As some of you may know, my mother had a heart attack around Easter. It was her fault as she felt healthy and stopped taking her BP meds. 2 weeks later she had a heart attack. Luckily she was in the hospital when it happened (she was experiencing stomach pain due to the impending attack). She is a very stubborn woman who didn’t want to take meds. The heart attack changed her mind.
The good news is after the attack (and 2 stents) she now takes her health seriously. Before the attack she had an HBA1C of 8.5-9.5 (8.5 on a good day). Now she has an HBA1C of 6.4 due to Empagliflozin and diet changes. She refused to take it before the heart attack!
Before the heart attack her LDL was 110. Now it’s 31 and her HDL is 34. Thanks Atorvastatin and diet changes! She refused lipid meds before the heart attack.
Before the heart attack, a SBP of 165 was good for her. Now she’s in the 80-120 range (we’re still adjusting the meds). Thanks Telmisartan! She was taking Lisinopril before… Until she stopped and had the heart attack!
Before the attack she regularly ate sugary cereals and pastries for breakfast. She’d eat fast food like McDonald’s. She’d eat crappy milk chocolate bars daily. No wonder she was diabetic! After the heart attack, she is eating healthy.
Unfortunately she developed AFIB from the heart attack. We’re working on fixing that, but her heart rate is too low due to the AFib meds (42. We want 60). Any advice here? The doctors want to ablate her heart and install a pacemaker. Is that the best option? @rivasp12 @DrFraser
All in all, without the heart attack, her diabetes, high BP, diet and cholesterol would have continued to get worse until it was too late. IMHO this heart attack was needed to get her to clean up her act.
Thank you for any advice that can help my 75 yo mother. And please, whatever you do, don’t stop your BP meds if you have high blood pressure!
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I’m sad she came to harm to get some good - but it is a frequently travelled path.
So I appreciate the Cardiologist and Electrophysiology folks being keen to just do one sedation and do both procedures. However, in the event the ablation is successful and she is back in a normal sinus rhythm, then they should be able to cease medications causing her to be bradycardic.
I also am unclear on why they’d be running the doses of the medications so high as to cause this currently?
They may thing she has sick sinus syndrome underlying and be convinced that even with a successful ablation and no medications she will have too slow of a heart rate.
There will likely be a lot of important details that are highly relevant that aren’t in the details above.
Irrespective, I’d at least ask about those items, as they may be game for doing the ablation and if successful, weaning the meds.
The EP guys are pretty smart, and I bet there is a good reason why they think both done together is the correct move. A pacemaker, if she needs it (as in her heart rate might go too low) is not a bad thing, as the consequences often include fainting, which leads to fractures, head bleeds, etc … which often starts the spiral of death in older individuals. Pacemakers rarely cause any complications.
So I’d ask the EP doctors on a risk benefit … what if she did just get the ablation? What would be the risk/benefit. Getting both … risk/benefit.
I suspect it’ll become pretty clear as to the right decision with a couple of sensibly framed questions.
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An update: My mother just had a pacemaker installed as she was checking her heart rate and found out that in the middle of the night her heart would stop beating. She went into the hospital a couple times and confirmed her heart would stop beating on occasion. Her heart rate would be around 40-130 other times (medication issues)
After the pacemaker implant, her heart rate doesn’t go below 60 and her ejection fraction has improved from the high 30s to the 50s.
She seems to be dancing with death. She still has an issue with aFIB. Should she get a heart ablation to solve this problem? Or rely on meds?
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RPS
#4
Tricky decision. Ablation doesn’t always work, on the other hand, the meds can make you feel permanently lethargic or just not very well.
The above is the experience my father had. Unfortunately for him it didn’t work and he was stuck on the meds which with a pacemaker did keep the heart in a normal rhythm.
Good luck either way!
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A very interesting take on heart attacks by Dr Robert Cywes, a double board-certified surgeon specializing in preventing metabolic disease, obesity, and chronic inflammation. Forget the clickbait title, he didn’t do that. Watch til the end for very interesting interventions.
Nicotine and elevated blood sugar levels (inflammation) are the primary causes.
Dr Rob Cywes: #1 Cause Of Heart Attacks & Strokes (AVOID THIS)
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@DrFraser and anyone else who cares to comment:
The cardiologist also placed my mother on the following drugs to prevent heart problems. Are these good meds or are there better alternatives? We’ve already replaced the Losartan she was taking with Telmisartan and reduced the amiodarone from 100 to 50. However, we asked for these two changes and the doctor consented.
I’m particularly concerned about the Metroprolol.
Meds:
amiodarone 50 mg
clotidogrel (Plavix) 75 mg
Metoprolol Succinate 50 mg
Ribaroxaban (Xarelto) 50 mg
Spironolactone (Aldactone) 12.5 mg
She is also taking Jardiance, Telmisartan, Metformin and Atorvastatin, but those are fine by me.
If anyone can comment on whether the other meds are good or bad, I’d appreciate it! Thanks in advance! (And my mother thanks you as well!)
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AnUser
#7
Get an Apple Watch to monitor Afib %, if she pays attention to charge it every day and wear it. It can also call an ambulance if it detects a fall and unconscious state. I would recommend everyone should use one unless they’re really young and healthy and use some other device.
Pixel Watch 3 have loss of pulse detection in Europe: Pixel Watch 3 introduces Loss of Pulse Detection feature
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It’s complicated without every detail.
The minimum dose needed on the amiodarone to prevent AF is sensible. If she is in normal sinus rhythm and monitors regularly, there are risks to Rivaroxaban, and she can always start taking it if she goes into AF.
Risk of bleeding is the worry with having an antiplatelet and Factor Xa inhibitor. The same people that are taking these are often at risk of falls, and getting an intracranial bleed is not a win. It’s all risk/benefit. The clopidogrel generally can be ceased, but aspirin 81 mg daily should continue life long, after 6-12 months.
Optimizing blood pressure is sensible, and so long as that is occurring, she is on low dose metoprolol and spironolactone … so probably fine.
Obviously chat with her doctor, but that would be my brief comments.
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FWIW: I have been taking metoprolol in the morning and telmisartan in the evening for quite some time.
This has kept my blood pressure in the range of 100-110 systolic and 60-70 diastolic.
I have felt zero side effects.
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Thanks @DrFraser and @desertshores . That’s exactly what I wanted to know.
My mother’s BP now tends to be around 100 SBP. Her heart rate is kept from getting too low by the pacemaker. She has a lot of energy.
How can we tell if she is suffering from afib anymore? She says she doesn’t think she has it any more, and when she goes into cardiotherapy, they say she doesn’t have afib while she is there and hooked up to the sensors.
Do the pacemakers record if she has afib?
Get her a Kardia Mobile on Amazon or direct and have her monitor a couple of times/day. It will tell her if in Normal Sinus Rhythm or AF. Is often on sale for $85.
I’m glad to provide you with some useful information.
