I am a 57 year old woman, and had an Nstemi 10 weeks ago, and one stent fitted. I am on 2.5 bisoprolol, tricagrelor, 10 of ramipril, 80 statins and also aspirin. My ejection fraction was poor at 45 (which I found a bit upsetting when it transpired I was the lowest in the rehab class) I was on HRT before my attack, and have reduced that hugely to one pump of oestrogel whilst I wait for my consultant to get and answer back from my cardiologist to see if I can remain on it.
My ramipril was bumped up each week until I reached the maximum. Each time it was increased I felt very tired and ill, then the feeling would go after a few days. My blood pressure and heart rate and kidneys are all fine.
My question is, since the last time it was increased, I just haven’t bounced back. I feel exhausted, and listless, and a bit breathless. I have spoken to the cardiac nurse about this at re-hab, but she says that my tiredness is not a reaction from the meds, as other wise I would have had this from the start, however I feel I have had this from the start, going up and down. I just don’t know what to do, I really really want to do the right thing by my heart, but I feel I can’t go on feeling this awful. I can remember a couple of weeks ago before the last medicine increase, I actually had my first couple of days where I felt totally normal since my attack, and now things are pretty awful.
I guess I am either hoping for advice, or just someone to tell my it is normal to take this long and still feel this bad. I had hoped after 10 weeks I would be feeling a bit more normal. I work for myself, and I can’t seem to manage to work more than a couple of hours a day. Feeling very old and ill.
Written by
Pinksock2
To view profiles and participate in discussions please or .
Just an initial thought as a man who's wife has and still is going through quite a challenging (HRT wise) menopause, why have you dropped the oestrogel?
I understand some GP's/Cardiologists/consultants are paranoid about HRT medication generally but in your case why do they (you?) think it has contributed to a progressive disease that will have started donkeys years before you went on HRT?
Maybe the current lack of it is responsible for a lot of your current problems, particularly if you are on 2.5mg of bisoprolol. also, I don't think your EF is particularly bad at 45.
Have you asked any of the medics what exactly in the problem in continuing with your HRT medication post HA and stent, especially if your BP is being controlled?
I am sure you are going through an awful time but the problem might seem relatively obvious? I hope you can get your questions answered as I think woman have been ignored for far too long regarding this, many of the GP's my wife has spoken to just make statements without seeming to know any of the reasons behind them!
I think that if ramipril is the cause of your symptoms it would be demonstrated by too low a BP,too high a potassium level and too high a BUN and creatinine. Low left ventricular ejection fraction and side effect of beta blocker (bisoprolol) are possible causes. In view of your shortness of breath,should you be taking a diuretic? Any tendency toward edema? Weight gain? Are you restricting salt use by not adding it at the table and avoiding obviously salty foods?
With respect I think you might need to have a look at the BHF guidelines as regards offering medical advice, are you medically trained by any chance or are you just regurgitating information haphazardly?
I practiced internal medicine and clinical cardiology in the US for 43 years. I joined this forum primarily because in my old age I developed significant atrial& ventricular irritability and severe aortic stenosis and I was interested in learning from the varied patients here more about the type of symptoms they experience and some of the current treatments in the UK. While doing so, I sense that many of the patients look for advice about their symptoms, test results&treatment. Some of them seem left hanging with no answers from their medical team. I emphasize that they discuss treatment & advice with their MDs however. I mostly try to explain. Yours is the first criticism I've received. I'll try to come on less strong but still try to be helpful.
This is peer to peer support group.In the UK registered healthcare professionals are advised to take great care when giving professional advice on forums.
I have been very careful in my advice. You can imagine the angst&anxiety people experience when they have concerning and scary symptoms such as frequent palpitations or types of chest distress and not get results of their cardiac monitor or other studies after 6 weeks of waiting and no appointments with a cardiologist for 2 months or more in the future. Of course it's ideal to get needed advice or reassurance from their physicians who know them best but I empathize greatly with the people who are left up in the air about their status ,many of whom who have thanked me for my replies to them stating they have been helpful.
Yes. I agree, stentsandrun. think you are right to remind bluemoon about the guidelines. It is irrelevant whether a member was a medical professional or not, we all agree to follow the same guidelines. I also agree with bluemoon that particularly here in UK NHS is really struggling and ‘people are left hanging with no answers’. So it can be tempting to step in, I’m sure.
no deems thank goodness, and the surging staff say no need to reduce salt below the level I am currently at, as no high blood pressure. Does that sound like it makes sense? I have put half a stone on since the attack as I feel so low in energy, which is not very helpful.
Hi, maybe that latest increase of meds just doesn't suit you. I'd discuss with dr and see if you can go back to the previous dose and see if how you feel improves again.As far as what other people say, you know your body best. You know when feelings started and how it fluctuates, so don't let other people make you question yourself. That's one thing I'm learning with all the after effects of my HA.
Estrogen is a blood thickener. It fights against the asprin/tricagrelor mix. Asprin brufen garlic onions leeks are. blood thinners
The tricagrelor is anti platelet
As for feeling tired comes with the territory, most likely the bisoprasole . Have a word with gp. I hope you get a cardiologist follow up pretty soon usually 3 months in.
Im 20 month in only at 38%. Was 25% post stemi.
Also i noted others commented low bp . Should be no lower than 90/60 thats a too much Ramiprill. The statins are to lower cholesterol .prolonged Atorvastatin upsets my stomach ( i have diverticulitis as well) .
You need to get your facts sorted before you start making statements such as "oestrogen" is a blood thickener. I presume you meant oestrogen, Estrogen is the naturally occurring hormone in a woman's body. I think what you think you meant was that oestrogen can cause the lining of the womb to thicken, which was a possibility years ago but very much less risk now. Have a look at Dr Newson's factsheet, she is a well respected specialist. Could you provide evidence that it is a "blood thickener" please? And by the way what is bisoprasole?? Do you mean Bisoprolol by any chance? Your comment regarding blood pressure, apart from being incorrect (it is subjective) are against forum guidelines as they fall under the category of providing medical guidance, are you medically qualified at all? Certainly doesn't sound like it!
The hormone estrogen can raise the risk of developing blood clots. Changes in estrogen levels can come from some types of birth control, pregnancy or hormone replacement therapy (HRT). Penn medicine.
My comments on bp is from nhs where is where it states Low blood pressure is a reading of less than 90/60mmHg.
And yes bisopralol.
I would be very careful with your statements as it’s against forum guidelines
Penn Medicine, Mmmm, I would stick to recent UK based information if I were you. I presume you are passing on Menopause information from your wife (why else would a man be informed on it), in which case I suggest she looks at later thinking and research, there is a lot of bad information surrounding this, even a lot of GP's have outdated information and attitudes. Modern Oestrogen is now manufactured from plant based materials and the risk of blood clot is much lower. What you need to understand is that when a woman is suffering the effects of menopause she is far less likely to undertake exercise and even everyday activities, as may be the case with the lady in question, which will be far more of a threat to her health and recovery than a slight clot risk. As I said look at the information in the link I sent you, your information is outdated.
And by the way could you please point out where I have made any statement that is against forum guidelines? I am stating and referencing facts, you are actually giving medical guidance regarding blood pressure and drug doses!
Just a thought - my husband felt breathless from pretty much the first week of taking the meds. After around 7 months the Ticagrelor was swapped out for Clopidogrel and that helped his symptoms. His bisoprolol was stopped a month later as his heart rate was low and he feels much better as a result (particularly when starting his jog which he's now doing almost daily).
I can only speak from my own experience. I had a HA in 2019, my EF is only 25-30 so yours is very good. I have been on HRT for over 30 years and I continued to take it after the HA, my choice. I tried Statins but stopped them because of side effects. Do some research and discuss what is best for you. I have certainly found that one size doesn’t fit all.
All I can say is that after my HA I had so many problems with the meds that gradually my GP either changed or stopped all of them. My worst culprit was bisopralol which knocked me for six. I struggled with my breathing on ticagrelor, atorvastatin crucified my stomach but simvastatin was fine. Your EF sounds slightly low but your cholesterol must be high to be on such a high dose. Maybe get your GP to look at each med in turn or if he doesn't feel qualified he can ask the cardiologist. I would carry on with the HRT unless someone gives you an absolute NO plus reasons for saying that
I think half the problem is that mentally you believe you are doing poorly which affects your physical health. 45% EF is pretty good. Mine was the same. Anything above 50/60% is considered perfectly normal.
I wonder if you are susceptible to either asthma or hay fever as both of those may have kicked in during the last 10 weeks as we have moved into summer. 10 of Ramipril seems high and its said by many on this board to knock them sideways. Perhaps you could get this reduced or replaced? A chat with the pharmacist might be useful, rather than the GP who could assess the likely effects of the various medicines you take and the quantities
After my quad I felt very sorry for myself until about week 6. I gradually grew in confidence and started driving again about week 10. I decided to fly last October-an easy one to Guernsey- to test the water and then to Austria a few months later.
Just got back from 3 nights in Penzance.
I wonder if you need to push yourself a little-after taking advice- to see what you are capable of?
I don’t believe the cardiac nurse was correct in stating that the meds are not the problem. My own experience is that when my Ramapril was increased, I felt extremely tired and unable to do anything but rest and it was reduced again. Bisoprorol caused me a great problem in that it reduced my pulse rate far too low and I had to go to A/E, where it was found I had raised troponin levels and eventually had to come off it entirely. What I am trying to say is that everyone reacts differently to medications and it can take along time to get it right. Quality of life is extremely important and I think you should speak to your doctor about reviewing your meds. I wish you luck.
We would always ask that members of the community avoid giving advice on medication or other lifestyle changes, for more detail on this please take a look at the BHF’s community guidelines: healthunlocked.com/bhf/post...
I had a triple bp 16 months ago. It seems common policy to get you on the maximum dose of most meds. I stuck it for about 5 months and couldn't stand the fatigue. I've seen my GP to get some of them reduced which he has. I feel quite a lot better now, I still feel tired sometimes but it's probably the best it's going to get.
So sorry to hear that you are not feeling your best at the moment, I hope you begin to feel better in the not too distant future. Potentially the dropping of your HRT dosage may not be helping with your overall feeling of well-being. I have friends who have changed their doses and changed brands and it has certainly made them feel dreadful. Dr Louise Newson is someone who is an expert on HRT and as a GP is well placed to look at the benefits and drawbacks of HRT it’s relationship with other health issues. There’s also an American Doctor called Marie Claire Haver who is also an expert on menopause and how the process can take its toll on the female body including issues with the heart and BP.
I have had significantly high blood pressure and ended up in A&E after waking up with palpitations one night last March. I went through different brands of medications, one of which was Ramipril. It lowered my BP but I never felt well on it and it certainly increased my anxiety about what was happening to me - in terms of palpitations, SVT and sky high blood pressure. I changed to another BP med and the feelings I f anxiety and tiredness subsided.
For some moral support - I had what I was told was a "big" HA in 2020 (12th July - I remember it well, I was getting going for running that morning with the park run group). Apparently had I not got help as quickly as I did I wouldn't be here. I was 51 at the time. I was whipped in to Barts hospital where my LAD was stented. It was 100% blocked. My EF was 45% in the aftermath. I was told that it was "pretty good given the 'size' of the HA". They said that with big events like mine they see EFs typically at 30%, sometimes 25% which is heart failure territory. Mine has since recovered to around 50%. My last consultation with the cardiologist 18 months ago (I'm now discharged) I asked whether my EF would recover back to nearer 60% which is considered normal (our hearts are not very efficient so I was told). The answer was "probably not, but it doesn't really matter whether your EF is 50% or 60%, what matters is heart function, which in your case is fine". So he wasn't concerned that my EF is a bit less than normal and will probably remain that way.
I'm on the same cocktail of meds as you, although some lower doses. Bisporolol 2.5, Ramipril 2.5, Aspirin 75, Atovastatin 80, Lansoprazole 30. I came off Ticagrelor a year ago and the bruising I was getting in the most inexplicable places has since gone away - hooray! I feel pretty normal and don't get the tiredness that you report, but did in the immediate weeks after the HA. So it could still be early days for you. I am back to running and did the Great South in Portsmouth last October. It was unfinished business because I'd put in for it in 2020. My HA remains unexplained - they told me that occasionally they see a case that can't be explained and mine is probably one of them.
I hope this helps, and I wouldn't worry too much about your EF.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Ramipril side effects 
Sudden drop in EF
Feeling a lot lot better!!
feeling not quite right at the moment 
