The last article I wrote about beta blockers was written last Summer when I was more or less just starting the beta blocker. I had noticed a decrease in performance and exercise tolerance and when I went to the cardiologist and had an echocardiogram it was determined that my rate was going up and my ejection fraction was going down – that means my heart was pumping less efficiently and was pushing out as much blood with each beat. I was put on a low dose of carvedilol (6.25 mg twice daily) and it was thought that this would allow my ejection fraction (EF) to come back up.
When I started my EF was 55%, but when I had the echocardiogram mentioned above it was down to 45%. As noted in my last beta blocker article I suffered on runs and bike rides but felt it was worth it as I anticipated improvement.
When I returned for the follow-up echocardiogram I was extremely disappointed to learn that my EF had actually gone down to 37%. Not good.
At that point I the dosage of my beta blocker (carvedilol) was titrated up from the minimum dosage to the maximum dosage (50mg twice daily).
As you might imagine between the atrial fibrillation, the decrease in EF, and the high dose of beta blocker – running became extremely difficult. All three of these things decrease my cardiac output and, of course, that translates to poor performance. I now found I had slowed to a ludicrous pace, and honestly, running was starting to become a chore.
Running was starting to become unenjoyable; but I continued anyway.
I felt like every run was my first run after not exercising for several years, and I was walking up the most minor hills.
Last week I returned to the Heart Clinic and had yet another echocardiogram. To be honest I haven’t been feeling any better and runs still seem difficult so I decided not to even look at the screen or ask the tech about my EF as I assumed it was still poor. I’d just wait until the follow-up appointment with the cardiologist. But the tech, who knows me by now, just came out and told me – “Well, it looks like your ejection fraction is improving – it’s up to 47%.”
Well, that is good news. At least this suffering through the beta blockers is leading to some benefit.
That was just the preliminary reading, my new cardiologist (my previous cardiologist retired from clinic but still works at our hospital) interpreted the echo and said it was more like 50%!!! That’s nearly back to normal range (52-70%).
One interesting thing the cardiologist told me: she said that one would expect that people who are more athletic would have higher ejection fractions than non-athletes but in reality the opposite is often the case. I told her that my heart is so big that if my ejection fraction was too high there would be too much blood – ha ha.
There’s something I don’t understand about echocardiograms and atrial fibrillation – as anybody who is in a fib knows some beats are better than others. It’s easy to feel that – some are short and weak and others are longer and more powerful. How, when looking at the heart with the echo machine, can you tell what kind of beat you are having?
So there is some good news. Runs are still difficult and I don’t see myself ever being completely off of the beta blocker – but hopefully a different dose in the future when my ejection fraction reaches whatever the goal value ends up being.
In my next article on running and beta blockers I will discuss “Beta Blocker Blues” and the way this unpleasant medication makes me feel fatigued and, often, quite depressed. But for now I’ll embrace the joy of knowing my ejection fraction is significantly improving and will likely get even better.
A Fib Runner - Distance Running and Mountain Biking With Atrial Fibrillation 
Great piece—as a longtime older (age 64) runner who has been experiencing paroxysmal AF and flutter for close to a decade now, it has been quite an adjustment to have my “running” be more like running/walking…but I find what’s so terrific about this site and posts like yours is the simple fact of knowing we’re not alone! (BTW you might want to check out the effiicacy of a calcium channel blocker like sotalol (generic for betapace; I find that the mental effects are quite tolerable, esp in comparison to the rough ride beta blockers tend to give my head…)
Thanks for your kind words. I’d love to hear more about your experience – are you interested in writing a guest post?
Thanks; I’m flattered—lemme think about
it…
Michael:
I have to ask the obvious question…why do you continue to run? It seems to me you may be making things worse than better. I know how you runners are addicted to running…lol…but it just seems to me you should lay low for a while. I would also seriously consider an ablation. I know you’ve said multiple times you wouldn’t be a good candidate but I would consider it anyway. Best of luck to you.
Travis
I asked my EP if my a fib would improve if I quit exercising and the answer was no. As far as ablation is concerned – it is unlikely to be successful, although I’m sure if I doctor shopped I could find somebody who would be willing to do it.
Hi Michael, I’m a 69 year older runner, albeit a very slow runner (best marathon time is 5:18 when I was 65). My atrial flutter (started about when I was 60 and occurred about once every 3 months) turned into atrial fibrillation about 1-1/2 years ago. To make a long story short, I had an ablation May 8, 2014, about a week after I ran the Big Sur Marathon (time was 5:52). My main cardiologist was a runner and he worked with me so I could run the Big Sur. Obviously, it was very important to me to run the Big Sur. Of course, I’ve always been a slow runner, since I started so late in life. I had no other “heart problems”; I have low cholesterol, high HDL, low LDL, low triglycerides. So far I’m one of the 70% ablation successes. I continue to run because I love running. Hope everything works out for you. Karen
Michael:
You don’t have to shop for a doctor. I know someone that can definitely help you but it would require you to take a trip to Austin, TX. His name is Dr. Andrea Natale. He’s a world-renowned EP. He’s done over 7,000 ablations and people from all over the world fly to Austin to be treated by him. I’m one of them! I will be having my first ablation with him on March 5th – as in just a few days.
I’m a fairly “simple case” as far as afib goes but he treats people with the most difficult cases of afib and has an unbelievable success rate. One of the persons that turned me on to him had persistent afib, had a pace maker because of some other heart condition, and Dr. Natale was able to successfully treat him. He’s going on 7 years now without any afib or drugs! As he describes it, his case was about as difficult as they come. I can actually put you in touch with him as he’s a strong advocate of Dr. Natale. Here is a link to his doctor profile (it doesn’t do him justice):
https://tcaheart.com/physicians/andrea-natale-md
If you want more info, hop over to my website and contact me through my contact page. I can give you a lot more information. If Dr. Natale can’t successfully treat you, nobody can. If nothing else, definitely see him for a consultation to see what he says.
Travis
MIchael—you’ve inspired me to put together a guest post—how do I submit it?
David
Please email me at ex_magician@yahoo.com. Thanks!
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OMG!!! Except for the running part (I’m a MTBer), this is like reading my story! I just took my first half tab of a 6.25 dose of Coreg last night, so just beginning this journey…get re-tested in 6 months…wow, thanks for sharing!!!
Thanks for your kind words. Good luck with the Coreg (carvedilol). I take a much higher dose and it has really taken the wind out of my sails, but it seems to be doing what it is supposed to do.
That’s what I’m reading…so I’m guessing I’ll have to up my dose as well. Will be interesting to see how it impacts my mtb’ing….at least I can still zoom on the downhills, even if I have walk more of the uphills. My local bike store where I bought my relatively new Specialized FSR 6Fattie just showed me electronic assist version of my bike so if my EF doesn’t go too much higher, I can switch to that bike! LOL!
Interesting. I took 6.25 mg of Coreg twice daily for almost four years but my ejection fraction remained low, hovering in the mid-upper 30’s. At the time I was taking Coreg, running was impossible. I was also on a lot of other heart meds at that point so I cant say it was only the Coreg that took the run out of me, but during the time I was on it, just trying to go for a short easy walk seemed like a pretty hard chore. After a few years of doing my best to follow a whole foods plant based diet with no added oils, I was able to wean off all the medication and I no longer experience the symptoms caused from the the heart damage, or the side effects from the meds. I just completed my fist two Marathons this past summer and managed a sub4 finish on the second one, even though my ejection fraction remains low at 37%. If interested, check out http://www.cardiacathletes.com and meet many people who competitively run, bike, swim, ect, who have low ejection fractions. Good luck to you. I hope you get back feeling strong again…
Thanks for your comment. Very interesting. I am hopeful to hear that you are doing marathoning again! I’m on the same page regarding diet. And thanks for the links.
Thank you so much for sharing! I’m going to check out that link.
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