Dear Dr. Roach: I am a very active 66-year-old man who had three stents put into my right coronary artery about 10 years ago after I had two heart attacks. I have not had any problems since then. I am restoring a 1966 GTO convertible, which includes many days of heavy work and have had no chest pains, shortness of breath or any problems.
I take Plavix, ramipril, aspirin, Crestor and metoprolol. My concern is with the metoprolol. Several months ago, I was taking a 25 mg dose, and I was lying in bed one morning and could barely breathe. I checked my heart rate, which was 38. I did not feel dizzy or lightheaded, but rather sluggish. I did some research to find that it was very low.
I reduced my metoprolol to 12.5 mg per day. My heart rate now is around 40 when I wake up and gets to around 50 when I am up and active, which, to me, is still very low. It also tells me that perhaps I would be better off without it. According to my recent research, athletes have a lower heart rate. I am very active six to seven hours per day, some days more stringently than others. I am in pretty good shape.
According to what I was told, there was no damage to my heart when I had my two heart attacks eight and 10 years ago. Our family physician, who was a very close family friend, once told us that if there was no damage, then it is like you didn’t have a heart attack at all. Do I need to take any metoprolol?
Beta blockers like metoprolol have multiple beneficial actions in people with blockages in their coronary arteries. They decrease the amount of blood the heart needs by slowing the heart rate down, by keeping it from contracting so hard and by reducing blood pressure. This all helps reduce or prevent symptoms. They also help prevent some types of severe rhythm disturbances. In people with a history of any type of heart attack, even one without much damage to the heart, beta blockers have been proven to improve survival and are therefore among the most important medicines we have for people with coronary artery disease. This is true for people with occasional chest discomfort (angina), even without any history of heart attack.
While a slow heart rate can limit the ability to use beta blockers, even the small dose of beta blockers you are taking now is helpful and does not seem to be limiting your activity despite your slow heart rate. I would recommend you keep taking it, and I am sure your cardiologist would agree.
Dear Dr. Roach: I have a hemorrhoid problem. I love to eat vegetables and fruits, but sometimes when I’m travelling, the destinations don’t have too many choices of those. Is there anything I can safely eat or bring to help with my problem?
I recommend a fibre supplement and plenty of water as protection against constipation and its attendant straining and worsening of hemorrhoidal problems. A stool softener such as docusate would be reasonable as well, but fruits and vegetables are certainly your best long-term choice due to the many other benefits.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu