blocker. I do think there was a correlation.

Bethsheba
Hi beth! Great to see you're back on the forum I've read a bit about that as well and wonder about maybe taking supplements, at about 250 mg. Women need about 310 per day but you can get it from a lot of foods naturally, like nuts and bananas. I think spinach is loaded in it too. I also read that magnesium deficiency seems to be overlooked in electrolyte testing and it's actually more common than most people believe.

These pains, though, seem to come close to my TOM and somewhat go away when it starts. It feels like an achy, to sharp stabbing sensations in my sternum and extends into my ribs on both sides, and even is felt in my collarbone at times, again on both sides. Sometimes I can gently press on my ribs and they feel a bit tender and hurt. I've heard that fibro does this too but never talked to my rheumatologist about it.
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^_^ Cats are a girl's best friend. ^_^
HBP, 3/2004, Rheumatoid Arthritis, 8/2007
Coreg, 6.25mg x2 daily, Maxzide 37.5/25 mg x1 daily, Claritin 10mg x1 daily

Last edited by Storm Moon; 08-30-2008 at 09:57 PM.

 
Old 09-03-2008, 06:36 AM   #8
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Re: Stopping carvedilol for today, stress test tomorrow

Hello Storm,

Sorry about not getting back to you...but I did want to check in to see how you're doing. Hope the stress test went well...

Quote:
Originally Posted by Storm Moon View Post
... I also read that magnesium deficiency seems to be overlooked in electrolyte testing and it's actually more common than most people believe.
Yes, I've read that the blood test that the doctor's use, misses over half of the mg deficiencies out there but it is relatively easy/inexpensive test to run. Yes, I've read a mg deficiency is quite common and given our Western diet, I'm not surprised. A hamburger, fries, and a malt doesn't have the same nutrients that fresh fruits, vegetables, or nuts!

I suspect your pains may be due to something else but I think it's helpful to rule out as many things in our power that we can rule out.

Off topic here, a very belated thank you for the information on low/no sodium blue chips. I love em!! especially with some homemade guacamole...so thanks again for that honey of a hint!

Bethsheba

 
Old 09-10-2008, 11:07 AM   #9
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Re: Stopping carvedilol for today, stress test tomorrow

Well I went for the stress test today at 11 am and it went pretty well. I could only stay on the treadmill for about 6 minutes. My heart rate went up to around 180. It'll be awhile until I get my results back (when I see my doctor next and the office is closed today) so when I get them back I'll post them here.

I did go ahead and take my medicine (coreg) at 6:30 pm last night but didn't take it this morning for the test. I asked the doctor about it and he said it probably wouldn't have much of an effect on the test so we'll see. I'm pretty pooped out right now as you can imagine LOL The only time I had any discomfort was when the tech was doing the actual ultrasound and when she got it under my left breast, it hurt pretty badly. My ribs felt a little tender and sore too.

No prob on the chips beth I'm glad you like 'em! I love them with salsa, the organic of course. Take it easy and I'll keep everyone posted when my results come back
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Old 09-10-2008, 06:31 PM   #10
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Re: Stopping carvedilol for today, stress test tomorrow

Storm,

Glad to hear the test went ok...we'll keep our fingers crossed for good news (and great health)!

Take care!

Bethsheba

 
Old 09-17-2008, 08:17 AM   #11
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Update

Well, I got the phone call just a little while ago and the nurse said the test was normal, but they did find that I have a mild leaky valve on the echo, though they didn't say which one. She said it's just mild and there's nothing to worry about, but I do intend to keep an eye out for anything unusual. Lately I have been having bouts of fatigue. My next doctor's appointment is October 2nd. Should I be too worried about it or just be aware of anything unusual?
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^_^ Cats are a girl's best friend. ^_^
HBP, 3/2004, Rheumatoid Arthritis, 8/2007
Coreg, 6.25mg x2 daily, Maxzide 37.5/25 mg x1 daily, Claritin 10mg x1 daily

Last edited by Storm Moon; 09-17-2008 at 08:17 AM.

 
Old 09-17-2008, 11:30 AM   #12
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Re: Stopping carvedilol for today, stress test tomorrow

Am so glad your test was normal!! I don't think the nurse would have mentioned the leaky valve unless it was nothing to worry about but then again, I have no experience with heart issues and can only recommend that you might want to check on another board.

As far as watching for anything unusual, that's always good advice to follow!!

Are you eating lots of fruits and veggies?? That may help with the fatigue...I hope, .

Take care and know that we are wishing you the best!

Bethsheba

 
Old 09-17-2008, 01:46 PM   #13
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Re: Stopping carvedilol for today, stress test tomorrow

Thanks for the well wishes. My diet is well, not so great aside salads and soup last night for dinner. I'm going to have to be very choosy when I go out for food from now on. Lots of grilled chicken and salads for me now. I love to eat bananas but we don't keep them in the house enough, and we really should. My bf recommended oatmeal for whole grains. Need to go shopping soon.
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