Managing Heart Health: Concerns About Multiple Medications and Side Effects

Medication-related heart issues?

Dear Dr.
He,
I have been taking medication for hypertension, including 10 mg of Betaloc (metoprolol), 5 mg of Amlodipine, and 160 mg of Perindopril.
Three years ago, I added 10 mg of Rosuvastatin to my regimen.
In October of last year, I experienced chest pain and discomfort under my ribs, along with shortness of breath.
I visited the cardiology department at Chang Gung Memorial Hospital, where I underwent a stress test and echocardiogram.
During the consultation, the doctor mentioned that I might have a myocardial infarction and recommended further tests at my own expense.
I expressed that it was a bit difficult for me financially, so I took the report to my local clinic, which also has a cardiologist.
After reviewing the report, he prescribed an additional medication, 60 mg of Ticagrelor, to be taken alongside my hypertension medications.
Yesterday, after taking a shower, I experienced a sudden heart pain that was quite distressing.
I coughed forcefully a few times, which provided some relief, but I still felt chest tightness and discomfort under my ribs.
This morning, I visited my doctor again to explain my symptoms, and he prescribed another medication, 5 mg of Isosorbide Mononitrate, to be taken twice daily.
Additionally, I take a sleep aid, 0.5 mg of Lorazepam, every night before bed, along with 500 mg of calcium carbonate.
I would like to ask you, Dr.
He, about the potential side effects of taking so many medications in one day.
Could there be any adverse reactions or interactions among these drugs? Specifically, what are the side effects of Isosorbide Mononitrate 5 mg, and is it safe to take it together with my other medications? I have been experiencing persistent pain under my ribs and intermittent chest tightness, especially after exercise, although I generally do not feel pain in the morning.

Xiao Cai, 30~39 year old female. Ask Date: 2016/03/21

Dr. He Dongjin reply Cardiology

Hello, these medications are all related to cardiac treatment and generally can be taken together without significant interactions.
However, if you experience headaches or dizziness, it could be concerning.
It's difficult to determine whether this is angina or not.
I recommend consulting a cardiologist for further evaluation.
Changhua Hospital cares about your health.

Reply Date: 2016/03/21

More Info

Managing heart health, especially when dealing with multiple medications, can be quite challenging. It’s essential to understand the potential side effects of each medication, how they interact with one another, and how to manage any discomfort or symptoms you may experience.

From your description, it appears that you are currently taking several medications for hypertension and heart health, including Betaloc (百肯), Amlodipine (安壓得穩), and other medications like Tenormin (樂心) and possibly others for sleep and calcium supplementation. Each of these medications serves a specific purpose, but they can also come with side effects that may impact your overall well-being.

Potential Side Effects of Your Medications
1. Betaloc (Metoprolol): This beta-blocker is commonly used to manage high blood pressure and heart rhythm disorders. Common side effects include fatigue, dizziness, and a slower heart rate. It can also cause shortness of breath or cold extremities in some patients.

2. Amlodipine: This calcium channel blocker helps to lower blood pressure by relaxing blood vessels. Side effects may include swelling in the legs or ankles, flushing, and palpitations.
3. Tenormin (Atenolol): Another beta-blocker, it can cause similar side effects as Betaloc, including fatigue and dizziness. It may also lead to depression or sleep disturbances in some patients.

4. Calcium Carbonate: Generally safe, but excessive intake can lead to constipation or upset stomach.

5. Sleep Medications (e.g., Lorazepam): These can cause drowsiness, dizziness, and may affect your coordination. Long-term use can lead to dependence or withdrawal symptoms.

Concerns About Drug Interactions
Taking multiple medications increases the risk of drug interactions. For instance, combining two beta-blockers (like Betaloc and Tenormin) can lead to an excessively low heart rate (bradycardia) or hypotension (low blood pressure). It’s crucial to monitor your heart rate and blood pressure regularly, especially when starting a new medication or adjusting dosages.

Managing Symptoms
Given your symptoms of chest pain, rib discomfort, and shortness of breath, it’s essential to communicate these issues with your healthcare provider. While some discomfort can be attributed to the medications, it’s also vital to rule out any serious cardiac issues. If your doctor has suggested further testing, it may be worth considering, even if it requires out-of-pocket expenses.

Recommendations
1. Follow-Up Appointments: Regular follow-ups with your cardiologist are crucial, especially since you have experienced chest pain and other symptoms. They can help adjust your medications as needed and monitor your heart health.

2. Lifestyle Modifications: Alongside medication, lifestyle changes such as a heart-healthy diet, regular exercise (as tolerated), and stress management techniques can significantly improve your heart health.

3. Medication Review: Ask your doctor for a comprehensive review of all your medications. They can help determine if any can be adjusted or if alternatives exist that may have fewer side effects.

4. Symptom Diary: Keep a diary of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare provider in diagnosing and managing your condition.

5. Emergency Plan: Be aware of the signs of a heart attack or other serious conditions (e.g., severe chest pain, shortness of breath, or radiating pain to the arm or jaw) and know when to seek immediate medical attention.

Conclusion
Managing heart health with multiple medications requires careful monitoring and communication with your healthcare provider. Understanding the potential side effects and interactions of your medications is crucial in managing your symptoms effectively. Always consult your doctor before making any changes to your medication regimen, and don’t hesitate to seek a second opinion if you feel uncertain about your treatment plan. Your health and well-being should always be the top priority.

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