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Valarie, Nurse (RN)
Category: Health
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Experience:  36+ yrs exprience medical, surgical, wound/skin care, nutrition, geriatrics, rehab, management
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The past couple of weeks I have had a rapid heartrate (120-140

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The past couple of weeks I have had a rapid heartrate (120-140 getting up from bed, walking around house, etc.) and resting 94-108 (normal resting for me has been in the 80's - low 90's). I was sick and on an antibiotice for one week of this, and I have also had alot of stress the past few months and I am very tense (knotted neck muscles and back muscles). I went to the cardiologist friday. My pulse was 125 when the nurse checked it and 114 when they did the EKG, which was normal. I had a 24 hr monitor on which I take back monday. He upped my Toprol dose to 50mg a day (I was taking 25mg for PVC's/rapid heartrate/anxiety for 5 years and take Xanax XR for panic attacks). I felt a little better saturday morning, my pulse only went up to 112 when I got out of bed, and resting stayed around 94, until in the afternoon it was back between 100-110. How long does it take for the increased dose to lower the heartrate? I am sure my anxiety is not helping. I am taking 25 mg 2 times a day.
Submitted: 7 years ago.
Category: Health
Expert:  Valarie replied 7 years ago.



Welcome to JustAnswer, and thank you for your question.


It might take one to two weeks before you see the full effect of the increase in your Toprol XL dose. It would be wise to continue monitoring your pulse and blood pressure at least twice a day, preferably 3 or 4 times a day, and record this with date and time. This way, your cardiologist can see the effects of the medication.


This drug is sometimes used to treat tachycardia (fast heart rate, but the problem for you with this drug is that it is primarily used to treat high blood pressure. Since you normally run a fairly low blood pressure, you will want to keep an eye on your BP. If it falls below 90/50, or is consistently lower than 100/60 you should call your cardiologist right away to let him know.


Hopefully, you have a follow-up appointment within a month or so to check on your progress with this medication.

Customer: replied 7 years ago.



Thank you for your quick reply. I will be taking the 24 hr heart monitor back tomorrow morning to the lab, and the cardiologist will read the results and either he or his nurse will give me a call tomorrow. He treated me for several years when I was first diagnosed with panic disorder. When we got the panic attacks under control, my family doctor, who is in the same medical office, took over prescribing my medication and doing my yearly checkup. I had thought the increased dosage of Toprol might take effect immediately, but I was reading a few things on the internet and it suggested, as you said, it might take 1-2 weeks to feel the full effect of the dosage increase. I am sure my anxiety over it has not helped it to slow down. I am 5'3". 134lbs, 22 bmi, non-smoker, non-drinker. I was diagnosed with anemia the first of september, and have been taking iron supplements for that and increased my fiber intake so the constipation would not aggravate an internal hemorrhoid I have too much. The cardiologist did not feel that that had anything to do with my rapid heartbeat. He feels that it is due to me being sick recently and the fact that I have been under alot of stress the past few months. I asked him if I should be concerned about my pulse going up to 130-140, and he said no, that he doesn't get too concerned until it is 150-160 and stays there for awhile, and it's not due to exercise or exertion. I know that reading things today about people having side effects to metoprolol (the generic toprol xl) has not helped me. I have never had a problem after being switched from Toprol XL to Metoprolol Succinate ER, but Iet all of those negative reactions make me worry. Right now, my pulse is 112, and I am just sitting here typing this, but my mind is thinking there is something wrong and I'm concerned about taking my evening dose, as it is by a new manufacturer, Watson. I know this shouldn't concern me, but that's why my anxiety does. Should I be worried about my pulse being 112 right now? Or just chalk it up to my anxiety and worry over other people's reactions to metoprolol? Thank you.

Expert:  Valarie replied 7 years ago.



I think you should stop reading things on the internet about your medicine, and try to do something a bit more relaxing. Your heart rate is a bit lower than before seeing your cardiologist, so this is a good thing. You have only been taking the dose for a couple of days. You should see some difference very gradually over some time until the medication reaches its full effect.


Besides, there's no sense worrying about it (I know, easier said!). From what you have said, it appears that your cardiologist and nurses there are taking very good care of you. He will be able to see in the heart monitor results whether the medication is going to be right for you or not. If not, I'm sure he will let you know and will want to make some medication changes.


As far as the differences in manufacturers: The FDA (Federal Drug Administration) is very good at making sure that prescription medications sold in the U.S. are effective, and have the correct ingredients/amounts of drug, etc. You don't have to worry about it as long as you are buying medication in the U.S.


Keep in mind that you will be able to find a problem with anything on the internet. Much of the information you find is not valid. And sometimes it is very hard to know the difference between what is accurate, valid information and what is "hog-wash".


So for something as important as your heart health---trust your Cardiologist. If you have any concerns about the medication you are taking, ask him. And if you think he is too busy to talk to, another excellent source of information is your Pharmacist.

Customer: replied 7 years ago.



That is exactly what my mother and husband told me....quite reading internet postings. :-) Yes, it is easier said than done to be able to relax. I have gone through this before, but it's been almost 5 years, so kinda scares me when this happens. I have an EKG every year at my annual physical, and it has always been fine. My pulse goes up when I do anything exerting, as it should, but for the most part I don't feel it beating so hard in my chest. I used to, years ago, when I was on the regular Xanax and having panic attacks all the time. The Xanax XR he put me on 5 years ago has been wonderful in stopping my panic attacks (I have a chemical seems to run in my mother's side of the family). He told me he wanted me to take the increased dosage of 50 mg per day for 7-10 days. He said I could taper off after that, if my pulse was back to normal. I guess that should have made me realize it wouldn't happen overnight. :-) I just get worked up over things and then worry about my health. He said he was doing the heart monitor to check my PVC's and make sure they had not gotten any worse and to see what my rhythms were like for that 24 hours. He told me to do my normal activities and not to worry if my heartrate went up. So I will do what he said, and your suggestions too, and try to do something to take my mind off of it and relax. I thought I had done that last night, as I went to a movie, but when I got home I felt jittery so I took a warm bath, but my pulse was 104, and I took a .25 mg immediate release Xanax that my doctor has prescribed for me for occassional anxiety. I went to sleep, but woke up 3 hours later feeling like I was really hot and my pulse was 110. That scares me, but he told me it could be that my mind working overtime while I sleep. Do you think that is any concern?

Expert:  Valarie replied 7 years ago.

If it is a concern, I'm sure you will get to the bottom of it. You are doing the right thing by having tests done by your cardiologist first.


If everything turns out OK in the heart department, you might want to re-evaluate your anxiety situation. Are you being following by a psychologist or psychiatrist? Have you been evaluated for depression that could be aggravating your anxiety?


Another thing that may be going on is hormone levels that start changing for most women when they are in their 40's. The "perimenopausal" time of life could possibly exacerbate any heart problems, or anxiety problems.


And it is very possible for mind to work overtime when you sleep. Everything that is worrisome to you during the day will follow you into sleep, causing odd dreams and a continuation of physiological response to anxiety.


Just take it one step at a time. Right now, you are dealing with your tachycardia. Your Cardiologist will know what to do.


When you get done with the heart issues, then follow up with your anxiety and the possible causes for problems in that department.


You know, things like jigsaw puzzles, crossword puzzles, complex games, are great at taking your mind off your troubles and anxieties. You need to find something to do that takes all of your concentration so you can't think about anything else. For us anxious people, sometimes "relaxing" only gives you more time to think about the very things you don't want to think about.


Just remember, you are OK. You are actively seeking treatment. This is good. You will find the problem with the help of your doctor. Just be patient. Like my husband always tells me: "Everything will be O....K.....!"

Customer: replied 7 years ago.

Thank you Valerie. I appreciate the answers and reassurance. The cardiologist told me friday that he did not think it was anything to be concerned about, and as my mother and husband said, if he did, he wouldn't have sent me home. I know he will get with me tomorrow and let me know how the monitor results turned out, and what he wants to do about my medication, if anything.


Yes, I am under the care of a Psychiatrist, for the medication management of my Xanax. My family doctor sent me to him 2 years ago, as we had tried other medicines (SSRI's mainly) that I had bad reactions with. We have found that only the benzo family works for me, so that is what he has kept me on. I have been very stressed most of this year, as we had damage to our home last year from Hurricane Ike, and we moved into my parents house May 1st this year so the remodeling could begin. We gutted the house first, and in August the contractors started moving walls and adding new rooms to the house. It has been stressful, as I had hoped we would be back in by Xmas, but it looks like it will be January. Also, I am now an empty nester, as my son went off to college this year. His sister is a senior in college, and it took me 2 years to get used to her being gone. :-) I am very close to my kids, and we talk several times a week. It's just been very strange to now not have practices, games, choir concerts, or meetings to go to for school, or have them comind and going and being there. Work has been another stress factor, as we had to let someone go, and her responsibilities were added to mine, which were already quite a bit. Add all of that to someone who has anxiety and stress and I guess you come up with what I am going through now, as it has happened before. :-) Again, I greatly appreciate your suggestions and comments, as it has helped me to feel somewhat more relieved that I am okay, my heart is just beating a little faster than normal, but them medicine will start to bring that down in a few days and I'll be okay in the meantime. Thank you.

Expert:  Valarie replied 7 years ago.

You are very welcome. You have a very eventful life. I will be "sending angels" your way in prayers that you will find some joy and happiness to go along with all this activity. Life might be more relaxing if it weren't so stressful, but then--how boring that would be.


My best wishes to you and your family. Be well.

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