Chronicles of the Heart, Part 39 – tweaking the new meds…

The new meds, as per Chronicles 38, are a beta-blocker (Nebivolol), and a calcium channel blocker (Adizem).

Now, until my GP stopped my calcium channel blocker about March last year, claiming they were a danger in heart failure (I checked, they are), I’d taken this class of drug for about 10-12 years, without it having the slightest effect on my chronic tachycardia. It did, though, via the same mechanism that relaxes the smooth muscle of the vascular system, reducing the risk of angina, improve my breathing quite considerably, as it also acts on the smooth muscle of the bronchi.

My chronic tachycardia – and I have yet to meet a cardiologist, physician, or nurse, who can actually grasp this – is not pathological, it’s drug-induced. Both my Salbutamol inhaler (Ventolin), and Phyllocontin Continus, cause tachycardia, possibly others do too, I haven’t checked. It’s not a secret, it’s in the literature, so why don’t they know this (or, if they know, why don’t they care?).

So it was with some trepidation that I embarked on this new meds regime to bring my heart rate down, I have, after all, lived with a resting heart rate of between 95 and 120 bpm for many years, even when I was super-fit and extremely active it was 120, and it appears to have done me no harm. I did, though, once ask my GP if hammering along at this rate would cause my heart to “wear out” prematurely, to which he’d only say that it was an interesting idea.

But here’s a thought. I have been obsessed – I think that’s a fair description – with the question of why I went into hospital in January 2011 with an apparently healthy heart, and came out a virtual basket case – this is my theory.

Suppose I was right about the more or less permanent tachycardia “wearing out” my heart? When I developed pneumonia, and more particularly empyema, that would have caused considerable back-pressure in my pulmonary circulation due to the difficulty of forcing blood through congested and damaged lungs, putting a lot of strain on my heart – was that simply the last straw that  triggered my heart failure, making the normally minor problem of aortic valve calcification and stenosis into a life-threatening condition, and that is otherwise inexplicable?

Makes sense to me. After all, the heart is just a cluster of muscles, and any muscle can be over-stressed and damaged.

So, in the absence of any other suggestions from people who should know more than me about it, I’m going with this theory.

So at 06.00 today, I took the Adizem. By 09.00, as expected, the effect on my tachycardia was minimal – a drop of a mere 7bpm (down from 95).

At 10.00 I took the Nebivolol. Now, at almost 13.00, I’m tipped into bradycardia (low heart rate), at 63bpm. This will bear watching.

However, the strength of my heartbeat is considerably improved and given a choice, I think a somewhat slow but very much stronger heartbeat (the latter is what I wanted from Digoxin), is preferable to one which is faster but very weak (there’s a bar indicator on my pulse oximeter – normally it’s very small and bobs up and down rapidly, but now I have almost the full bar – I can’t see any way that’s not good).

Isn’t this fun, boys and girls?

I don’t feel unduly light-headed, despite the bradycardia (no more than normal!), but this does mean that I have no scope for introducing Digoxin into the mix.

On the plus side, the persistent, uncontrollable coughing (I got through 2 weeks supply of codeine linctus in 4 days), has gone, and other problems caused by Candesartan/Losartan are on the wane.

And my breathing is better than it’s been since this seemingly never-ending “crisis” began so, tentatively, I’m chalking this up as a win. However, if the bradycardia continues, or even worsens, then the dose of Nebivolol will have to be reduced. Currently I’m taking 2.5 mg.

In fact, I’ve just noticed that the Nebivolol tablets are scored, so once more I’m going to take matters into my own hands.

That’s because if I go back to my GP with this bradycardia problem, he’ll respond by stopping the Adizem (which he really doesn’t want me to take), and the 7bpm it contributes to the problem will bring me up to an almost normal 70bpm – in theory, at least. However, as my breathing is greatly improved by the Adizem, that’s a risk I’m not willing to take.

So what I’m going to do is reduce the Nebivolol by 50%. That, plus the Adizem, should bring my heart rate down to the mid 70s, not too high, and definitely not too low.

Looks like a plan to me.

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9 thoughts on “Chronicles of the Heart, Part 39 – tweaking the new meds…

  1. Hi Ron,
    Just found you in the my junk mail! why? I dont know. Been topped up with blood, 2 units for a bleed and it was’nt an ulcer! Nice to know your feeling well, so get on your scooter/wheelie and get snapping, weather permitting. So good luck and good hunting. All my recent posts went into cosmic void, lost in the web, hope this one makes It. Keep up the good work.

    Fred.

    • Getting there.

      The Nebivolol tablets cut cleanly, so I can get an accurate half-dose tomorrow, just as well as, this afternoon, depression nearly wiped me out. And guess what? Nebivolol causes depression! Just what I don’t need but, hopefully, halving the dose might fix that.

      We’ll see what tomorrow brings.

  2. WOW Ron! bit of good news for you:) bout time!
    Ive just been told I have diabetes type 2!!! Cholesterol 6.4..BP 170/98. blood sugar 6.7!!!! only got these results because I pressured my GP, fed up with him fobbing me off! My BP has been high for long time, and because of heart artery disease should have had blood tests done every month but, GP not bothered!!! I had 3 appointments with nurse to fill in forms for my blood test, but, she was ill or away each time and when I asked GP, he said make another appointment!!!! He gave me Metformin 500mg twice a day..information says:.not to be taken if any heart problems!!?? I take Lisiniprol for bp, so he has given me Amlodipine 5mg. to take as well. No advice on what I should do etc., Its really shook me up and Ive been reading up on diabetes and not good! Any info you know about it?
    Knew I werent well lol
    Darcy.

    • Hi Darcy,

      That’s a bugger, but the good news is it’s controllable, often just by diet, without drugs.

      I’ve been given a drug that’s not supposed to be taken in heart failure, but I know from experience – I took it for months last year before my GP decided to panic and stop it – I’ll be fine. You might well be OK with the Metformin, but you might not be, so go back to your GP, and show him the information – he might not know.

      Sorry, I know very little about Type 2 diabetes but try these people

      http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/What_is_diabetes/What-is-Type-2-diabetes/

      and these

      http://www.diabetes.co.uk/type2-diabetes.html

      Both have information on Type 2 diabetes.

      Ron.

    • Darcy i’m type 2 diabetic on diet only. 6.7 blood sugar is within limits. anything above 7 is classed as type 2. Cholesterol 6.4. is a bit high so need to work on lowering that. use Benecol spread for instance. its lowering mine slowly. ask your doctor or diabetic nurse at your surgery about seeing a dietician and going on the Desmond course. this gives you an insight into diabetes and how you can keep your blood sugars within normal limits. any questions you have can be asked then too.unfortunately it might take a few months to get on the course so ask at your GP’s for booklets etc to help you as a newbie. you can attend a group one or a one to one.
      although the sites Ron mentions are excellent,(I use them myself) i found them a bit confusing at first, especially as you can get some Americans come on even though its a UK site, and confuse people because their fasting blood sugars are measured differently to us in the UK. cut out or lower sweets/cake etc although you can have a little as a treat.use sweetener instead of sugar if you need to sweeten anything and with fruit, only have as much as will sit on the palm of your hand. as that has its own sugars called fructose. i use Splenda to sweeten drinks or bake with, they say use wholegrain flours bread and cereal if poss too. and skimmed or semi skimmed milk. its all a bit scary at first i know. i also found that ,although the docs say type 2 patients don’t need to monitor the daily fasting blood sugar. NICE,who regulate meds etc and give guidelines for such things, say ALL type 2 diabetics, not just those on insulin (yes some type 2s take insulin as well as type ones. but dont worry about that. too confusing. tackle it if you ever get to that stage yourself.), should have access to monitors, test strips and lancets (to prick your finger with.) unfortunately this doesn’t happen for all. a few docs will prescribe strips but most wont,. i got a meter from the diabetes.co.uk website.(who also have a campaign going to get docs to prescribe test strips etc to all type 2 diabetics)
      you can get a kit there which includes monitor,lancets,strips etc. but you will have to buy strips & lancets once the initial few are gone. you can also buy monitors and strips etc on ebay much cheaper than elsewhere. they are expensive… another downside…but i found it invaluable to find out what affects my blood sugars, both fasting and between meals initially. i don’t use a fresh lancet every time, though your supposed to. couldn’t afford to buy those AND strips all the time.
      Hope this helps.
      Dee

      Ron sorry to take up your blog but i know what i felt like when i first found out about my diabetes. confused and well out of my depth in spite of nursing diabetics all those years ago… things are so different now. i also had to get all the old ways out of my head before i could make sense of the new.

  3. Hi Ron,
    Yes Ron! They should have got me the commode, not in NHS minute, it was rather messy, and it was not, all blood.
    Fred.

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