Ramapril

[Pilchard2]

Hi. It's been a while since I last posted. I have vasospastic angina. After a year of trying different medication I've now been put on ramapril. Had slight headache yesterday (oral nitrates made my headaches so bad I couldn't function at all) which is now just in the background (thank god). I feel very woozy, light headed and just not with it (my kids would say that's normal😄). My heart rate is very up and down which isn't normal for me. It's been sitting between 51 and 49 when it's usually low 60's. I didn't think this medication affects heart rate. Is this normal and has anyone else had this issue? I shall reply when I can.Thanks guys 😊

[Tos92]

Hi Pilchard2

I also have vasospastic angina, however, my medications are different to yours.

When I first started one of my medications for vasospams, Verapamil, it caused bradycardia which is a lower heart rate. Sometimes it was low in its 40’s. However, being on the medication for 1.5 years now, I have built a tolerance to the side effects and I can say that it doesn’t really bother me anymore. Could this be a similar case with your Ramipril? As you’ve only just started taking it, you may need to give it a week or two until your body adjusts.

There is another member on here, Milkfairy who also has vasospastic and microvascular angina. I hope she will be by to offer her experiences with this.

All the best.

Tos

[Pilchard2 in reply to Tos92]

Thanks for your reply. I think I definitely need to give it sometime, but nowhere does it say this medication lowers heart rate. I have a face to face (yes, you read that right🤗) appointment with my doctor on Monday so I can discuss it. I've also had some good help from milkfairy in the past. How do you find your everyday life with your medications? My consultant has been helping me for the last year trying different meds. My body just can't tolerate them. I'm hoping we're getting near to getting some sort of normality back. Happy days. 😁

[Tos92 in reply to Pilchard2]

I’m still in the “trial and error” phase with my medications. Most that I’ve been on, I’ve had side effects to, so it’s not been the most easiest journey and knowing how niche our condition is, I suppose it’s harder for the doctors to treat it as well. I wish there was one formula that could be applied to all of us with vasosapstic angina, unfortunately, that’s not the case. How was your diagnosis made?

[Pilchard2 in reply to Tos92]

It took 9 years to get a diagnosis. I was told by doctors there was nothing wrong with my heart. I'm not one to give in so I kept chipping away!! I eneded up self referring to a private consultant who specialises in vaso and micro vascular problems. Mine is a very complicated story. I had stress test, an angiogram and an MRI that stressed the heart. A 24 hour tape that showed the spasms. I saw my consultant in February and my ECG's are no longer coming back normal and I eneded up in AE a few days ago which also showed abnormal ECG. My consultant now thinks there's also something else going on so I'll need more tests. Ugh.

[Tos92 in reply to Pilchard2]

So were you managing without medication for those 9 years? And have you found any medications that have helped since your diagnosis?

Mine is slightly complex too. I’ve been diagnosed what seems like from my angiogram when my myocardial bridge spasmed, which triggered a heart attack. Even now, some doctors question the diagnosis and are also very reluctant to let me have the angiogram with Acetylcholine due to being concerned about the risks of administering the chemical. So I think I’ve got a bit of bumpy ride ahead still, but it’s going more towards the right direction now I think. Would you mind sending me a PM with the consultant that you saw if that’s okay?

[Pilchard2 in reply to Tos92]

I did manage for 9 years without meds. I have no idea how. I find myself explaining my condition to alot of people( medical) included. My consultant is looking at doing the angiogram you mention but he said its a kadt resort as it's not very nice.I'm happy to send you consultant but have no idea how to PM you. Might need your help for that. Thanks

[Tos92 in reply to Pilchard2]

I recently had a cardiologist also tell me that a part from the fact that it’s not very nice, it’s not commonly used yet and was concerned about the safety aspect of it as it induces spasms. But there seems to be no sure fire way of diagnosing vasospasms without this test really. Maybe as technology and science advances, there’ll be other ways to diagnose vasospastic angina in the future.

Right at the top of the forum, you’ll see an icon that looks like a paper airplane with “chat” underneath it. If you click into that and select “new” it will ask you to type in my username which is “Tos92”. From there, you should be able to write me a message and then send once you’re done. Let me know if it works!

[Milkfairy Heart Star]

Hello

Ramipril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

It's a medication used to treat high blood and heart failure.

They relax the blood vessels so usually lower your blood pressure rather than lower your heartrate.

The most common side affect of Ramipril is a dry cough.

The BHF website has this information.

bhf.org.uk/informationsuppo...

Usually coronary vasospasms are treated by calcium channel blockers such as Diltiazem, Verapamil or Amlodipine.

Long acting nitrates such as isosorbide mononitrate can help or GTN patches.

We all respond to medication differently and this can make it more difficult to find the best combination of medication that will help you best.

There is no one size fits all with treating microvascular and vasospastic angina.

It's good to hear that your Cardiologist is working with you trying different options.

I suggest you keep a diary of your symptoms and discuss how you are responding to the Ramipril when you see your Cardiologist.

I actually see my Cardiologist face to face too two or three times a year.

There is a spectrum of how people are affected by vasospastic angina.

Some have a one off episode, some are successfully treated by medication, some have their symptoms on the whole managed, then a group who don't respond to the available medication.

An important starting point is an accurate diagnosis. Vasospastic angina is usually confirmed by an angiogram using acetylcholine to see if it induces coronary vasospasms.

Adenosine and guide wires can be used to assess the function of the small blood vessels.

Has your Cardiologist offered you this type of functional testing to determine whether you have microvascular dysfunction or coronary vasospasms?

It was May 2012 that I was first admitted to hospital with suspected acute coronary syndrome. My life was turned upside down.

It's been a journey as they say!

I have had to come to terms with my altered life.

I hope you can find your way to live as well as you can with your vasospastic angina.

[Pilchard2 in reply to Milkfairy]

Thanks for replying. The cardiologist is talking about doing the angiogram you've just mentioned. We're trying the ramapril first and going from there. These past few months have been awful. It's the worst it's been. This all started off with a pericardial cyst. But there's another story to go with all the other stories in my quest for help🤣. At least I've managed to keep a sense of humor.

[Milkfairy Heart Star in reply to Pilchard2]

I had my angiogram with acetylcholine in 2014.

This type of testing is now becoming more common.

There is research evidence suggesting that it is no more risky when carried out by experienced Cardiologists in a centre of excellence.

A large study is in progress which will probably demonstrate that functional testing should be offered during an angiogram when no blockages are seen.

My angiogram with acetylcholine wasn't a pleasant experience because I had my usual chest pain and I was given morphine.

In my experience Cardiologists who lack the relevant skills and knowledge about how to do the testing over play the problems.

It is important though to take advice from an experienced Interventional Cardiologist whether this type of testing is appropriate for you.

It might be worth asking to be referred to a specialist.

However before the test I was assumed to have microvascular dysfunction, I now know I have vasospasms in my small and large coronary blood vessels.

I am unfortunately very badly affected by vasospastic angina despite the input from world leading experts in diagnosing and treating patients with microvascular and vasospastic angina here in the UK, all through the NHS.

My care improved once I had my correct diagnosis.

I have a very supportive Cardiologist who I can email for advice.

I tell him when I need to be admitted which I am once or twice a year.

I hope the Ramipril helps.

It's also important to look at your life style and see if you can manage any possible triggers.

The cold, mental, emotional and physical stress are common triggers.

You may find this website helpful. It was written by 4 patients with over 50 years of combined experience of living with microvascular and vasospastic angina.

internationalheartspasmsall...

[Pilchard2]

Thanks for the useful information. I hope my knowledge will catch up with yours one day. When I had an angiogram in 2019 it was an awful experience. I've said if ever I need another one they'll have to sedate me. I did find out that some of my veins literally went round like spaghetti junction. They weren't tree like at all. As my mum would say 'trust me to be different'. 🙂

[marypw]

I was fine on 5 mg ramipril, but when I tried increasing the dose to 7.5 and then 10 mg I felt quite unwell as you describe - bit dizzy, a bit nauseous and brain fog. I’m now trying amlodipine.

As Milkfairy says above, do keep a diary of how you feel, particularly when changing meds. We can all react very differently!

P.s. my surgery insisted that I had renal function tested when starting ramipril and when the dose was increased - so I hope you’ve had those tests done.

[Pilchard2]

I'm only on 2.5 mg and I already take Amlodipine. I think the Amlodipine is the only medication I haven't reacted too. I shall talk to the doctor about the renal test. I hope you get on OK. Thanks for your reply🙂

[Tay99]

Hi there rampril can cause palpitations 6it's one of the side effects unfortunately along with many others l had them blurry eyes headaches feeling generally unwell fatigue l stuck with them but still every now and then feel a bit rubbish on them.

[Pilchard2 in reply to Tay99]

Hi. I have to say that I feel completely rubbish on this tablet. Sometimes the side effects feel worse than the symptoms. Thanks for your reply🙂

[PeterpPiper]

taking it at night before bed usually works

[Pilchard2 in reply to PeterpPiper]

Hi. I do take it at night but feel really awful in the morning. 😊

[PeterpPiper in reply to Pilchard2]

So sorry to hear that .. I hope you get the meds sorted

[Pilchard2 in reply to PeterpPiper]

Thank you so much.

[Buckrodgers]

hi I came off ramipril as it gave me a cough.

Went on losartan

When I went on tablets I had them all at the same time, my heart rate was very low , it was by chance I spoke to a ward sister on my road and she told me to take 2 before bed and the other two first thing in the morning which sorted it out.

May b check what time each day to take them .

[Pilchard2 in reply to Buckrodgers]

Hi there. I just find it weird that my heart rate has been normal prior to this tablet. Hope to get some answers tomorrow. 😊

[lisburb]

I'm on Ramapril, took me a while to get used to it. I dont have the same condition as yourself. My pharmacist said it can take a while to adjust, however if you are having issues which are worrying you, go back to your GP. Medications work in different ways to control blood pressure. One medication does not fit all. There are other medications you can have, GP's will try you on the cheapest first. I know 2 people who were very breathless on it, worried them selves silly, then when changed to another medication, it solved that issue. Good luck with tomorrow, do as I do write everything down before you go, I always forget.

[Pilchard2 in reply to lisburb]

Hi. I tried numerous meds. My blood pressure and heart rate were normal before I started the ramapril. Now they are both all over the place. I'm seeing the doctor tomorrow so hope to sort it out.Thanks for your reply🙂

[Auiron]

I have been on Ramipril for about 15 months and also take Amlodipine and have taken that for over 20 years. 10mg Ramipril was added as 10mg Amlodipine was not working well anymore.

nhs.uk/medicines/ramipril/s...

A few months after taking Ramipril, that did reduce my blood pressure, my feet and ankles were no longer swollen and that remains the case.

I experienced leg pain at night in the lower legs though my doctor was dismissive of it being caused by Ramipril. My Simvastatin was changed to Rosuvastatin though this only reduced the leg pain and I sometimes use freezer spray.

[Pilchard2 in reply to Auiron]

Not getting on well with this at all. It's funny you should mention leg pain as I've noticed pain in the tops of my legs. 🤔. Thanks for replying

[Ellester]

Hi, i was put on this med. After my heart attack. I had a cough for 4 weeks, came off but had the cough for 4 more weeks as it effected my respiration.

[Pilchard2 in reply to Ellester]

Hi. It amazes me how one tablet can affect people in so many different ways. I'll either start to feel better soon or I'll be trying something else. Thanks for replying 🙂

[Scroll]

Had a HA and a stent fitted now on max dose of Ramipril, 10mg. Was slowly built up initially. Reviewed after 2 weeks before each increase.

Heart rate dips to mid 40s when sleeping, resting is around 51 to 54, it can lower your blood pressure that can lead to woozy feelings when you stand up etc, why it is usually given gradually monitoring its effects.

[Pilchard2 in reply to Scroll]

Hi. My blood pressure has remained normal buy my heart rate hasn't. The last 3 meds I've tried have all had servere side effects. I'm beginning to feel uneasy about trying new ones now. Hay hoo🙂. Thanks for your reply

[wischo]

My current heartrate is 50bpm while writing this reply, and my cardiologist reduced my dose of Ramipril from 7.5mg to 5mg 10 days ago. Prior to the dose reduction my resting heartrate would drop to as low as 42bpm so not sure what is going on. My cardiologist said Ramipril do not reduce heartrate even though he reduced my doseage and it appears to have increased my heartrate for now.

[Pilchard2 in reply to wischo]

Hi. This tablet has definitely affected my heart rate. I've been taking readings before and after I started. Heart rate was always constant before. 🤔. Thanks for your reply

[Mater123]

Hi there I take it at nite in bed as it makes me dizzy and unable to function well too

[Pilchard2 in reply to Mater123]

Hi. It's the next day all day I feel bad. Still early days. 😊