Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

182 Doctors Online
Doctor Image
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Suggest dosage for beta blockers while having mitral valve prolapse

Answered by
Dr. Sameer Maheshwari


Practicing since :2010

Answered : 711 Questions

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 ?
Answered by Dr. Sameer Maheshwari 46 minutes later
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi Sir,
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.
Take care
Above answer was peer-reviewed by : Dr. Prasad

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,  
Drug/Medication ,  
Medical Topics

Recent questions on  Arrhythmia

doctor1 MD

Hi...My relative had intense coughing and sputum in his blood 6 months back.He got x rays blood reports Pleural Effusion test CT Scan,Pet Scan, , and finally needle biopsy left that order. Only test positive was pleural effusion for TB,rest all were negative. For Biopsies, got slides analyzed from 3 cancer etc. So doctor advised to continue with TB treatment.All the while in last 6 months arrhythmia was there....not severe...but was there. Since last couple of weeks hs is experiencing vertigo(guess due to arrhythmia). Anyways TB follow up was due, so got all the blood/urine reports. All normal. Got Chest Ct Scan which did not show any improvment in white spot on the lung. Almost Same size etc.No growth in spot size though.

So Question is? What is causing arrhythmia ? Biopsy was done very close to heart.Also the CT scan shows no improvement yet? Major concern is Arrhythmia which is affecting mental state of patient?

doctor1 MD

Mom is 90 years old, hospitalized for heart attack May 26. She is now taking digoxin .125 mg, enalapril 5 mg, furosemide 20 mg, metoprolol 12.5 mg, potassium 20 meq, synthroid 88 mcg. Her blood pressure and heart rate is so low that her home machine won't register it. Took bp at grocery store: Wednesday 91/33, heart rate 71; Thursday 69/34, heart rate 0. Checked heart rate at home on finger device: 70-74. She also has arrhythmia (ongoing before heart attack). She feels terrible, very low energy, no appetite, diarrhea. Research on meds indicate conflicts e.g. furosemide and digoxin; enalapril and furosemide. What is your opinion of this med cocktail?

doctor1 MD

I have been taking 40mgs of celexa and 100mgs of Lamictal for my bipolar disorder for over 2 years. I was also born with 2 heart defects: ventricular septal defect and mitral valve prolapse. Over the last two months, I have developed an arrhythmia that occurs several times an hour. I'm waiting for the results of my echo, stress test, etc. (done yesterday). Question: What is the likelihood that I'm experiencing side effects of my medication? I've never had any other problems in the years that I've taken Celexa or Lamictal, but I want to make sure I treat this arrhythmia soon. (btw, I'm 32 yrs old) Thanks!

doctor1 MD

I am almost 60 years old. When I cut the grass (self-propelled mower) walking at its max speed, I get very fatigues, short of breath, and experience tightness in my chest. I use a treadmill 5 days a week and may need to lose 20 pounds. I had a stress EKG 2 years ago and everything was fine. I have high BP, controlled with medication and Type 2 Diabetes controlled with medication. Many times I get arrhythmia during these events. What could this be?

doctor1 MD

patient is negative for provocable arrhythmia ...meaning

doctor1 MD

I was diagnosed with attrial flutters ( arrhythmia ) and the cardiologist did a cardio version and a subsequent EKG showed the condition was corrected. The doctor has me on Xarelto and a beta blocker . I feel fine and I am wondering if I can drink...

doctor1 MD

I recently had an echo and stress test due to abnormal EKG following six months of FOLFOX chemo. I was told I have RBBB and a shadow at and behind the tip of my heart. I asked if it were a possible metastasis as I have an inherited cancer...