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British Heart Foundation
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Beta Blockers?

I would really like to pick up on a point I raised a while ago regarding Beta Blockers. Brief history, I had an out-of-the-blue episode of Angina and was admitted/diagnosed with 95% blockages of LAD and 50% right, fitted with 2 stents to LAD. Echo is completely normal and did not have a HA, although family history is evident. 3 months later I am now back running and have just completed local park run 3 miles in 30 mins, no Angina symptoms, no problems at all. Although diet was previously pretty good I have now cut out all red meat and am mostly vegetarian, as well as eliminating most diary products. I have been doing a lot of research into the use of Beta Blockers, and am convinced they are just part of a blanket prescription. I was prescribed Ramipril, although my BP was never high, and had to come off them due to adverse side effects (including too low BP!), which convinces me of the previous statement. I have been discharged from the hospital with no follow-up discussion with the cardiologist, due to the results of my Echo, so no chance to discuss anything there. Following a brief appointment with my local GP I see no point in trying to discuss anything with someone who has one eye on the clock and obviously no time for any sort of proper discussion within the 7 minute time limit, so, I am left to form my own opinions. It makes me chuckle when "discuss with your GP" is advised, when mine and probably most other peoples GP have no time for "discussions". So, could someone tell me why a drug that restricts your heart from working hard is prescribed to someone who has a perfectly normal heart function and has been told throughout the rehabilitation process that the best thing is to exercise the heart and thus make it work? I do not understand why someone who has had stents fitted, and thus a restored supply of blood/oxygen to the heart, should still be treated as though they have "heart disease" by way of a reduced capacity heart? Statins, diet, healthy lifestyle I get, its obvious, but for the life of me I don't get the BB's unless your heart has been damaged and is not capable of working without problems. I understand that I still have CHD, as in a propensity for the arteries to block, but am convinced we are just prescribed a blanket cocktail of "fix all" remedies with little real opportunity to deal with anything subjectively.

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Interesting questions you raise. There is a good article on WebMD.com which examines whether or not beta blockers are needed following angioplasty where not heart attack has occurred and the heart is already performing well. I am hopeless at providing copy of links but Google ' do angioplasty patients really need beta blockers' My cardiologist was considering stopping my beta blocker even though I did have a heart attack and have ongoing issues with artery blockages, she wanted to stop them as an echo scan shows my heart function is relatively good EF 55. I have said I don't want them stopped until further scans assess heart situation in more detail. So my issue is the opposite of yours. Cardiology seems a wierd world at times.

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BB's are not going to cure ongoing blockages, but I can see the sense in restricting the heart if you are likely to suffer from the blockages. Are you having Angina symptoms? As far as I am aware an EF of that figure is completely normal? I should have mentioned that the reason I want to come off the BB's, apart from being prescribed them possibly without real reason, are the very real side effects of which i am getting pretty fed up, without going into too much detail. My resting pulse when not taking them is around 45 so you might get a feel for the effects when taking them. I am glad you are able to talk to your cardiologist about them, as said I didn't even get the chance!

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I see where you are coming from and in your situation I would be looking at coming off beta blockers unless I was given convincing reasons for staying on them. I took bisoprolol (most commonly prescribed) for about 6 months (5mg) but every afternoon I was fighting fatigue. After doing my own research I identified an alternative beta blocker nebivolol (my GP like yours was not interested) but I persisted and after GP wrote to Cardiologist tge reply was 'give it a try'. I have no fatigue on Nebivolol. I do have ongoing intermittent problems with angina type symptoms mainly at rest of during period of emotional stress but not on exercise when I go to gym 3 or 4 times a week. I am thinking of having a private consultation - I realised I would choose from same pool of Consultants but I would be assured of a 30 minute consultation and would be seeing the Consultant and not a Registrar. I know not everyone can do this. In a previous conversation I had with an attentive GP she expressed. Concern that my resting pulse was sometimes 45 BPM but that was on beta blocker! Since switching to Nebivolol it averages about 52 at rest which feels ok. I meant to say I take your point about beta blockers not curing an ongoing blockage - my reason for wanting to continue is until I can be more convinced things are stable in view off the ongoing 50% blockage in LAD and another totally blocked artery. I am on low dose 2.5mg Nebivolol. To get back to you if you have been discharged it is up to your GP to manage - are you able to see another GP in the practice to talk over the specific issue of beta blocker

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I am in the exact same position and my resting HR is now low 50s and overnight into the 40s

webmd.com/heart-disease/new...

Ihave been told my discharge will be via the cardiac rehab team but I have asked for referral to cardiologist I really do not understand the benefit of BB I am tired and weary. Ramipril ditto - initially 2.5 titrated up to 5 and little difference my BP is 135/75 but they want it lower so now it’s about to be increased to 10mg. I feel so powerless, apart from being told I needed a stent I have had no conversation with cardiologist, my GP shrugs off side effects and quite honestly I don’t know which med causes what.

I am not trying to be a medical expert just want to understand and be involved in ways to improve my future health. I would consider seeing a cardiologist privately but they wouldn’t have access to my notes so it sure of the benefit and to be honest not sure the response would be massively different.

Very interested in this conversation as it mirrors my position so closely

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The other thing I would like someone to clarify is that everything I’ve read suggests the heart as a muscle needs to be exercised surely the premise of The beta blockers works against that?

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Hi Susie. My thoughts entirely! The whole point and ethos of the Rehab is exercise, exercise and more exercise - daily if possible, the whole reason for which is to strengthen the heart, which is just a muscle. Then they put you on a drug that as you say does the complete opposite, I really don't get it. As I said I was prescribed Ramipril, and after protests from myself due to too low blood pressure I was "allowed" to come off it, so what was the point in prescribing it other than it is part of a "blanket" cocktail of drugs, rather than a subjectively prescribed one. I understand that the NHS does not have the resources to deal in detail with every case, but I am convinced there is a "cure all" prescription that is used. If the heart has been damaged or not performing as it should then yes, I get why BB's are prescribed, but in my case my heart is completely normal and I have no Angina when exercising or at any other time, so as I say I just don't see why I am on them. As regards the GP's, I can only imagine some people live in a different world from mine! I asked the last one about side effects and her answer was "Oh I tell my father not to look at the leaflets in the box, most side effects are imaginary". Every time I visit I see a different doctor, some seem quite hopeless to be honest.

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I asked the same question when I had my cardio rehab. My understanding of the explanation was that exercise while on BBs increases the heart's capacity as pulse rate is restricted. That efficiency applies during the rest of the day and during rest & should lower heart rate. I guess that eventually leads to a situation whereby the BBs can be dropped?

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It is my belief that the best way to exercise is to use the BORG method of perceived effort, and not have an artificial restriction placed on the heart, otherwise how is it going to strengthen? I am sure it is dependant on the individual concerned

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Susie just read your post again - have you had a stent fitted or need to have one fitted? If you have not had it fitted yet then I can see why you are on BB's to be honest?

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Hi - yes very similar to you my ‘angina’ attack was a period of breathlessness diagnosed earlier in the month as a chest infection (twice). I didn’t have a heart attack but my BNP level was found to be raised by a later more investigative GP. I ended up in hospital and stent fitted which was described as ‘timely’. Discharged from there to home and care of GP and cardiac rehab.

I have managed to see the same GP since and she is good but time pressured and Just as you describe there is a script to these things and you do feel a passenger for the most part 😕

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"I would consider seeing a cardiologist privately but they wouldn’t have access to my notes"

You're legally entitled to access your notes, whenever I've requested this the doctors and hospital staff were always happy to oblige. You can read about the process here,

nhs.uk/using-the-nhs/about-...

I make sure I keep a complete set of all my NHS test results. The reason is because I'll have a blend of private and NHS treatment in this country, plus I've duel citizenship, so there's a possibility of treatment in both Canada and the UK.

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Thanks Chappychap

I don’t want to appear a moaner or that I know better than the professionals but I’ll quickly outline where I’m at as I’d welcome advice and it’s a continuation of the above.

My ‘event’ was in October - the chest infection diagnosis was September and I went to GP and A and E with the breathlessness, at the hospital I had ECG and blood tests but was reassured that it was a chest infection and to go off on holiday. My trail through airports and a week in Majorca is thankfully a memory that I got through. On return a trip back to a different GP saw me in hospital and a stent fitted within a week. During this time I saw the cardiologist for a short bedside consultation and for minutes after the angiogram.

The cause of my problem was a severe blockage to LAD since found out it was 99% and also a couple of ‘fuzzy’ areas they would check out during angioplasty (done at different hospital). That was on the Friday so nothing at all happened and on Tuesday sent to Leeds as emergency and eventually had stent fitted In the afternoon - discharged from there to home 8pm that night.

In the immediate aftermath I was so shocked and sleep deprived I really struggled to do anything other than give in to it. The GP agreed to reduce the atorvastatin to 40mg. I should also say that I am on lifelong anticoagulation due to problems 12 years ago with pulmonary embolisms. So triple therapy for me was an ordeal - Clopidogrel, aspirin and also apixoban, plus the usual ramipril, Bisoprolol, lanzaprosol.

I am really trying to get on with things, I attend cardiac rehab and am reducing weight and walking most days. I am off work at the moment but at the stage where I need to make choices About returning. have a fairly full on pressurised job and I haven’t got the energy or stamina to do so. Anyway I have asked both the cardiac team and GP about the extent of the findings ie size of lesion and stent fitted plus the outcome re the ‘fuzzy’ areas.

I am getting nowhere other than they will try and get me a referral to cardiologist but that could take a long time..... I need to negotiate with work and I need to know the facts to make informed choices moving forward.

I just don’t see the advantage in returning to work exposing myself to stress and anxiety, taking more tablets for BP and not having the time to make the lifestyle changes to keep me well.

Sorry I’ve hijacked the thread. I know you can get copies of records but mine don’t seem to say anything and I completely get the point that despite being encouraged to be advocates for ourselves we struggle to make progress in the system.

It’s a variation on your theme Lateguitarist x

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Couldn't you try returning to work on a part-time basis to ease yourself back into things?

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Thanks

Yes I could to negotiate that and make sure my pension position is protected I want to give an accurate account of my condition, whilst I accept my treatment would be the same I think the facts are important.

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When I returned to work I took my cuff BP monitor with me and took my BP at breaks. It was 190+/90+ while it was lower at home. My doctor advised me to retire, so I did.

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Thanks - it’s a conundrum I’m at an age where that seems the best option but Have been told early retirement on health grounds unlikely so I would have to resign and take a very large drop in income. At 60 it’s another 6.5 years until I get state pension. I’m at the finding out stage but don’t want to get into a cycle of increasing meds to try and keep pace at work

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Can't you lay it on a bit thick, have a few periods of sick leave and so on? A lot of other people do, until the employer gets the message? I reckon you have probably earned it, few years back you would have gone at 60 anyway, I reckon women have had a bit of a rough deal pension wise over the last few years, just saying.

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Yes, as lateguitarist says, but look for a new job in the meantime. Avoid adverts that sound like the job could be high pressure or mention targets. Universal Job Match is a good website, there is a bit of messing about to get set up but I used it every day when I was out of work. Also try Indeed (they get jobs from a lot of websites) and try some agencies (tell them what you are looking for).

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I can understand that needs to be medication to aid your recovery after a heart event, and a blanket cover as a starter package until you have stabilised and you learn where your body is at. Medication is good to stop you attempting to do too much too soon and undoing the good work of the stent, we have to repair.

I never have had high blood pressure ( I was on 12 month medicals at work once over 40), I was always fit and trained, climbed and enjoyed mountains immensely. The tablets were nearly as big a shock as was the heart problems. I started on minimum doses ,had them reduced, had allergic reactions and in the end I have ended up on statin ( rosuvastatin) and my aspirin. Blood pressure tablet ( Ramapril) gone, beta blocker( bisoporol 1.25mg ) gone, blood pressure this morning 113/77.

Everyone is different, has different cardio problems and different outcomes. Some people need to be on the medication to aid and protect their bodies to enjoy life. Some people find the the drugs intolerable due to reactions. It's always worth trying talking to a doctor who is sympathetic but they are very, reluctant to leave NICE guidelines.

I train within my limitations ( normal heart rate zones for a 58 year old), back in the mountains but not a fast uphill.

Ramapril, Tildiem and bisoporol are horrors of tablets all gone, thank god

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I think you're correct, you only have to read people's treatment accounts on this forum to realise there's a fairly standard, "one size fits all", response by the NHS to atherosclerosis.

But in the majority of cases that standard response may actually be pretty effective, especially if the patient recognises that they're a major part of the problem/solution and knuckles down to lose weight, stop smoking, manage stress, and start exercising.

Where the system might be far less effective however is with people like yourself.

You were doing the critical lifestyle stuff before, your blood pressure was pretty good too. As you say, you still have atherosclerosis, but what are you doing differently to halt its advance? Not that much under the standardised NHS model. If I read your post correctly it seems managing lipid levels via statins is the only material thing you're doing differently (yes, you've tweaked your diet, and some would say that's critical, but other would say the changes you've made are the wrong ones, and another group of experts would say unless you know which of three different versions of the Apo E gene you carry then it's impossible to know what diet is right for you!).

I've read some interesting accounts of people leading healthy lifestyles who suffered heart disease, and subsequently found that the underlying root cause in their individual cases was none of the major, obvious things. Their heart disease was triggered by other explanations, a common one being they were "pre-diabetic" an interim stage on the road to type 2 diabetes. But other explanations were much more esoteric, such as Niacin deficiency or a history of gum disease that can lead to heart disease.

The obese, 40 a day, couch potato presenting with heart disease probably gets a good service from the NHS. But the slim, non smoking, regular exerciser, especially if their blood pressure and lipid levels aren't too far out of whack, might not get the deep medical investigation that's warranted?

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Blimey Chappy you have just got me thinking along totally different lines! As you say, I am a slim, non smoking all the rest of it - BUT - I have had gum disease for a large part of my life. It was only maybe 10 years ago that I was sent off to regular visits to the hospital in Sheffield for specific treatment for it, and still have to see the hygienist regularly, although it is now under control (I have a lot of bone loss in my jaw but it's now stable and have not lost any teeth (yet!). I used to have really bad bleeding gums for years as a younger man, but never really advised or had any treatment for it. I have heard there is a link between the two, is it still regarded as such?? How would it make arteries block up?

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There's an influential American cardiologist called Bradley Bale. He runs a very forward thinking heart disease clinic that believes in identifying the underlying cause or causes for each individual's atherosclerosis, and then works to eradicate those very particular triggers. This approach is the exact opposite of the "one size fits all" blanket solution. Obviously it's particularly relevant to the small minority of heart disease sufferers who followed healthy, heart disease resistant lifestyles BEFORE they showed any symptoms.

Plenty of specialists have recognised the link between gum disease and heart disease, but Dr Bale gives a number of compelling case studies and covers it extensively in his writings.

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Well, thanks for raising this - something more to get my teeth into, not too hard though.......Funnily enough I am just off to the hygienist!

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'But the slim, non smoking, regular exerciser, especially if their blood pressure and lipid levels aren't too far out of whack, might not get the deep medical investigation that's warranted?'

Haha that pretty much describes many of us with non obstructive disease, Microvascular and vasospastic angina we are well down the pecking order. No specific tests or treatment options. No NICE guidelines.

We require treatment tailored to our individual needs....however don't we all need to be treated in a holistic manner?

I took ill health retirement and my managers were stunned when I was given permanent incapacity....a rare outcome in the NHS along with the comment. 'Oh so this heart condition of yours is serious then?'.

An actuary would have done a calculation just like the Travel insurers do when calculating my crazy premium which costs me a bomb!

Another question that could be asked is whether a NHS consultant should be providing private treatment they know should and they personally already provide as a NHS consultant.....

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Very interesting thread. I'm sure lateguitarist is right, you get a standard package of medication at the beginning as part of a blanket prescription. That's what happened to me. I had a stress echo which showed fairly global ischaemia, so I got the works including beta blockers. On the one hand I was concerned about the meds because they were prescribed by a consultant who came into the room for 2 minutes at the end of the echo and who had no access to my medical records. On the other hand I accepted it because the situation seemed quite grim.

When I had the angiogram the situation turned out to be rather different than expected. Only mild atheroma in a couple of the main arteries, so the diagnosis was probable microvascular disease. At the end of the procedure the consultant prescribed isosorbide mononitrate in addition to the rest of the tablets and I was discharged, so no chance of discussion.

I couldn't get a GP appointment, so I decided to go see a consultant privately who is a specialist in my condition. Fortunately he works in the same NHS Trust as the one where I had my stress echo and angiogram, so he has access to these records. I am now working with him to get my medication to an optimum position. I've recently come off the beta blockers (yeh, so thankful). I'm very happy to spend the money to see this consultant privately or I would have felt very unsupported. It's difficult to get to see a GP at my practice and they have a very laid back attitude. No doubt I would still the on the standard package if I hadn't seen the consultant privately. But I am aware that I'm in a very fortunate position of having savings to be able to pay for the consultations.

So yes lateguitarist, I totally agree. You get the standard package but unless you can get from there to a consultant or a GP who you can work with to tailor the meds to your particular needs it's likely you will stay there and you may be taking meds unnecessarily.

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"Fortunately he works in the same NHS Trust as the one where I had my stress echo and angiogram, so he has access to these records."

Lots of people on this forum seem to wrongly assume that your medical records are somehow off-bounds or restricted. You have an absolute legal right to access copies of all your medical tests and records within the past ten years, private or NHS. I request a copy of each and every test whenever I have one, and I've never once been met with anything other than cheerful compliance. If I walk into a private clinic, or a medical facility overseas, I can present them with a full record of my NHS treatment.

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I've had some interesting conversations with the cardiac nurse and then my GP. (It seems that much cardiology is so routine nowadays that the chances of a meaningful conversation with a specialist post event is virtually nil!)

Anyway - it seems there is a considerable body of evidence to support the "cocktail" of post event drugs we are prescribed. This is worth a look at - academic.oup.com/eurheartj/...

As indeed is this - nice.org.uk/guidance/CG172/...

Both these links were provided by BHF following an enquiry I made during my research. For me, the key was in understanding that while these types of drug are primarily aimed at reducing blood-pressure, they also help by allowing the heart and arteries to be more elastic.

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Simple. Change your GP. Lots of them do care about their patients and will discuss your concerns - and they are the professionals.

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My husband is taking Ramipril, a statin and asprin. He had one stent fitted quite a few years ago and every time he speaks with the GP about coming off any of these pills, he is told that it is "his" choice", but, they have been prescribed because they protect the stent.

His blood pressure is ridiculously low, but he still gets the same advice. I agree with the contributor who comments that at times it appears there is "all-for-one" prescription after a problem heart diagnosis, or heart op, with no-one able to prescribe individually. As regards beta-blockers - I am on Sotalol (and Apixaban and Bendroflumethiazide) for AF. Once again, after consulting the GP as I am always tired, I was told it was my choice - stop taking the medication and risk having a stroke, or take the medication and reduce the risk; that Sotalol is the preferred drug for AF. It frightened me into continuing to take them both. However, I do sometimes wonder if the companies that manufacture these drugs have some type of influence.

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Interesting post and discussion.

The guidelines for treating all diseases are based on research, yet not all diseases have a researched evidence base and the exclusions in the research are very important. If you are rare, atypical, idiopathic or in any way outside the norm then it can be difficult to access individualised care as Evidence Based Care is King!

My microvascular angina and thoracic ascending aortic aneurysm are secondary to my rare, auto immune Rheumatic disease, I have no other risk factors. Interestingly my rare disease affects my mouth and I have had problems with inflamed gums and some bone loss in my jaw.

All we can do is ask questions and be our own best advocates. It would use be great to access evidence based care that also took accpunt of personal circumstances as well though.

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I might be wrong but I don't think Ramipril is a beta blocker, you should check

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I have been titrated up to the maximum dose for (me ) of 10mg Bisoprolol and 32 mg Candesartan. This is what I was told is the Nice guideline for Maximum Medication Therapy prior to going down the ICD route. My EF is currently 40 % I believe it needs to be 35% or less for an ICD. My next Echo is later this month or early February so we will see !!!

The Bisoprolol I have been told is to relieve the workload of my heart and in my case to dampen the ectopic beats that lead on occasions to AF type Palpitations. I was taught a long time ago what's the definition of an "Expert " someone who knows when it's time to call an "Expert" and in my case that's the Cardiologist and Heart Failure Nurse. This is their Job I would never dream of asking a Cardiologist was he sure the GT is ready to Start, same as I wouldn't ask my Cardiologist is he sure Bisoprolol is the right medication for me !!

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Are we not all experts by experience?

A respectful partnership between a Cardiologist and patient is important. Especially for those of us who live with rare conditions as Tynemouth commented we need to be our own advocates.

I regularly have to explain to on call Cardiologists I meet that beta blockers make my condition worse....

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Very interesting topic as I'm in the same boat as lateguitarist. I've had 3 stents fitted 3 months ago (never had a HA) and put on Bisoprolol 2.5mg, Clopidogrel 75mg (1 year), Atorvastatin 40mg and Aspirin 75 (for life). I think* they said I should take statin for life as well as aspirin... Anyway, I'd like to stop taking some of those if they do more harm than good but I'm not sure. I have slight reaction to one of those (first week I got covered in rash and hives) but now I take 1 antihistamin tablet every 5 days when the itching starts and I'm good. I also started to look after myself since and from a couch potato, smoker and drinker, I'm none of that any more, just today I run 3 sessions (7K and twice 5K) and I run 5K in 28:14. I managed to shave off a lot of weight and soon I'll be within healthy range... My worry is if the Bisoprolol helping with slowing down my heart when I'm doing everything I can to give it a good workout? My RHB is now in 50s, used to be in the 40s but not in a while... BP is normal. I might give my GP a visit soon. Thanks for raising this issue.

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Interesting to see the difference in prescription though. I am on Bisoprolol at 1.25, Clopidogrel the same 75, Atorvastatin 80 (I think that's pretty normal?) Aspirin 75. I am also on Isosorbide Mononitrate 10mg and Lanzoprazole (Which is giving me a big problem and am going to see the GP next week to discuss it along with the BB's.) I wonder if it is just a different hospital regime or that we fall into different categories? The Lanzoprazole is to prevent stomach ulcers due to the Aspirin but quite a few people I have spoken to are not on this, mind you it would be good if you were constipated.......

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Oh, I don't think there are two people with same meds on this forum. I wonder sometimes why someone is prescribed different type of statin to me? Or in this case, why you taking Isosorbide Mononitrate and I don't? Never even heard of that one. What's it for? No one even suggested stomach lining protection pill to me and I actually wouldn't mind that. If I have to take a drug for the rest of my life and me being only 46, it make sense to try to make my stomach last a while yet.

I should have my first proper check up in about 3 months from now and I will do everything by the book till then as I don't have major issues so far. Other than itching and a little dizziness when getting up too suddenly, I don't have cramps or other pain some people complained about. I have plenty of energy and I exercise all the time.

Hopefully, the lifestyle changes I already made are working and will result in at least reducing the dosage of some of the meds if not stopping them completely.

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The Isosorbide is to dilate the arteries and make it easier for the heart to pump blood round, seems logical. I think it is like a very much milder but constant version of the GTN spray. Again, whether or not it was prescribed for me as an individual who knows? I suspect it is just one Cardiologists recommendation as part of the blanket cocktail. Being as how I never have to use the GTN spray it makes you wonder if it is worthwhile taking it but the side effects don't seem to be many.

The Lansoprazole is not a stomach "lining" pill (I thought it was originally), it actually reduces the amount of acid in the stomach. It is certainly very good for causing dioreahh I can tell you that much! once again, it seems hit and miss as to whether you are prescribed it or not, no one ever asked me if I had had stomach problems.

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"The Lansoprazole is not a stomach "lining" pill (I thought it was originally), it actually reduces the amount of acid in the stomach."

Which is all well and good, but once you start tinkering with the ph levels in the stomach a side effect can be that without normal levels of acidity you struggle to absorb sufficient magnesium from your diet. I'm suspicious of diet supplements for all sorts of reasons, however if your medication is responsible for a deficiency in a critical mineral like magnesium (google it, you may be shocked how important it is) then that's a different matter.

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Another thing, a lot of these drugs are prescribed for Angina. Now, for people like us who have had stents fitted (or bypass), and thus had the blood supply to the heart restored, we don't have Angina any more, as confirmed by the Rehab nurses, which goes back to the blanket prescribing of BB's that I raised originally?

I think the truth of all this, is that there is still an awful lot that is not understood, and each cardiologist is left to make their own decisions on a very large number of patients whom they have very limited time to see. As someone else remarked, I personally have had about 5 minutes total time with a cardiologist, 3 of which was watching a video run-through of the Angiogram. At the end of the day we are on a production line.

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The Isosobride does sound like a pill form of GTN spray. I only used mine about twice or three times before stenting, never since. I do take it with me when I go running though, just in case...

The Lansoprazole doesn't look like something I'd want either. :D If Aspirin (and other stuff) start causing me trouble I'd look at it then. Not too keen on diarrhea to avoid something that might not happen anyway.

I'm taking 4 pills at the moment and it doesn't seem too much, I don't have major issues (touch wood) and should leave it at that. At least for now.

I was thinking about BBs. They may be helpful in a way that they slow down the heart rate so you can plough on harder on exercise without exerting too much. Yesterday I've done 3 running sessions (over 17K in total). I did first 5K in 28m 14s, which is my personal best. My HR was on max for only 1 minute of that time and was 144BPM on average. How would I perform without BBs? Would my HB go through the roof? I never run that much in my life. Not even as a young lad. I only have a slight pain in my muscles but I feel like have another run, just because I can. Maybe not that long, just to get my HB up a bit.

If I'm not mistaken, you and I had stents done roughly at the same time (3 months ago), both are doing well enough with exercise? When I went to my GP to ask few questions two months ago I was told that I'll have first major check up 6 months after stenting, which is end of March, beginning of April and I'll give it that long.

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Yes I had 2 stents 3 months ago, still have a 50% blockage in RCA but been assured it is not too worrying. I am now 60 and have a proud family history of CHD. I have been progressively exercising starting with brisk walking, power walking and now jogging/running. I managed the 5K park run in 32 mins last week, but to be honest I am being held back to a degree by sticking to my advised maximum heart rate of 115 BPM, which I find very frustrating. I have to admit that towards the finish line I wound it up to about 134 but had no hint of problems. I have not tried but according to what I have read you can only get your rate up to a certain figure if you are on BB's, although I am only on 1.25mg. When I used to run before (probably with arteries in a worse state than they are now, which I feel is an important comment) I used to sit at a comfortable pace of 135 to 145 ish. The problem as I see it with BB's, is that they limit not only your heart rate but also the ejection of the heart, which means you are never going to reach your potential, in other words, get as fit as you might do, which seems to be defeating the object of it to a degree, in my mind. I am also getting side effects, and have no wish to be on a drug unless there is a real reason, which I am failing to see. Maybe someone might comment on this thread with a real reason as to why I should be on them, but I have a suspicion that in fact there is not one. I have an appointment with my GP next week so will see what they say, but I am not holding my breath to be honest.

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Yesterday the heart sensor on my watch was showing 196BPM and it made me cautious and I stopped running to calm it down even though I wasn't feeling bad at all. Then I realised it doesn't show as high number if I cover it with sleeve, the bleeding thing was reacting to cold or whatever. Also, none of those things are 100% reliable so listen to your body as well and if you feel you are OK and the number isn't too high, carry on or slow down.

Regarding BBs, I'm looking forward to hear what your GP says about them. I'm not bothered at the moment even though my resting heart beat is 45bpm right now. I better get up from my chair a bit.

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I think you have got to be realistic though. I would be quite happy if my maximum HR was set at, say, 135 ish. To be honest I think the one given to me at Rehab is way too low and unrealistic. Most HR monitors are prone to throwing a wobbler and giving false readings now and again, but they are good to see what the average or constant reading is. I am looking forward to the appointment I suppose, but I am not holding my breath! I have decided I am coming off the BB's one way or another, so the doctor can either help me or not, it's up to him, but I've had enough of them.

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Your max HR roughly translates as 220 - your age. My max is 174bpm (220 - 46) and I often go over. I still have readings from back in November when I started running and it is showing regular over 180 - 190bpm for up to 10 minutes. I survived and now I've build up stamina I don't run for more than a minute on max, the rest is well within normal - around 140 - 150bpm. I didn't have a HA so my heart muscle is strong, stents have opened blood flow, there's no reason for me not to try a bit harder. That or I'll kill myself one of these days. :D

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There is no need to go over. if you stay within the band (60-80%?) then you will be getting very real benefit. You certainly won't get as much as you should at 115! As you say once blood flow is restored to a healthy heart, I don't see the problem, certainly not in the short term. Maybe someone might come along soon and tell us why we are wrong?

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I don't intentionally go over the limit. I'm chasing PB over 5K and sometimes I go over the HB limit and that's that. My aim is to run 5K under 25 minutes but I may start running 10K soon and do it easy, not trying to beat the time, just to make it to 10K. Today I just went for a light interval training (1m running - 30s walking) as my body was still aching from yesterday's 3 sessions of 17K in total.

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Have you got any Park runs near you? They are fantastic fun. parkrun.org.uk

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Yes, there's one tomorrow starts at 9AM, but is too early for me. Maybe next time.

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They all start at 9 I think! Lazy sod....

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On a serious note I think there is a higher risk of heart attacks early morning and launching yourself out into the freezing January air might be dangerous for some folk.

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True, we are on a production line. But it's important to remember that for most people it's actually a pretty good production line. For the evidence supporting that statement just look at the reduction in the heart disease mortality rate over the past twenty years. It's pretty impressive, so the NHS must have been doing something right!

However, "good" isn't the same as "perfect" or even "best".

And personally I want nothing less than the very finest care possible. Unfortunately I'm coming to the conclusion that in order to hit international gold standards for cardiac care I'm going to have to augment NHS care with some top-up private sector elements. And if that's true for me, the kind of classic heart disease case that NHS care is most designed to tackle (male, middle aged, bit overweight, low exercise, slightly high blood pressure, not great diet, etc) then it must be even more the case for anyone who departs from that classic risk profile.

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As a matter of interest, how much has the prevalence of smoking changed over the past twenty years?

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Good point, yes of course the decline in smoking has yielded enormous health benefits. However, the decline in UK heart disease mortality rates from 1990 to 2013 was 52%, far outstripping the decline in smoking. Especially as the decline in the mortality rate was higher amongst women despite reducing their smoking less than men. And let's also not forget that as smoking has declined obesity has grown. Public Health England has controlled for smoking and their analysis shows fundamental mortality dividends from improved clinical responses. Here's an international study showing much the same thing,

ncbi.nlm.nih.gov/pmc/articl...

Improved medication, improved surgical procedures, improved diagnostic tools, they've all played a part in driving down heart disease. So I'll stick to what I said before, the NHS must have been doing something right.

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Yup; law of averages? :-D

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We are 'episodes of patient care'

The CCGs commissions bundles of care from providers hospitals etc usually based on NICE guidelines.

Some CCGs stipulate that 5 drugs must be prescribed to patients following a heart attack. One of which is a beta blocker.

As others have said sometimes individualised holistic care with kindness and a tincture of common sense is not happening.

kingsfund.org.uk/audio-vide...

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Good luck! If post-prandial insulin levels were measured, what a picture we would see.

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Well, if it showed I was at risk of increasing levels of atherosclerosis then there is nothing I can do. I have radically changed my diet, am doing everything by the book. BB's are not going to halt it are they? I am going to enjoy my running and exercising and sod it, what will be will be, I am not a big TV watcher.

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Which book please lateguitarist? The consensus book needs re-writing; the ICS-NHS Diabetes Prevention Programme provides radically different information with which to make informed decisions.

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You will have to fill in my blanks here, as far as I am aware I have never been, and am not suffering from any form of diabetes. Fortunately I was not unlucky enough to be born with it, and I don't stuff my face with cakes and biscuits or do anything else I shouldn't, so I don't really understand the comment?

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All carbohydrate is converted to glucose in the body, and as a result insulin-resistance is rife in our society.

Jaminet and Jaminet (2012) assert that most people's body uses between 120g and 160g per day in the form of carbohydrate. Less than this and the body attempts to make up the deficit from other foods. More than this and the excess contributes to high insulin levels, and the conversion to fat that causes dyslipidaemia.

Many starches are converted to glucose faster than table sugar, spiking those insulin levels, including those that have been touted as healthy such as Weetabix, Shredded Wheat, wholemeal or white bread, potatoes, or rice phcuk.org/sugar .

Baked beans are an anomaly in that they spike insulin despite being slow-release carbs, and removing the fat from milk increases the insulin response of skimmed milk by 2.5 times over whole milk insulinandmore.com/2018/01/... . Well meaning authorities have told us to cut the fat from meat for decades with similar detriment, advising us to have man-made oils instead that impair cell integrity.

It's a minefield!

The ICS-NHS Diabetes Prevention Programme, is a voice of sanity in all of this phcuk.org/wp-content/upload... Unfortunately copyright restricts publishing the information online.

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Concerned, here's the problem I have with ALL these diet based solutions, they're recommended as a universal solution that are perfect for absolutely everyone. That to me feels more like religious fanaticism than scientific enquiry.

From what I understand about the diet you're recommending let me raise some concerns.

What about someone who, for faith based or ethical reasons, doesn't want to consume animal products?

What about (the great majority of humanity) who are lactose intolerant? How are they catered for with a diet that recommends full fat milk, cheese, etc?

What about the cost of this diet, how appropriate is it for people on a restricted budget?

What about people carrying the Apo E 4/4 gene, what diet should they eat?

And that's just off the top of my head, I'm sure if I sat down and thought about it I could find plenty of other questions.

I could accept that your recommended diet might be right for you, but to recommend it willy nilly without first understanding anything about the individual seems to me to be lacking in both humility and scientific rigour.

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