From the Guidelines
You should contact your doctor's office immediately to report your ongoing heart palpitations and inquire about the status of your heart monitor. Given your symptoms have persisted since last night, it's crucial to seek medical attention promptly, especially considering the cardiologist's prior request for a heart monitor, which suggests your condition warrants closer observation 1. Heart palpitations can be caused by various factors, including symptomatic cardiac contractions and ventricular ectopy, and in some cases, they may indicate more serious conditions such as supraventricular arrhythmia 1. If your palpitations are severe or accompanied by other concerning symptoms like chest pain, shortness of breath, dizziness, or fainting, it may be necessary to visit the emergency room instead of waiting to hear back from your doctor. While waiting to speak with your doctor, it's advisable to avoid stimulants like caffeine, alcohol, and nicotine, as these can trigger or worsen palpitations. Additionally, keeping a log of when your palpitations occur and what you were doing at the time can provide valuable information to help your doctor determine potential triggers. The European Society of Cardiology guidelines suggest that for patients with frequent palpitations, 48-hour ambulatory electrocardiography should be performed, and if a cause is not identified, an implantable loop recorder (ILR) may be considered 1. Given that you are still awaiting the monitor requested by the cardiologist, it's essential to follow up on this as well, to ensure you receive the necessary diagnostic tools to manage your condition effectively.
From the FDA Drug Label
Bradycardia, including sinus pause, heart block, and cardiac arrest have occurred with the use of metoprolol. Patients with first-degree atrioventricular block, sinus node dysfunction, or conduction disorders may be at increased risk. Monitor heart rate and rhythm in patients receiving metoprolol. If severe bradycardia develops, reduce or stop metoprolol
The patient is experiencing heart palpitations, which may be related to the use of metoprolol. It is essential to monitor heart rate and rhythm in patients receiving metoprolol. If severe bradycardia develops, the dosage of metoprolol should be reduced or stopped 2.
From the Research
Heart Palpitations and Beta-Blockers
- Heart palpitations can be a symptom of various heart conditions, including atrial fibrillation and arrhythmias 3, 4.
- Beta-blockers, such as metoprolol, have been shown to be effective in reducing the incidence of atrial fibrillation and arrhythmias in high-risk patients 3, 4.
- The use of beta-blockers, including bisoprolol, has been supported by current evidence for the treatment of supraventricular and ventricular arrhythmias 5.
Delayed Monitor Request
- The delay in receiving the monitor requested by the off-site cardiologist may be a concern, as it may impact the timely diagnosis and treatment of any underlying heart conditions.
- However, there is no direct evidence in the provided studies to address the issue of delayed monitor requests.
Beta-Blocker Therapy
- Beta-blocker therapy, including metoprolol and carvedilol, has been shown to reduce the risk of sudden death in patients with chronic heart failure 6, 7.
- The use of beta-blockers has been associated with significant mortality and morbidity benefits in the treatment of heart failure 3.
- Different beta-blockers may have different effects on arrhythmias and heart rate variability, and the choice of beta-blocker may depend on the specific condition being treated 4, 5, 6.