Drugs for Congestive Heart Failure

[DottyCece]

I read recently that Toprol is a good alternative for Coreg in the treatment of CHF.   What drugs are considered to be current best practices in the treatment of CHF?

[Konopka1955]

Hi Dotty,  Alot of people I've spoken to have switched to toprol as the coreg is very expensive.  I have a very good prescription plan - right now - but I may ask to switch to toprol as I think I'm gaining weight on this coreg.  I see my CHF specialist this month and I'll ask if I can.  

quote - You would start out at a very low dose and then increase it every three to four weeks until they get you to a therapeutic level. It took me about 6 months to get to 25 mg twice a day.
end of quote  

That's good to know.  I'm on half that at the present time.  I have noticed that my INR is running very high.  I can't help but notice its been high since I started the coreg - I wonder if that could be effecting my INR.  I was 4.7 last Monday and my coumadin clinic cut my doseage in half on 2 days and I'm still at 4.1 tonight..   So I'm sure they'll be cutting it again.  I had an appt with my dentist last week and had to cancel it as my INR was to high.  SO I rescheduled with my dentist and I'm going to have to cancel it again this week.  I just need my 6 mos cleaning.  I can't imagine if I had a toothache - how would they take care of it !!!   I don't know - I've never been in this situation.  My mechanical mitral valve works great though.  But the down side is I have to take coumadin..  

What diuretic do you take?  Are you on coumadin?  I have an ICD to.  I've heard the biventricular device has helped certain cardiac patients.  I don't have one at this time.  But my ICD was recalled - but I'm not getting it replaced till my battery goes dead.  Which should be about 6 mos to a year.  

quote - I had severe CHF symptoms even with all the drugs. - end of quote

How is your CHF doing now?  

Maybe we could e-mail each other off this board.   If your interested my e-mail is:   ***@****  

I have a couple of ICD patients I correspond with by e-mail and we share lots and lots of JOKES..  Some are a riot.  I go to an ICD monthly information meeting and a Medtronic Rep will be the speaker this month.  I'm looking forward to asking lots of questions that day.  

I know what you mean about good days and bad days..  Its a struggle for me some days - and I'm hopeing the CHF meds will help me to at least stabilize my symptoms and to breath when exerting myself would be nice.  I can walk and I'm getting the best of care - so I'll do what I can and be happy.  My EP doc says even doing alittle exercise is so good for CHF patients.  So I don't look at my speed or my length of workout - I just do it and have FUN..  and I'm getting better adjusted to accepting my limitations.  It was hard at first.  But I feel better if I slow down.  Working out every other day has been better than everyday.  I see a CHF specialist this month.  Hopefully, I can get my EF rate up and my enlarged left ventricle down and hopefully this will make breathing better for me.  

Thanks for asking how I am.  I hope your doing well and if you want to correspond - I would like that.  I work during the day so I can only respond at night.  SO I may run a day behind.  

Best Wishes
Marilyn

[PikaPika88]

Thanks for the reply.  My dentist said my teeth are very clean.  How I brush it?  Hardly can see the teeth so clean by just using a toothbrush.  I'm now 47 yrs old.  I still have a good condition baby tooth with me.

I saw one post that the lady said his son has WPW.  He born with 2 teeth.  I don't know is WPW related to teeth???  

Our custom have brushing the tongue by using the Glycerine start in baby time.  I did that for my 2 daughters as well.

Thanks again.

Pika.

[Konopka1955]

Hi Pika,  Yes, your dentist is right there are numerous types of cleaning.  There is a type of teeth cleaning which I can't have as they mentioned to me.  I guess it's some sort of machine that really whitens your teeth.  

But I get a "regular cleaning" - they use a sharp hook like and check my gums for gum disease.  They also scrape the plaque off my teeth if I have some with a sharp pic.  Then they use a power brush to clean.  They use dental floss as well.   It doesn't really hurt - but I'm a terrible dental patient.  I literally grip the chair till my knuckles turn white.  My feet will sway back and forth and they always ask if I'm "OK"..  Of course,  I just smile and say:  Oh yes,  I'm fine - Really I'm fine - are we almost done...  :-)

I have used the battery toothbrush at home to clean my teeth and it actually cleans better than brushing with a regular tooth brush.  The battery toothbrush didn't effect my pacemaker/defibrilator - but it wouldn't hurt to ask the manufacturer of your device.    

I think its very important to keep your teeth in good shape.  I also recommend brushing your tongue.  SO much bacteria is in this area and people don't think to brush that as well.  

My hygenist is very nice and I go every 6 mos..

My teeth feel so great after my cleaning.  :-)

Best Wishes
Marilyn  :-)

[PikaPika88]

Hi,

My dentist told me I can't have my teeth clean because the cleaning equipment has microwave.  It'll affect my pacer.  Do your dentist using the equipment clean or manual (no equipment) clean?  I'm interesting that.  appreciate for your answer.

Pika.

[DottyCece]

Hi Marilyn,

Sure we can email each other off this board.  I would highly recommend the biventricular pacer if you are a candidate for it.  It has made a huge difference for me..much more than drugs.  I take Demadex for my diuretic.  Yes, i am on coumadin and my INR has been all over the place.  I get it checked at least every three weeks.  I am looking for a home machine that I can use and that the insurance company will support.

My email address is ***@****.  You may send me email there.

[DottyCece]

Hi Marilyn,

I wondered about Toprol insteach of coreg.  Sounds like the jury is out on this questions. Coreg is very expensive for me so I am looking for a more economical alternative. Coreg is an alpha and beta blocker (of sorts) which is suppose to be better than other beta blockers.  You would start out at a very low dose and then increase it every three to four weeks until they get you to a therapeutic level.  It took me about 6 months to get to 25 mg twice a day.  I also take lisinopril very low dosage because by BP is pretty low. Coreg doesn't affect potassium..it is the diuretics that cause you to loose potassium.  I do take diuretics to keep the fluid off and have to take potassium, magnesium and calcium which are depleted with the diuretics..  I feel much better when my weight is down.  
I also have a biventricular pacemaker and ICD which has helped me more than all the drugs I take.  I am sure the drugs are necessary but before I got my biventricular pacemaker, I had severe CHF symptoms even with all the drugs.  

How are you feeling?  How is your endurance and stamina?   For me, every day is different and some are a real struggle and others are really good.  I am grateful for the good days!!  Take care.

[Konopka1955]

Hi Dotty,  Very good question.  I'm glad you asked the doctor.  I just started taking 'coreg' and I have put on a couple pounds in the course of a couple weeks.  But more importantly I feel very bloated some days..  But I'm just starting on a small doseage and may have just been drinking more water than normal.

I was on atenolol - for years - but my doctor suggested coreg might be better for my heart.  He also set me up with an appt. to see a CHF specialist next month.  I think they have to do blood testing for your liver or maybe it was the kidney and also for potassium when you take coreg..   Since I have an ICD - I think potassium effects the arrhythmia.  I'm not sure.  

I've heard many people take toprol and have tolerated it better than coreg.  But I don't know that for sure.  Just the patients I've encountered.  

I hope all is going well for you.  

Best Wishes
Marilyn

[Cleveland Clinic]

Dotty,

Thanks for the post.

There is a lot of debate over what are the correct drugs for heart failure. Unfortunately, when it comes to specific differences between drugs -- you need to be wary of marketing by each company.

Overall, you should be on a beta blocker. Which one is still a matter of some debate.

Other drugs important in a core heart failure regimen include ACE inhibitors and diuretics.  

Depending on other circumstances Angiotensen II blockers, blood pressure control with drugs such as calcium channel antagonist, digoxin, or antiarrythmics may be important.

Hope this is a start.