First time posting. Medication comments. - British Heart Fou...

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First time posting. Medication comments.

TeflonT profile image
11 Replies

Completely out of the blue, February 2017 whisked in with cascade angina. It took two blood tests to eventually find trace indicators of heart attack. Two stents fitted. On discharge told my heart valves were strong. Now on Atorvastatin 40mg, Ramipril 2.5mg, Bisoprolol 1.5mg and Aspirin 75mg. Nearly three years on I’m now convinced that the meds are my biggest problem. I have almost constant muscle pain and cramping. Bouts of tiredness sometimes bordering on exhaustion. I exercise pretty well daily, cardio and resistance work, but don’t feel I’m improving. I understand the statin I’m on is one of the most potent, and it has successfully dropped my LDL to well below 2. I’m seeing my GP to see if I need to be on it, or if I can switch to something less potent or a lower dose. Prior to the episode, I had no history in the family of heart disease, exercised regularly and stayed active even after retirement. I’ve never smoked, and only ever drank moderately, no history of high blood pressure, also not overweight. So overall almost boringly healthy.

Any useful comments welcomed. Cheers.

11 Replies
Dolphin14 profile image
Dolphin14

Does the md know you have muscle pain? That can be caused by the statin

Lezzers profile image
Lezzers

Hi TeflonT, it is a known side effect that statins can cause muscle pain in some people. Definately ask your GP if you can reduce the doseage or try a different one, a lot of people have found changing their statin has worked for them.

Dickyticker26 profile image
Dickyticker26

With me Atorvastatin caused diarrhoea so I was switched to Rosuvastatin plus Lansoprazole

Aspirin causes me to urinate black blood so I don't have that

Bisoprolol I am on 10 mg and trying to get the Gp to alter it

I have been asked to make notes of the side effects-in additional to the overwhelming fatigue I have cold hands and feet and runny nose, left leg cramp, some loss of balance and dizziness, hissing and ringing in the ears, some nausea and loss of appetite, and breathlessness, blurred vision and dry mouth

I am also on Apixaban blood-thinner and Clopidogrel anti clotting but do not feel any side-effects from them

I have only just the other day read on the prescription form "Review date at which the prescriber would like to review the treatment with the patient" so it does give you some say officially it seems

I've been tolerating Atorvastatin 80mg well for the past 10 months. I do get muscle aches, but nothing above what I'd expect for the fairly heavy exercise regime I've adopted. But it's certainly a known side effect.

The bisoprolol can also cause tiredness and make exercise feel harder. I was on 2.5mg but my cardiologist was happy to stop it at the 6 month (ish) review after my HA and stent. The difference in my gym performance was almost immediate and like taking off a 30kg backpack!

Essentially, if your resting heart rate is low and your blood pressure is ok then you probably don't need it by now. It's main purpose in the standard cocktail is to reduce your pulse, not your blood pressure (that's why there's normally an ACE or ARB inhibitor in there as well) but can also protect against some arrhythmias so if your resting pulse is good and you have consistent sinus rhythm then definitely worth talking to yoru GP about that one.

It does have a protective effect against harmful remodelling of your heart but current advice suggests that's only a real benefit for the first 6 - 12 months in most cases.

The trouble is, a lot of doctors still follow the old "take it for life" principle - the attitude seems to be that it's cheap (my 2.5mg were 68p per month to the NHS!) and (usually) harmless even if it's not strictly needed so "why take the chance".

TeflonT profile image
TeflonT in reply to Thatwasunexpected

I have wondered if I was on a generic cocktail of meds that they put everyone on just to play it safe. And I do wonder how many people actually need to be on them. About four months before the angina episode a personal trainer, because of my age, insisted I had a heart check before he took me on. My GP gave me a clear bill of health....go figure! If my heart was ok then and doesn’t appear to have suffered much damage as a result of the angina, then I’m wondering if the focus needs to be on keeping the arteries clear of plaque and just let my heart strengthen normally through regular exercise. I’ve always found it odd, that I’m supposed to make my heart work but then I’m expected to take meds to keep my heart rate down. Seems contradictory to me.

Cheers.

Thatwasunexpected profile image
Thatwasunexpected in reply to TeflonT

Yes, it is a pretty standard meds pack. You most likely had clopidogrel for the first 12 months as well, and possibly a proton pump inhibitor (such as lansoprazole) to protect your stomach?

* The statin is to keep cholesterol down, to help prevent further plaque forming, but also appears to have a stabilising effect on existing plaque.

* The ramipril reduces blood pressure by relaxing and opening your arteries, which indirectly reduces the work your heart has to do.

* The bisoprolol reduces blood pressure and pulse by blocking the effect of adrenaline on your heart muscle. That directly reduces the load on your heart and the work it does.

It also has the benefit of reducing the risk of your heart "remodelling" itself in harmful ways - one of the risks of heart damage is that it enlarges to compensate for reduced efficiency, but that enlargement increases the amount of blood supply it needs itself, and restricted supply was the root of the problem in the first place - you can see where that can head!

* The aspirin (and clopidogrel while you had it) reduce blood clotting and minimise the risk of sudden blockages - plaque builds up slowly, a clot can form in seconds!

As an immediate response to a cardiac event, all of those make absolute sense:

* Regardless of the initiating process (which you'll find hotly debated around here now & then) , plaque undoubtedly holds cholesterol in its core so, by reducing it as aggressively as possible, you reduce the opportunity for it to start building again. When your arteries are already recovering from an event and intervention, that can only be a good thing.

* Similarly, giving the heart muscle as much of an easy ride as possible while it does whatever healing it can is pretty obvious - you wouldn't continue to run 10k's on a torn hamstring! While you can't rest your heart completely, the ramipril and bisoprolol give it as gentle a time as possible.

* The anti-platelets (aspirin and clopidogrel) initially help to stop clotting within the stent while it embeds properly into the artery - it's a foreign object inside you and your body may not like that! Once that's had time to settle properly, the clopidogrel is normally stopped.

* The aspirin - as a generally safe and well tried drug - is kept going indefinitely because a big risk of SUDDEN heart attack is where a plaque ruptures and a clot forms at the rupture site. The rupture itself may be relatively harmless - and give plenty of time to seek help - but the sudden formation of a clot can literally be a heart stopper.

So, out of those, once you're well settled into your post-event life :

* there's little reason to stop the aspirin unless you have a real problem tolerating it .

* the statin makes sense IF you don't experience serious problems but a different statin may help here if you do.

* the bisoprolol is useful at least to start with, but may well be superfluous after the first year or so. By then any risk of remodelling will likely have passed and your improved fitness by following the rules will hopefully have dropped your heart rate enough on its own.

* the ramipril is potentially redundant IF you can get your blood pressure consistently low, and keep it that way, through lifestyle changes.

Milkfairy profile image
MilkfairyHeart Star in reply to Thatwasunexpected

Good points made with eloquence.

I loved your explanation.

TeflonT profile image
TeflonT in reply to Thatwasunexpected

Thanks for that. Very clear. I neglected to mention I’ve been on Lansoprazole 15mg for nearly ten years and the anti clotting agent was Ticagrelor. The latter was stopped after twelve months; as you suggested. I’m also now taking a sachet of Cosmocol per day to counter the constipation caused by the meds.....such fun!😂

Thatwasunexpected profile image
Thatwasunexpected in reply to TeflonT

Unfortunately, constipation (or, curiously, diarrhoea!) is a possible side effect of just about all of them :(

As you're planning to speak to your doctor about meds anyway, it would certainly be worth mentioning the bisoprolol.

The NHS guidelines are beta blockers for a year after heart attack, then to stop them unless there's evidence of heart failure or left ventricular dysfunction. But it often gets overlooked unless you actively remind them!

To give an idea of the effect 2.5mg of biso had with me, while I was taking it (up to early Aug this year) I kept a daily average to show the cardiologist:

My resting pulse (first thing in the morning after visiting the bathroom, going downstairs and making a coffee but not drinking it) was 48, averaged over 5 weeks. My average blood pressure (one daily morning reading as above, one evening before bed) was 101/61.

Since I stopped it, my figures (same conditions) are pulse 51 and BP 102/62. So, really very little difference on BP and a few beats on heart rate, but that was comfortably low anyway.

On the other hand, while I was on it I would struggle in the gym once heart rate got up around the 130 mark - that was pretty much the limit of what I could maintain for more than maybe 10 minutes.

Since stopping them, if I really push, I can average mid - high 130s over a 90 minute session and hold 140+ for quarter of an hour. It makes real-life stuff soooo much easier!

TeflonT profile image
TeflonT

Saw my go this morning. Having blood test next Wednesday and from that point I stop taking my statin for one month. Then a review to see if the muscle pain has eased. If not then the assumption will be that it’s just the normal aches and pains of aging. If they do ease off then we’ll look into alternatives. He seems to be taking a softly softly approach, one medication at a time. I’m ok with that....seems sensible.

TeflonT profile image
TeflonT in reply to TeflonT

That’s “GP” not “go”. Bl#&*£(dy predictive text!😂

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