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Dr. Andrew Rynne

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Suggest dosage for beta blockers while having mitral valve prolapse

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Dr. Sameer Maheshwari

Cardiologist

Practicing since :2010

Answered : 640 Questions

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Posted on Wed, 15 Mar 2017 in Hypertension and Heart Disease
Question: Continuing question for Dr. XXXXXXX Makode-
Patient (my wife) has been on beta blockers for 8 hrs. - symptoms have improved with no ectopics. However, she has always had a very low heart rate of approx. 55-and low BP of 105/62.
Now that she is on the beta blockers ( 25 mg. twice a day)- her heart rate is running 40-42 and BP of 90/46. Dr. has made her more active for last 24 hrs. When she does laps around the ward her BP only goes up to 98 at most and the heart rate goes to 46.
You mentioned reducing the beta blockers- what do you suggest?
Also, what about anti- arrhythmia drugs ?
XXXX
doctor
Answered by Dr. Sameer Maheshwari 46 minutes later
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi Sir,
Welcome.
This is Dr Sameer, cardiologist.
I went through your previous questions & the subsequent answers and came to know that your wife has a Mitral Valve prolapse with secondary mild to moderate MR(grade 2 to 3) with dilation of LV and she has frequent ectopic beats.
In these type of patients we generally desire a low heart rate to keep the activity of heart low & increase the filling time of heart for effective cardiac output. If she is having persistent low heart rate (<50), than I'll recommend decreasing the dose of beta blocker to 25mg once daily.
For ectopic beats without treatment of choice is beta blocker which are itself anti arrhythmic drug & do not need any other anti arrhythmic drug.
Other drug which could be added to the treatment is diuretic (if she is dyspnoic) & ACE inhibitor when her bp improves. Both beta blocker & ACE inhibitor help in long term prognosis in such patients.
These ectopic beats are coming because of dilated LV.

For your knowledge, surgery for MVP is indicated when patient has a severe MR (grade 4) & is symptomatic. Otherwise medical treatment is the treatment of choice.

Regarding pacemaker. Pacemakers are indicated for heart blocks & ICD (implantable cardiac defibrillator) is indicated in patients who have runs of VT.

So continue beta blocker as 25mg once daily & as her bp improves increase the dose & consider adding ACE inhibitor as both will decrease cardiac remodeling & thus prevent dilation of heart.
Thanks
Take care
Above answer was peer-reviewed by : Dr. Prasad
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