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Use of ACE Inhibors with HOCM

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janeelynne 66 years old, retired registered nurse, Hypertrophic Obstructive Cardiomyopathy diagnosed 5 years ago when a doctor finally decided to check out the heart murmur I had had for 20 years! Medically retired at 62 yrs. I live in a rural area in a small farming town about 2 hours from Adelaide. I do not tolerate exercise very well but like to walk my greyhound when I can. My Great Dane is walked by the dog walker! Find out more about janeelynne
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  • Use of ACE Inhibors with HOCM

    I recently have been doing some research on HOCM because I am not feeling as well as usual and am wondering if my medications need tweaking again. I have been taking Prerindopril for my blood pressure yet my research says that ACE inhibitors should not be used with HOCM. I take metoprolol 100 mgs BD to keep my heart at 60bpm. Any thoughts on what is right?

  • #2
    Ace inhibitors are generally not recommended in Obstructive HCM. Ace inhibitors dilate the arteries .... and can cause the pressure gradient in the LVOT ( left ventricular outflow tract ) to increase. So essentially they can increase any symptoms caused by obstruction. Are you working with an HCM specialist? As this is a pretty well accepted and recommended position concerning ace inhibitors in HCM. If you were in dilated heart failure that would be an exception.
    You may want to talk to your cardiologist about a different medication for your blood pressure.
    After years of symptoms:
    Officially Diagnosed HOCM 2006
    Myectomy 3/11/13 at non-COE
    Extended Myectomy 7/23/14
    At Mayo with Dr. Joseph Dearani

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    • #3
      Yes, what Jill says is right. Generally we shouldn't take ACE inhibitors.

      Gordon
      Myectomy on Feb. 5, 2007.

      Comment


      • #4

        thank you Jill and Gordon, I was originally on Coveram (Amlodipine and Perindopril) but the swelling of my ankles and feet was very debilitating and painful. The medication was changed to Perindipril 8 mhs and Lercandipine 10mgs daily. The ankle swelling remained a problem so I stopped taking the Lercandipine with good effect and I have weaned myself off of the Perindopril over the last week. My BP is 130/75 and I feel better. I will check the BP randomly. I am seeing my GP tomorrow who will almost certainly send me back to the cardiologist early for further medication review. Hopefully the Metoprolol will be enough to manage my blood pressure.

        Just one more question - have you had any reports of side effecgs with Fexofenadine (antihistamine)? I have horrible hay fever as we are going into Spring here and was recommended this drug by the pharmacist who is familiar with my current medications but I had an episode of bradycardia which lasted most of the day and made feel rotten, confused, dizzy, sick. Pulse rate was 48 at the apex beat. I almost had to think of calling an ambulance but being the typical nurse I didn't and got into trouble with my friends and family. I am not a good patient and I am a long way from a major hospital (think helicopter retrieval for serious conditions). Obviously I have not taken this medication again and the episode has not repeated.

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        • #5
          There are many antihistamines that have the effect of inhibiting the CYP2D6 enzyme path ..... this can cause Metoprolol to not break down as fast as it normally does. The effect would be as if you have taken too much metoprolol and might cause Bradycardia etc. Without doing research, I don't know about fexofenadine....but it sounds like that's what might have happened. I know in the US the first line of treating inhaled allergens is continuous use of nasal inhaled steroids like nasocort. This would have the least effects systemically for drug interactions. If this is not enough, you may need to work with your MD on decreasing your metoprolol while on the anti-histamine.
          It is good you are so aware of your body and it's response to various drugs! Don' t let anyone discount that.... it can save your life and send you on to find the treatment that is best for you.
          After years of symptoms:
          Officially Diagnosed HOCM 2006
          Myectomy 3/11/13 at non-COE
          Extended Myectomy 7/23/14
          At Mayo with Dr. Joseph Dearani

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          • #6
            Thanks so much Jill, excellent feedback and advice. I will talk to the pharmacist who is very approachable and bring him up to date about the episode. I would rather sniffle and stream now than take any more antihistamine.

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            • #7
              The nasal steroids work pretty well .....they target receptor sights in the nose and sinuses and prevent such strong reaction to allergens. It takes a few days of using them to build up the needed amount on the receptors....so they may not work right away ....but they are a good long term or seasonal treatment. They used to be prescription here in the US, but now are sold over the counter.....There also may be drugs besides anti-histamines to use but I'm not versed in allergy.......More of a heart and lung gal.
              I hope you can get your dripping under control and enjoy the spring! We got our first snow in the mountains here in Colorado yesterday.
              After years of symptoms:
              Officially Diagnosed HOCM 2006
              Myectomy 3/11/13 at non-COE
              Extended Myectomy 7/23/14
              At Mayo with Dr. Joseph Dearani

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