Choosing Heart Medications: Alternatives for Patients with Asthma

Selection of Cardiac Medications

Hello Director He: Thank you very much for your detailed response to my last inquiry.
My current question is regarding my condition; I have been diagnosed with postural tachycardia syndrome after my diagnosis, and I also have mild asthma, which was triggered after the diagnosis.
I understand that beta-blockers are very effective in controlling heart rate, but since I have asthma, I would like to ask you, Director He, what medications you would recommend for a patient who needs beta-blockers but cannot take them due to asthma? Are there any alternatives that can help stabilize heart rate similarly to beta-blockers?
Additionally, following up on my previous question about the medication "Nedopram," could there be a situation where the medication becomes ineffective? I have been using it at a fixed time every day.
Today, I experienced a situation where I climbed from the first floor to the fifth floor.
Although my heart rate usually increases significantly, it typically decreases to 90-100 bpm shortly after sitting down.
However, today, after sitting down, my heart rate spiked to 135 bpm.
I wonder if my anxiety could be contributing to this increased heart rate.
I noticed that it took about 20 minutes for my heart rate to gradually decrease to 100 bpm.
Is this situation dangerous? Under what circumstances would you recommend going to the emergency room for a high heart rate? Thank you very much for your careful answers; I truly appreciate it.

Miss Jian, 40~49 year old female. Ask Date: 2022/11/21

Dr. He Dongjin reply Cardiology

Hello, if you cannot use beta-blockers for asthma, you can use other medications that are effective.
Currently, I haven't heard of any issues with medication efficacy.
Anxiety can increase heart rate, so it's best to monitor the situation for now.
There's no immediate danger, so there's no need to rush to the emergency room.
Take care, and I'm here for you.

Reply Date: 2022/11/21

More Info

When it comes to managing heart conditions, particularly for patients with comorbidities such as asthma, careful consideration of medication options is essential. In your case, you have been diagnosed with postural orthostatic tachycardia syndrome (POTS) and mild asthma, which complicates the use of beta-blockers, a common treatment for tachycardia.
Beta-blockers, such as propranolol, are effective in controlling heart rate and reducing symptoms associated with conditions like POTS. However, they can exacerbate asthma symptoms by causing bronchoconstriction, which is why they are generally contraindicated in asthmatic patients. Therefore, alternative medications must be considered.

One potential alternative to beta-blockers for managing tachycardia in asthmatic patients is the use of non-selective beta-blockers with caution, or cardioselective beta-blockers like metoprolol or atenolol, which may have a lesser impact on bronchial smooth muscle. However, even these should be used with caution and under close medical supervision, as individual responses can vary significantly.

Another class of medications that may be beneficial is calcium channel blockers, such as verapamil or diltiazem. These medications can help to lower heart rate and improve symptoms of tachycardia without the bronchoconstrictive effects associated with beta-blockers. However, they also have their own side effects and contraindications, so a thorough evaluation by your healthcare provider is necessary.

Additionally, lifestyle modifications can play a significant role in managing symptoms. Staying well-hydrated, increasing salt intake (if not contraindicated), and wearing compression garments can help manage POTS symptoms. Regular, gentle exercise can also improve cardiovascular fitness and potentially stabilize heart rate over time.

Regarding your concerns about your heart rate increasing to 135 beats per minute after climbing stairs, it is important to note that physical exertion can naturally increase heart rate, especially in individuals with POTS. However, if you experience symptoms such as dizziness, chest pain, or shortness of breath, it is crucial to seek medical attention promptly. Generally, if your heart rate exceeds 150 beats per minute at rest, or if you experience significant symptoms, it would be advisable to go to the emergency room.

In summary, for patients with asthma who require heart rate control, alternatives to beta-blockers such as calcium channel blockers or cardioselective beta-blockers may be appropriate. It is essential to work closely with your healthcare provider to tailor a treatment plan that considers both your heart condition and asthma. Regular follow-ups and monitoring are crucial to ensure that your treatment remains effective and safe.

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