Afib, Cardizem, Discomfort after meals

Discussion in 'Health and medical' started by Aaron, Sep 26, 2003.

  1. Aaron

    Aaron Guest

    Hi,

    Short version: otherwise healthy male, 31, with only high blood
    pressure (previously regulated with Avapro), had an episode of Afib
    about 4 weeks ago. Woke me from sleep. No previous afib experiences
    although I have had what I believe are "benign PAC" or what my doc
    calls "extra beats" for several years. Figured I was dying, went to
    hospital and was not able to be converted with drips (CCB and
    Betablocker), eventually converted with small electric shock. No
    problems with that. Approximately 12 hours length of entire episode
    before successful conversion. During this time numerous tests were
    done and all EKG/echo readings were pronounced completely normal.

    No acute stimulants present night of event (no alcohol, caffeine,
    etc.), theories started to point to stress/anxiety, which has been a
    big factor esp. for 4-5 months prior (career changes, relationships,
    etc). ICU doctors had me drop the Avapro in favor of Metaprolol --
    next 4-5 days were a living hell, not from the arrythmia (which has
    not returned) but from the Metaprolol -- faint, zombie-like,
    half-alive feeling. Primary care doc took me off Metaprolol and
    switched me to Cardizem.

    Have been on Cardizem about 3 weeks, recently increased dosage to
    240mg once daily (CD version). As indicated in side effects,
    constipation/regularity has been an issue. But even more of an issue
    is serious discomfort after normal sized meals.

    To put it quite simply, after eating a normal meal I feel as if I've
    just stumbled away from stuffing myself at a buffet -- leads to major
    shortness of breath and labored breathing, increased pulse, increased
    feeling of anxiousness. Takes 45min-1 hour to subside into relief.
    This is not a pleasant experience to look forward to at mealtime.

    Any ideas? I am assuming this is related to the digestive disruption
    caused by the cardizem, because I have no history of this experience.
    I haven't found much info on the net about it other than constipation,
    and my primary care doc didn't take it as seriously as I do.

    A very light meal does not trigger this effect, but a "normal" meal
    feels twice its size and leads to this suffering. Aside from the
    post-meal trauma I've been feeling quite good -- relaxation
    techniques, counseling, daily cardio exercise, no problems with any of
    those, all very helpful.

    Advice appreciated!
    Aaron
     
    Tags:


  2. Aaron wrote:

    > Hi,
    >
    > Short version: otherwise healthy male, 31, with only high blood
    > pressure (previously regulated with Avapro), had an episode of Afib
    > about 4 weeks ago. Woke me from sleep. No previous afib experiences
    > although I have had what I believe are "benign PAC" or what my doc
    > calls "extra beats" for several years. Figured I was dying, went to
    > hospital and was not able to be converted with drips (CCB and
    > Betablocker), eventually converted with small electric shock. No
    > problems with that. Approximately 12 hours length of entire episode
    > before successful conversion. During this time numerous tests were
    > done and all EKG/echo readings were pronounced completely normal.
    >
    > No acute stimulants present night of event (no alcohol, caffeine,
    > etc.), theories started to point to stress/anxiety, which has been a
    > big factor esp. for 4-5 months prior (career changes, relationships,
    > etc). ICU doctors had me drop the Avapro in favor of Metaprolol --
    > next 4-5 days were a living hell, not from the arrythmia (which has
    > not returned) but from the Metaprolol -- faint, zombie-like,
    > half-alive feeling. Primary care doc took me off Metaprolol and
    > switched me to Cardizem.
    >
    > Have been on Cardizem about 3 weeks, recently increased dosage to
    > 240mg once daily (CD version). As indicated in side effects,
    > constipation/regularity has been an issue. But even more of an issue
    > is serious discomfort after normal sized meals.
    >
    > To put it quite simply, after eating a normal meal I feel as if I've
    > just stumbled away from stuffing myself at a buffet


    Perhaps your "normal" meal is excessive.

    > -- leads to major
    > shortness of breath and labored breathing, increased pulse, increased
    > feeling of anxiousness. Takes 45min-1 hour to subside into relief.
    > This is not a pleasant experience to look forward to at mealtime.
    >
    > Any ideas?


    Cardizem can worsen reflux. If you are overweight, perhaps eating less is
    the solution. This should be discussed with your doctor.

    > I am assuming this is related to the digestive disruption
    > caused by the cardizem, because I have no history of this experience.
    > I haven't found much info on the net about it other than constipation,
    > and my primary care doc didn't take it as seriously as I do.
    >


    Print this discussion out and hand it to your doctor when you next meet.

    >
    > A very light meal does not trigger this effect, but a "normal" meal
    > feels twice its size and leads to this suffering. Aside from the
    > post-meal trauma I've been feeling quite good -- relaxation
    > techniques, counseling, daily cardio exercise, no problems with any of
    > those, all very helpful.
    >
    > Advice appreciated!
    > Aaron


    You are welcome.

    --
    Dr. Andrew B. Chung, MD/PhD
    Board-Certified Cardiologist
    http://www.heartmdphd.com
     
  3. doe

    doe Guest

    >Subject: Re: Afib, Cardizem, Discomfort after meals

    Blood Flow to Heart Hampered After High-Fat Meal
    Mon Apr 1, 5:54 PM ET

    NEW YORK (Reuters Health) - While a lifetime of fatty meals can lead to a heart
    attack, a study released Monday suggests that chowing down on just one high-fat
    meal can interfere with blood flow to the heart in healthy young men.


    In the study, 15 healthy men in their 20s or early 30s consumed a shake
    containing a whopping 1,200 calories and 100 grams of fat--roughly the
    equivalent of eating a fast-food meal plus dessert. All of the men underwent a
    heart test and had blood samples taken before and after consuming the liquid
    meal.

    The researchers, led by Dr. Takeshi Hozuml of Osaka City University in Japan,
    found that 5 hours after the high-fat meal, the ability of heart arteries to
    expand and increase blood flow to the muscle--a measure known as coronary flow
    reserve--dropped by 18%.

    In addition, five men underwent the same tests after consuming a low-fat 1,200
    calorie meal that contained only 10 grams of fat. In that case, the men did not
    have a drop in coronary flow reserve after consuming the meal, according to the
    report in the April issue of the Annals of Internal Medicine.

    The findings suggest that coronary microcirculation--the tiny blood vessels
    that provide oxygen-rich blood to heart muscle--can be impaired by a high-fat
    meal. Although the study did not include people with heart disease, the results
    could explain why those with heart disease-related chest pain, known as angina
    (news - web sites), can have increased pain after a high-fat meal. The pain of
    angina is thought to be due to a reduction in blood flow to the heart.

    The heart, the body's blood pumping organ, requires its own blood supply to
    function properly. Coronary arteries are the main blood vessels that supply the
    blood to the heart, and if a blockage occurs the surrounding vessels compensate
    by expanding in size to keep the proper amount of blood flowing to the heart.

    Doctors have know that a high-fat meals, which increase the amount of fatty
    substances in the blood such as triglycerides, can over time lead to artery
    clogging and eventually heart attacks. In the new study, the investigators
    found that triglyceride levels jumped from 140 milligrams per deciliter of
    blood (mg/dL) after the high-fat meal, but only 10 mg/dL after the low-fat
    meal.

    While the researchers were not able to determine if the increase in
    triglyceride levels was responsible for the decrease in the heart's blood flow
    reserve, the authors say the findings suggest implications for patients with
    heart disease.

    SOURCE: Annals of Internal Medicine 2002;136:523-528.

    Who loves ya.
    Tom
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
    Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
    DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking
     
  4. Bob Cardone

    Bob Cardone Guest

    Not going to make the Atkins people very happy.




    [email protected]oe (doe) wrote:

    >>Subject: Re: Afib, Cardizem, Discomfort after meals

    >
    >Blood Flow to Heart Hampered After High-Fat Meal
    >Mon Apr 1, 5:54 PM ET
    >
    >NEW YORK (Reuters Health) - While a lifetime of fatty meals can lead to a heart
    >attack, a study released Monday suggests that chowing down on just one high-fat
    >meal can interfere with blood flow to the heart in healthy young men.
    >
    >
    >In the study, 15 healthy men in their 20s or early 30s consumed a shake
    >containing a whopping 1,200 calories and 100 grams of fat--roughly the
    >equivalent of eating a fast-food meal plus dessert. All of the men underwent a
    >heart test and had blood samples taken before and after consuming the liquid
    >meal.
    >
    >The researchers, led by Dr. Takeshi Hozuml of Osaka City University in Japan,
    >found that 5 hours after the high-fat meal, the ability of heart arteries to
    >expand and increase blood flow to the muscle--a measure known as coronary flow
    >reserve--dropped by 18%.
    >
    >In addition, five men underwent the same tests after consuming a low-fat 1,200
    >calorie meal that contained only 10 grams of fat. In that case, the men did not
    >have a drop in coronary flow reserve after consuming the meal, according to the
    >report in the April issue of the Annals of Internal Medicine.
    >
    >The findings suggest that coronary microcirculation--the tiny blood vessels
    >that provide oxygen-rich blood to heart muscle--can be impaired by a high-fat
    >meal. Although the study did not include people with heart disease, the results
    >could explain why those with heart disease-related chest pain, known as angina
    >(news - web sites), can have increased pain after a high-fat meal. The pain of
    >angina is thought to be due to a reduction in blood flow to the heart.
    >
    >The heart, the body's blood pumping organ, requires its own blood supply to
    >function properly. Coronary arteries are the main blood vessels that supply the
    >blood to the heart, and if a blockage occurs the surrounding vessels compensate
    >by expanding in size to keep the proper amount of blood flowing to the heart.
    >
    >Doctors have know that a high-fat meals, which increase the amount of fatty
    >substances in the blood such as triglycerides, can over time lead to artery
    >clogging and eventually heart attacks. In the new study, the investigators
    >found that triglyceride levels jumped from 140 milligrams per deciliter of
    >blood (mg/dL) after the high-fat meal, but only 10 mg/dL after the low-fat
    >meal.
    >
    >While the researchers were not able to determine if the increase in
    >triglyceride levels was responsible for the decrease in the heart's blood flow
    >reserve, the authors say the findings suggest implications for patients with
    >heart disease.
    >
    >SOURCE: Annals of Internal Medicine 2002;136:523-528.
    >
    >Who loves ya.
    >Tom
    >- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    >Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
    >Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
    >DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking
    >
    >
     
  5. Aaron

    Aaron Guest

    While I appreciate both of the replies to my original post, this is
    not exactly my problem. Both responses assumed that I'm somehow
    pigging out and gorging myself. The issue I described has nothing to
    do with the composition of my meal -- it is purely a function of how
    "filling" the food is. For example -- and this nicely illustrates my
    point -- I can begin to feel the pressure develop from eating only two
    apples (and nothing else). Yet, I can eat a serving of chicken or pork
    just fine. Add some rice along with the mix -- the bloating and
    pressure begins.

    What I wanted to know is what/how the cardizem is causing this
    inability to consume food that is "filling" (including fiber such as
    apples). It is certainly a function of the cardizem because it only
    began with the prescription.

    Unfortunately, doctors do not seem to take this report very seriously
    and even the good doctor's response to my original post blamed the
    patient and assumed excess.

    thanks
    Aaron


    [email protected]oe (doe) wrote in message news:<[email protected]>...
    > >Subject: Re: Afib, Cardizem, Discomfort after meals

    >
    > Blood Flow to Heart Hampered After High-Fat Meal
    > Mon Apr 1, 5:54 PM ET
    >
    > NEW YORK (Reuters Health) - While a lifetime of fatty meals can lead to a heart
    > attack, a study released Monday suggests that chowing down on just one high-fat
    > meal can interfere with blood flow to the heart in healthy young men.
    >
    >
    > In the study, 15 healthy men in their 20s or early 30s consumed a shake
    > containing a whopping 1,200 calories and 100 grams of fat--roughly the
    > equivalent of eating a fast-food meal plus dessert. All of the men underwent a
    > heart test and had blood samples taken before and after consuming the liquid
    > meal.
    >
    > The researchers, led by Dr. Takeshi Hozuml of Osaka City University in Japan,
    > found that 5 hours after the high-fat meal, the ability of heart arteries to
    > expand and increase blood flow to the muscle--a measure known as coronary flow
    > reserve--dropped by 18%.
    >
    > In addition, five men underwent the same tests after consuming a low-fat 1,200
    > calorie meal that contained only 10 grams of fat. In that case, the men did not
    > have a drop in coronary flow reserve after consuming the meal, according to the
    > report in the April issue of the Annals of Internal Medicine.
    >
    > The findings suggest that coronary microcirculation--the tiny blood vessels
    > that provide oxygen-rich blood to heart muscle--can be impaired by a high-fat
    > meal. Although the study did not include people with heart disease, the results
    > could explain why those with heart disease-related chest pain, known as angina
    > (news - web sites), can have increased pain after a high-fat meal. The pain of
    > angina is thought to be due to a reduction in blood flow to the heart.
    >
    > The heart, the body's blood pumping organ, requires its own blood supply to
    > function properly. Coronary arteries are the main blood vessels that supply the
    > blood to the heart, and if a blockage occurs the surrounding vessels compensate
    > by expanding in size to keep the proper amount of blood flowing to the heart.
    >
    > Doctors have know that a high-fat meals, which increase the amount of fatty
    > substances in the blood such as triglycerides, can over time lead to artery
    > clogging and eventually heart attacks. In the new study, the investigators
    > found that triglyceride levels jumped from 140 milligrams per deciliter of
    > blood (mg/dL) after the high-fat meal, but only 10 mg/dL after the low-fat
    > meal.
    >
    > While the researchers were not able to determine if the increase in
    > triglyceride levels was responsible for the decrease in the heart's blood flow
    > reserve, the authors say the findings suggest implications for patients with
    > heart disease.
    >
    > SOURCE: Annals of Internal Medicine 2002;136:523-528.
    >
    > Who loves ya.
    > Tom
    > - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    > Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
    > Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
    > DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking
     
  6. Aaron

    Aaron Guest

    I wanted to add, in addition to my previous follow-up, that even
    accepting the results of the posted study, this does not explain why
    Cardizem would worsen the situation.

    In fact, my understanding is that the mechanism by which Cardizem
    works is to dilate the coronary arteries so that blood flow to the
    heart is increased (thus slowing it down and reducing BP). In that
    case it almost sounds as if Cardizem would mitigate the phenomenon
    described in that study. Again, none of this really addresses my issue
    which is not caused by high-fat meals per se, but a point I wanted to
    add.

    thanks
    Aaron
     
  7. Aaron wrote:

    > While I appreciate both of the replies to my original post, this is
    > not exactly my problem. Both responses assumed that I'm somehow
    > pigging out and gorging myself. The issue I described has nothing to
    > do with the composition of my meal -- it is purely a function of how
    > "filling" the food is.


    You mean amount, don't you?

    > For example -- and this nicely illustrates my
    > point -- I can begin to feel the pressure develop from eating only two
    > apples (and nothing else).


    Two large apples can be quite substantial.

    > Yet, I can eat a serving of chicken or pork
    > just fine.


    That may very well be less food than the two apples (especially if the apples are large).

    > Add some rice along with the mix -- the bloating and
    > pressure begins.
    >


    More food.

    >
    > What I wanted to know is what/how the cardizem is causing this
    > inability to consume food that is "filling" (including fiber such as
    > apples).


    The lower esophageal sphincter (LES) can be "over-relaxed" by calcium channel blockers such as cardizem.

    > It is certainly a function of the cardizem because it only
    > began with the prescription.
    >


    It is a known potential side effect of cardizem.

    >
    > Unfortunately, doctors do not seem to take this report very seriously
    >


    that would depend on the doctor(s).

    > and even the good doctor's response to my original post blamed the
    > patient and assumed excess.
    >


    perhaps you should read my post again.

    >
    > thanks
    > Aaron


    You are still welcome.

    --
    Dr. Andrew B. Chung, MD/PhD
    Board-Certified Cardiologist
    http://www.heartmdphd.com
     
  8. Aaron wrote:

    > I wanted to add, in addition to my previous follow-up, that even
    > accepting the results of the posted study, this does not explain why
    > Cardizem would worsen the situation.
    >


    Correct, it doesn't.

    >
    > In fact, my understanding is that the mechanism by which Cardizem
    > works is to dilate the coronary arteries so that blood flow to the
    > heart is increased (thus slowing it down and reducing BP).


    That is not how Cardizem does either.

    > In that
    > case it almost sounds as if Cardizem would mitigate the phenomenon
    > described in that study. Again, none of this really addresses my issue
    > which is not caused by high-fat meals per se, but a point I wanted to
    > add.
    >
    > thanks
    > Aaron


    You are welcome.

    --
    Dr. Andrew B. Chung, MD/PhD
    Board-Certified Cardiologist
    http://www.heartmdphd.com
     
  9. doe

    doe Guest

    >Subject: Re: Afib, Cardizem, Discomfort after meals
    >From: [email protected] (Aaron)
    >Date: 9/28/2003 10:10 AM Mountain Daylight Time
    >Message-id: <[email protected]>
    >
    >I wanted to add, in addition to my previous follow-up, that even
    >accepting the results of the posted study, this does not explain why
    >Cardizem would worsen the situation.
    >
    >In fact, my understanding is that the mechanism by which Cardizem
    >works is to dilate the coronary arteries so that blood flow to the
    >heart is increased (thus slowing it down and reducing BP). In that
    >case it almost sounds as if Cardizem would mitigate the phenomenon
    >described in that study. Again, none of this really addresses my issue
    >which is not caused by high-fat meals per se, but a point I wanted to
    >add.
    >


    Seems to be a bit MORE to the 'action' of calcium channel blockers ..

    http://www.sciencedaily.com/releases/2003/09/030918093327.htm


    Who loves ya.
    Tom
    Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
    Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
    DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking
     
  10. Aaron

    Aaron Guest

    Again, thank you for the response. Yes, the ultimate issue here is one
    of quantity, but as I've described, quantities that were not an issue
    before (and they were actually quite small cox orange apples ;-) are
    now. Your information about the LES relaxation is useful and
    appreciated.

    The situation is not limited to periods of eating. For example, I
    recently completed my workout which includes abdominal crunches. For
    about 30 minutes afterwards I can feel a bit of "backup" up the
    esophagus as if one were about to get sick, although it does not get
    to that point and eventually subsides.

    The logical question is, since I may well be experiencing over-relaxed
    LES due to the cardizem -- is there anything I can do about it while
    remaining on the cardizem? The obvious answer, "eat less," is indeed
    logically true, but it is akin to the old joke where the patient says
    "it hurts when I do this" and the doctor says "don't do that." Perhaps
    that's the only answer, I don't know.

    thanks
    Aaron

    "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message news:<[email protected]>...
    > Aaron wrote:
    >
    > > While I appreciate both of the replies to my original post, this is
    > > not exactly my problem. Both responses assumed that I'm somehow
    > > pigging out and gorging myself. The issue I described has nothing to
    > > do with the composition of my meal -- it is purely a function of how
    > > "filling" the food is.

    >
    > You mean amount, don't you?
    >
    > > For example -- and this nicely illustrates my
    > > point -- I can begin to feel the pressure develop from eating only two
    > > apples (and nothing else).

    >
    > Two large apples can be quite substantial.
    >
    > > Yet, I can eat a serving of chicken or pork
    > > just fine.

    >
    > That may very well be less food than the two apples (especially if the apples are large).
    >
    > > Add some rice along with the mix -- the bloating and
    > > pressure begins.
    > >

    >
    > More food.
    >
    > >
    > > What I wanted to know is what/how the cardizem is causing this
    > > inability to consume food that is "filling" (including fiber such as
    > > apples).

    >
    > The lower esophageal sphincter (LES) can be "over-relaxed" by calcium channel blockers such as cardizem.
    >
    > > It is certainly a function of the cardizem because it only
    > > began with the prescription.
    > >

    >
    > It is a known potential side effect of cardizem.
    >
     
  11. Aaron wrote:

    > Again, thank you for the response. Yes, the ultimate issue here is one
    > of quantity, but as I've described, quantities that were not an issue
    > before (and they were actually quite small cox orange apples ;-) are
    > now. Your information about the LES relaxation is useful and
    > appreciated.
    >


    You are welcome.

    >
    > The situation is not limited to periods of eating. For example, I
    > recently completed my workout which includes abdominal crunches. For
    > about 30 minutes afterwards I can feel a bit of "backup" up the
    > esophagus as if one were about to get sick, although it does not get
    > to that point and eventually subsides.
    >
    > The logical question is, since I may well be experiencing over-relaxed
    > LES due to the cardizem -- is there anything I can do about it while
    > remaining on the cardizem?


    You should consult with your doctor. S/he probably would like to do some testing to exclude other possible causes from underlying
    pathology prior to commencing treatment of acid reflux.

    > The obvious answer, "eat less," is indeed
    > logically true, but it is akin to the old joke where the patient says
    > "it hurts when I do this" and the doctor says "don't do that." Perhaps
    > that's the only answer, I don't know.
    >


    Losing weight if you are overweight will help ameliorate acid reflux (by lowering intraabdominal pressure).

    >
    > thanks
    > Aaron
    >


    You are welcome :)

    --
    Dr. Andrew B. Chung, MD/PhD
    Board-Certified Cardiologist
    http://www.heartmdphd.com
     
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