Heart attack followup treatment

  I had a heart attack in december '97.  A cath showed a totally blocked  circumflex (sp) artery and no further treatment was warranted per the cardiologist.     I am now on Ticlid and vasotec ( I am allergic to aspirin).  At a recent followup visit the Dr. noted that I had a very rapid heartbeat,  did an Ekg and prescribed digitalis.    I have Asthma, emphysema and take slo-bid .  I have been aware of the rapid heartbeat for a couple of years.  It has not concerned my other physicians. I have two concerns:
  1. First,  I am not taking beta blockers or channel blockers.....should I be?
  2. Secondly,  I am in a monitored exercise program and have begun to lower my heart rate that way.  What will be the effect of digitalis on that and what could be the effect of any interaction with the slo-bid.  Wouldnt the slo-bid tend to increase my heart rate anyway.
  I have recently retired to Florida and am concerned  as I am not familiar with the reputation of my cardiologist (I would normally be in the northeast where I am familiar with the reputation of the area physicians and have other medical contacts there  to depend on for advice. )  I am in the habit of taking charge of my medical care and my new physician is not in the habit of giving detailed explanations.  Thank you for your help.
  Jan in Fl.
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Dear Janet:
Beta-blockers are very useful in people with coronary artery disease.  However, they must be used with caution in people with asthma or emphysema, as beta-blockers can worsen these conditions.  Calcium-channel blockers are useful in patients with high blood pressure and in some patients with angina, though there has been some controversy about possible side effects from their use in the press lately.  Digitalis can be useful for certain types of irregular heart beats; its effect on exercise-induced increases in heart rate  is minimal.  Slo-Bid can cause irregular heart beats if the level of the medicine in the blood is too high, so this should be investigated.  Specific medications are indicated for specific circumstances, especially in patients with multiple medical problems on multiple medications.  This is something that is best done by your own doctor, who knows you and your medical history.
If you wish to be evaluated here at the Cleveland Clinic (or our Florida satellite), please call 1-800-CCF-CARE for an appointment with a cardiologist.  Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your doctor.