How to Cope With Beta-Blocker Side Effects When You Have Obstructive Hypertrophic Cardiomyopathy

If you have obstructive hypertrophic cardiomyopathy (oHCM), a genetic form of heart disease in which thickened heart muscle partly blocks blood from leaving the heart, it’s very likely that you’re taking a beta-blocker.

These medications have been first-line therapy for decades for oHCM, but they can come with bothersome side effects like fatigue, dizziness, or sleep issues that may make work and everyday activities a challenge.

Fortunately, there are now more options and formulations of beta-blockers, and by working with your healthcare team, you can often find the right dose to manage oHCM while keeping side effects to a minimum, says Ajay Vallakati, MBBS, an associate professor of internal medicine in the division of cardiovascular diseases at the Ohio State University Wexner Medical Center in Columbus, Ohio. There are also lifestyle changes that may reduce the impact of certain symptoms, he says.

“If that’s not possible, there are also different medications that your doctor may prescribe instead of a beta-blocker,” says Dr. Vallakati.

Here’s what you need to know about how beta-blockers help people manage oHCM, which side effects to expect, what can help, and when it may be time to ask about a different treatment.

How Beta-Blockers Help to Manage Obstructive Hypertrophic Cardiomyopathy

“When people with oHCM are exerting themselves, there is an increase in the obstruction inside the heart, leading to higher pressures in the heart and less ability to get oxygenated blood out to the body,” says Andrew Wang, MD, a cardiologist and a professor of medicine at Duke University School of Medicine in Durham, North Carolina.

Beta-blockers work by helping the heart beat more slowly and less forcefully, says Vallakati. “This reduces the narrowing or blockage of blood flow out of the heart, which can worsen during exercise, stress, changes in body position, or other situations that increase adrenaline levels,” he says.

“Beta-blockers reduce the force of the heart squeezing and may allow there to be less obstruction and more easily allow blood to leave the heart, especially during physical activity,” says Dr. Wang.

Common Side Effects of Beta-Blockers

Fatigue is the side effect people mention most, says Wang. “People often feel like it reduces their energy, even though that’s the opposite effect of what we intend,” he says.

• Cold hands or feet
• Dizziness or lightheadedness
• Weight gain
• Depression
• Shortness of breath
• Trouble sleeping
  

How to Manage Beta-Blocker Side Effects With Your Healthcare Team

If you are struggling with beta-blocker side effects, don’t change your dose or stop taking your medication on your own. Work with your healthcare team to optimize your treatment to minimize side effects.

If a larger, once-daily dose causes low blood pressure and dizziness, splitting a shorter-acting beta-blocker into two smaller doses a day sometimes works better, he says.

Doctors often favor long-acting versions because they’re easier to take as prescribed, adds Wang.

Check in about your heart rate. A resting heart rate of about 50 to 60 beats per minute usually means the beta-blocker is working as intended, says Vallakati. “However, if the heart rate becomes too low and you feel unusually tired, weak, or sluggish, the medication dose may be too high and might need to be reduced,” he says.

Talk to your doctor about beta-blocker timing. “Beta-blockers have been linked to insomnia and vivid dreams or nightmares; taking your dose earlier in the day may help,” says Eric Smith, MD, a cardiologist at the University of Michigan Health Frankel Cardiovascular Center and a clinical instructor of internal medicine-cardiology at the University of Michigan Medical School in Ann Arbor.

Talk with your doctor about a safe level of exercise. In studies, metoprolol eased symptoms, but it did not significantly improve people’s maximum exercise capacity (the most exertion your body can handle), says Vallakati.

“Beta-blockers can reduce how high the heart rate gets during exercise, and that can be a limitation to exercise,” says Wang. Talk with your doctor about a safe level of exercise that considers oHCM as well as any other conditions you may have.

Check in about salt. Extra salt may help some people, but too much can cause fluid retention, swelling, higher blood pressure, or worsening heart failure (when the heart struggles to pump enough blood), says Vallakati. The right amount can vary from person to person, so ask your cardiologist before changing your salt intake, he says.

Lifestyle Modifications That May Help

Certain lifestyle habits that may lessen the side effects of beta-blockers or help you manage them when they do occur.

Stand up in stages. To prevent a sudden drop in blood pressure, move from lying down to sitting to standing one step at a time, and sit or lie down right away if you feel dizzy, lightheaded, or faint, says Vallakati.

Crossing your legs, tightening your leg and buttock muscles, or wearing compression stockings (tight-fitting stockings that squeeze the legs) can keep blood from pooling in your legs and reduce dizziness, he says.

Stay hydrated. Dehydration can make the blockage worse and bring on shortness of breath, dizziness, or chest discomfort, says Vallakati.

“Using that as a goal is important, but even going beyond that could be beneficial,” says Wang.

Drinking water can also help manage acute symptoms, says Vallakati. “Drinking about 16 oz (500 mL) of water rapidly can help raise blood pressure within a few minutes,” he says. It can be especially helpful first thing in the morning or after meals, he adds.

Keep your hands and feet warm. Wearing layers and warm socks can help if beta-blockers leave your hands and feet feeling cold.

Exercise moderately. Staying active helps maintain strength and fitness, while long stretches of inactivity can make symptoms worse over time, says Vallakati.

“Moderate, steady aerobic activities such as walking, cycling, or swimming are generally preferred,” he says. Sudden bursts of intense effort, heavy weight lifting, and straining while holding your breath can increase the heart’s blockage and trigger symptoms, he says.

Signs You Should Talk to Your Doctor About Alternative Treatments

If you’ve tried these adjustments and still don’t feel well, it may be time to ask your cardiologist about a different treatment.

If oHCM symptoms like shortness of breath, chest discomfort, dizziness, or fatigue continue even when you’re taking the highest dose of a beta-blocker, then your doctor will likely consider other treatment options, says Vallakati.

“If beta-blockers cause bothersome side effects, we often lower the dose rather than stop the medication completely,” he says.

There are also certain side effects that may prompt a medication switch, Vallakati says. Those include:

• A very slow heart rate
• Problems with the heart’s electrical conduction (how electrical signals move through the heart to trigger each beat)
• Worsening breathing problems
• Severe fatigue
• Significant dizziness when you stand

Options include switching to a different type of medicine called a calcium channel blocker, such as verapamil (Calan, Covera-HS, Verelan) or diltiazem (Cardizem, Cartia, Dilacor XR, Diltia XT), or adding a newer drug called a cardiac myosin inhibitor, such as mavacamten (Camzyos) or aficamten (Myqorzo), says Vallakati.

Whatever you do, don’t stop taking your beta-blocker on your own, says Wang.