Medication Changes for Heart Patients

[Prada47]

Just thinking about medications after reading the thread on Statins.

I was thinking about Changes to Meds and Why. Just to start it off last two visits to Cardiology Increase Furosemide 40mg pd next visit Cardiologist ( different one ) says stop Furosemide Heart Nurse says monitor weight closely, no change after approx. 6 months. So Furosemide not required and no alternative given. or required.

Ramipril stopped after persistent cough Started on Candesartan cough went away ! Next Entresto started, Isosorbide Mono stopped and Candesartan stopped. I know they are trying to increase Blood Pressure to increase dose of Entresto . Clopidogrel stopped one year after stents (routine)

Bisoprolol increased from 5mg to 7.5 mg to 10mg by Intervention Cardiologist, Heart Failure Cardiologist said reduce to 7.5 after Holter revelled Over Beta Blocked pulse 33 BP 90/60 with Nocturnal Pauses of 3 seconds.

So currently on Asprin 75 mg Bisoprolol 7.5 mg Omeprazole 20mg Pravastatin 10 mg Eplerenone 25 mg and Currently No 1 med for Heart Failure Entresto 49/51 mg I do have a GTN spray which I currently don't require, even thou GP says always keep it in your pocket !

Just a few of the changes but most changes have been an adjustment to dose..

Laura Drop Stich picked this up "interesting that they have prioritised Entresto over other Meds " to try to get the dose of Entresto up to the maximum dose I can tolerate !!

So being a good boy I just do as I am directed I don't question so much as just do. Must be some of the Royal Navy still in me !

As they say Once Navy always Navy

[Lezzers]

Can I answer for husband?

[Prada47 in reply to Lezzers]

Like me I am sure he is a good boy and will do just as he is told, so answer away Please

[Lezzers in reply to Prada47]

OK, was on lisinopril but was changed to candesartan because of cough, but then cough was found to be heart related not meds related.

Husband is quite intolerant to most, if not all, meds used to treat his heart condition so is only on low doses. Cardiologist wanted to titrate up candesartan & bisoprolol with the aim being to start on Entresto but BP is a big issue. Gradual reduction in isobide to zilch hasn't increased BP. As from yesterday he's stopped taking furosmide but was only on 20mg so unlikely to increase BP either. Was told this week that there is nothing more they can do other than keep they eye on him.

So current meds for heart is 12mg candesartan, 1.25 bisoprolol plus aspirin & atorvastatin (will have to check the dosage) Does have other meds for other conditions.

Yep he does as he's told after discussion with medical team. We're pinning our hopes on the stem patch trials & the drug used for diabetes currently bring trialled, (rubbish with names but it begins with a D!) 😂

[Shoshov in reply to Lezzers]

that’ll be dapagliflozin. as i wrote when i saw that about the trials id been on it for years for diabetes. it was when it was stopped as i’d beat the diabetes that things started to go pear shaped. iv since had a restenosis stent in different artery developed angina and unstable angina, low bp which like your husband causes havoc with taking meds as i too am intolerant. i’m just on aspirin,clopidrogil,and atorovastatin and lanzoprazol. i’m seeing cardiologist in 3 weeks and i’m going to have this conversation with him. i’m tempted to start taking them as i have some hanging around to see if symptoms improve but scared it’ll lower blood sugars too much. it really is a balancing act. i just wish i could tolerate the meds that help to prevent further damage as it’s a worry and i’m just waiting for it to happen again. anyway good luck in your quest❤️shiona

[Lezzers in reply to Shoshov]

I remember your post, I'm just rubbish with names especially the long ones! Our GP is so very good & supportive, we practically begged her to take a chance but she really couldn't & we accept that. However. We do know cardiologists are able to be a bit more lax with the NICE guidelines so that's our next mission. As Kevin is still quite young it was hoped that if we could optimise the meds to get his heart in the best condition before the aging process starts then he would be in a better position, so we felt a bit like our future had been taken away. But, we're not giving up , things are happening real fast in the medical world so who knows what tomorrow will bring. I totally get your worries. Hopefully, they'll let you go back on this med, keep in touch x

[Shoshov in reply to Lezzers]

you too lezzers and say hi to kevin for me..big hugs

[Lezzers in reply to Shoshov]

Big hugs to you too Shiona, I'm not hugging Kevin though he's got man flu (well just snuffles really!!) 😂

[SpiritoftheFloyd in reply to Lezzers]

Steady on with the accusation of man flu, see link enclosed which confirms it does exist

irishtimes.com/news/health/...

It's from the Irish Times, now I'm just going to scan the IT for the article that says there are leprechauns living at the end of the garden!

[Lezzers in reply to SpiritoftheFloyd]

Brilliant 😂. It must be true if it's in the British medical journey, however, the article has most definitely been written by a man... I leave this paragraph here as proof!

"Perhaps now is the time for male-friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort.”

I believe I already have that set up in my living room!

[SpiritoftheFloyd in reply to Lezzers]

I have to admit, that pretty much describes my living room

[Lezzers in reply to SpiritoftheFloyd]

I guess the most important question is who gets control of the TV remote!?

[SpiritoftheFloyd in reply to Lezzers]

Not an issue, only me here!

[Lezzers in reply to SpiritoftheFloyd]

I hope I wasn't insensitive

[SpiritoftheFloyd in reply to Lezzers]

No no, don't worry.

[laura_dropstitch Heart Star]

You're a very good boy, Frank. I'm still being monitored for my Entresto increase but seeing less side effects now so hopeful I am starting to tolerate it. Maybe I should have been in the Navy, as I always do exactly what the consultant tells me

[Milkfairy Heart Star]

It can be a balancing act to get our medication spot on.

Some drugs can only be prescribed initially by a Cardiologist so ties the hands of the GP.

It can be complicated if you have more than one condition.

My Cardiologist and Neurologist have different views about which Calcium channel blocker I should take.

My change to verapamil has to be done in hospital just to make everything more challenging.

When they tried me on Candesartin I was on 48 hours BP monitoring at home. Within 24 hours after taking only a baby dose of 1mg! My BP crashed. Cardiologist resisted the urge to say I told you so to my Neurologist!

[Lezzers in reply to Milkfairy]

That's very true, I believe only the cardiologist or HF nurse can prescribed Entresto and the nurse can only prescribe it under strict NICE guidelines. The cardiologist apparently does have a bit more flexibility.

[Prada47 in reply to Lezzers]

My HF Nurse started me on Entresto 1st prescription was issued by her and then GP started to issue. HF Nurse increased dose then Cardiologist instructed HF Nurse to increase to Maximum after a blood test. My BP has come up to around 110/55 and pulse is around 58 after stopping Isosorbide and Furosemide !!

I think the trigger for Entresto was NYHA scale, i.e. limited in Normal Activity like tying shoes and short of breath on showering and dressing. Currently don't need pacing although I have a recognised high burden of Ectopic Beats with Trigeminy and Bigeminy. EF is stable around 40 to 43 % On NICE guidelines I would qualify for an ICD due to gap in QRS interval. not sure if qualify is correct terminology -) lol I am in pretty good condition except for the shortage of breath at times which can come on for No Apparent reason !! Crazy this Heart Failure

[Lezzers in reply to Prada47]

Hi Frank, your BP is the same as Kevin's but he's on just a low dose of candesartan & bisoprolol. They've stopped his Isosorbide (think I might have been spelling that wrong for years!) & stopped his furosmide in the hope they can get his BP up which will then allow them to titrate up his candesartan & bisoprolol with a view to starting on Entresto. Unfortunately, his BP isn't playing ball, yes this HF business is a funny old game! Your EF is pretty good, Kevin's is 30 but then it's not always about the EF is it. Have you been offered an ICD? And would you accept it if you were offered it?

[Prada47 in reply to Lezzers]

Good Morning Leslie

I have had the discussion with my GP with regard to an ICD and she has wrote to both of my Cardiologists (Intervention and Heart Failure ) stating my view that should we be going down that road, I would rather have it sooner than later. I was 72 a few days ago and I am reasonably well and fit so rather now than when I am 80 LOL

( hopeful ) Ticking over well this morning at 127/75 65 so it looks like the garden today.

ps My candesartan was stopped 24 hours before starting Entresto and never been restarted

[Lezzers in reply to Prada47]

Good BP reading, hope the garden got done, would like to have done mine but fortunately it's been raining.☔ ☺ Fingers crossed your GP wins the ICD battle, let us know. We're not giving up with this BP issue, we'll be seeing the cardiologist in a couple of months, we may kidnap him until he gives in to our demands!! Take care.

[lilymeg]

you can take the chap out of the Navy but you can't take the Navy .......I know from experience...........

[Dickyticker26]

I was interested in your expression "Over Beta-Blocked"

I have just come home after a Quad bypass and trying to get to grips with the "Discharge Medicines"

Although I had a post-op appointment with the hospital "pinged" on my mobile immediately for some reason the medication could not be electronically transmitted by the hospital to the surgery and we ended up with me still in my pyjama shorts and dressing gown at the surgery to hand over the document

A year ago when I first presented at A&E with chest pain I was prescribed Bisoprolol 2.5 mg on a diagnosis of atrial fibrillation At Christmas following an angiogram showing "severe stenosis" of 4 arteries it was upped first to 5 mg and then 7.5 mg

Now following the bypass it is 10 mg which I believe is the maximum

I was in hospital for 10 days most of it in the High Dependency Unit

I had Delirium which I was told is quite common and could not distinguish between what was actually going on and what was in my imagination, I thought that night was day and that I was somewhere else-USA, France, Epsom

I could never remember the name of the hospital I was in and I had to ask the nurses if they were real as they just stood there motionless or suddenly moved off like automatons

My recollections are disjointed but still vivid and I can remember a lot of shouting and crying and people marching off or being led away It was always about Bisoprolol and patient resistance to prescriptions

After a week at home I can do routine chores and yesterday had a walk on the common opposite of 1,000 steps

My food still tastes of anaesthetic and I need the pain-killers But the hallucinations have gone completely and the mental confusion much better

I have already had my statins changed because of diarrhoea but feel that the strength of the Betablockers and the "zombie" effect is a problem which I will raise when I get the chance with the surgeon at the post op review on 21 October and mention to the clinical nurse specialist and the GP-given the opportunity

[Prada47 in reply to Dickyticker26]

Hi Dicky Hope your feeling well.

The over" beta blocked " was written from one Cardiologist ( Heart Failure ) to the Intervention Cardiologist who had upped the dose of Bisoprolol from 7.5 to 10 mg. The letter was after I had a 24 hr Holter.

Results

Normal Beats Total 70992 Aberrant Total 5046 avg 238 /hr 6.6 % of total

Premature Normals 2801 Premature Aberrants 4581 avg 216/hr 6.0 % of total

Bradycardia 54 longest 38 beats 1min avg

slowest 22 beats

Maximum Heart Rate 84 bpm

Minimum Heart Rate 44bpm

QRS Total 76187

5 Ventricular couplets

5 Ventricular Bigeminy

2 Ventricular Trigeminy

Very Frequent VEs

Frequent SVEs

Not sure what all that means but this was the results that prompted the "Over Beta Blocked " !!!

Would be interested if anyone could interpret this lol I have wrote this just in case anyone else has a copy of their Holter results . I also believe that 10mg is normal Max for Bisoprolol

[Dickyticker26]

Yes thanks for that

Amidst all the scans and procedures I have had at 5 different London hospitals for some reason the holter monitor has been missed out and I have an appointment at Kingston on Christmas Eve for one

I hope I can raise my concerns with the cardiologist over the lengthy periods I get feeling woozy and weird just sitting and staring into space which I put down to the Bisoprolol

The ward was full of patients just like that

If nothing else I suppose it tends to give the medical staff a quiet life

I have read on the forum of patients delaying taking the tablets till the evening or cutting them in half

[Prada47 in reply to Dickyticker26]

Hi Dicky

I am quite alarmed over your comment " The ward was full of people like that, people sitting staring into space which I put down to Bisoprolol " I take 7.5 mg and I don't believe that is personally the case with myself or I would stop Driving my Grandchildren as a 1st action, are you still driving ??

Wards full of people like that are normally full of the Elderly with Heart Related problems that may be a reason they stare into space. This is not to criticise your observations it just to try to understand it and the reason why you think Bisoprolol is the cause.

Regards

[Dickyticker26 in reply to Prada47]

I am so sorry if I alarmed you

I am on 10 mg Bisoporol and put it down to my "zombie" sessions

I am communicating with the clinical nurse specialist who tells me that the zombie sessions are hangovers from the surgery experience and will go in time and therefore not down to the medication side-effect

It is comforting to hear and I hope it is right

I am also pursuing the GP about the post op medication as the Bisoporol dose has crept up in a year from 2.5 to 5 to7.5 and now 10

Obviously I can only speak for myself and my observations and conclusions

So please don't take it any more than that

[Prada47 in reply to Dickyticker26]

Hi Dicky as you know I have also been on 10mg my side effects were Low Heart Rate and Blood Pressure. I can honestly say I haven't experienced the Zombie effect. I do think I came out of the by pass surgery reasonably well !! My only problem being on the ventilator for quite a long time due to body temperature not increasing ( When wrapped in Tin Foil ). Just to share a little more on my personal case.

After angiogram Cardiologist said I think I can fit your arteries with Stents. Later he returned and said after another look you need by pass surgery

" I will put you to the Surgeon with the shortest list "

A few months after surgery I was told I had Heart Failure with an EF of 27 %

I told my GP I felt No Better after the surgery than I did before, that's when it came out RCA totally blocked couldn't do anything with it. Circumflex by passed OK then LAD by passed OK mmmmm

2 years later still no better, New Cardiologist said another Angiogram whilst he was rooting about in my Heart he just said "The Information on what has been carried out is INCORRECT you have not had a bypass to your LAD " it was to a branch of your LAD I think I can fix the occlusion with Stents. 6 weeks later stented LAD and quite a lot better

EF has increased to 40 ish % and No Angina.

So I feel I have been through the mill with Heart Problems and I don't have the blank stare. That's why I responded as I did We are all Different lol

[Dickyticker26 in reply to Prada47]

Thanks for that

I had no idea

So my medical history was relatively straightforward by comparison

The medical team mentioned to me that they had got my sinus rhythm back on course which should straighten out the fibrillation

I have yet to see any written report of the surgery

One of the doctors at the surgery (you get a different one every time) said that after the bypass I would not be on any medication at all

Many thanks again

[senorsilk]

I'm an old salt as well but I suggest you don't give doctors carte blanche power over your meds. No one knows your body better than you.