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Suggest Treatment For Low Pulse Rate And Headaches After Discontinuing Atenolol

Posted on Thu, 23 Jul 2015

Question: My pulse rate is running in the 40s and sometimes 50s and I have headaches all the time in the back of my head. I had an ablation done and the doctor told me to stopped taking Atenolol. The Atenolol keeps the pulse very low. Any suggestions?

Answered by Dr. Rajesh Teli (1 hour later)

Brief Answer:
you should stop atenolol for the time being

Detailed Answer:
Hello,
I am Dr.Rajesh Teli,MD
I have gone through your query.
Thanks for using HCM.
First of all I would like to know 2 things from you.
1.What was the indication for Ablation ? was it recurrent SVT or otherwise?
2.what was Indication of atenolol ,was it given to control rate or hypertension.
At present your headache may be due to high blood pressure ,so just check your blood pressure and let me know.so we can decide whether your headache is due to high blood pressure or not.
Heart rate below 50 is surely due to atenolol and you should stop it,though you don't have symptoms of low heart rate viz.giddiness or syncope.At your age there may be slowing of conduction system of heart and it may be aggravated by atenolol.Having stopped atenolol watch your blood pressure and if it shoots up you may replace it with Amlodipine or medicine from similar group in consultation with your doctor who too has advised you to stop atenolol .your blood pressure should remain below 150/90.
kindle furnish details which i have asked for ,
My best wishes
Dr.Rajesh Teli,MD

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Rajesh Teli (8 hours later)

I have Atypical atrioventricular Nodal Reentrant Tachycardia and had the ablation due to that. When I stop the Atenolol, I still have headaches and my blood pressure varies from high to low. On my blood pressure machine, it still shows irregular heart beat, although I do not have the palpitations as previous. I was at the doctor's office yesterday and my pressure was 150/ under 90 but I don't remember the exact number; however, the number for the pulse was still low and I had taken the Atenolol that morning before I went to the doctor and then he stopped the medicine and the doctor told me to return in 7 days to check the pressure again without medicine and if anything happens during the week, call him. The headaches are concerning to me. I am going to a neurologist on Friday the 26th of XXXXXXX and maybe he can give me some answers regarding the headaches.

Answered by Dr. Rajesh Teli (32 minutes later)

Brief Answer:
atenolol may have blood level and effect beyond 48 hrs.

Detailed Answer:
Hello,first of all BP of 150/90 is normal at your age hence neither atenolol nor blood pressure is responsible for your headache.Atenolol is long acting betablocker hence after stopping it one needs wash out period of a week for your heart rate reassessment.
You may take simple paracetamol for relief for your headache and neurological consultation will surely guide us for headache.
My best wishes
Dr.Teli,MD

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Rajesh Teli (3 days later)

I took your advice and I purchased a bottle of acetaminophen, since the medicine you mentioned is not sold in the United States and it has helped a little bit. I take four a day, two in the morning and two in the late afternoon. I also went to a neurologist and he said that I don't have a tumor, but he ordered blood tests and cervicogenic x-ray. The blood tests he ordered is C-reactive protein, systemic inflammation, C-reactive protein, quantitative; ESR, sed rate EST, Erythrocyte sedimentation rate in the blood. I anticipate your reply. My heart rate has been pretty normal since I stopped Atenolol. It's 140/70 with a pulse rate of 58 and no irregular heart beat detected.

Answered by Dr. Rajesh Teli (12 minutes later)

Brief Answer:
headache needs evaluation

Detailed Answer:
Hello,
I have gone through you reply .so one aspect has become clear that you may stop atenolo and your heart rate and BP are stable now.
Now we need to focus on headache part.I agree with the investigations suggested will give us clue to cause of headache .meanwhile you may continue acetaminophen in same dose .please inform me all reports ,after which I shall guide you further.neurologist ruled out serious cause like tumor.
Waiting for reports
Dr.Teli.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Rajesh Teli (3 days later)

Dear Dr. Teli,

I have the lab results for blood work only, which was C-Reactive Protein Quantitative and Erythrocyte Sedimentation Rate and the results were normal. I also had my blood pressure tested this morning and it was normal. I'm still taking acetaminophen four a day and they help but only for about four hours. I'm still waiting for the results of the cervical xray and I still have headaches on and off. What else can I do?

When I get the xray results I will notify you.

thank you,
XXXX

Answered by Dr. Rajesh Teli (20 minutes later)

Brief Answer:
headache needs further work up

Detailed Answer:
Hello ,Mr XXXXXXX
Well your headache is still a matter of concern.as your blood reports are normal ,it has ruled out infective cause of headache .Now your cervical x ray may give us clue,but if they are normal ,then following possibilities should be considered.
1.check your eyes for any possible refractory error.
2.Discuss about vascular headache as a possibility with your treating doctor.
3.Do have some stress? Is your sleep adequate ?if we can't get any other cause, stress related headache remains a possiblilty .
Kindly consider above possibilities and inform me about updates including x ray cervical spine.
My best wishes
Dr.Rajesh Teli,MD

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Rajesh Teli (2 days later)

Dear Dr. Teli,

Do you think that the ablation possibly didn't work 100% because if I drink caffeine, I still get palpitations sometimes for a few minutes and also I still get a reading on my home blood pressure machine that the irregular heartbeat shows up - not all the time, but sometimes? Should I worry about it? I'm still waiting for the results of the xray of the cervical spine.

Please advise.

Thank you,
XXXX

Answered by Dr. Rajesh Teli (5 hours later)

Brief Answer:
RF Ablation has success rate of 90 to 98%

Detailed Answer:
Hello,Mr XXXXXXX
I can understand your anxiety.RF Ablation in most centers of world have high success rate.Recurrence has been reported less than 2%,so my personal opinion is not to worry about occasional palpitations .Ofcourse avoid coffee.If you have persistent spell of run of palpitations as you used to get pre ablation then you should get ECG with ongoing Tachycardia,but mostly it will not be needed.
Still cause of your headache is not established,hence right now lets wait till we get x ray cervical spine.
My best wishes
Dr.Teli.

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Above answer was peer-reviewed by : Dr. Yogesh D