Managing Heart Medication: Guidance for Patients with Cardiovascular Issues

Cardiac medications

Hello Doctor, I am inquiring on behalf of my father.
He has partial cardiovascular blockage that has not yet reached the point of requiring stenting.
He has been on chronic heart disease medication for ten years, with an average blood pressure of 100/60 and a pulse of 55.
Recently, he stopped taking Concor and has been on Propafenone (5 mg, half a tablet each time) for nearly a month.
His blood pressure remains unchanged, but his pulse has increased to 70.
In the past month, he has experienced three episodes of shortness of breath, mild chest tightness, nausea, and near-syncope, each lasting three to five minutes.
Should he continue taking Propafenone, switch back to Concor, or consider other medications, or is it possible to discontinue medication altogether? If he continues with Propafenone and experiences further episodes of shortness of breath, mild chest tightness, nausea, and near-syncope, what should he do before seeking medical attention? Should he lie down or drink more water to mitigate the effects of the medication? Is it advisable to take sublingual Nitroglycerin immediately? Thank you, Doctor, for your clarification! I greatly appreciate it.

GLC, 60~69 year old female. Ask Date: 2015/09/01

Dr. He Dongjin reply Cardiology

Hello, your blood pressure seems to be too low.
It may be advisable to completely discontinue the medication and monitor your condition.
Please do not take sublingual nitroglycerin, as it may further lower your blood pressure.
Changhua Hospital is concerned about you.

Reply Date: 2015/09/01

More Info

Managing heart medication for patients with cardiovascular issues requires careful consideration of the patient's symptoms, medication side effects, and overall health status. In your father's case, he has a history of cardiovascular issues and has been on chronic heart medication for ten years. Recently, he switched from Concor (bisoprolol) to a new medication, Heart Rhythm (propafenone), which may have contributed to his recent symptoms of shortness of breath, chest discomfort, nausea, and near-syncope.

Understanding the Medications
1. Concor (Bisoprolol): This is a beta-blocker that helps manage heart rate and blood pressure. It is commonly prescribed for patients with hypertension and heart failure. It can help reduce the workload on the heart and improve symptoms related to heart conditions.

2. Heart Rhythm (Propafenone): This medication is an antiarrhythmic agent used to treat certain types of irregular heartbeats. While it can be effective for managing arrhythmias, it may also have side effects, including dizziness, fatigue, and in some cases, worsening heart failure symptoms.

Current Symptoms and Management
Given that your father has experienced episodes of shortness of breath, chest tightness, nausea, and near-syncope after switching medications, it is crucial to evaluate whether these symptoms are related to the new medication or if they indicate a worsening of his underlying cardiovascular condition.

1. Continue or Discontinue Heart Rhythm: It is essential to consult with his cardiologist regarding whether to continue with Heart Rhythm or revert to Concor. The symptoms he is experiencing could be side effects of propafenone, and if they persist, it may be necessary to switch back to bisoprolol or consider alternative medications.

2. Immediate Response to Symptoms: If your father experiences severe symptoms such as significant shortness of breath, chest pain, or near-syncope, it is crucial to seek immediate medical attention. While waiting for help, he should remain calm and sit or lie down to avoid falls. Drinking water may help if dehydration is a concern, but it is not a substitute for medical treatment.

3. Use of Nitroglycerin: If your father has been prescribed nitroglycerin for angina or chest pain, he may use it as directed during episodes of chest discomfort. However, it is essential to ensure that he has been advised by his healthcare provider on when and how to use it. Nitroglycerin can help relieve angina by dilating blood vessels, but it should not be used indiscriminately without medical guidance.

Monitoring and Follow-Up
Regular follow-up appointments with his cardiologist are essential to monitor his heart condition and medication effects. Blood pressure and heart rate should be closely monitored, especially after any medication changes. If his blood pressure remains low (100/60) and heart rate is on the lower side (55-70 bpm), this could indicate that his medications need adjustment.

Lifestyle Considerations
In addition to medication management, lifestyle changes can significantly impact cardiovascular health. Encourage your father to maintain a heart-healthy diet, engage in regular physical activity as advised by his doctor, manage stress, and avoid smoking and excessive alcohol consumption.

Conclusion
In summary, it is vital to communicate with your father's healthcare provider about his recent symptoms and medication changes. They can provide personalized advice based on his medical history and current health status. Managing heart medication is a collaborative effort between the patient and healthcare team, and regular monitoring is key to ensuring optimal heart health.

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