Side effects ACE inhibs II

[Robin__0__0]

Posted by Robin  on June 26, 1999 at 11:20:53
I had posted some concerns about the side effect of ACE inhibitors last week and thanks much to all who replied. RE-cap; I have idiopathic cardiomyopathy; taking 10mg monopril 2x day; atenolol 50 1 x day; aspirin 325 1 x day; lasix as needed and xanax as needed. I have become orthostatic, nausea, dizziness, lightheaded-faint feeling, dry cough, weakness, tiredness, fatigue, and edema. Well here is where I stand now; I went to cardiac rehab (where orthostasia was diagnosed) yesterday 6/25 and had symptoms again really for the first time in two weeks. (I'm not totally convinced that it is all meds fault) The attending RN Stopped my exercise because of blood pressure and the "achy" feeling in my left arm turned to numbness and tingling, that’s when she stopped me and called my cardiologist. He advised me to cut all my medicine dosages in half i.e. monopril 10mg. 1 x day, atenolol 25mg. 1x a day, NO lasix, though I have not taken any in a week. I am now concerned that my treatment is less aggressive and that my arrhythmias, tacacardia, & pvc's (in the form of couplets, by-jiminy & tri-jiminy) will return. I have already experienced that old familiar feeling of a mild explosion in the middle of my chest (never caught on tape) that sends a tingling, lightheaded feeling upwards into my head and down my left arm. This one was mild compared to the ones of the past before the monopril, and only lasted seconds instead of sending me into hours of irregular heart beat, nausea, and what appeared to be signs of hypertinsive heart disease (pain & tight chest, achy/numb left arm, tense feeling from left shoulder traveling up my neck into my left jaw).
Q; given my age of 34, shouldn’t my treatment be more aggressive?
Q; are there any other medicines that work the same that are more easily tolerated at higher doses?
Q; My EF was 46 in March by cath. but I am very symptomatic, my tricuspid, mitral, & pulumic valves all regurgitate. Does the EF alone represent the severity of the progression or do symptoms play a role?
Q; these symptoms I have are bothersome but more concerning is the idea that they make my heart work hard, and could that contribute to the progression of cardiomyopathy?
Q; finally, could my past problems start to return as early as 5 hrs. Post my first missed dose of monopril ?
Thank you for your time and any answers you can give me. I plan to make an appointment with my Dr. on Monday while still looking for a specialist in cardiomyopaty & heart failure.  
Posted by CCF CARDIO MD - CRC on June 28, 1999 at 12:15:32

Dear Robin,
Thank you for your question.  Heart failure, or congestive heart failure (CHF) is a syndrome of low heart output, shortness of breath and swelling in the extremities.  The most common cause of heart failure is ischemic (secondary to blockages in the arteries).  Other common causes are hypertensive (high blood pressure), viral, valvular and idiopathic.  The diagnosis of CHF is made by symptoms and testing of the heart.  An echocardiogram or heart catheterization is usually done to measure the function of the pumping chamber.  Other investigations may be performed depending upon the cause of the CHF.
Treatment of heart failure can be medical or surgical.  If failure is due to blockages or valve problems then surgery is often recommended.  Medical management includes digoxin, ACE (angiotensin-converting enzyme) inhibitors and diuretics.  Newer evidence has shown that low dose beta-blockers improve symptoms and survival in patients with CHF.  End stage CHF is treated with heart transplantation if the patient is a candidate.  
CHF is a common problem and there are new treatments being developed.  It is a chronic problem and must be followed closely by your doctor with adjustment of your medication as directed by your doctor.  
Further information can be found at:
http://www.healthanswers.com/health_answers/search_get_answer/forums/circulatory/frame1.htm
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.