Contraindications of Heart Medications: A Patient's Guide

Contraindications for Xinshuping (心舒平)

Hello, Director Li.
To avoid being overly verbose, I will directly list my questions and hope for your assistance in clarifying them.
1.
In 2013, I had a heart attack and received a stent.
In 2015, dizziness that had disappeared for many years reoccurred.
I underwent a cervical ultrasound at the neurology department, which revealed a narrowed area in the brain, but it could not be determined whether it was congenital or acquired.
I was prescribed Cerebrolysin and Diphenhydramine, and advised to continue taking Aspirin and Rosuvastatin as directed by the cardiology department.
For the past four years, I have asked the neurologist annually if follow-up examinations are necessary, and the doctor has always said no.
2.
Since the stent placement, I have occasionally experienced missed heartbeats, which have become more frequent recently.
After undergoing three 24-hour Holter monitors and echocardiograms over the past nine months, the cardiologist indicated that it was not concerning, at less than one percent, but switched my long-term medication from Kadyzine extended-release tablets to Sotalol (to be taken in half doses).
3.
The main points of my inquiry are as follows:
3-1.
I still have some Kadyzine left, so I am currently continuing its use and have not yet switched to Sotalol.
3-2.
One day, while searching for information on Sotalol, I noticed that its contraindications mention caution in patients with cerebrovascular disease and diabetes.
My blood sugar is stable, but the term "cerebrovascular disease" raises some concerns for me.
3-3.
Could the condition mentioned in question 1 be classified as cerebrovascular disease? (The doctor always says that no further follow-up or tests are needed.)
3-4.
Or does "cerebrovascular disease" refer specifically to patients who have had a stroke?
3-5.
Since I am on a chronic medication plan, if Sotalol is indeed unsuitable for me, can I return for an earlier consultation to allow the doctor to assess whether a medication change is necessary?
Thank you very much, Director Li, for your time and assistance in clarifying these matters.

Mr. Zhang, 50~59 year old female. Ask Date: 2020/03/07

Dr. Li Wenguang reply Pharmacology

1.
In medical terms, cerebrovascular disease typically refers to stroke, which can be categorized into two types based on the underlying cause: cerebrovascular occlusion (ischemic stroke) and cerebrovascular rupture (hemorrhagic stroke).
The symptoms of stroke primarily involve neurological deficits, including common signs such as unilateral paralysis, unilateral numbness, facial drooping, and speech difficulties.
Additionally, symptoms may include sudden changes in consciousness, cognitive decline, visual disturbances, visual field deficits, diplopia, hearing loss, spatial disorientation, reduced cognitive function, lethargy, and gait instability.
In 2015, you underwent a cervical ultrasound examination that revealed a narrowing in the intracranial region, which could not be determined as congenital or acquired.
The physician did not pursue further investigation, but you have been receiving continuous treatment for approximately five years, and your condition has remained stable.
It is recommended that you discuss your thoughts with your physician during your next visit to the neurology clinic.
2.
The medication you were previously taking, Cardizem SR, is primarily used to treat angina and hypertension.
Since you mentioned experiencing more frequent episodes of missed heartbeats (arrhythmia), your cardiologist switched your medication from Cardizem SR to Sotalol.
Sotalol is mainly used to treat hypertension, angina, and arrhythmias.
It is advised that you follow your physician's instructions regarding medication.
If you still have concerns, you can ask your physician during your next appointment.
Additionally, if a prescription has been issued but you have not yet picked up the medication or if your condition changes, you may return for an earlier consultation.
Thank you for consulting through the Taiwan e-Hospital website.

Reply Date: 2020/03/07

More Info

Understanding the contraindications of heart medications is crucial for patients, especially those with a history of cardiovascular issues. Based on your situation, let’s address your concerns systematically.

1. History of Heart Attack and Stenting: You mentioned having a heart attack in 2013 and receiving a stent. This is a significant medical history that requires ongoing management. The recurrence of dizziness, which you experienced in 2015, could be related to various factors, including cardiovascular health. The fact that your neurologist has noted a narrowing in your cervical arteries but has not recommended further follow-up may indicate that they do not see it as a significant risk at this time. However, it is always wise to seek a second opinion if you feel uncertain.

2. Medication Adjustments: You have been switched from Kadyzin (a brand of diltiazem) to a different medication, likely due to the frequency of your heart rhythm irregularities. It’s important to follow your cardiologist's recommendations regarding medication changes, as they are based on your specific health needs and the results of your tests.

3. Concerns About Heart Medications:
- 3-1: It’s understandable to be cautious about continuing Kadyzin while transitioning to another medication. If you have leftover Kadyzin, consult your doctor about whether to continue it until the new medication is fully effective.

- 3-2: Regarding the contraindications of the new medication (likely a beta-blocker or calcium channel blocker), it’s essential to understand that "cerebrovascular disease" refers to conditions affecting blood flow to the brain, which can include transient ischemic attacks (TIAs) or strokes. Your history of dizziness and the noted narrowing could be considered a form of cerebrovascular disease, but it does not necessarily mean you have had a stroke.

- 3-3: The term "cerebrovascular disease" can encompass a range of conditions, not just those who have experienced a stroke. If your neurologist has indicated that your condition does not require further monitoring, it may mean they do not consider it severe enough to warrant concern. However, if you have symptoms that worry you, it’s always appropriate to seek clarification from your healthcare provider.

- 3-4: The term does not exclusively refer to patients who have had a stroke; it can include any condition affecting the blood vessels in the brain, including narrowing or blockages.

- 3-5: If you have concerns about the suitability of your current medication, you should absolutely return to your doctor for a discussion. It’s important to have an open dialogue about your medications, especially if you have concerns about side effects or contraindications.

In summary, your health history and current symptoms warrant careful monitoring and communication with your healthcare providers. If you feel uncertain about your treatment plan or have concerns about specific medications, do not hesitate to advocate for yourself by requesting further evaluations or adjustments to your treatment. It’s essential to ensure that your medications align with your health status and that you feel comfortable with your treatment plan. Always prioritize open communication with your healthcare team to ensure the best outcomes for your cardiovascular health.

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