Question about heart medication

[GentleOtter]

I wonder if anyone can advise me with regard to the medication dh has been given post heart attack in early May, please?

He is on:
Bisoprolol fumarate 5mg
Rampiril 5mg
Clopidogrel 75mg (until the end of July)
aspirin 150mg
Atorvastatin 80mg

His normal resting BP is usually around 70/55 but is 120/80 although this can fluctuate to slightly below.

My concern is that he is becoming quite mentally confused, very tired and very isolated from us. (He is not depressed). His body thermostat seems to have gone into overdrive too and he feels warm when the rest of us feel cold.

He has spoken to different G.P's but they seem to feel that 'these things happen' and have not explained why.

My question is, is this normal on this cocktail of medication?

I am very worried.

Hello GentleOtter - been reading your blog. Have been pleased to read that dh has been improving but sorry that you're currently worried about him.

His resting BP is quite low I think (even for someone on Ramipril) dd takes Lisinopril which is the same drug family, and aspirin. When you take his BP, don't take it straight after his meds as it won't be a good reading. Ramipril can make people feel a bit cold usually as it opens up the blood vessels so feeling warm is unusual IME. Has he had any renal bloods done? It can affect kidney function.

I can't really help with the other drugs sorry. Is there someone at the hospital he can speak to? Is he due for a check up there?

Thank you, MynameisMike.

He goes to the heart unit for rehab twice a week but he forgets to ask or does not like to ask as he is painfully shy.
He has not had renal bloods done since he was discharged from the cardiac unit.

Something is not right but I think I'll try to phone the heart nurse on Monday although we can never get her in as she is always busy with other patients.

Little things are happening like trying to squeeze Fairy from a bottle and the lid is on but he thought it was not working or scraping his food from the plate on to the table and thinking he has eaten it.

He gets uncomfortably hot in bed despite a very thin quilt and the windows wide open plus no heating. (room is very cold).

He is just back from a calving and looking quite flushed but I will wait a while and retake his BP although he says he feels ok.

He sounds really unwell .
You need to persue this ( even if means making a "fuss " /stating your case very clearly) with heart nurse or hospital - can you go with him ?

Can you try GP again - be forceful ,the symptoms you describe are not something that "just happen " FFS.

My dad has had similar symptoms (except for the being hot thing - he now feels the cold when he never used to) for the last 6 years after his heart attack. He started off being very tired and 'disassociated' from his family which is most unlike him and in the last 6 months has been diagnosed as severely depressed and suicidal. His GPs have attributed this to the statin he has been taken and depression is a well known side effect. I would be shouting a bit louder if I were you and making it clear that it is the change of personality that you are concerned about. Certainly don't leave it as long as my dad has to seek help.

Yes - sad but true ,IME you really do have to shout .

Thank you all.

We have just discussed where to go from here and he admits that he does not feel right. He also seems to be in a constant bad and crabby mood and he was never like this before.

Physically, he is in good shape due to a complete change of diet and exercise but mentally, not in a great place due to the fogginess and naps plus it is frustrating for him to feel a bit restricted workwise as his job is so physically heavy eg calving and he cannot do this quite yet.
He has never been off work in his grown life and hates not working but I cannot let him drive the tractor when he feels confused and sleepy.

I have written a letter to the heart nurse so hopefully she will have time to read it and speak with my dh.

He wants to come off the statins and try to control the cholesterol with diet alone - 5.0 just now so not too bad, but feels scared to do so.

GentleOtter - you sound like me writing a letter ,that's just the sort of action I would take .
I suggest though that you also phone her to ask if she's read it - these things have a habit of dragging on and you'll find that you have to keep chasing ,otherwise the weeks drag on .
Poor you and DH ,it's very early days .
I'm sure diet will help with the cholesterol ,can understand why he would not want to rely on statins .

Sorry but what is his bp? 70/55 or 120/80? There is quite a difference in my response depending on what it is.

Sorry, his pre coronary BP was 70/55 but it is now 120/80.

And he walked round with that!! Usually see people on the floor with that reading.

Anyway 120/80 is ok, the medication combination is standard, but is he on a beta blocker which can make people feel rough. It depends on his pulse rate somewhat.

I also would not discount depression completely. Heart attacks and other major sudden illness do make people very susceptible to it.

I think he is best going to his gp for a review. Perhaps he'll let you go with him? Medication gets started in hospital but frequently needs adjusting once home.
Hopefully a set of bloods and a bit of tweaking will be all thays needed.

GentleOtter given that the response so far from him seeing GP's about his symptoms has been "these things happen " ,you are going to have to go up a gear .
You must make it quite clear what his current symptoms are and the impact they are having .
Wish I could be more help.

Ah missed that bit . Unsympathetic gp in this situation calls for change of gp imo. The gp is going to be dping most of his management so having one who can be bothered makes a huge difference.

If it were me I wouldnt waste time arguing and pushing I would just change practice. Ask the cardiac nurse who is good in your area.

Gentle otter, after a heart attack, the aim of starting drugs is to try and heal the hearts ability to pump as well as minimise the risk of further heart attacks.

The dose of statin he is on is high, but normal post mi (for high risk patients the evidence suggests aiming for a cholesterol of less than 2.6)

The ramapril will control blood pressure and increase the hearts ability to pump.
The bisoprolol as a betablocker is mostly for lowering blood pressure but does help the heart to pump as well.

The issues thar need to be addressed.

1. b blockers can cause depression and his bisoprolo could be reduced, uping his ramapril if bp control is necessary
2. all these drugs can have affects on the liver and kidney, so he needs his bloods checked (this is routine)
3. heart attacks is themselves can cause depression, the heart failure nurse can assess for this
4. although you are worried about the statin, I would continue with this for as long as the cardiologist recommends unless he is getting muscle pains
5. the fact that your husband has had a cardiac event does mean he is more at risk of mini strokes or strokes. These can present as confusion poor balance, poor co ordination and personality change. Tell ur gp you are worried about this ASAP and if they find any evidence of this, they will get him seen by a stroke specialist tomorrow. Stroke is an unlikely but real possibility, so please don't sit on this. Get back to ur go and get some answers. If you want to know anything else just ask xx

Thank you very much for these replies.

Mini stroke had been on the back of my mind and I have been trying to keep a close eye on him (which he gets a bit miffed at) but I do feel he has been struggling with these meds especially in the last three weeks.
He has been clumsier than usual and doing these strange things - scrubbing the 'black' from a frying pan which was actually teflon and not burned.

I asked if he could get counselling but this never came to fruition - tricky as he does not talk very much but I am looking at private counselling as a matter of urgency.
He has taken to barely speaking a word to us, just the bare minimum and I find that difficult.

We are stuck with this GP unit as we live remotely and there is only one surgery which will accept us in their catchment area. It is very frustrating.

The ramapril has recently been upped and he tells me that he had bloods taken on Thursday so I assume that will be the liver function test.

I am going to go down to Perth and find the heart nurse at the hospital tomorrow. If she is busy then will ask to speak to someone else.

I really do appreciate the help and support you have all offered here. Thank you. x

Remember that the heart charities can offer great support and counciling too
British heart foundation has a large amount of information and support available x

Oh dear you're stuck with them. In that case get the cardiac nurse onside and consider complaining /making waves with her support. "Just one of those things" is not an acceptable answer, especially when with a bit of tweaking he mau feel so much better.

Is he having problems with his vision? mini strokes are always a concern but the clopidogrel and aspirin should ward against this. Does he attend a cardiac rehab group? If there is one available I would ask about his suitability for it. He may not talk much but being able to listen to others in a similar situation can be very useful.

Firstly,some more questions for you -
Did he have stents , clot busting drugs or just medical therapy (or a combination?)
Did he have an ECHO (ultrasound scan similar to the one women have during pregnancy)
Has he completed any psychological assessment before starting his rehab?

Regarding his meds, his dose of aspirin is high at 150mg - normally patients are on 75mg of aspirin plus 75 clopidogrel post MI. FWIW Low dose aspirin will help to reduce the risk of stroke as well.

He has one stent (the non impregnated by meds type) but the cardiac unit voiced concern over another area of damage to the heat viz a possible second stent and they wanted to see if the damage could be repaired/ controlled by meds.
I think this was diagnosed using ECHO.
No psychological assessment apart from the heart nurse telling him she would not be offering him counselling. We both had a meeting with her and I asked her if he could as it was important - she assured me that he would then changed her mind for whatever reason the following week.

It is not so easy to find a suitable counsellor here due to the distances we have to go to get to town and I worry about him driving.

Yes, he has had problems with his vision and says that it is quite blurry sometimes.
He attends heart rehab twice a week and it has been good as he knows several of the other rehab patients but the driving there leaves him quite tired.

Some reasonable points, might b a bight confusing... 75-150mg aspirin is recommended by national guidelines and most cardiologist will prescribe the higher dose for at least 3 months post mi.
Secondly strokes are not always caused by blood clots.
Strokes in the very middle of the brain are normally caused by High blood pressure and plaque. Strokes can also be caused by bleeding which would be exacerbated by aspirin and clopidogrel.

Long and short is that you need to see a specialist who will make an informed decision based on all the physical findings.

All you need to know is that you are right to be concerned and that he warrants an urgent medical review.

Let us know how you get on xx

Statins cause wasting of the muscles, including the heart muscle, which leads to debilitation.

He needs to take Co-Enzyme Q10 with them.

I have just spoken with him and am a bit shocked when he told me that several of his group have had experiences which were misdiagnosed (eg treated for gastric when it turned out to be heart) then put on an eight to ten week waiting list to see a cardiologist.

A few of them went private and were seen immediately.

It was quite some time after his mi that we saw the heart nurse despite trying to get in touch with her. We met her about five weeks later.

Trying to get an appointment with the GP is difficult too as the surgery only take emergency appointments between 8 - 8.30 am so we often have to wait around ten days to see the 'good' GP.

I do not want to dismiss the care offered here but the system is dire as it is all centralised through one massive hospital many miles away plus the distance involved means that an ambulance takes a long time to arrive.

Was he in ccu/icu had lots of oxygen? And numerous other iv drugs? Has he had an eyesight test since? If not then get him to go for one. Some of the drugs in high dependency can have side effects on eyesight. Its worth getting checked before assuming strokes.

Poor man and you. You sound like you've had a rough time.

Whoa, hidden home!!
That's exactly the sort of Internet advice that you take with a pinch of salt.
Statins CAN cause breakdown of muscle tissue but on relatively rare occasions.

OP, the other option you have is to phone the cardiologists secretary and ask for an urgent review.
Explain ur concerns and say that your GP is having difficulty managing and addressing the problems. Beyond that ? Send me a PM, I am in the health service in Scotland and if u let me know where u are, could perhaps suggest another line of help?
X

In the US Q10 is always prescribed with statins.

It's well known that they cause debilitation and weakness.

I didn't get this information from the internet either.