The Patient:
72 year old male, my father.
A brief history:
April 27, 1998 - My father experience a heart attack. No prior symptoms, but had been
livingAdvanced care directives with
AtrialAtrial fibrillation/flutter
Atrial myxoma
Left atrial myxoma
Right atrial myxoma fibrulation for 2 years. Drugs in use - Rhythmol, Varapamil. (Not sure about spelling)
April 28, 1998 -
EmergencyEmergency airway puncture
Emergency contraception tripleTriple antibiotic
Triple paste
Triple paste af
Triple sulfa topical
Triple tannate pediatric
Triple x pediculicide bypassHeart bypass surgery
Heart bypass surgery - series surgery. Hypoxia suffered.
May 18, 1998 - Staff infection in chest made second surgery necessary. Debreding was performed. Many days spent in ICU. While on ventilator, experienced something called
encephalopathyCerebral hypoxia.
While in Rehab it was determined that he is now experiencing BradyTachy syndrome, i.e. the drug used to prevent atrial flutter slows the heart down to much, and drugs to stimulate cardiac output speed it up too much (?). A pace maker was recommended. Loss of appetite noted during this time.
June 23, 1998 - Drugs stopped in preparation for surgery. Significant recovery of appetite experienced. I was amazed!
June 24, 1998 - Pacemaker was inserted. (Medtronic Kappa 400). He asked for food immediately after the procedure!
June 25, 1998 - Pigtail lead came loose and a second procedure was performed to reconnect in the heart. Again still eating well, and asked for a candy bar after surgery!
June 27, 1998 - Back to Rehab. He is currently better but a loss of appetite has returned. In addition, he has tremors and fatiques easily. In order to get out of the hospital he must get stronger. In order to get stronger, he must eat. He won't eat, can't eat, doesn't know why, and is very depressed. NOW THE ASUMPTIONS AND QUESTIONS:
Based on this history I believe this is strictly drug related. I am not a physician, just a worried son. He is on Amiodarone and Lotensin. Are these drugs responsible for his fatigue, tremors and loss of appetite? And, if so, what can be done to get out of this vicious cycle? Are there other choices?
Sincerely,
Bruce and a concerned family.
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Dear Bruce:
Amiodarone can cause profound loss of appetite and fatigue in some patients. This is usually not the case with the lower doses of amiodarone used for atrial fibrillation. It may be that he needs a lower dose of amiodarone or that he needs a different type of medication for his afib [amiodarone is however, a good medicine for afib]. There are several different types of medications for atrial fib, though each has its own set of potential side effects. Another possibility to consider is that his depression is what is causing his loss of appetite and fatigue.
I wish your father the best of luck.
If you wish to be evaluated here at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at desk F15. Information provided in the Heart Forum is for general purposes only. Specific diagnoses and therapies can only be provided by your doctor.