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Beta Blocker dosage vs. symptom relief

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  • Beta Blocker dosage vs. symptom relief

    Hi,

    What is the average symptom relief rate per dose of beta blocker? I mean: if i take 50mg of Toprol a day, what would be the expected effect on say, my gradient? If i up the dose, what should happen (on average)?

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    \"Hope is disappointment postponed\"

    Dx in 2004, first symptoms 20 years ago? Obstructed, A-fib, family history!

    Combined Morrow and (left atrial) Maze procedures & PVI at St. Antonius Hospital, Netherlands, March 28, 2013.

    Meds (past) propranolol, metoprolol, disopyramide, sotalol, amiodaron, aspirin, dabigatran, acenocoumarol.

    Meds (current) sotalol, dabigatran, furosemide.

  • #2
    This varies so widely from patient to patient and beta-blockers doses are not tested on HCM patients so the literature refers to blood pressure.

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    • #3
      I think that this is highly individual. One patient will react so differently from another that you can't compare. Also, they adjust doseages on HCM'ers based on symptoms, not on test results.
      Daughter of Father with HCM
      Diagnosed with HCM 1999.
      Full term pregnancy - Son born 11/01
      ICD implanted 2/03; generator replaced 2/2005 and 2/2012
      Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

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      • #4
        FYI: Norpace is the only drug that affect gradient directly. Beta-blockers are going to soften the heart beat a little but are mostly rate and some rhythm control (and bp).

        S

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        • #5
          Sarah, i was not aware of that (Norpace).

          What can generally be expected of it (say, a resting gradient of 60 without BB's)?

          Ad
          \"Hope is disappointment postponed\"

          Dx in 2004, first symptoms 20 years ago? Obstructed, A-fib, family history!

          Combined Morrow and (left atrial) Maze procedures & PVI at St. Antonius Hospital, Netherlands, March 28, 2013.

          Meds (past) propranolol, metoprolol, disopyramide, sotalol, amiodaron, aspirin, dabigatran, acenocoumarol.

          Meds (current) sotalol, dabigatran, furosemide.

          Comment


          • #6
            I have not read up on Norpace in a long time --I recommend some "Googling" for disopyramide gradient reduction and variations on that theme to see what you get. Google Labs also has an academic section if you click on "more" on their home page, you can drill down to it. But most stuff will pop up in regular Google.

            And, again, keep in mind that most medical studies are not taking an HCM heart into account. An HCM heart's muscle is fundamentally different from a normal heart, even one with other problems and so you can't expect identical results.

            Also, it is important to understand how the heart works. People will respond better or worse to beta-blockers vs. calcium channel blockers vs. potassium channel blockers (disopyramide, dofetilide, amiodarone) depending on factors that are impossible to determine ahead of time. It is all trial and error.

            For example, calcium channel blockers make me faint immediately while potassium channel blockers are very effective for me. However, I need ever increasing doses after a while as my body "adapts" to them. How do I know? Trying them all. No doctor can tell you what will work for you without a doubt.

            S

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            • #7
              Actually, there are recent studies which discuss the effectiveness of disopyramide at reducing gradients for those with HCM. They are authored by Dr. Mark Sherrid of St. Lukes in NYC. They have shown results that can reduce large gradients to just about nothing.

              My own gradient went from about 85 mm/hg to less than 20 mm/hg. My SAM was also diminished, as were my symptoms.
              Daughter of Father with HCM
              Diagnosed with HCM 1999.
              Full term pregnancy - Son born 11/01
              ICD implanted 2/03; generator replaced 2/2005 and 2/2012
              Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

              Comment


              • #8
                Thanks, Cyn. As I said, I've not really kept up on Norpace. Dr. Sherrid is a great guy (I've met him) and one of the few doing HCM-specific work.

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                • #9
                  OK! That's maybe something of importance to me too. I think my doc is proposing ablation to reduce my gradient, but if Norpace could do the job as well... i'll take that into account seriously.

                  Thanks all!

                  Ad
                  \"Hope is disappointment postponed\"

                  Dx in 2004, first symptoms 20 years ago? Obstructed, A-fib, family history!

                  Combined Morrow and (left atrial) Maze procedures & PVI at St. Antonius Hospital, Netherlands, March 28, 2013.

                  Meds (past) propranolol, metoprolol, disopyramide, sotalol, amiodaron, aspirin, dabigatran, acenocoumarol.

                  Meds (current) sotalol, dabigatran, furosemide.

                  Comment


                  • #10
                    Definately look into Norpace and let us know how you are doing.

                    S

                    Comment


                    • #11
                      My cardiologist didn't want to try me on Norpace (my gradient is 159) due to potential side effect of rhythm issues. I have family h/o SD. So for whats that worth, weigh the chance of arrhythmia when considering.
                      Laura
                      Dx: HOCM 1991, Myectomy/Mitral Valve Repair @CCF July 19, 2005. Wife and Mom of two: ages 5 and 3.

                      Comment


                      • #12
                        I have read several articles on Norpace and HCM, and they all seem to say that they have found no increased incidence of pro-arrythmia from administering Norpace to HCM patients. See esp. Dr. Mark Sherrid's research in this area.

                        My EP also told me that he hasn't experienced pro-arrythmia problems with Norpace and doesn't even routinely hospitalize patients starting Norpace.

                        Lastly, I have not had increased arrythmia problems with Norpace. In fact, if anything, I have noticed that my arrythmias have decreased.

                        I do have an ICD, so I am protected from this problem, but I wouldn't let the label warning stop me from investigating the possibility of using this drug. For me, it sure beats having an invasive procedure.

                        Laura - Do you have an ICD? If so, I would try the Norpace.
                        Daughter of Father with HCM
                        Diagnosed with HCM 1999.
                        Full term pregnancy - Son born 11/01
                        ICD implanted 2/03; generator replaced 2/2005 and 2/2012
                        Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

                        Comment


                        • #13
                          Every single heart medication that reduces arrhythmias can also cause arrhythmias --the stronger the medication, the higher the risk, however the risk even then is quite low.

                          Medications that are higher risk require a hosptial stay of couple days when you start the medication to make sure that if something does happen, they can reverse it immediately. I had this with sotolol and dofetilide.

                          I took Norpace for ten years --no problems. Not even hospitalized for it at start.

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