Unsure if getting appropriate treatment

[Adam1234]

Hi Everyone. I am trying to get some answers regarding the treatment of an elderly male in the UK. He has been diagnosed with heart failure and has a leaky valve and some irregular heart rythums. At the moment he still gets breathless after walking up a few stairs and I'm not happy with this situation. He also has a persistent cough which may be linked to his medication. He does have some water retention in lower legs. At a recent appointment we were told that the ECG showed his irregular heart rhythm is now more controlled with the medication.

Below I've listed 4 questions. Thanks in advance for the advice. I'm really look for another opinion as the patient is not really able to function as fully as he used to, but the doctors seem to be quite complacent about it.

Q1) A few months ago I took him to a specialist who took him off some other medications previously prescribed by our GP (local doctor). The specialist put him on Digoxin. He said it was better for his condition. However the patient recently had another appointment where his blood pressure was high and so another specialist has now added Doxazosin. (You don't always get to see the same specialist at appointments). The patient is also on Furosemide, Warfarin, Simvastatin and Ramipril.
Are these medicines appropriate for his condition? Any other medicines you would suggest finding out about?

Q2) The patient has had high blood pressure for many years now but when he was on Atenolol he never had a problem with his heart and his BP was controlled. When he switched to a different GP (local doctor), the new doctor said the Atenolol dose was too high and halved it. Within 6 months the patient had developed heart failure. Then they took him off Atenolol and put him on other medications they said were better for his heart condition. I am now wondering whether reducing and taking off the Atenolol may have led to the problems or made them worse? Could it be better for him to now go back to that? Are there any risks with that? He was on Atenolol for decades and had no problems with it at all.

Q3) The patient is overweight. What can be done to reduce his weight considering he cannot exercise that much now?

Q4) Are there any particular tests the patient should have? He has had an echocardiogram and ECG in recent months..

[Encephalomalcia]

Water retention in the legs usually mean right side heart failure.  Whether caused by the valve and by a plugged artery is what I am wondering?  Has he had an angiogram?  Echocardiograms do not always show everything.  If he has not had an angiogram, he should.  If it's a plugged artery, surgeons can put a stent in and he will feel a lot better.  

[Momto3]

Hello and welcome to the forum.  We're glad you found us, but sorry for the circumstances that bring you here.  The questions on this forum are not answered by doctors.  Rather, they are asked and answered by patients, caregivers and friends.

Do you know the classification of Heart Failure?  

Digoxin is a commonly prescribed medication for patients with heart failure, afib/flutter or fast heart rhythms.   Doxazosin can be prescribed alone, or in combination with other medications to treat high blood pressure.

Furosemide is a diuretic, used to treat fluid retention as a result of heart failure.

Warfarin is used to prevent blood clots, and is often prescribed for patients with afib (though it is also used for other reasons).

Simvastatin is used to treat patients with elevated cholesterol.

Ramipril is an ACE inhibitor, commonly used to treat heart failure and high blood pressure.

It appears that your friend has been prescribed a number of medications to treat his heart failure, afib and elevated BP.  Whether they are the optimal medications is something a doctor would need to determine.  In the U.S., coreg is a very common medication prescribed to CHF patients....not sure if it is available in the UK.

As to the atenolol, has anyone asked the doctor whether it would be worth trying it again?  Although given the CHF, his new regime may actually be better for him.  Given the development of CHF after the change in medication, I'd also want to know if the change was a mitigating factor.

Make sure your friend is limiting sodium and fluid intake.  It is very important for CHF patents to watch their sodium and fluids.  Perhaps his physician would recommend an appropriate cardiac rehabilitation program at your local hospital or wellness center.

Has he had a stress test?  My Dad has CHF and beside an echo, he has a yearly stress test.  He also had bypass surgery, so that may be the reason for the stress test....Still, it might be worth asking about.