Echo without meds

[Abbygirl2]

Hi everyone, I just finally got my results back yesterday from Dr Wigle in Toronto (it only took 2+ months).
Anyway he is considering switching my medication(currently taking 75mg Atenolol) but would first like me to have an echo(with Amyl Nitrate) to see how high my gradient can be provoked. Currently on Atenolol my gradient(provoked) is about 37. At rest it is 18.
I rely heavily on the Atenolol, usually counting the minutes until I can take it.
At this point I have refused the Echo, and my husband is irate. He thinks I should have it done. (Easy for him to say).
How important is it to have this test done without meds?

Thanks

Pam

[Sarah]

stress echo

Pam,

It is not safe to go cold turkey off a beta blocker, even for a test. You need to have this conversation with the doctor, to find out how important it is for you to have the test.

S

[Reenie]

I agree, call Dr Wigle's office and get more info. He's a leading expert so I have to doubt that he'll suggest testing that he feels would harm you.

Reenie

[Abbygirl2]

Thanks for the replies. He suggested cutting down 25mg a day. However my GP didn't feel comfortable with this and said she would rather me cut back slower then that.

At this point I am just wondering what would be the reason to do this test.

The med he wants to switch me to is Disopyramide (Rhythmodan), however everything I know about this type of medication is telling me to steer clear unless ABSOLUTELY necessary.
All my tests came back fairly good(HCM good) and they have not caught any dangerous arrhythmias so I don't see how the switch is warranted.

I do get a lot of arrhythmias BUT I do not feel comfortable going on this type of medication, without good reason.

What are your thoughts??

Thanks for your time.

Pam

[Sarah]

arrhythmia

Pam

If you are having a lot of arrhythmias, then it sounds like the atenolol it not doing enough for you and Dr. Wigle may be on target.

Arrhythmias are something to be avoided as much as possible.

I was on disopyramide for ten years or more and it was much less annoying to take than a beta blocker. Every medication has risks, but they need to be weighed against the arrhtyhmias.

Take care,

S

[Paul S]

Hi Pam,

You should do what Wigle says, he is the specialist after all.

Your first post did not mention cutting down meds. "echo(with Amyl Nitrate) " is simply an Echo where you sniff the Amyl Nitrate during the test. It is not a medication switch.

I was on Rythmodan (Norpace) and did just fine. It helped and the only side effect I had was dry mouth, which got better over time.

Don't fight the specialists, question and clarify more yes, fight them and refuse, no

[Laoshur]

Hi, Pam,

I am also not clear about your coming off the beta blocker before the test. Is that what Dr. Wiggle is recommending? I did come off both beta blockers and calcium channel blockers before a stress echo last year. I am not sure of the reason, but apparently it is to get some idea of the maximum degree of gradient. My doctor said he would admit me to the hospital for the time I was off, if I was nervous. I said rather cavalierly, "Oh no, I haven't been on beta blockers that long, so I'm not worried." Well, after the test I read all the stuff about not coming off beta blockers quickly, but truthfully I did OK. I think, if I were you, maybe I would ask if you can be hospitalized before the test to make sure that you do not develop serious rebound problems.

Rhoda

[Cynaburst]

I take Norpace along with a beta blocker to reduce my gradient after 2 years of varying doses of atenolol. none of which reduced my gradient enough. I was on 175 mg. of atenolol. Now I take 100 mg. of atenolol and 400 mg. of Norpace daily. (I never went off the beta blockers to see how bad my unmedicated gradient was, but I suspect that is because it was quite bad enough, even on very large beta blocker doseages).

I suspect that Dr. Wigle wants to see how severe your unmedicated gradient is so he can see whether Norpace might reduce it more than the beta blocker, or whether the beta blocker does it enough.

A side benefit of Norpace is that in addition to reducing gradients, it reduces arrythmias. I guess that is actually a backwards way of saying it because it is actually an antiarrythmic drug which was found to have great success in reducing sub aortic gradients in HOCM.

[Abbygirl2]

I'm sorry I wasn't very clear in my earlier posts.
Dr. Wigle wants to do an echo without Atenolol to see what my gradient is unmedicated. (I have had Amyl Nitrate with nearly every Echo-so yes I am aware of what it is used for).

Now, the only reason he suggested the switch to Rhythmodan is because of the arryhthmias, not to reduce my gradient. He was content with my numbers as they were.
He didn't suggest the med switch until I complained several times about the arrhythmias, which he told me were benign and not going to effect the health of my heart.

Side note:
I take my Atenolol in the evening, so I figure IF I do decide to have the test done, I could just not take it one night, have the test early the next morning then take my Atenolol right after the test. That way I could avoid being symptomatic for days.

Ok thats about it. I really appreciate your input on this. I am so sick of all the tests but I DO want to feel better.

Pam

[Reenie]

If you are feeling poor and counting the minutes before you can take the atenolol every day, try moving your dose to the morning. It will wear off overnight and you can take it as soon as you get up. I had to change my allergy meds to mornings for the same reason, it would wear off in the evenings and I would rely on my inhaler more.

Reenie

[Pam Alexson]

Also , you may need a tad bit more or a split dose . I have always had to take am and pm dosing no matter how much for the same reason you report. Some days I still have to take the pm a little earlier.

[smccormick]

I have been on atenolol for about 5 years now. At first I started out at 50mg, then 75mg and now 100mg. I too had lots of benign PVCs that were really aggravating and scary. When I went to Cleveland Dr. Asher asked me what time I took my meds ( I was then on 50mg) and I was taking them in the evening like you. He told me that the meds usually only last 12 hrs in your system so he suggested taking 1/2 in the morning and then 1/2 early evening. You would not believe the difference this made in how I felt! Dr. Lever has had to increase the atenolol over the years due to my symptoms and with each increase I feel better but I continue to take it in the morning and early evening (7:30 pm and then around 5:30 pm.) I don't like changing medicines since I tolerate the atenolol very well and mostly my symptoms are sob and pvc's. I too am obstructed with a gradient of 20 hg at rest but it goes to 119 after amyl. You might just want to try taking your meds differently and increasing the atenolol (with your doctors permission) and see how you do.

[Abbygirl2]

I had wondered if I could take split doses of Atenolol, I think I'll talk to my cardiologist and find out if I could try the split dose first and if THAT doesn't work then maybe I'll think about switching meds.

I have tried taking my dose in the morning and found I was forgetting often. I am pretty foggy headed in the morning. I'll have to work on that.

Thanks for all your input on this.

Pam