A bit surprised : Today I had my first... - British Heart Fou...

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A bit surprised

Chelsea55 profile image

Today I had my first consultation with my Cardiologist 17 weeks since my HA . I will add it was a phone call consultation and he was a hour late in calling .

I have been very lucky and I am nearly back to full fitness but to my surprise he had doubled my dosage of both Ramipril ( from 2.5 Mg to 5MG ) and Bisoprold ( from 1.25 to 2.5 Mg ) . He stated he was looking at the long term and it would hopefully keep blood vessels healthy . Don’t know why as I was doing so well I really thought he was going to lower dosage . I also did ask about on any chance lowering my statins from 80Mg to a lower 40 Mg . He did state as my cholesterol was very low he would considering lower the dosage after 12 months .

Can anyone else have any thoughts on this

34 Replies

I guess the consultant knows best? They are the experts. I'm sure it's frustrating though as you didn't expect him to say this? Perhaps a wee chat with your cardio rehab nurse or your gp?? Good luck

What the consultant is doing is titrating your medication.

Titration is a way to limit potential side effects by taking time to see how your body will react to a drug. In titration, the medication is started at a low dose. Every couple of weeks, the dose is raised (“up-titrated”) until the maximum effective dose (“target dose”) has been achieved or side effects occur.

Certainly for the first 12 months they are very unlikely to reduce the dosage of anything. I asked exactly the same question saying that as I felt so well why can't my medication be reduced and got the answer that maybe the reason you're feeling so well is because the medication is doing its job! That put me in my place! When I researched it all I did understand the logic behind this approach, some of these meds are quite powerful and to hit us with a full dose to start with would just bowl us over, so it's a balancing act between getting the most benefit out of the medication without leaving the patient wiped out by side effects.

Unless you’re on statins which seem to be the other way round.

I've told my consultant to stick the statins where the sun doesn't shine. I already had low cholesterol and they were insisting that I take them. I found they affected my mood and so I've said no.They don't like it but they can get knotted. I think it does them good to have a difficult customer sometimes 😂

Curlyman83 profile image
Curlyman83 in reply to Snoweybm

Statins aren’t just for cholesterol. They are an anti-inflammatory.

Snoweybm profile image
Snoweybm in reply to Curlyman83

Mine were prescribed for cholesterol... Either way, sometimes I think it does the consultant good to be told to naff off 😂

Curlyman83 profile image
Curlyman83 in reply to Snoweybm

Can’t disagree with that 😂

I don't think any consultant should be told to "naff off". Whatever you might think they are professional people who are in the post because of their training, knowledge and experience. You are also ignoring the fact that Statins have been demonstrated to stabilise plaque and make them less prone to rupturing - I think it might be a good idea if you do a bit of research before making such comments to be honest, but's its your life, I have never heard of anyone on here saying they affect their mood by the way so that may have other causes unless it is just psychological.

I note your comments and dismiss them accordingly but thank you for your opinions

Well said

Sunnie2day profile image
Sunnie2day in reply to Snoweybm

My cardiologist kept saying 'We probably should start statins...' owing to my symptoms and bloods indicating elevated levels (but somehow I always managed to get out of the consults without the drug being prescribed).

And then he did an angiogram and simultaneous 'right-heart study'. Crystal clear arteries, he no longer mentions statins;)

Milkfairy profile image
MilkfairyHeart Star in reply to Sunnie2day

Sunnie2day,

Statins have their place in the treatment of microvascular and vasospastic angina.

The reason is to improve the function of the inner lining of the blood vessels ( endothelium)

Endothelial dysfunction is thought to be one of the causes of coronary vasospasms.

Statins reduce inflammation and hopefully prevent the build up of plaque. Stabilising any plaque.

The Editor of the European Heart Journal recently commented that men's plaque erodes, women's explodes even if it is tiny and just a thin layer throughout the arteries.

Everyone has some plaque, often women have a thin continuous layer rather than big lumps.

Sunnie2day profile image
Sunnie2day in reply to Milkfairy

Thank-you for that, I had no idea. I did think it was only for people with high 'bad' cholesterol and visible plaque, I now stand corrected:)

TRST profile image
TRST in reply to Sunnie2day

I have seen two cardiologists who disagree as to whether I should start statins. So I am doing what you used to do - get out of the consults without any!

Prada47 profile image
Prada47 in reply to Snoweybm

You need to hope your Cardiologist doesn't hold a grudge !!! I wouldn't want to be on the table when he is trying to fit a stent after telling him to Naff Off. He may just say Naff Off, Fix it yourself !!!ps Bet you are happy the Cardiologist was there after your HA, just Think about what you have posted I rest my case.

Stay Well Stay Safe as you can

Snoweybm profile image
Snoweybm in reply to Prada47

My issue with the cardiologist and the other so called specialists is that they fix the problem that's in front of them and that's all they do. They don't look at the wider view, namely the person. I've seen post after post on this forum from people who have had their heart related problems fixed only to be left living a sad problematic life.Consultants do a hard job, I accept that but my experience has been of extremely excellent surgically adept specialists who then fail to see the big picture and prescribe treatments and medicines that negatively impact on life.

I don't have the benefits of a good pension or financial security. I have to work. The best alternative is living on £115 (means tested against my wife's meagre income) per week. Pips awarded me 4 points and I'm having arguments with them over that. As stated I therefore have no choice but to work. My consultant fails to recognise this and is recommending treatments and medicines that are not vital that change my life adversely. This is why I am annoyed with them and I will continue to tell them to naff off when they try to impose treatments on me that are not necessary.

Prada47 profile image
Prada47 in reply to Snoweybm

Hi I think the system works like this

A&E to Cardiologist or GP to Cardiologist

Intervention Cardiologist carries out Angiogram, Stenting or Cardio Surgeon performs Bypass Operation

Cardiologist Discharges to Heart Failure Nurse ( if you have lower than normal EF )

or

Discharge from Cardiologist to GP. If the Cardiologist deems your Fixed they don't see you Ever Again until your GP request them to see you again ???

If I have that wrong I do stand to be corrected

After re reading your reply to me, I think you have a grievance with the System ( pips etc ) rather than Cardiology who look like they saved your life !!!

Stay Well Stay Safe

Milkfairy profile image
MilkfairyHeart Star in reply to Prada47

Hi Prada47, Nine years as a heart patient with vasospastic angina.

Here's my regime.

I see my Interventional Cardiologist every 6 months or so.

Email him when needed.

I am admitted to hospital at least once a year for about week for my unstable angina to be stabilised.

I see a Neurologist every 6 months, my vasospasms are happening in my brain too.

I trot off to see my GP after every Cardiology appointment and admission at his request.

Prada47 profile image
Prada47 in reply to Milkfairy

Hi Milkfairy

My journey started in 1982 with a Heart Attack I never saw a Cardiologist again until 2015 with no medication for 33 years !! My GP carried out an ECG after saying I appeared a little short of breath and just said "that doesn't look right I will send it to Cardiology " so 2015 started with ECG, Cardiologist said Treadmill, then Cardiologist said Echocardiogram. Then after these tests he said an Angiogram. So booked for angiogram which revealed blockage in RCA and LAD and Circumflex. Couldn't be fixed with stents so bypass operation. RCA 100 blocked so couldn't be opened . In 2018 again GP not happy with my breathing so referred to Cardiologist, Stress MRI which after a multi discipline team meeting indicated another Angiogram. After which I needed stents in my LAD so that was in 2018. I was discharged from Cardiologist to Heart Failure who have said I fit criteria for an CRT pacemaker, but holding off for now !! On max dose of meds so I just keep ticking over

I am 74 in a couple of days and live life to the full.

I think what I am saying is like you, if you need further treatments/monitoring you get it. If they think your fixed it's goodbye until you need us again !!!

ps Heart Failure Nurse Face to Face next Mondays first time for around 18 months

Best Regards Pepsi

Milkfairy profile image
MilkfairyHeart Star in reply to Prada47

Oh the joy of a face to face appointments 😊

I saw my Neuro face to face in July, seeing my Cardiologist in clinic next month.

Snoweybm profile image
Snoweybm in reply to Prada47

The only person I've dealt with has been the cardiologist who did the stents on the day of my HA. I don't have a grudge against him, if anything I hope that my resistance to him will help him become better at what he does.As I've said, it's the whole person that needs to be fixed, not just the heart..

He's a cardiologist not a magician, and I doubt your "resistance to him" will have any effect on his ability to attempt to fix cardiovascular problems one way or the other, he is already pretty damn good at that, as you have previously stated yourself. You have also mentioned that you have sleep Apnea, which I believe can lead to heart problems, this is not the responsibility of your cardiologist, have you had a diagnosis for this or explanation of what is causing it?

It's ongoing, I've been rushed in for an urgent appointment in October

That's not bad then, given the fact cancer patients are waiting much longer than usual for appointments. Hope you get sorted. Hope the Sleep Apnea consultant doesn't go golfing with the cardiologist eh?

Lol, they probably do but then I can always tell him to naff off too 😂😂

80mg statins is the automatic starting point after an HA. I asked my GP to lower it at the first opportunity (about 6 weeks) which she was happy to do as my cholesterol had not been particularly high to start with (4.7 I think). However my HF nurse kept up-titrating everything else, which may well have been to the benefit of my heart, but after 3 years left me 3 stone heavier, unable to walk more than a mile or so, and with aching shoulders, legs and feet. I am now finally beginning to sort things out and get a compromise between great heart health and quality of life.

Chelsea55 profile image
Chelsea55 in reply to Alison_L

Hi Alison , thanks for the reply , your so right about a healthy heart and quality of life , you can have a cardiologist telling you have a healthy heart whilst walking around like a zombie dosed out on all these drugs. I just feel I am getting to that point with this increasing dosage

I am still waiting for a follow up from the cardiologist 8 months after my heart attack. I don't know if my heart has recovered as he informed me it took a big hit during the HA! I am still taking the same meds that he prescribed 8 months ago! No follow up from my GP either, just left to get on with it! I am Male aged 74. Any suggestions???

Chelsea55 profile image
Chelsea55 in reply to Rodfan

Hi Rodfan thanks for your comments . Like you I felt the same . Do you have a cardiologist nurse . I spoke to her and she said get hold of my GP and ask for a blood test to ascertain if the statins are causing harm to your liver . The GP did call blood test set up and she took me off the furosemide . It’s all about patient empowerment

No cardio nurse Chelsea! No anybody! Thanks for your prompt response!

MissisF profile image
MissisF in reply to Rodfan

Have you seen your GP since? If not do ring your GP & ask for some blood tests. You should have bloods every 6 months. I think it’s in the NICE guidelines. I’m not surprised you haven’t seen anyone else. My husband hasn’t seen a cardiologist in 4 years & it’s much worse since COVID but he did at least have a little bit of cardiac rehab.

Rodfan profile image
Rodfan in reply to MissisF

Thank you. I will strive to get an appointment with my GP, which is no mean fate these days. Thanks for your response!

I have no doubt some of the comments on here regarding "Titration" are correct and required in a lot of cases, I guess it needs to be looked at subjectively. In my own case, I have gone the opposite way, my GP with cardiologists approval has taken me off both of the drugs you mention, not increased them (same dose as you), but then again I didn't have a HA, just severely blocked LAD. However my blood pressure is within limits and heart undamaged and particularly the bisoprolol was inhibiting my (fairly vigorous) exercise routine. You say you are back to full fitness does this mean you are back in the gym and coastal walking? What was your echocardiogram result was your heart damaged during the HA?

Thanks for the kind comment. I died first time around when I had the HA. I'm hoping next time I stay there. The process of dying is pretty horrible but death itself was wonderful I'll miss the wife and don't want to leave her but the rest of this world is pretty shit. Thanks for wishing it on me again, you're a star.

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