 | Joseph P. Galichia, MD is the founder and Medical Director of the Galichia Medical Group, PA. He is an internationally recognized pioneer in the field of interventional cardiology. In the 70's, Dr. Galichia studied in Zurich, Switzerland with the inventors of the balloon angioplasty technique for treating heart disease. As a result of his experience, he was able to bring this historic technique back to the United States where he was one of the first physicians to perform coronary angioplasty here. A noted medical spokesman, he appears on a weekly Newstalk segment on KWCH Channel 12 and has a weekly syndicated radio talk show on KNSS 1330 AM every Saturday live from 11:00 am to noon. Dr. Galichia may be contacted by sending an e-mail to service@galichia.com |
Health & Medicine
2002-04-01 14:47:00
What about toprol?
Question: I am taking Toprol XL, 50 mg a day, for rapid heart rate. My problems began while taking Claritin-D for sinus congestion. It has continued for over a month after I have stopped taking the Claritin and I can't seem to stop the Toprol without it racing again. Do you thing the Claritin could be the underlying problem with my heart rate? Question #2: My other question is: if I have to stay on Toprol forever to control my heart rate, can I still safely use it during a pregnancy?
Answer: The problem of a rapid heart rate always should be evaluated and medications are always a consideration as a cause of this problem. However, it is also true that Claritin-D can cause your heart rate to go up, but having stopped this drug even for as long as 48-hours, your heart rate should return to normal. Thus, I am concerned that there may be some other reason for a racing heart rate. Heart rates of greater than one hundred at rest are always of concern to me and should be evaluated in depth. Problems such as a hyperactive thyroid, underlining heart disease, high blood pressure, and a host of other medical problems can cause your heart to beat too fast. Certainly, even a chronic state of anxiety could cause such a problem. Toprol XL is a Beta-blocker which does tend to slow the heart rate. You have been on this drug for a while and is seems that you still need it to keep your rate under control. Leaving someone on a drug like this indefinitely without searching for further causes for the rapid heart rate is not reasonable, in my opinion. Looking for other abnormalities and finding some explanation for the elevation in your resting heart rate should be pursued further.Toprol is a drug that you could conceivably use during pregnancy, but no medication is completely safe in this regard. My recommendation would be to have an in-depth analysis of your rapid heart rhythm and try to solve this problem without taking medication over a long period of time. In unusual circumstances, we have given patients Beta-blockers throughout the duration of their pregnancy and have seen very few problems. At the time of delivery, however, it is important for your doctor to know that you are on these medications because they should be withdrawn prior to delivery because they may cause the fetal heart rate to be slow at the time of delivery. Beta-blockers are generally very safe medications, but there are some long-term side effects including insomnia, fatigue, sexual dysfunction, and weight gain which make it difficult to use these drugs long term.Angina pectoris occurs when the blood supply to the heart is impaired. There is an inadequate amount of oxygen and other metabolites to supply the heart muscle. Often, there are enough nutrients when the heart is resting, but when the workload of the heart is increased, the blood supply is inadequate to meet these demands. Exercise, excitement, increased blood pressure, or increased heart rate is common events that create this kind of "starving effect" that results in the chest pain of angina pectoris.The clinical syndrome of angina pectoris consists of chest pain often consisting of a pressing or burning sensation in the center of the chest radiating to the left shoulder, jaw or arm brought on by exertion and relieved with rest or nitroglycerin. Many variants may occur including shortness of breath, weakness or sweating and the pain may occur at rest. In short, any pain or discomfort above the waist may be a variant of this syndrome and thus may be a manifestation of coronary insufficiency. I have often said that few patients have read the textbook on angina pectoris and few stories I hear are classic descriptions. The job of a good clinician is like that of Sherlock Holmes sorting through lots of misleading information to arrive at an answer. Technology, fortunately has come to our rescue and provided us with more scientific data in the form of treadmill tests, nuclear stress tests, stress echoes and, most important of all, angiography to give us a definitive diagnosis in almost all cases. Indeed, the saying, "an ounce of dye is worth a roomful of cardiologists" is often reflective of our need to ultimately proceed to these tests in a timely manner.
