Poor circulation to hands and feet

[Crystalbowl]

I have been having issues with the circulation to my hands and feet for a couple of years’ now. I only see my feet before I get dressed in the morning and after I undress in the evening but at those times they always look a very unhealthy shade of purple. My hands vary throughout the day and sometimes look normal, sometimes various shades of red-purple and sometimes white and feel ‘dead’. I have not seen my Cardiologist since before the pandemic started but I am under the care of the GP of the local Community Cardiac team. I had a CRT pacemaker implanted in October 2019 and I take a variety of meds. The Cardiac GP has been changing my meds. I started off on Bisoprolol and had a couple of others I can’t remember now and have been on Nebivolol for a while starting at 10mg. These changes did not help. I was also started on Entresto (now on full dose) and Dapagliflozin and take 6.25mcg Digoxn plus Fuorsemide and Spironolactone. The dose of Nebivolol has been gradually reduced to see if this would help until I am not taking any at all at the moment but it has not helped. Even in this hot weather it is a problem. For the last two winters I have had problems with chilblains despite buying warm socks, sheepskins insoles for my shoes/boots and a variety of warm gloves. The Cardiac GP rang me yesterday to see if stopping the Nebivolol had helped and I had to say it hadn’t so he wants me to start taking it again at 2.5 mg and presumably building back up to 10 mg. He is referring me to another GP to see if it is not heart related but there is some other explanation. Just wondering if anyone else has this issue and what, if anything, has worked as I dread what it will be like again this winter. I never had this problem until after a I was diagnosed with HF. I also have permanent AF which is largely asymptomatic.