Symptoms and Medications in Cardiovascular Health

Questions about symptoms and medications?

Initially, there was a noticeable temperature difference between the left and right sides of my body (the right side's limbs would turn black and purple, with a temperature difference of at least 3 degrees).
I experienced muscle atrophy and hypertonia.
After a consultation, the neurologist diagnosed me with unexplained degeneration of the central nervous system (not a stroke or a rare disease).
Then, on the night before my discharge, I suddenly experienced shortness of breath, tightness and pressure in my chest, severe back pain, and a feeling of overall weakness.
After an emergency ECG, the doctor instructed me to take sublingual medication (which worked remarkably well, providing complete relief shortly after; I wondered which painkiller was so effective! Previously, I had used morphine-like medications with less satisfactory results).
The next day, I underwent blood tests and an ultrasound (the ECG later showed no issues, but the ultrasound revealed mild mitral valve prolapse).
A perfusion scan was also conducted (the doctor mentioned something about grading??).
The conclusion was to discharge me with medications: Pletaal 100mg, Mecobalamin 500ug, Ubiheart 10mg (cardiovascular support medications??), Silvinol 5mg (medication for angina? Why was this prescribed?), Trileptal F.C.
300mg, Sennosides 20mg, Tizalin 2mg, Propranolol 10mg (which is generally for arrhythmias; my resting heart rate was around 45-55, but then suddenly spiked over 100...).
Additionally, I was given a can of NTG (this raised a question—if the doctor said I had no cardiovascular disease, why was this prescribed?).
The doctor's advice included having two oxygen tanks at home (why was this necessary??)...
and a list of other considerations regarding cardiovascular and neurological conditions.
I consulted two cardiologists; one (the attending physician during my hospitalization) indicated there was an issue (myocardial hypoxia) and that medication management was sufficient; the other said there was no problem and "recommended" that I stop all medications (the outpatient physician).
However, the more I reviewed my medical history, the more uncertain I became, and I was advised to consult the neurologist for a comprehensive assessment before making any decisions! I also consulted two psychiatrists, both of whom believed there was no issue (not autonomic dysregulation or hyperventilation) and suggested I return to neurology.
I believe I have neurological issues, but what about the cardiovascular system?? (There are many medications, and I feel somewhat helpless; I know NTG should be used sparingly, and I try to endure discomfort, but eventually, I became so weak and breathless that I fainted! At that point, even if I had medication, I had no strength to take it, leading to an emergency situation).
PS.
Previously, I thought chest and back discomfort was due to nerve pain or muscle strain and that rest would suffice (later realizing I may have been too simplistic in my thinking); however, the medications mentioned above have clearly improved my symptoms.
I have always hoped to live a normal life without feeling restricted.

A-Yuan, 30~39 year old female. Ask Date: 2016/03/13

Dr. He Dongjin reply Cardiology

Hello, it seems that you suspect the discomfort is caused by a sudden coronary artery spasm, so you are using sublingual nitroglycerin (NTG) effectively and less frequently? That's alright; it shouldn't lead to dependence.
You might feel the need to use it quickly when you sense an impending episode.
UBIHEART, which is likely referring to Q10SIVINOL, is a cardiovascular vasodilator that you might consider discussing with your physician to adjust your PROPRANOLOL to HERBESSOR to reduce the chances of vascular spasms.
Changhua Hospital cares about your well-being.

Reply Date: 2016/03/13

More Info

Understanding symptoms and medications in cardiovascular health can be quite complex, especially when multiple factors are at play. Based on your description, it seems you are experiencing a range of symptoms that could be attributed to both cardiovascular and neurological issues. Let’s break down your situation and the medications you’ve been prescribed.

Symptoms Analysis
1. Temperature Discrepancy and Color Changes: The difference in temperature and discoloration (black and purple) in your limbs could indicate poor circulation or vascular issues. This might be related to peripheral artery disease or other vascular conditions.
2. Muscle Tension and Weakness: The high muscle tone and weakness you describe could be linked to neurological issues, particularly if a neurologist has diagnosed you with a central nervous system disorder.
3. Chest Tightness and Pain: The acute chest tightness and back pain you experienced, which improved with sublingual medication, suggest that you might have had an episode of angina or myocardial ischemia. The fact that NTG (nitroglycerin) provided relief indicates that your symptoms may have a cardiac origin, even if previous tests did not show significant heart disease.

4. Heart Rate Variability: Your resting heart rate of 45-55 bpm is on the lower side, which could be normal for some individuals, especially athletes, but it can also indicate bradycardia. The sudden increase in heart rate to over 100 bpm could be a response to stress, pain, or other stimuli.

Medications Overview
1. Pletaal (Clopidogrel): This is an antiplatelet medication used to prevent blood clots, particularly in patients with cardiovascular issues. It’s appropriate if there’s a concern about ischemic events.

2. Mecobalamin: This is a form of vitamin B12 that is often used to treat neuropathy and support nerve health. It may help with your neurological symptoms.

3. Ubiheart (Coenzyme Q10): This supplement is thought to support heart health and improve energy production in cells. It’s often used in conjunction with other heart medications.

4. Silvinol: This is typically used for its vasodilatory effects, which can help improve blood flow and reduce angina symptoms.

5. Trileptal (Oxcarbazepine): This medication is primarily used for seizure disorders but can also help with neuropathic pain. Its use here might be aimed at managing any nerve-related symptoms.

6. Sennosides: This is a laxative, likely prescribed to manage any gastrointestinal issues that may arise from other medications.

7. Tizalin (Tizanidine): This muscle relaxant may help with muscle tension and spasms.

8. Propranolol: A beta-blocker that can help manage heart rate and blood pressure. It’s often used for anxiety and migraine prevention as well.

9. NTG (Nitroglycerin): As mentioned, this is used for angina relief. It’s effective in dilating blood vessels and improving blood flow to the heart.

Recommendations
1. Follow-Up with Specialists: Given the complexity of your symptoms and the differing opinions from your healthcare providers, it’s crucial to have a comprehensive evaluation. A cardiologist and neurologist should collaborate to assess your cardiovascular and neurological health.

2. Medication Management: Since you have received conflicting advice regarding your medications, it may be beneficial to have a medication review with a pharmacist or a specialist. They can help clarify the purpose of each medication and whether they are necessary.

3. Lifestyle Modifications: While medications can help manage symptoms, lifestyle changes such as regular, moderate exercise, a balanced diet, and stress management techniques can significantly improve your overall health.

4. Monitoring Symptoms: Keep a detailed log of your symptoms, including when they occur, their severity, and any triggers. This information can be invaluable for your healthcare team in determining the best course of action.

5. Emergency Preparedness: Given your history of severe symptoms, having a plan in place for emergencies, including access to oxygen and knowing when to seek immediate care, is essential.

In conclusion, your situation requires careful management and a collaborative approach from your healthcare providers. By addressing both your cardiovascular and neurological symptoms holistically, you can work towards a better quality of life.

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