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Should I stop the Ramipril
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Should I stop the Ramipril

13 months ago I had a HA. 100%blockage of the ALD. Stent was inserted. Prior to this event I had low BP, Low cholesterol, don't smoke, exercise and no family history of heart disease. Ef was 20-25 after the HA. last Echo put EF at 35-40. Stopped taking plavix after one year, now taking 81 aspirin every other day.  Stopped taking beta blocker at one year. Still taking 2.5 Ramipril twice a day.
My BP can run 95/65 & Heart rate 60 when resting. I have had two Nucular stress test and performed outstanding. Not currantly seeing any cardiologist as all previous only want to do is test and interventions and or Pacemakers.
I exercise three times a week in health club where I do HIT training and get my heart rate up to 175. Have lost about 20 pounds since my HA. Six foot tall and 152 pounds
I cant see any reason to continue the Ramipril.
2 Comments
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Avatar_dr_m_tn
Franco,
That is great news that you have been exercising so well and have lost 20 lbs after your heart attack!
I would very strongly recommend that you continue to see a cardiologist or at least an Internist who is comfortable in managing ischemic cardiomyopathy (reduced left ventricular function in the setting of known coronary artery disease; which is what you have).  An ejection fraction of 35-40% is NOT normal and is called systolic heart failure.  Without medication optimization and appropriate therapy, this can lead to worsening heart failure overtime with loads of other complications and eventual early death.  There are many, many trials of hundreds of thousands of patients over decades of research that show that both beta blockers and ACE inhibitors (like ramipril) improve left ventricular function and decrease mortality in patients exactly like yourself.  The only reason to stop these medications in the setting of systolic heart failure is if you have symptomatic low blood pressures on a regular basis (you get lightheaded, pass out, etc), if you have profound bradycardia (very slow heart rate in the setting of beta blockers), or if you have worsening renal function (in regards to ACEI).  Many patients who has systolic heart failure will slowly recover function overtime with medical optimization (meaning to a normal ejection fraction of >50%).  It has also been proven that putting an ICD (defibrillator) and/or pacemaker into patients with an EF of 35% or less with a wide QRS on EKG (which is reflective of damaged electrical conduction in the heart and is permanent after things like a heart attack) reduces mortality in patients with systolic heart failure compared to those who do not get those therapies.  The physiology behind that is two fold: 1. fatal heart rhythms like ventricular tachycardia and ventricular fibrillation occur at much higher rates in patients with systolic heart failure and ICDs (defibrillators) can abort those rhythms before death is caused).  2. synchronizing the pacing (beating) of the heart when the native electrical system is damaged allows for the heart to beat in its more natural way, preventing worsening heart failure over time and leading to recovery of ejection fraction in many patients.  
I hope that helps.  Maybe you should see a new cardiologist?
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Avatar_m_tn
When I asked my past three cardiologist how long I would have to stay on the beta blocker and ace inhibitor. they all said. "forever" In 2012 the AHA updated guidelines for beta blockers, admitting that use was based on studies from the 80's. At best studies showed a 25% increase in survival rate. If you look at the studies, (all studies are suspect,as they are done by drug companies that only have profit in mind...Remember Vioxx)  you have to ask yourself. Ok, out of the 50,000 people in the trial, how many continued to smoke, how many were overweight, how many were not exercising,how many were mostly eating crap..If you removed all those out of the group, then the beta blocker had little or no effect on the remaining people, except to maybe damage their kidneys.
I do not think there is an drug effectiveness than cant be trumped by lifestyle changes. I have a doctor friend who agrees that all drugs are just "damage control".  
The studies on Pacemakers are suspect in the same way. I don't see myself as in the mainstream of the "study group". Lets now forget their negative aspects  
My EF was 20 after the HA, so 35-40 (tech rated at 41) was a good improvement.
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