Any advice for someone with no joie de vivre

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I'm in my 60s - previously with a healthy lifestyle and no heart history in the family - I had a heart attack early May.  Never took any medication before this - bp and cholesterol were fine - am now on daily aspirin, clopidogrel, ramipril, atorvastin and 2.5mg bisoprolol. Stress echocardiogram two weeks ago absoutely fine.  Have been told to step up exercise to 20-30 minutes a day. I used to go to the gym and consultant suggesting I return.  Everyone is telling me I am looking well etc etc ............and now for the truth.  I feel totally drugged up.  If you add up the number of hours I sleep at night, combined with naps during the day because I can't keep awake even though I try and force myself to do so, it's certainly more than 12 hours.  Record so far is 15 hours!  I feel permanently lethargic.  Food intake the same but have gained about 7lbs in 2  months.    I take a daily walk but doubt that it's exercising my heart as it's more of a gentle stroll. No stamina.  Given the medication I'm on, can we pinpoint bisoprolol as the main culprit?  The docs aren't paying much attention to my side effects.  I'm wondering whether to halve the dose myself. Is that a stupid thing to do?  Any comments would be most appreciated.  Thank you.

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  • Posted

    Hi Alexandra,I am 78 years old and was diagnosed with AF last September and prescribed 5mg Bisoprolol, various doses of Warfarin and 40mg Simvastatin. One of the factors that caused my AF was my drinking which I have stopped completely. Since then I have not had another episode. Along the way I experienced various side effects similar to what you are experiencing. I played golf three or four times a week but had to cut back due to the side effects caused by the Bisoprolol. I had muscular problems, I couldn't sleep, I had head aches but when I saw my GP he was very unsympathetic at first but agreed later to reduce my dosage from 5mg to 3.75mg and hopefully eventually to zero. I had to agree to this at my risk in case my AF returned. What I didn't tell him was that I had already decided to reduce my dosage by cutting my tablets in half. At my age I wasn't prepared to carry on living with these side effects. I have not had any further AF episodes and have returned playing golf three or four times a week. I keep some tablets in reserve just in case I have any problems. I am not suggesting that you or others do the same as me. It is my choice!. I have also stopped the Simvastatin as well but continue taking the Warfarin. There is plenty of evidence on this web site regarding the side effects of Bisoprolol. Best regards, Joiner
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    • Posted

      No problems with the statin or Warfarin?

      Statins gave me aching muscles, warfarin joint pains so I have stopped each of them. I'm about two years older than you

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  • Posted

    Not certain if you are aware of drug on drug action/recation? But in my experience the medical profession do not always take these into consideration. There are websites to advise you of these issues.

    Also each med. has a "half life" which means how long it takes to start working and how long it may affect you. Again there is a website to assist.

    Were all the meds. and dosages prescribed by the same person? only it seems a machine gun approach rather than selective. It is good to ask what each med. is for and how you will know if it is doing what it should.

    I sorted out my own med dosages and timings and now no longer feel sleepy at 11.o'clock having woken at 09.00. In fact I am fine to be awake from 08.00 to 23.00 . Have AF and a leaky valve and am only on bisop 3.75 and Digoxin plus of course warfarin

    Don't accept your situation

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  • Posted

    Hello, Alexandra123… Wow… In reading your story it reminded me of my MI in 1987 at  age 51… I smoked at the time, was skinny, and under constant stress as a widow trying to support a daughter about to graduate + head for College. My son had just left to become a Green Beret after 2 years of College … My mother was not well, Reagan had made it impossible for me to finish NSG-school, and I had to move to another state to get work as a NSG assistant, due to Reagan's Medicare and other cuts.

    That MI also came out of the blue to me… but I was released from hospital later after stress-tests with only Nitroglycerin , as I had had occasional  Angina for years due to a childhood illness….

    Now I got interested to see why you are on so many meds after your MI… when I sofar am only on Bisoprolol, suffering it's SEs

    so I checked out your meds online :

    clopidogrel, ramipril, atorvastin and 2.5mg bisoprolol.  + daily aspirin

    1]… I think your BP and other factors are considered satisfactory by your doctor, AFTER the effects all those medicines bring… NOT  BEFORE !

    2]… I'm sure your Docs based your MedsRegimen on the tests done in the hospital and later AFTER your MI….

    3]… Did your Docs tell you that the MI  ITSELF REQUIRES  MONTHS  OF  RECOVERY with extreme  TIREDNESS, to the point, where I had to immediately return to care for an Alzheimer patient, because she missed me, could not understand my absence... yet when I had to carry my pocketbook to the car, I had to ask my daughter or others to do it, because I could hardly lift it…. ?????

    4]… Did your Docs tell you about hospital supervised Exercises after an MI that will help this recovery ?????????

    5] …Have you had a chance or the strength to research the side effects {SEs} -  of your meds,-  and add all the same SEs

    of each medication - meaning that if each med. has  i.e. "tiredness" as a SE., and you take that x 4 meds, you can bet you are going to be tired….!!!!!!!?????.......... Each MI is different !

    My MI AFTERCARE requires Beta-blockers, hence I was put on Bisoprolol, for over 10 years, and my dosage is 10mg/6.25 - that is 4 times the mg amount of yours. Have been on that level since 2001, and before that on 5mg/6.25mg for years.   The 6.25mg is an added diuretic, HCTZ, to which my kidneys have now gotten used to.  We tried to change my meds several years back, and that left me "ill + swollen" within 3-4 days - because I needed the diuretic.

    If your 2.5 mg dose is without a diuretic… your Kidney function must be fine, unlike mine………

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    By now I have many of the  BISOPROLOL  SEs. >> WEIGHTGAIN, surely aided by the fact that I am too >>TIRED to exercise,

    FULLNESS + RINGING EARS, BRADYCARDIA,{pulse at rest is at times as low as 40, never more than 50} >> DIZZINESS, >>LEG/FOOT-SWELLING, >>sometimes MUSLE/JOINTPAIN, >>but since I am close to 80, some of the symptoms can be related other some arthritic, allergy, and other old age symptoms….

    I am sorry you have to cope with this!  It's a darned if I do [take the meds], darned if I don't  …situation…

    Since I do not know what caused your MI and what damage it left, I can only say that: " You keep "bugging your Doc " . DO NOT CUT  the Bisoprolol without seeing your Doc first… If he decides to try out your meds regimen minus the Biso… he will take your BP + other Vitals and maybe even do bloodtests, BEFORE you get off the Biso….  This allows him the courtesy of letting him find out later - by your next Doctor's appointment - to do the same tests again, so he can evaluate HOW  YOU  DID  without the Biso….

    If he does not respond in a similar manner to your present problems… ask for your medical records and find another 2nd opinion…

    Or simply tell him you would like a 2nd opinion… call your Insurance to verify - that they will pay for a 2nd opinion !!!

    If you have a cardiologist, and a family Doc… you could visit both with the same complaint, of being unable to cope with the SEs.

    Eventually someone will come up with a solution or strategy to ease this mess! .Maybe just an increase in "cups" of coffee might  help!

    In the meantime- I am doing a lot more research online, before I also see my Doc, re: to the miserable SEs of Biso..

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    Below are more sites where I found SEs for each of your meds…Each med. affects each person somewhat differently!

    A]……    Tell all of your doctors and your dentist that you are taking  PLAVIX  …

    Tell all Docs / Dentists not just Rx meds, but also non-prescription medicines, vitamins and herbal supplements.

    JUST MAKE THIS ALL-INCLUSIVE, IMPORTANT LIST+ HAND IT TO THE NURSE or DOC, WHEN YOU ARRIVE @ YOUR  APPMT.

    Know the medicines you take. Keep a list of them to show your doctor or pharmacist when you get a new medicine.

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    I posed this Q. to Google search:  clopidogrel mechanism of action Among many this site "rxlist" came up and I checked side effects  on this site:  >> http://www.rxlist.com/plavix-drug/medication-guide.htm < plavix="" can="" cause="" serious="" side="" effects="" including:="" see="" “what="" is="" the="" most="" important="" information="" i="" should="" know="" about="" plavix?”="" a="" blood="" clotting="" problem="" called="" thrombotic="" thrombocytopenic="" purpura="" (ttp).="" ttp="" can="" happen="" with="" plavix,="" sometimes="" after="" a="" short="" time="" (less="" than="" 2="" weeks).="" ttp="" is="" a="" blood="" clotting="" problem="" where="" blood="" clots="" form="" in="" blood="" vessels;="" and="" can="" happen="" anywhere="" in="" the="" body.="" ttp="" needs="" to="" be="" treated="" in="" a="" hospital="" right="" away,="" because="" it="" may="" cause="" death.="" get="" medical="" help="" right="" away="" if="" you="" have="" any="" of="" these="" symptoms="" and="" they="" can="" not="" be="" explained="" by="" another="" medical="" condition:="" purplish="" spots="" (called="" purpura)="" on="" the="" skin="" or="" in="" the="" mouth="" (mucous="" membranes)="" due="" to="" bleeding="" under="" the="" skin="" your="" skin="" or="" the="" whites="" of="" your="" eyes="" are="" yellow="" (jaundice),="" you="" feel="" tired="" or="" weak,="" your="" skin="" looks="" very="" pale,="" fever,="" fast="" heart="" rate="" or="" feeling="" short="" of="" breath.="" headache,="" speech="" changes,="" confusion,="" coma,="" stroke,="" seizure,="" low="" amount="" of="" urine,="" or="" urine="" that="" is="" pink="" or="" has="" blood="" in="" it="" ,="" stomach="" area="" (abdominal)="" pain,="" nausea,="" vomiting,="" or="" diarrhea="" ,="" vision="" changes="" tell="" your="" doctor="" if="" you="" have="" any="" side="" effect="" that="" bothers="" you="" or="" that="" does="" not="" go="" away.="" tell="" your="" doctor="" if="" you="" develop="" an="" allergic="" reaction="" while="" taking="" plavix.="" these="" are="" not="" all="" the="" possible="" side="" effects="" of="" plavix.="" for="" more="" information,="" ask="" your="" doctor="" or="" pharmacist.="" call="" your="" doctor="" for="" medical="" advice="" about="" side="" effects.="" you="" may="" report="" side="" effects="" to="" fda="" at="" 1-800-fda-1088.="" -------------------------------------------="" i="" found ="" ramipril="" in="" ::=""> https://patient.info/medicine/ramipril-an-ace-inhibitor-tritace

    Ramipril is used alone or in combination with other medications to treat high blood pressure.

    It is also used to reduce the risk of heart attack and stroke in patients at risk for these problems and to improve survival in patients with heart failure after a heart attack.

    Is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors

    It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.  

    What SIDE EFFECTS ?  from Ramipril : Tell your doctor if any of these symptoms are severe or do not go away:

    Headache, dizziness, cough, upset stomach, vomiting, excessive,  TIREDNESS,  WEAKNESS,  

    The following symptoms are uncommon, but if you experience any of them, call your doctor  immediately:

    swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs, hoarseness, difficulty breathing or swallowing

    yellowing of the skin or eyes, fever, sore throat, chills, and other signs of infection, lightheadedness, fainting.

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    Lipitor.......found in :>>>..https://www.lipitor.com/choice-card < lipitor®="" (atorvastatin="" calcium)="" tablets="" are="" a="" prescription="" medicine="" that="" is="" used="" along="" with="" a="" low-fat="" diet.="" it="" lowers="" the="" ldl="" ("bad"="" )="" cholesterol="" and="" triglycerides="" in="" your="" blood.="" it="" can="" raise="" your="" hdl="" ("good"="" )="" cholesterol="" as="" well.="" lipitor="" can="" lower="" the="" risk="" for="" heart="" attack,="" etc.="" side="" effects::="">> include constipation, diarrhea,  FATIGUE,   gas, heartburn, headache, myalgia, and rhabdomyolysis.

    This is not a complete list of side effects and others may occur.

                    Stop taking atorvastatin and call your doctor at once if you have any of these serious side effects:

    unexplained muscle pain, tenderness, or weakness; fever, unusual tiredness, and dark colored urine; swelling, weight gain, urinating less than usual or not at all; or nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

                    Less serious side effects may include:

    mild muscle pain; diarrhea; or mild nausea., Call your doctor .  You may report side effects to FDA at 1-800-FDA-1088.

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    http://www.drugs.com/sfx/bisoprolol-side-effects.html…. For the Consumer…….. Applies to bisoprolol: oral tablet

    Along with its needed effects, bisoprolol may cause some unwanted effects.

    Check with your doctor immediately if any of the following side effects occur while taking bisoprolol:

    Less common: >> Body aches or pain,,chest pain,,chills,,cough,,difficult or labored breathing,,ear congestion,,fever,,headache,,loss of voice,,nasal congestion,,pain or tenderness around eyes and cheekbones,,shortness of breath or troubled breathing,,sneezing,,sore throat,,stuffy or runny nose,,tightness in chest, UNUSUAL TIREDNESS  or weakness,,wheezing,,

    RARE: >> Chest discomfort, lightheadedness, dizziness, or fainting, slow or irregular heartbeat

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    Your MI was less than 2 months ago…please give yourself more recovery time…. The tiredness from the MI itself will ease !!!

    You should be exercising  in a setting that can monitor your heartrate + BP while exercising…and give you limits when to stop.

    As far as I can see, each medication you are on includes  FATIGUE  ,  sooooooooooo…………  I do wish you well !!!

    Patient Moderator Note: I have removed an URL (a link) from this reply as it was unsuitable for inclusion within these forums however I have provided a suitable replacement. If any user is interested in this removed information they should contact the author via the Private Messaging system requesting such. Sorry for any inconvenience.

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  • Posted

    Hi Alexandra, Have some similarities to your story - in my 60's, healthy lifestyle before being diagnosed with AF a few months ago, now on aspirin, atorvastatin, bisoprolol 10mg and digoxin. I found same symptoms as you with Bisoprolol - really lethargic tho not sleeping that well either, just felt half alive and flat. Not nice, I have to say my body seemed to adapt to the Bisoprolol dose after each increase and the lethargy decreased a bit after about a week. It was doing nothing for my AF, digoxin seems to have helped a bit but my GP was reluctant to let me decrease Bisoprolol. However (I'm a Registered Nurse - the worst kind of patient!) and decided to take things into my own hands - sensibly tho! I've now decreased my Bisoprolol to 7.5mg and my Atorvastatin to 20mg, I'm waiting a couple of weeks then decreasing again if no increase in my symptoms. You definitely have to take it slowly. Sorry your docs aren't taking any notice of your side effects - I felt that too and have considered getting another opinion. Maybe your other drugs also cause fatigue? It seems crazy that they give you drugs to fix something but they then can cause worse symptoms than you had in the first place!! As I said I'm trying to decrease my Bisoprolol, but I'm doing it slowly and just seeing what happens. You may be different with having had a heart attack but sounds like life isn't much fun at the moment? All the best, you'll get there! Cheers Maggie
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  • Posted

    What explanation for the heart attack was given? And have they explained the purpose of each medication? Sounds like they are throwing everything at you. Ask more about the statistical benefits of each med. you'll have to make the choice to stop some of it if you want to feel better.
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  • Posted

    Just another thought. May be not similar to you but I too had a heart attack, in June - went to ED with chest pain and blood test showed I'd had a heart attack. Subsequent angiogram showed my coronaries were all fine. They eventually diagnosed Stress Cardiomyopathy (you can google it and see causes). Can be caused by any undue stress and symptoms mimic a heart attack even tho arteries fine. I think for me the stress of starting with AF brought on symptoms. So just wondered if you'd be having any stress prior to heart attack.

    Cheers Maggie

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    • Posted

      Just googled.  Fascinating and sounds like a good diagnosis to have with excellent prognosis.  Don't know in my case. I had no ECG changes. Chest pain and troponin rise - presumably your experience too.   Angiogram showed major arteries were fine but there was a problem in a side branch.   Yes guess I was stressed prior to all of this.  Oh well - we'll see.  Thanks for your messages and good luck  with the lowering of the drugs.  Do keep me posted. 
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