Diltiazem - advice please

[AngelRain]

I have vasospastic angina and have managed with GTN only for the six years since diagnosis. GTN seems to be less effective than it was. The consultant I saw on 30 December believes I may be becoming resistant and prescribed 60mg of slow release Diltiazem. He gave me specific instructions to take it at 9pm every night and to stop taking it immediately if my systolic BP drops below 100.

I was ready to take the first tablet on Friday night but thought it would be a good idea to check my BP before I did so that I would have a baseline. It was 95/57, which is not unusual for me in the evening, so I didn't take a tablet.

I tried again last night and my BP was 105/67. I wasn't sure what to do. I know that Diltiazem is basically a BP medication and I was concerned that if my systolic was already only 105, that it might reduce still further.

I don't know what to do. It's as simple as that. I'm not due to see the consultant again until the end of March and there is no support forthcoming from my GP (another long story). Do I just bite the bullet, take a tablet and see what happens, or do I need to speak to someone now?

Thanks

[sandandkev]

Hi I take diltiazem instead of gtn as get angina when walking, it gives me a freer life. I have cad and was in af

[Poppy451]

I take diltaizem morning and night for microvascular angina. My blood preassure is allways 90/60 but the cardiologists have allways prescribed it. In the past I also took nicorandil maybe because the addition of that would not further effect my bp. I am due for a consultation in a few weeks. Maybe give the BHF nurses a ring and see what they advise.

[AngelRain in reply to Poppy451]

Good call. Thank you.

[AngelRain]

My BP tonight came back at 105/57.

[Milkfairy Heart Star]

Did your Cardiologist offer you any further tests to confirm your diagnosis?

There is growing evidence that nitrates are not as affective in treating people living with microvascular angina.

I was originally presumed to have microvascular angina, until I had an angiogram with acetylcholine which confirmed my diagnosis of vasospastic angina.

Knowing whether you have microvascular or vasospastic angina can help your Cardiologist prescribe the medication that may help you best.

We're all certainly different.

I am at the moment on my winter dose of 360mgs of Diltiazem, twice a day.

Many years ago, I was prescribed a very small dose of Candesartin. My BP was monitored by an ambulatory BP machine at home.

My BP dropped to 80/ 40 after one tablet.

I felt awful.

When I am in hospital on IV GTN my diastolic BP has to be above 60.

I find drinking water helps raise my BP.

If you feel unwell and your BP stays low, I suggest you contact your Cardiologist.

There are alternate calcium channel blockers that you can be offered such as Amlodipine or Verapamil.

[AngelRain]

Thanks. No tests at the moment, but he said I might need an angiogram in the future. I do feel however that my diagnosis was based simply on - you have no blockages but you're still getting the chest pain!As always, I feel absolutely fine but yes, I think I might have to contact the cardiologist to ask if it is actually safe to take this medication.

[AngelRain]

102/60 tonight

[AngelRain]

I've e mailed the consultant's secretary, but sadly no response at all.

[AngelRain]

E consult with GP today. They advise me not to take the Diltiazem and they will contact the consultant. No timescale, so I wait - again.

[AngelRain]

The consultant has now advised that I should start the Diltiazem and only stop it if my systolic blood pressure drops below 80 or I experience dizziness. He's moved the goalposts. It was 100 before.

Does anyone have any experience of this?

Thanks

[Milkfairy Heart Star in reply to AngelRain]

Do you feel the Cardiologist is knowledgeable about vasospastic angina? Have they offered you any tests to confirm your diagnosis?

When I am in hospital on IV GTN my diastolic BP has to be no lower than 60mmHg.

The criteria has changed overtime as I didn't have any symptoms.

[AngelRain]

He seems to be knowledgeable. He's worked with the team at the Royal Brompton and others in our area with the same diagnosis seem happy with him. He thinks I may need an angiogram at some point to check for blockages any cholesterol is higher than he would like, but my diagnosis was basically a diagnosis of exclusion. My diastolic is sometimes lower than 60 anyway

[Milkfairy Heart Star in reply to AngelRain]

I was originally given a diagnosis of exclusion, from a well known Cardiologist at the Royal Brompton.He completely missed my vasospastic angina and even when I took my angiogram with acetylcholine results to show him, he refused to acknowledge he had got it wrong!

I was presumed to have microvascular angina even prescribed beta blockers as a result.

I ended up in hospital with unstable angina.

I transferred my care elsewhere.

One of the best expert Cardiologists is at St Thomas's Hospital. He is totally dedicated to research and doesn't see any private patients.

You might be interested in this post?

healthunlocked.com/bhf/post....

[AngelRain]

Thanks. I have completed the survey.

[AngelRain]

Finally started taking this on Monday, so I am 4 x 60mg in. Feeling awful. Constant headache, exhausted, light headed (keep losing my balance), some ankle swelling, heart rate is noticeably dropping, and at the last count BP was 84/57. Will any of this get better as I get used to the medication? Thanks