Unhealthy side-effects of drugs

I am a 72 year old female being seen at Stanford by a "heart failure" physician.  Emergency visit with ATF and shortness of breath in Jan.  Chest X-ray & EKG found enlarged heart, hypertension, ATF; injections to reduce hypertension and stabilize ATF; given diltiazem.  Overall health is good, take nutricianal supplements consistantly.  Take no medications, LDL too high, HDL 85 and triglycerides within range;  risk ratio is about 3.5+/-.

Stanford doc started me on carvedilol 12.5 2 x/day, lisinopril 5 mg 1/day and coumadin 5 mg 1 x/day; unable to tolerate lisinopril, switched to divan 160 1 x/day.  Carvedilol increased to 25 mg 2 x/day.  Ejection factor 30.  I feel worse now than I did when I left the emergency and was placed on diltizem;  heart rate is even higher (today 175/129 - pulse 50) similar in my local physician's office 2 days ago.  I have worse symptoms since I started taking drugs.  I have heart noises, am breathless, have fatigue, and feel the need for more oxygen.

Stanford will do stress tests, etc. cardionversion in 3 mos.  Not sure I want to continue taking these drugs (except coumadin) or go through that.  If I had arrythmia for 50+ years, what is normal for me and how will jolts with "jewels" get me there.  I am opposed to taking anymore medication - especially for cardioversion as they are so toxic.

I wouldn't mind a second opinion about the drugs.  Thanks, 1Jackie    

[Michael J. McWilliams, M.D.]

I think what you are telling me is that:

1. You have heart failure with decreased heart function
2. You have atrial fibrillation
3. You have uncontrolled blood pressure

If you are not sure about your treatment, I recommend seeing another doctor in consultation.  Only a face to face review can really answer your questions.

That being said, it sounds like you are being treated with the standard of care and there is very good data to support the coreg, diovan, and coumadin to decrease your risk of cardiovascular events including hospitalizations for heart failure, stroke and death.  Beta blockers like coreg can cause fatigue.   Some people have decreased fatigue if they continue to take the medications.  There are other beta blockers like metoprolol that can be tried to see if there is less fatigue.

Depending on how long you have had atrial fibrillation, some people benefit from a cardioversion.  Being in a normal rhythm does improve symptoms in many people.  

It sounds like you need a second opinion.  If you live close to Stanford, you can probably see another doctor there to see if your doctors agree -- my guess is that they will because the data is so strong for the medications you are prescribed already.

I hope this helps.  Good luck.