Falling apart after taking Propranolol

[idris77]

Ive always had the odd SVT over the last 13 years, they lasted about 5 mins and were controlled by doing the Valsalva manoeuvre. Ive had ECGS, Echo, worn a holter monitor, and the Docs have said my heart is fine.  Im 46, haven't touched alcohol or smoked for 12 years, BP around 120/70, cholesterol 3.3, normal weight, but do suffer from anxiety (but also a single Mum to three LIVELY teenage boys...)  

Last week I had a corking SVT episode (HR 180) which I couldnt stop, and ended up in hospital after an hour and needed 2 doses of Adenosine to regulate it.  The next morning the same thing happened, but I only needed 1 dose of Adenosine.  My blood tests came back showing I have hyperthyroidism, which the doc said is causing my SVTS to become difficult and prescribed me Carbimazole 40mg once a day, and Propranolol 40mg three times a day.  

For the first five days I felt dreadful, tired, queasy, felt like I couldnt take a deep breath, resting heart rate at 58.  Then I had a migraine aura for 10 minutes (zigzag vibrating patterns, large C shape, in both eyes), followed by a headache in my right temple.  A couple of days later (yesterday) I woke up with the zigzags at 6am, and had them again at 9am.  I have NEVER EVER had any visual issues before, or ever had a migraine.  I only get mild headaches about once a month, so this is really unusual for me, and worrying!  

My doc said that its the Propranolol, so I halved the last three doses down to 20mg, but this morning Ive again woken with the zigzags, but an even worse headache at the back of my head and in my left eye.  Im not sure whats safe to take on these pills, so Ive been taking paracetamol.  

I cant believe the change in how I was feeling just over a week ago, and how dreadful Im feeling now.  I feel trapped between the fear of having more of those SVTS and that disgusting Adenosine, or staying on the Propranolol which is clearly messing my body up and giving me other problems.  The Endocrinologist says I will need to be on the beta blockers for at least 6 weeks while my Thyroid responds to the Carbimazole :-(

Sorry for the essay, but if anyone out there can give me any advice, or share their experiences, I would be really very grateful.

[tom_h]

Mine was very well concealed.  Some cardiologists almost wished a delta wave there, but in the end, it was a pretty unremarkable waveform. That in itself was a problem becasue the doctor's wanted to see proof or evidence of the condition.  It wasn't until I got the 30 day monitor and recorded a couple events that it caused the cardiologist to sit up and actually call me on a Sunday evening to make sure I was alright.  I had 54 years of it.  To me, it was just another event!  Once they saw evidence of it, the wheels stated to roll much easier towards treatment,   As it turned out that I had Circus Movement Tachycardia, a form of AVRT similar to but, not WPW.

[is_something_wrong]

Thanks for keeping us posted!

Tom: I agree, but wouldn't that usually show on a resting EKG as delta waves? Did that happen in your case or did you have the rare "hidden WPW-syndrome"?

[tom_h]

Is a cardiologist prescribing your current Carbimazole and Propranolol?  If you have a definite history of SVT, I'd request an appointment with a cardiologist if you aren't seeing one already.  Hasn't anyone suggfested alternatives to drug therapy?

Your SVT may not be isolated to AVNRT although that's certainly the most common.  It could also be AVRT.  Wolff Parkinson White is a type of AVRT, and there are several others that fall into that category as well.  I wish you the best.  I had it for a very long time as well, so I can relate to what you're going through.

[idris77]

Thanks for your quick reply!  I had no idea my thyroid was an issue, as Ive had no symptoms, but the thyroid doc said it had probably taken a year to get to its current levels.  The previous SVTs/AVNRTs came about once or twice a year, and were probably down to stress I think.

My general doctor has just called me and said that as I have never had migraines before she wants to send me for an urgent brain scan to rule out any issues with 'small blood clots'!  Trying hard to think happy thoughts about that!!!  Somethings not right, so I hope that doesnt take too long.  Will keep you posted.

[is_something_wrong]

Hello.

Your story seems a bit weird, you say the SVT (which I assume is so-called AVNRT, AV nodal reentry tachycardia since it responds to adenosine) has bothered you the last 13 years. AVNRT is caused by an abnormal pathway in the heart. Hyperthyreoidism can clearly worsen it, but I assume you haven't been hyperthyreoid for 13 years, so it's obviously not the cause itself.

Propranolol is treating hyperthyroidism only for symptoms. It's better than other beta blockers, because it doesn't only affect the heart, but also relieving other symptoms of hyperthyreoidism, such as tremor, heat, upset stomach, etc.

AVNRT is set of by a PAC, so eliminating the PACs will of course make the arrhythmia go away, but no one can completely eliminate PACs. Elevated thyroids is one of the main triggers for PACs, so when you get this condition under control, your SVT will be less bothersome, but probably not go away completely. To do that, you need an ablation, which in the case of AVNRT has a high success rate (above 90%).

Propranolol is affecting the blood vessels more than other beta blockers (constricting blood vessels) which usually doesn't matter but in some cases it can make some symptoms worse. A solution may be (as far as I know) the same as they do to relieve symptoms from phaeocromocytoma, adding an alpha blocker which will dilate the blood vessels. Maybe you should ask your endocrinologist this question?

People with normal blood pressure and normal heart rate will often poorly tolerate beta blockers. It would be interesting to know how your blood pressure is at heart rate 58. It may be either too high or too low.

Please keep in touch with your doctor regarding this. What you experience is unacceptable and I would refuse to leave the doctor's office until he provides an explaination and treatment.