CHF w/COPD Recommended CHF prevention drug?

[Kimrose]

Could you please provide comments for 79 yr old woman? Has CHF, COPD, NO hypertension, and Manic Depression. On Coumadin, Lasiks(ON-HOLD for now), Lisinopril (10 mg),Advair,Combivent,Lamictal (25 mg/day)(was taking 450mg/day Escalith until last hospital visit) Also on an antibiotic, oxygen and cough medicine to treat pneumonia. Aug-03, she was hospitalized for tachycardia, atrial flutter, severe shortness of breath, pneumonia, and acute myocardial infarction. In Nov, she was hospitalized for CHF, tachycardia, shortness of breath. Atrial flutter/fib not resolved. Jan-04 had RF Ablation of AV Node – Permanent, single-chamber pacemaker implantation. Set to 80 bpm. Taken off all drugs except Advair(500mcg/twice daily). Prior to pacemaker implantation 2 echos showed EF at 50-55%, Cath showed 36%. Feb-04 added Lasiks for minor edema. Feeling “good”. Best she felt since July 2003.  Apr-04 Cardiologist introduced Lisinopril and reduced Advair dose to 250mcg twice daily. She has felt lousy ever since. Needed Albuterol 2-3 times daily. Fatigued with mild activity. 2 ER visits since drug changes. First ER visit, had severe shortness of breath (gasping while talking), fatigue, shakiness/instability, and diarrhea. ER gave her breathing treatments, prescribed Albuterol and antibiotic for infection. On the next ER visit was admitted with similar symptoms and had dehydration, slurred speech, Lithium toxicity (1.8 mmol/L), elevated potassium (5.1mmol/L), pneumonia and UTI. Blood pressure fluctuated between approx. 126/56 to 88/40. Reduced Lisinopril

[Cleveland Clinic]

kimrose,

it is very difficult to make comments on such a complex history without examining all of the data.


Lithium interaction or COPD?

As far as i know there is no interaction with lithium and an ace inhibitor unless the ace causes renal dysfuction leading to accmulation of the lithium and toxicity.  The creatinine would be an indicator of her renal function.

Any comment on Losartan instead of ACE inhibitor?

Generally I reserve ARBs (losartan) for people that develop symptoms of cough on an ace or in extreme cases of heart failure after maximizing other meds.

Better for CHF patients w/COPD? Thank you.

There shouldnt be a significant interaction with the COPD and the medications you list. The main concern would be the use of beta blockers in that case.


good luck

[Kimrose]

Missing info on post: Reduced Lisinopril from 15 mg to 10 mg/day. No indication of CHF during either of these two events. Seems she is not responding well to the Lisinopril.  Lithium interaction or COPD? Any comment on Losartan instead of ACE inhibitor? Better for CHF patients w/COPD?  Thank you.