Medication and Hiccups After Myocardial Infarction

Medications for myocardial infarction and symptoms of hiccups?

Hello Dr.
Lee,
My mother recently went to the emergency room on September 6 due to upper abdominal pain and chest pain.
After blood tests showed elevated cardiac enzymes, she was diagnosed with acute myocardial infarction.
She underwent a cardiac catheterization and was subsequently hospitalized.
It was determined that her vascular anatomy was not suitable for stenting, so she is currently being treated with medication (Inderal, Bokey, Famotidine, Crestor).

I would like to ask the following questions:
1.
She has been experiencing persistent belching for over a week, even though she hasn't been eating large meals or eating quickly.
I found some information online suggesting a possible connection between belching and myocardial infarction (article: https://www.edh.tw/article/19110).
Should we be concerned about this symptom and seek further medical attention, or could it potentially resolve with medication?
2.
My mother has a history of hyperthyroidism, which has been treated successfully.
Is there any possibility that this could be related to her myocardial infarction?
3.
The Inderal medication has a warning stating to discontinue use if heart rate is less than 50 or systolic blood pressure is less than 100 mmHg.
If her blood pressure is low in the morning but normalizes after a couple of hours, should she take the medication? Or would it be better to wait until noon to take it all together?
Thank you, Dr.
Lee!

Chen, 50~59 year old female. Ask Date: 2022/09/12

Dr. Li Han reply Cardiology

Hello, regarding your inquiry, first of all, hiccups are not a typical symptom of angina.
If this symptom persists, it may be necessary to consider other systemic disorders, especially since the antiplatelet medication aspirin, commonly used in patients with coronary heart disease, can exacerbate gastroesophageal reflux or peptic ulcers.
Secondly, an elevation in cardiac enzymes indicates myocardial injury, but there are many potential causes.
If the patient is only on monoclonal antibody therapy rather than dual antiplatelet therapy, the physician may not consider it a typical case of acute coronary syndrome or myocardial infarction.
As for the relationship between hyperthyroidism and myocardial infarction, this is not a simple "yes or no" question.
Furthermore, Inderal is a beta-adrenergic antagonist; if the patient does not report any discomfort after taking the medication, it can be used or continued as per the warning guidelines.
These are general principles, but individuals are not machines.
It is advisable to discuss and consult with your attending physician.
The Changhua Hospital of the Ministry of Health and Welfare is concerned about your well-being.

Reply Date: 2022/09/12

More Info

Hello! Thank you for your questions regarding your mother's recent health issues following her acute myocardial infarction (AMI) and the medications she is currently taking. Let's address each of your concerns in detail.

1. Hiccups After Myocardial Infarction: Hiccups can be a perplexing symptom, especially after a significant cardiac event like a myocardial infarction. While hiccups are generally benign and often related to irritation of the diaphragm or gastrointestinal issues, they can occasionally be associated with cardiac conditions. In the context of AMI, hiccups may arise due to irritation of the phrenic nerve, which can occur if the heart is inflamed or if there is any pressure on the diaphragm from surrounding structures. Additionally, certain medications, including those used to treat heart conditions, can have gastrointestinal side effects that might contribute to hiccups. Since your mother has been experiencing this symptom for over a week, it would be prudent to discuss it with her healthcare provider. They may want to evaluate her further to rule out any underlying issues or adjust her medications if necessary.

2. Thyroid History and Myocardial Infarction: Your mother's history of hyperthyroidism (overactive thyroid) is indeed relevant to her cardiovascular health. Hyperthyroidism can increase heart rate and lead to other cardiovascular complications, which may predispose individuals to heart disease. However, if her thyroid condition has been treated and is currently stable, it is less likely to be directly related to her recent myocardial infarction. Nonetheless, it is essential for her healthcare team to be aware of her thyroid history, as it can influence her overall treatment plan and medication management.

3. Inderal (Propranolol) and Blood Pressure Monitoring: Inderal (propranolol) is a beta-blocker commonly prescribed for various cardiovascular conditions, including after a myocardial infarction. It is crucial to monitor heart rate and blood pressure while on this medication, as it can lower both. The warning you mentioned regarding stopping the medication if the heart rate falls below 50 beats per minute or if the systolic blood pressure is below 100 mmHg is important. If your mother experiences low blood pressure in the morning but normalizes later, it may be reasonable to wait and see how her blood pressure stabilizes before taking the medication. However, it is vital to follow her healthcare provider's recommendations regarding medication timing and dosing. If there is any uncertainty, it is best to consult her physician for personalized advice.

In summary, while hiccups can be a benign symptom, their persistence warrants further evaluation, especially in the context of recent cardiac events. Your mother's thyroid history is relevant but may not be directly linked to her AMI if well-managed. Lastly, careful monitoring of her blood pressure and heart rate while on Inderal is essential, and any concerns should be discussed with her healthcare provider to ensure her safety and well-being.

Please encourage your mother to maintain regular follow-ups with her cardiologist and report any new or worsening symptoms promptly. Thank you for your thoughtful questions, and I wish your mother a smooth recovery!

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