Other drugs to prolong valve problems

[lynnebhunt]

Hi everyone --

I'm new to this website and have gotten a lot of great information reading everyone's postings.

I recently have been diagnosed with an aortic valve problem - regurgitation. The doctors say it isn't bad now and no heart enlargement, so for now we are monitoring it. I also have been having palpitations from various arrhythmias which they say are benign and not much to be done.

I was put on Lipitor as well, because a "speck" of plaque was found in my aorta. I could not tolerate the Lipitor. Then I was put on a very low does of a beta blocker (Toporol) to lower my blood pressure, since it isn't always high, but it's been somewhat erratic. The cardiologist also put me on Altace because he says studies have shown that this will slow the progress of heart enlargement.

Does anyone have any experience with taking these drugs to treat aortic valve issues? I NEVER take any meds and don't tolerate them well. They are making me tired, and I feel worse since I've been on these, although my heart doesn't seem to be racing as much and my blood pressure has been lowered.

The doctor wants to try the meds for awhile, although my tendancy is NOT to take anything I don't need. I've done some research on my own, but would like to hear your experiences if anyone has taken any drugs.

Thanks!

Lynne H

 

[Ross]

Hello and welcome aboard. I moved you to your own thread so as to get more answers.

All of what you are on is common in treating the problem. I would however, warn you about Altace. If your feeling poorly, it is most likely the reason why. Many people have problems with it. You may ask your Doctor about something else other then it.

Others will be along to make more suggestions.

Welcome to the group

 

[lynnebhunt]

Thanks to Ross

Thanks to Ross

Hello and welcome aboard. I moved you to your own thread so as to get more answers.

All of what you are on is common in treating the problem. I would however, warn you about Altace. If your feeling poorly, it is most likely the reason why. Many people have problems with it. You may ask your Doctor about something else other then it.

Others will be along to make more suggestions.

Welcome to the group

Hey -- thanks for moving me. I was having trouble starting a new thread, but I think I figured it out now. We'll see what others say.

Lynne

 

[Harpoon]

There are a number of REALLY good medications for treating heart related issues that have mininmal side-effects. The trick for you may be in finding the right ones to take that have the least impact on your apparent increased sensitivity but these are NECCESARY medications, not something that you can take as you please (or not please.)


The big advantage to these kinds of drugs is in how the support the heart which can delay the need for major surgery. However, you have to take them as prescribed, regularly and without fail. It's better to feel lousy because of a certain medication, tell your doctor right away about it (obviously), and stay on it until he says otherwise than to go off a drug you've already been on which may make your heart situation worse.

Most people that are on heart medications and get taken off of them are weened off unless another medication is replacing the one being taken away. That process of weening is important because the heart needs to be able to adapt to working without the help of the medication.

Talk to your doctor about your concerns. There are a lot of good meds out there that treat the same problems in different ways, it's just a matter of finding the right combination for you.

 

[Rush20]

I had AVR about 1.5 years ago. During my rehab, my Cardio placed me on a low dose of Toprol XL to help with random heart palpitations. He eventually weaned me off all medications expect for the Coumadin which I will take for life due to my mechanical valve.

I empathize with the lethargic feelings associated with any medication that slows heart rates and blood pressure. Like you, I would rather focus on lifestyle changes to reduce bloodpressure, etc. than simply medicate.

I have been off the Toprol XL since last July and have noticed less general fatigue - especially during the afternoon. I feel very well and have really cut back on the high octane coffee.

 

[gadgetman]

I'll let you go to some of my long posts about my experience with Altace. If you feel short of breath, hard to get a deep breath, loss of energy, feel like your tongue and/or lips are swelling, let your Doctor know immediately. There are other meds out there to help blood pressure.

Mine got so bad while I was on Altace I could only take 5 or 6 steps before having to stop to get my breath. And I was thirsty all the time.

 

[lynnebhunt]

Thanks for the info!

Thanks for the info!

thanks to all of you that have responded so far!

Lynne

 

[labguides]

Our daughter took Altace for about a year prior to her mitral valve repair (Jan 03). Her cardio was hoping to postpone surgery in hopes that new advances would be made before she needed surgery. She started with a low dosage and tha was gradually increased to a high dosage. She had NO problems with Altace. The warning was do NOT get pregnant while taking Altace.

 

[ken]

Aortic regurgitation/insufficiency is usually extremely slow moving & if yours is a simple AI with your heart not enlarged & your BP is normal you could easily be looking at 10 to 15+ years before you require surgery.

Altace (ramipril) http://www.altace.com/ is an ace inhibitor & is almost certainly causing the shortness of breath & tiredness you are experiencing. It is equally almost certain that all the other ace inhibitors (see list below) will cause you the same problems. I am assuming your doctor is competent & started you on the lowest dose available. If not I suggest you speak to him about stopping the Altace completely for one week ( there is no risk as ace inhibitors do not need to be stopped gradually) & then try starting back at the lowest dose for 2 weeks & titrating up from there.

Beta blockers are notorious for causing tiredness. I do not understand if your heart is not enlarged and your BP is normal why you would be on both an ACE & a beta blocker. I would seriously consider asking your doctor to take you off the beta blocker and even get a 2nd opinion no matter what from another doctor - I presume your doctor is a cardiologist?

Alternatively:

I suggest you try the 2nd generation of these drugs called ARBS -Angiotension II receptor blockers & specifically recommend Cozaar (see LIFE study below) starting at 25mg x 1 per day for 2 weeks & then titrating to 25mg x 2 per day. You should not need to go higher than 50mg per day.

If you do get a breathing problem or excessive tiredness from the Cozaar then that means you are also allergic to this class of drug.

If it turns out you are not able to tolerate any of these drugs & you do not have high BP it is just not worth being miserable to force take them & you should discuss with your doctor stopping all medication.
_______________________________________________
Cozaar (losartan) - LIFE study:

LIFE (Losartan Intervention For Endpoint reduction in hypertension) study to evaluateCozaar's potential compared to beta-blockers (atenolol) in reducing cardiovasculardeaths and non-fatal heart attacks or strokes in hypertensive patients with left ventricularhypertrophy (LVH). Results, published in March 2002, suggested that whilst bothlosartan and atenolol reduced blood pressure to similar levels in the trial, patients takinglosartan had a significantly lower risk of cardiovascular death, heart attack and stroke.As a result, in March 2003, the US FDA approved Cozaar for the reduction of stroke inpatients with hypertension and LVH (although there is evidence that this benefit doesnot apply to black patients). Cozaar is the first A-II antagonist to be approved for thisindication
_______________________________________________
Ace Inhibitors
benazepril - Lotensin by Novartis
captopril - Capoten by Bristol-Myers Squibb
enalapril - Vasotec by Merck
fosinopril - Monopril by Bristol-Myers Squibb
imidapril - Not approved for human use in the USA - approved in Japan
lisinopril - Prinivil by Merck or Zestril by Astra-Zeneca
moexipril - Univasc by Schwarz Pharma
quinapril - Accupril by Pfizer
perindopril erbumine - Aceon by Rhone-Polenc Rorer
ramipril - Altace by Hoechst Marion Roussel, King Pharmaceuticals
trandolapril - Mavik by Knoll Pharmaceutical (BASF)
_______________________________________________
ARBS - Angiotension II Receptor Blockers
candesartan cilexetil - Atacand by Astra Merck
eprosartan - Teveten
irbesartan - Avapro by Sanofi
losartan - Cozaar by Merck
olmesartan medoxomil - Benicar by Sankyo Pharma
telmisartan - Micardis
valsartan - Diovan by Novartis

 

[ARossGuy]

Welcome to VR.com! In my case, my aortic regurgitation developed over about 20 years. It went from trace to mild to moderate and then to severe over this time frame. I was also on a beta blocker (Inderal) during this time for high BP. When my echo showed that I moved to moderate regurgitation, my cardiologist prescribed Procardia (niphediprene) which is a calcium channel blocker (vaso-dilator). He informed me that this will relax the blood vessels and lessen the strain on the heart and also help with the BP. He also said that there was a study in the NEJM that the use of niphediprine was shown to delay the need for surgery (i.e.would buy me more time).

I recently had surgery, the Ross Procedure (11/30/04), since my LV started to dilate due to the regurgitation. However, I believe that the drugs did help delay the progression (I was on the niphedipren for 9 years) and had been at severe for about 4 years. I know the drugs are hard to get used to, but they are prescibed to help out the heart. In some cases, you may never need surgery if the regurgitation does not progress .

--Doug

 

[lynnebhunt]

Thanks

Thanks

Aortic regurgitation/insufficiency is usually extremely slow moving & if yours is a simple AI with your heart not enlarged & your BP is normal you could easily be looking at 10 to 15+ years before you require surgery.

Altace (ramipril) http://www.altace.com/ is an ace inhibitor & is almost certainly causing the shortness of breath & tiredness you are experiencing. It is equally almost certain that all the other ace inhibitors (see list below) will cause you the same problems. I am assuming your doctor is competent & started you on the lowest dose available. If not I suggest you speak to him about stopping the Altace completely for one week ( there is no risk as ace inhibitors do not need to be stopped gradually) & then try starting back at the lowest dose for 2 weeks & titrating up from there.

Beta blockers are notorious for causing tiredness. I do not understand if your heart is not enlarged and your BP is normal why you would be on both an ACE & a beta blocker. I would seriously consider asking your doctor to take you off the beta blocker and even get a 2nd opinion no matter what from another doctor - I presume your doctor is a cardiologist?

Alternatively:

I suggest you try the 2nd generation of these drugs called ARBS -Angiotension II receptor blockers & specifically recommend Cozaar (see LIFE study below) starting at 25mg x 1 per day for 2 weeks & then titrating to 25mg x 2 per day. You should not need to go higher than 50mg per day.

If you do get a breathing problem or excessive tiredness from the Cozaar then that means you are also allergic to this class of drug.

If it turns out you are not able to tolerate any of these drugs & you do not have high BP it is just not worth being miserable to force take them & you should discuss with your doctor stopping all medication.
_______________________________________________
Cozaar (losartan) - LIFE study:

LIFE (Losartan Intervention For Endpoint reduction in hypertension) study to evaluateCozaar's potential compared to beta-blockers (atenolol) in reducing cardiovasculardeaths and non-fatal heart attacks or strokes in hypertensive patients with left ventricularhypertrophy (LVH). Results, published in March 2002, suggested that whilst bothlosartan and atenolol reduced blood pressure to similar levels in the trial, patients takinglosartan had a significantly lower risk of cardiovascular death, heart attack and stroke.As a result, in March 2003, the US FDA approved Cozaar for the reduction of stroke inpatients with hypertension and LVH (although there is evidence that this benefit doesnot apply to black patients). Cozaar is the first A-II antagonist to be approved for thisindication
_______________________________________________
Ace Inhibitors
benazepril - Lotensin by Novartis
captopril - Capoten by Bristol-Myers Squibb
enalapril - Vasotec by Merck
fosinopril - Monopril by Bristol-Myers Squibb
imidapril - Not approved for human use in the USA - approved in Japan
lisinopril - Prinivil by Merck or Zestril by Astra-Zeneca
moexipril - Univasc by Schwarz Pharma
quinapril - Accupril by Pfizer
perindopril erbumine - Aceon by Rhone-Polenc Rorer
ramipril - Altace by Hoechst Marion Roussel, King Pharmaceuticals
trandolapril - Mavik by Knoll Pharmaceutical (BASF)
_______________________________________________
ARBS - Angiotension II Receptor Blockers
candesartan cilexetil - Atacand by Astra Merck
eprosartan - Teveten
irbesartan - Avapro by Sanofi
losartan - Cozaar by Merck
olmesartan medoxomil - Benicar by Sankyo Pharma
telmisartan - Micardis
valsartan - Diovan by Novartis

Thank you SOOOO much for this information. It is very helpful.

Lynne

 

[lynnebhunt]

thanks

thanks

Welcome to VR.com! In my case, my aortic regurgitation developed over about 20 years. It went from trace to mild to moderate and then to severe over this time frame. I was also on a beta blocker (Inderal) during this time for high BP. When my echo showed that I moved to moderate regurgitation, my cardiologist prescribed Procardia (niphediprene) which is a calcium channel blocker (vaso-dilator). He informed me that this will relax the blood vessels and lessen the strain on the heart and also help with the BP. He also said that there was a study in the NEJM that the use of niphediprine was shown to delay the need for surgery (i.e.would buy me more time).

I recently had surgery, the Ross Procedure (11/30/04), since my LV started to dilate due to the regurgitation. However, I believe that the drugs did help delay the progression (I was on the niphedipren for 9 years) and had been at severe for about 4 years. I know the drugs are hard to get used to, but they are prescibed to help out the heart. In some cases, you may never need surgery if the regurgitation does not progress .

--Doug

thanks so much for this information!

lynne

 

[McCln]

Lynn, what the meds try to do is to slow the progression, not to cure the problem. Just take the meds for as long as you can, the doctors are trying to keep you from having surgery for as long as they can. At least, they are doing something. Good luck and keep us posted.

 

[lynnebhunt]

Update

Update

Lynn, what the meds try to do is to slow the progression, not to cure the problem. Just take the meds for as long as you can, the doctors are trying to keep you from having surgery for as long as they can. At least, they are doing something. Good luck and keep us posted.

Hi Everyone --

Thanks for all of your information. Today, for the second time, I almost passed out. Last week, it was driving home and today, my husband had to cart me out of church because I just about keeled over. We came home and took my BP and it was 111/64! Yipes. I'm dizzy all the time. I've been on these 2 meds for over a week now.

I will call my cardio tomorrow because these two meds I'm on are NOT working for me. I am tired, dizzy, nauseated, have worse palpitations than ever, can't sleep at night, am thirsty and hungry all the time and gained 5 pounds in a week. Plus headaches. I'm on such a low dose of Toporol (12.5) and Altace, 2.5 -- but I must not be able to handle them. It is very scary.

Lynne

 

[Rebecca]

I?ve had moderate aortic regurgitation/insufficiency with some heart enlargement for almost ten years. Four years ago I was put on procardia a (niphediprene) 30MG for high blood pressure. The doctor slowly up my procardia meds. to 60MG then to 90MG. At 90Mg I had elephant thighs, chest pressure and chest pain. My cardiologist at that time had dropped my HMO. My new cardiogist change my meds. to Diovan HCT 160/12.5 . Five months ago my cardiogist added procardia 30MG. At the end of March I go back for another echo. My cardiogist wants my blood pressure as low as I can tolerate. Over the last ten years my echo numbers have went up and down. With my next upcoming echo I will find out if the added procardia has improved my numbers.

 

[SHerrin Hutt]

Weclome to a great sight and a great bunch of people.
I had mitri valve problem and irr. heart beat. But I could not take any kind of Beta Blocker. They caused all kind of problems. I have asthma and that doesn't help much. I was on procarda about 10yrs while I was teaching and it effected me so bad I couldn't even stay wake couple hrs. after I took it, I was like a zombie.
I want to welcome you again!!!!!

 

[lynnebhunt]

Weclome to a great sight and a great bunch of people.
I had mitri valve problem and irr. heart beat. But I could not take any kind of Beta Blocker. They caused all kind of problems. I have asthma and that doesn't help much. I was on procarda about 10yrs while I was teaching and it effected me so bad I couldn't even stay wake couple hrs. after I took it, I was like a zombie.
I want to welcome you again!!!!!

Thanks!

I have stopped taking everything temporarily and feel much better.

I have more appointments coming up, so we'll see what they want to do next. I'm printing out some of all of your answers to me so I can remember what to ask.

Lynne

 

[KimC]

Question for Ken

Question for Ken

Ken,

I have AI with sclerosis and started Cardizem LA after a few trials of other CCB's for chest discomfort. The drug definitely provided benefits initially, but by the third month I started having severe night sweats with a pounding heart rate and sometimes chest pain. My doc diagnosed me w/ angina decubitis, and put me on lisinopril. I elected to stop taking the CCB, and started the ACE. Two weeks later, I'm experiencing renewed energy and no night sweats. I still have chest discomfort which I treat w/ nitro as needed.

Here's my question for anyone willing to offer an answer ... is it possible that the Cardizem was causing angina decubitis ... or did the lisinopril relieve it? My HR and BP are low. (I was a runner for 20 years).



Many thanks,