Dr. Petr Ruzicka PhD FRCP's Answers - Cardiologist Cheadle

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Atrial fibrillation is a major risk factor of stroke. The top heart chambers (atria) fibrillate and stagnation of blood predisposes to clotting; the blood clot can then get dislodged into circulation and finally wedged in one of the arteries in brain cutting off blood supply and causing a stroke.

Rivaroxaban is one of anticoagulants ('blood thinning' drugs) which reduce the risk of excessive clotting and so the risk of stroke. So, the answer is yes - a previous stroke automatically places your mother in the high risk category - but she seems to be on a good treatment to reduce this risk as much as possible.

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Cardiovascular.

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I assume that the diagnosis was mitral regurgitation (MR) due to prolapse of one of both mitral leaflets. Mitral valve normally allows only blood flow from left atrium (top heart chamber) to left ventricle (bottom heart chamber). Mitral valve prolapse occurs when one or both parts of the valve slips into the left atrium during systole (heart contraction). The significance of the prolapse depends on the degree of MR (=amount of blood that leaks back), severe MR may lead to heart failure, arrhythmias etc. In your case MR was probably judged not significant. It may remain so but in some people MR may deteriorate over the time and eventually require heart surgery with either mitral valve repair (preserving the valve) or replacement (with an artificial valve). The symptoms (breathlessness, tiredness etc) may appear relatively late in the course of the disease and it is therefore important to have mitral valve checked with echo in regular intervals as recommended.

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No, it is the opposite. Cardicor (generic name is bisoprolol) is a beta-blocker which slows the heart rate down. Cardicor is used for treatment of angina and arrhythmias.

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Slozem (diltiazem) is one of calcium antagonists that reduce heart rate and blood pressure. Diltiazem is normally used for treatment of hypertension (high blood pressure) and angina (chest pain due to coronary artery disease). I would not recommend this drug in a person with heart rate 50-55 bpm because it will likely lead to further slowing below 50 bpm which may cause tiredness, breathlessness, dizzy spells and even blackouts.

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Not very much! The test is only useful the if patient can achieve a reasonable workload as assessed by increased heart rate to at least 85% of (220-age). Even then the treadmill test less reliable than other tests for suspected angina such as coronary CT angiogram, stress echo, myocardial perfusion scan or cardiac MR scan which don't depend on patient's mobility.

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Yes, depression is a possible side effect of Tildiem (generic name is diltiazem). If the change in mood is significant, the drug may need to be stopped. I would advise you to see your GP or cardiologist to discuss this and if appropriate try an alternative.

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You should not drink alcohol at the same time as taking Adizem XL. Alcohol speeds up the rate of absorbtion of the medication, so the effect of Adizem XL is stronger but shorter which is exactly the opposite of what the sustained release formula is for. The combination with alcohol may therefore lead to excessive drop in blood pressure and slow heart beat. However, alcohol does not need to be completely avoided, only used not sooner than 2-3 hours after the medication.

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Yes, absolutely. There is no significant interaction between alcohol and isosorbide mononitrate which is the active substance in Isodur.

Having said that, nitrates should be normally taken in the morning to keep nitrate-free interval overnight to maintain their efficacy... and that is somewhat early for wine.

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Disprin CV contains aspirin 100mg which is a low dose used for cardiovascular prevention. Analgesic dose for treatment of migraine is much higher, around 1000mg. Such a dose can have side effects, especially stomach irritation and ulceration. There are better treatment for migraine, so called triptans, eg sumatriptan.

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Disprin CV is a low dose aspirin for secondary prevention for cardiovascular (=CV) diseases, ie heart attack, stroke etc.

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Beta-prograne is a brand name of a drug called propranolol which is one of beta-blockers, often used for anxiety, palpitations, tremor, hypertension (high blood presseure) and angina (chest pain caused by narrowings or blockages in coronary arteries).

Verapamil is a calcium channel blocker and it is a completely different drug, even if some of the indications are the same; verapamil is usually used for treatment of hypertension, angina and some arrhythmias (heart rhythm disorders).

It appears that your mum was indeed given wrong drug and would advise you to check urgently with pharmacy or doctor who prescribed it.

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The most common is headache. Sustac expands blood vessels which is used to improve blood supply to the heart in treatment of angina but it also expands arteries elsewhere in the body which can lead to low blood pressure with ensuing dizziness or even collapse. Widening of the arteries in the brain can cause headache because the brain can't expand against the skull. In most people headaches with Sustac settle within a week or so but occasionally require discontinuation of the medication.

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It certainly could - via its effect on heart rate and heart pumping function. It would be best to see the doctor who prescribed Adizem for some basic checks and if appropriate to consider replacing Adizem for alternative antihypertensive to see if it helps.

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Univer is a brand name for Verapamil 120mg in sustained release form, alternative is Half Securon SR manufactured by Abbott.

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The short answer is no.

The long answer:

Isotard XL is brand name for isosorbide mononitrate, a long acting nitrate used for treatment of angina. Isotard XL should taken as one tablet in the morning and if dose is increased to two tablets, both should be taken together at the same time.

It is important to keep a nitrate-free interval overnight when at rest there is no need for antianginals anyway. Constant exposure to long-acting nitrates (eg when Isotard XL is taken twice daily in the morning and at night) increases risk of nitrate tolerance, ie reduction in effectiveness (body 'gets used' to nitrates and stops responding to it).

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Adipine (=nifedipine) relaxes smooth muscles in the walls of arteries which leads to temporary increase in their diameter and improved blood flow. This is used in medicine in treatment of angina (nifedipine improves blood supply to the heart), hypertension (nifedipine increases capacity of arteries and thus reduces blood pressure) and Raynaud syndrome (nifedipine relaxes the spasm of the arteries of fingers).

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Severe mitral regurgitation is a mechanical problem and requires therefore a mechanical (=surgical) solution. Medication - diuretics (water tablets) can help with symptoms of breathlessness but have no impact on the leaking valve.

Surgery (preferably valve repair preserving the valve rather than replacement with mechanical prosthesis) should be always considered if mitral regurgitation is severe and causes symptoms. Surgery is also recommended in certain situations even in absence of symptoms (e.g. if there is a high likelihood of successful valve repair, in case of new atrial fibrillation = type of irregular heat rhythm, elevated blood pressure in lungs etc).

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Headaches are common side effect of Elantan LA (isosorbide mononitrate). Elantan is a long acting nitrate which is just one of several classes of medication for angina. There are multiple alternatives including beta-blockers, calcium channel blockers, ivabradine, ranolazine and nicorandil. Please see your GP or cardiologist to discuss which one is best for you.

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Viazem XL 240mg (generic name is diltiazem) is used for treatment of hypertension (high blood pressure) and angina (exertional chest pain due to coronary artery disease).

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Dr. Petr Ruzicka PhD FRCP's Answers - Cardiologist Cheadle

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