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Feeling discomfort and pain in breast bone after taking metoprolol. On Lisinopril. Still feel the same. Help?

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Practicing since : 1998
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After taking metoprolol Suc for 3 1/2 years some serious effects started to occur: Constant feeling of going to past out, discomfort and mild to med pain under breast bone, cool lightness spreading out from stomach and chest into arms, in the past week this feelings were occurring several times a day so my Doctor put me on Lisinopril. I quit the Metoprolol 9-12-13 and took the first dose of Lisinopril 4am 9-13-13. After two doses there is a tightness in the chest with a almost constant light/cool feeling in the chest - also felt in the arms. This a not radiating, its a steady feeling. The passing has gone. Since Metoprolol is a BETA and Lisinopril is a ACE is there a problem switching from one to the other in the short time span stated? Also, I noticed my heart rate jumped into the 90"s just by walking calmly and watering plants. My age is 70, and my over health is great, no other problems. Why I started this BP crap is one of the biggest mistakes i have ever made. # 1/2 years ago my BP was 140 over 70.
Posted Tue, 8 Oct 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
Please see details

Detailed Answer:
Respected Sir
1. Whenever we switch over from a beta-blocker (metoprolol like drugs) to other group of drugs, we taper beta-blockers slowly. We usually overlap the two blood pressure lowering drugs for about a week so that the new drug has time to achieve its effect. WE also take care about the dosage of first drug, at times, so that BP do not fall excessively during the overlap period.
2. Whenever we use a single dose of a drug for blood pressure control, we prefer to use it at bed time. Discuss it out with your physician.
3. Jumping of heart rate on trivial exercise is common after sudden withdrawal of beta-blockers. This is a physiological response which is expected to go away after sometime. However I am more concerned about the feeling of tightness of chest and its radiation to arm. Although tightness of chest which is constantly there for hours to days is less likely to be anginal in origin, but in this kind of setting, angina should be ruled out. Precipitation of angina after sudden withdrawal of beta-blocker is well known in patients of anginal heart disease.
I would recommend you to seek an opinion of your physician or Emergency room (ER) doctor to clarify the origin of this tightness of chest on priority.
Hope this provides some insight into the issue. Feel free to discuss further.
Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Feeling discomfort and pain in breast bone after taking metoprolol. On Lisinopril. Still feel the same. Help? 15 hours later
Today I had Carotid scan, NO narrowing or blockages detected. Most of the feelings in the chest now as dissipated, also the tight feeling in the chest is waning. Feels just a little sore. Now the feeling is a cool, light feeling across the chest into arms, this is not a radiating feeling . . it just comes and goes. There is now a new feeling of shakiness (jittery).
The real problem, and I hope time lapsing will help, is the high pulse rate. This morning went to the shower and upon returning to the bedroom my PR was 116! Wow, just for washing, drying and walking back the the BR. If I sit long enough the PR will drop into the mid 70's. Don't like the high PR because it may interfere with the tread-mill. I know that walking and tread-mill are good ways to lower ones PR. My PR XXXXXXX is 150 BPM, and if my PR is always in the 70-100 or more range how can one exercise? I'm only suppose to work out at a 50-60% BPM rate of the 150 BPM.

In conclusion:
Will see my Doctor again tomorrow to disgust why he didn't slowly taper down on the Metoprolol before starting the Lisinopril and if can I take a few days break from taking any BP meds.
Little or no chest pain or tightness
Shakiness/jittery feeling somewhat constant
Fleeting light, cool feeling in chest and arms, not constant.
No more feeling "I'm going to pass out"
Pulse rate too high? to work out?
Also there is a slight feeling of being a little tired.

Hope this new info will help.

I also have a appt with my Heart Doc 9-19-13 for a (maybe) Nuclear Stress Test

Seems like ALL my health problems can be put right at the door of using Metoprolol for 3 1/2 years. You see I don't have any other health concerns. Today the 16th of september I turned 70.
Answered by Dr. Sukhvinder Singh 8 hours later
Brief Answer:
please see details.

Detailed Answer:
Respected sir
I apologize for being late.
1. When you were taking metoprolol for three and a half years, it was blocking the channels (receptors) on heart muscle on which certain hormones (epinehrine etc) act. This led to increase in number of those channels. This is called up-regulation. once you stop the metoprolol, Suddenly all those channels which were blocked as yet become available for the hormones to act. Hence their (epinephrine and others) effect suddenly increased. This has led to increase in heart rate. This will take time till the down-regulation or decrease in these channels will occur.
2. It is not correct that one has to measure his exercise in terms of heart rate only. We sometime make our patients to run up to 115% of their age predicted maximum heart rate in treadmill testing. Hence the number is not the absolute one. You can go further after consulting your cardiologist. Moreover it is likely to be a transient phase, your heart rate will settle down after a few weeks.
3. Wait for your appointment with your cardiologist. Do not lose hope or get depressed. If he advises do take a stress test. That will help us in answering many questions.
Hope this helps. Feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Feeling discomfort and pain in breast bone after taking metoprolol. On Lisinopril. Still feel the same. Help? 13 hours later
Seems like we have time difference, so don't "worry" about being late.

Do you like the Nuclear Stress Test?
I have read that the CT Angiography is better. What do you think?
Also I read that Radiation Dose can be lowered in the CT scan by 27% with a technique called Adaptive Statistical Iterative Reconstruction (ASIR), are you aware of it?
You didn't comment on the Carotid Artery scan, being clear doesn't mean there could be some kind of blockage elsewhere, right?
I didn't tell you that I take a Many Herbs, Extracts, Compounds, Vitamins.
Many for inflammation that I read is #! in heart disease. They include Hawthorn, Turmeric, Garlic, Bromelain , Astaxanthin, Fish & Krill oil, Resvertrol, Magnesium, Ginkgo Biloba Leaf, Gotu Kola, Bacopa leaf extract and others. At age 66 when this all started I was on no medication except for some skin creams and lotions.
I'm seeing my primary doctor today and I'm going to tell him I stopping the BP meds at lease through 9-22-13. What do you think?
Note: Last Metropolol was taken 2pm 9-12-13 and only two Lisinopril since then. better today (9-

Thank you for your informative replies.

Please comment on all the above. . . . .
Answered by Dr. Sukhvinder Singh 15 minutes later
Brief Answer:
Please see details

Detailed Answer:
Respected Sir
1. Since I have much more expertise in "stress echo" I prefer it to nuclear stress test but it does not mean that they are inferior to Stress echo in any manner. In fact, in relatively older people they are more preferred because of difficulty in viewing heart in ECHO.
2. Stress test and CT angiography provide entirely different kind of information. CT angiogram tells you about the structural aspect but stress test tell you the functional significance of those structural defects. Both have their own role. But I will not recommend CT angio in place of a stress test. A stress test is better as it provides functional significance of whatever obstruction is there in coronary arteries. We are currently more concerned about your symptoms and would like to evaluate if recurrence of symptoms occur on stress testing or not. So that it can be determined if your symptoms are related to coronary artery disease or not. CT angio will not answer this.
3. No, I am not aware of ASIR as we don't perform CT angiograms in India. We only interpret them for our patients. Radiologist perform them here.
4. A normal carotid artery scan is good but does not signify that there will not be obstruction elsewhere. Neither It rules out brain ischemia as a cause of relevant symptoms.
5. None of the herbs or traditional therapies or vitamins has been proved to have a role in coronary artery disease as yet. Not enough to be recommended by our governing bodies (American college of cardiology & others). Hence I don't use them. Fish is good for cardiovascular health provided it is not fried.
6. I would not recommend you to stop taking your medicines. Let your doctor decide this. At times this may be counterproductive.
Hope this helps.
Above answer was peer-reviewed by
Follow-up: Feeling discomfort and pain in breast bone after taking metoprolol. On Lisinopril. Still feel the same. Help? 38 minutes later
My Friend, who was on Metoprolol had the same symptoms as me and after over a week of quiting it, ALL the bad feelings already described in prior comments went completely away. I, also have almost a complete revisal of my symptoms. Again Sir, no chest pain present, occasional, and fleeting sensation of coolness/lightness in chest. As for the heart rate and BP bouncing around a bit, I think cleansing my body of the BP chemical crap for now is a good idea. I will run this by both my Primary and Cardiologist.
Since this is the last contact, thanks again for your thoughts and information.
Answered by Dr. Sukhvinder Singh 10 minutes later
Brief Answer:
Have good health sir.

Detailed Answer:
Respected sir
1. A number of patients develop chest tightness with metoprolol. they are either smokers or they have hypersensitive lungs. The reason for such tightness is constriction of airways wall smooth muscles. But this should come early in the therapy not after 3 years. However this may come anytime because the sensitivity of lungs/ airways changes dramatically, at times after trivial viral infections.
2. Body does not always adjust to all new drugs. That's why there are so many options most of the time. Still I will not advise you to stop your medication on your own. Its a matter of few days only.
Good luck
Have a good health.
Above answer was peer-reviewed by
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