Chronicles of the Heart, Part 36 – meds change, and more buggeration.

I’ve been prescribed a different drug, Losartan. The previous drug, Candesartan, had become ineffective, needing double the dose to get the same effect. It happened so abruptly – between one generic brand and the next, a span of 24 hours, that I assumed the drug was of very poor quality, not entirely unknown in the wonderful, unregulated, world of generic drugs. I suppose it’s possible I could have suffered an abrupt worsening of my condition, but all the literature says it’s progressive. A sudden deterioration is unlikely, then, but not, I suppose, impossible.

Despite the patient leaflet advising caution in heart failure – which left me deeply unimpressed and heading online! – I’ve since discovered that heart failure is off-licence but recommended. It’s licensed, in the UK at least, for hypertension plus, and this is particularly relevant to me, left ventricular hypertrophy (LVH), which my now-vanished cardiologist insisted I don’t have.

However, having five risk factors – being overweight along with having COPD, hypertension, aortic stenosis, and heart failure – NOT having LVH is statistically unlikely (as well as potentially being caused by COPD and aortic stenosis, heart failure is also caused by LVH). So what different info does my GP have that I don’t? Am I  in deeper shit than I thought? (My conclusion, yes, and also no, as it also provides an explanation for other symptoms, as we’ll see.)

Since my cardiologist has absented himself, I have no way of knowing for sure whether he was wrong or not. I’ll say, until proven otherwise, he was wrong And that’s far more charitable than I feel. After all, he initially told me I didn’t have aortic stenosis, before I pointed out that with all but the most minor aortic calcification (and from its effects mine is way past minor – in fact everything I’ve read says that cases which are too minor to cause stenosis are also too minor to cause symptoms, and symptoms I have, in spades), stenosis is a given, with which he concurred.

Why do doctors do this? Do they think everyone they see is completely uninformed? Probably and, sadly, they’re mostly right, but it’s still a reckless assumption. Hell, he had my letter to my GP – surely that told him he was on shaky ground trying to bluff? And that pisses me off, big-time – no matter how unpalatable, most people deserve the truth. Which, as he must have read, I’d already figured out.

In LVH the ventricular muscle becomes enlarged (hypertrophied), the ventricular contraction becoming increasingly less efficient as the thickened wall pumps less well and reduce the blood capacity too – this would go a long way to towards explaining my extremely adverse reaction to even gentle exercise. In extreme cases, the thickened muscle can compress the local coronary arteries, as well. The Mayo Clinic has a particularly good image here of the restricted ventricular volume.

Complications also include abnormal heart rhythm (arrhythmias) and insufficient supply of oxygen to the heart (ischemic heart disease, IHD), both of which have been diagnosed in the past, including, in the latter’s case, in one of the ECGs in my possession from my stay in Arrowe Park Hospital last year.

Which poses a question – how far back does this clusterfuck  really go?

IHD was, in fact, diagnosed at Stockport Infirmary in 1986, after I keeled over on a backpacking weekend with a suspected coronary, only to be subsequently rubbished by my then GP.** Arrhythmias, too, have been a long-standing, and medically dismissed, problem, since 1985, as has tachycardia.

My idea, agreed with by the guys at Stockport A&E, who actually believed in engaging with the patient (APH – you could learn a lesson there), as this wasn’t the first episode, it had plagued backpacking trips since the late seventies (but who thinks of heart disease in their thirties – I assumed I just needed to take things a bit easier, which seemed to work), was that because of my respiratory problems, my heart was unable to get enough oxygen to enable it to support my level of activity  – de facto IHD. (The usual cause is furring up of the coronary arteries, but it’s not the only cause!)

So, I’m arguably worse off than I was told, but no worse off physically, if you see what I mean (I’ve had the symptoms for over a year; now I have the explanation), but if I really do have LVH, and as I’ve shown, it’s more likely than not that I do, then why the denial? It would be utterly pointless, not least because I have the entire major symptom set, though I didn’t know it then. So my inescapable conclusion is that  cardio numpty agreed with me where I had the facts at my fingertips (aortic stenosis), but bluffed when I didn’t (LVH).

LVH main symptoms:-

  • Shortness of breath
  • Chest pain
  • Sensation of rapid, fluttering or pounding heartbeats (palpitations)
  • Dizziness
  • Fainting
  • Rapid exhaustion with physical activity

(Source: Mayo Clinic website, an excellent source of medical information, should you need it.)

They are also the symptoms which got me referred to the cardiologist, Dr. Newall, in the first place, and as I said, it’s going to take two months to get an explanation of his conduct and, apparently, get a referral to another cardiologist – two months that I really don’t have to spare. Just a pity Legal Aid has been reduced to a rump.

There’s one thing about LVH that I seriously disapprove of – alcohol is only permitted in moderation. Hmm… moderation – I’ve heard of that.

Seriously, though, my Thursday trip to the pub has been making me very ill of late, and occasionally triggering angina the following day. Which really should be medicated and isn’t being. Hopefully, though, Losartan will go some way to ameliorating that, plus it’s clear that I HAVE to cut down, and sooner rather than later. Like now.

Bugger!

Oh, and according to the AHA I have Stage C heart failure. (Just D to go. Oh joy!)

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3 thoughts on “Chronicles of the Heart, Part 36 – meds change, and more buggeration.

  1. Hope the new medication works much better for you. Don’t wait for the missing cardiologist have your GP give you another referral, he could have moved on and someone else is in his place now. I’m an avid researcher and especially when it comes to things that affect myself or my daughter, but also know that as with myself I have several complaints that overlap in symptoms as well as side effects of medications so let’s think positive 😉 xx

    • Doc’s gone for way too high a dose. Recommended starting point in heart failure is 12.5mg increasing to 50 over 4 weeks, if it’s tolerated – he’s gone for 50. Sod that – I’ll cut them in half and go with 25. That’s equivalent to 16mg of Candesartan, so it’s pushing my luck. If I have to I can crush a tab, make it up to 4 grams with powdered sugar, mix it very well. 1gram will give me 12.5mg.

      I don’t think the GP is going to be much of an improvement – it took three months to get a referral last time. At least I’m already in the system and, over the weekend, I’ll be writing to the hospital CEO, pointing out that I really can’t afford to waste 2 months just hanging around. My seeing another consultant should have no effect on their enquiries.

      Unfortunately though, Beverly, almost 18 months of research shows there is no positive – all roads lead to one point – endgame. Which is why I want decent meds – get the most out of what time’s left. Being stuck in one room shouldn’t be an option.

  2. Ron….go down pub every night! at least you;d feel happier..(for couple of hours a day)…till you get a reply from ANYONE at the Hospital…..Only joshing (a bit) 🙂 Happy Bank Holiday:) x

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