??'s on Medications

[Bw3taz]

Jan 2005 was when I was diagnosed after giving birth to twins. I am 31 years old. My question is I have been on the same dose of medicines since starting them in Jan. should they be increasing. Will an increase in my medicine make my heart get better faster or is it just finding the dose that works with you as an individual. I was on Coumadin for the first 6 months and it took me asking to be taking off for them to take me off it. I had one Cardiologist saying keep me on for another 3 months and one saying my EF was at 30% and didn't need to be on it. What is your opinion on that. Also I read in another post she was up to 18.5 mg of Coreg. I am only on 6.25 mg twice a day and am asking if I should be raised. Also I have been on since day one Digoxin 250mcg once a day and Ramipril 1.25mg once a day. Just wondering if these should be increased. My Ef was 20% wen I left the hospital in Jan and in July it was up to 30%.

One more question have you ever heard of this associted with PPCM? When I take a deep breathe or inhale I feel a tingling sensation go down my arms to my fingers. It also goes down my body but seems to fade out. It is not with every breathe but happens very frequently. Is this related to heart or could it be Nuerologicial?

Any help would be great,

Thank you,

Shelly

[Lisa V]

Welcome to our site.

I do not find it to be strange that you are since on the same meds since diagnosis. I am over 5 years out since diagnosis and I just recently came off of my Digoxin....I was on all meds for the first 2 years before anything was even changed. SOme of my meds I will be on for the rest of my life and that is okay with me if it will keep my heart beating and me staying here on earth. I think you asking these questions to your doctor is excellent, you want to know how your care is and why they are making the cjoices they are. Maybe Dr, Fett, who is our online doctor could better answer some of the medicine questions. Try not to be too alarmed if you are still on low dosages, they may be waiting to see how your heart is handling them and how your body is as well.

[tabs]

While you are on the right meds (although there is some concern about women and digoxin), I am a bit surprised about your Ramipril (Altace) dose. From my understanding, and I am hoping Dr.Fett will correct me if I am wrong, the therapeutic dose for HF is 10mg/day. I had real problems taking this dose at first and we did many things, like splitting the dose and decreasing the total dose to 7.5mg, to try to help me tolerate this med.

At the same time, you have seen some recovery with these meds and their dosages.

Twilah

[miracle baby]

My Doctor Started Me Low On Coreg And Has Slowly Went Up I'm Now At 25mg Twice A Day That Was Her Ideal Dose For People. :) :)

[JAMESFETT]

Shelly, you bring up some really important issues. In the final analysis it is up to you and your doctors to work out the specifics. In general, I can say:

1)Dosages depend upon results, your heart output (such as EF) and disappearance of heart failure symptoms. If you aren't at a target level and you still have symptoms, then careful increase in medication is indicated. The secret of success is a very slow increase as prescribed by your doctor. If side-effects develop, then one has to back off and maybe later try again to increase the dosage. For example, a beta blocker, such as carvedilol, one may start at 3.75 mg 2x daily, with the intention to work up to maximum of 25 mg 2x daily IF dosages can be tolerated and IF better results are needed.

2)In general, when the EF is below the 35 percent range, there is still an indication for anticoagulants (Warfarin/coumadin) because of the risk of throwing a small piece of the clot into the circulation (embolus), with risk of stroke or other blood vessel blockage eslewhere in the body.

3)Digoxin is a medication with limited usefulness and with a rather narrow safety margin. Women who use digoxin for heart failure may have an increased risk of death compared to men who use digoxin for heart failure. A dosage for women, if digoxin is to be continued, may be safer in the 125 mcg range. I hardly ever use digoxin, and if I need to I discontinue it as early as possible. Its use in some rhythm disturbances, such as atrial fibrillation is a separate issue, and may require use and longer use.

4)Your symptoms of tingling (paresthesias) is very common in PPCM patients. We have found an autoantibody, transaldolase, in PPCM patients. It is also an antibody found in multiple sclerosis, and is toxic against nerve sheath. Hence, that may be the reason paresthesias are found. Happily, in PPCM, this symptom gradually subsides, which could mean the autoantibody gradually decreases. So in PPCM the paresthesias disappear, whereas in multiple sclerosis they wax and wane, but generally progress. With or without these paresthesias from whatever cause, they may be made worse by hyperventilating--breathing deeply. Even a normal person can, by hyperventilating, cause numbness and tingling to happen, particularly in the fingers. Basically, I am saying to you that you should not worry too much about this symptom, because it is very likely to just disappear.

James

[Yvonne]

Hi Shelly,

I'm now more than one year after Dx and I still haven't reach the target levels of medication. I started with 3,25 Coreg once a day and 1,25 Ramipril. Within the last year they're both uptitrated, but I had to do in very small steps. After every increase of my Coreg I had worsening of my heartfailure symptoms and after I had reached 6,25 mg twice a day I was told I propable would never reach a higher dosage. Last Friday my Coreg is increase to 18,75 mg (twice a day) and I'm on 7,5 mg of Ramipril. The next step will be 25 mg of Coreg and after that 10 mg of Ramipril, but I know I have to take the time to adjust. Sometimes I think I need more time than the average to adjust, but in retrospective I can say it was worth waiting for. I feel better than before and I feel I'm still improving.