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Why Would Cardivas Be Prescribed Instead Of Ivabrad?
Question: Hello Doc,
I sincerely request you to look into this case and answer my query.
Medical history : hypertension from past 9 years and acidity problem
Age: 60 years
Sex: Male
My Father got an acute MI on 16th November, prior to this from past 10 days he was suffering from low blood pressure and our family doc asked him to stop the BP tablet for few days . on 16th nov since morning 5 am he got high acidity and chest pain but we thought it was acidity we gave rantac and other home remedies but he started sweating and got severe pain in the chest. We took him to the nearby hospital and the doctor immediately did the angiography and found the main coronary artery was 100% blocked which had to be stented immediately but he said its very risky as you have reached late the damage has already happened. He processed with the angioplasty there were total 3 blockages on the left side 2 were done via balloon and the 100% blockage one was stented.
Post the surgery on the next day my dad started feeling high acidity, big burps, heaviness in the chest and his heart rate was very high. From then we were in the hospital till 25th Nov till his heart rate and BP and other things got normal. He had little breathlessness also.
Post returning home on 25th, my dad felt very weak at home and again on 2nd dec we got readmitted for Low blood pressure as my dad fainted at home and we checked the bp was very low and hence we got him to the hospital. Doctors admitted him to the ICCU and started giving fluids to bring up his BP.
Doctors said, low BP was due to dehydration as my father had gone for motions thrice that particular morning and since the intake of fluids is restricted to 1.5 ltrs XXXXXXX
Previous medication when we got discharged on 25th Nov : Cardivas, Ivabrad, ecosprin, brillinta, restyl for sleep and now since my dad complained of breathlessness they have changed the medication and now they have discontinued cardivas completely and increased the dose of ivabrad and asked to stop brillinta and take prax 10mg.
Currently My dad went for a follow up session with the doc , he asked him to stop ivabrad and start taking cardivas tablet, I would like to know the reason for the same and what is the difference between the two tablets Ivabrad and cardivas ? please suggest
My question is:
Doc has asked to stop ivabrad and take cardivas 3.125mg I want to understand y this change and is it ok if he can start cardivas instead of ivabrad.
I sincerely request you to look into this case and answer my query.
Medical history : hypertension from past 9 years and acidity problem
Age: 60 years
Sex: Male
My Father got an acute MI on 16th November, prior to this from past 10 days he was suffering from low blood pressure and our family doc asked him to stop the BP tablet for few days . on 16th nov since morning 5 am he got high acidity and chest pain but we thought it was acidity we gave rantac and other home remedies but he started sweating and got severe pain in the chest. We took him to the nearby hospital and the doctor immediately did the angiography and found the main coronary artery was 100% blocked which had to be stented immediately but he said its very risky as you have reached late the damage has already happened. He processed with the angioplasty there were total 3 blockages on the left side 2 were done via balloon and the 100% blockage one was stented.
Post the surgery on the next day my dad started feeling high acidity, big burps, heaviness in the chest and his heart rate was very high. From then we were in the hospital till 25th Nov till his heart rate and BP and other things got normal. He had little breathlessness also.
Post returning home on 25th, my dad felt very weak at home and again on 2nd dec we got readmitted for Low blood pressure as my dad fainted at home and we checked the bp was very low and hence we got him to the hospital. Doctors admitted him to the ICCU and started giving fluids to bring up his BP.
Doctors said, low BP was due to dehydration as my father had gone for motions thrice that particular morning and since the intake of fluids is restricted to 1.5 ltrs XXXXXXX
Previous medication when we got discharged on 25th Nov : Cardivas, Ivabrad, ecosprin, brillinta, restyl for sleep and now since my dad complained of breathlessness they have changed the medication and now they have discontinued cardivas completely and increased the dose of ivabrad and asked to stop brillinta and take prax 10mg.
Currently My dad went for a follow up session with the doc , he asked him to stop ivabrad and start taking cardivas tablet, I would like to know the reason for the same and what is the difference between the two tablets Ivabrad and cardivas ? please suggest
My question is:
Doc has asked to stop ivabrad and take cardivas 3.125mg I want to understand y this change and is it ok if he can start cardivas instead of ivabrad.
Brief Answer:
Ivabrad and cardivas are totally different.
Detailed Answer:
Hello,
Ivabrad and cardivas are totally different things.
Ivabrad has no role in the treatment of myocardial infarction or cardiac patient. Its only role is when heart rate of patient is high it decreases the heart rate without affecting the blood pressure of the patient. As your father's BP was low and heart rate was high he was on Ivabrad.
On the other hand, Cardivas is a betablocker and should be given to every patient post M.I and stenting. It reduces the size of the fibrous tissue, helps restore blood supply and helps to improve the cardiac functions of the patient.
Cardivas has to be started and doses have to be increased gradually to 12.5 mg twice daily for optimal benefits.
Breathlessness was a side effect of Brilanta.
Please tell me the ejection fraction of your father or attach the latest report of echo for further suggestion.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Rishu Saxena
Cardiologist
Ivabrad and cardivas are totally different.
Detailed Answer:
Hello,
Ivabrad and cardivas are totally different things.
Ivabrad has no role in the treatment of myocardial infarction or cardiac patient. Its only role is when heart rate of patient is high it decreases the heart rate without affecting the blood pressure of the patient. As your father's BP was low and heart rate was high he was on Ivabrad.
On the other hand, Cardivas is a betablocker and should be given to every patient post M.I and stenting. It reduces the size of the fibrous tissue, helps restore blood supply and helps to improve the cardiac functions of the patient.
Cardivas has to be started and doses have to be increased gradually to 12.5 mg twice daily for optimal benefits.
Breathlessness was a side effect of Brilanta.
Please tell me the ejection fraction of your father or attach the latest report of echo for further suggestion.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Rishu Saxena
Cardiologist
Above answer was peer-reviewed by :
Dr. Kampana
Hello Doc,
Thanks for the clarification. My dad has started Cardivas from today twice daily.
My dad is not on Brilinta from past 4 months he had just taken Brilinta for few days and stooped he is on Prax tablet now . He is having breathlessness and hence we visited 2 docs recently, I am attaching the ECHO report done from 2 different hospitals.
Can you please evaluate and tell me if there is any further deterioration or the report seems okay. I also what to understand the meaning for mildly dilated ascending aorta 36 mm is this of concern?
Also, his LVEF after stent and immediately after attack was 30% and now it seems to have gone up but i understand LVEf is just an indicator. Also the report has global longitudinal peak strain measure of -20% what does that indicate.
Request you to please advise.
Thanks for the clarification. My dad has started Cardivas from today twice daily.
My dad is not on Brilinta from past 4 months he had just taken Brilinta for few days and stooped he is on Prax tablet now . He is having breathlessness and hence we visited 2 docs recently, I am attaching the ECHO report done from 2 different hospitals.
Can you please evaluate and tell me if there is any further deterioration or the report seems okay. I also what to understand the meaning for mildly dilated ascending aorta 36 mm is this of concern?
Also, his LVEF after stent and immediately after attack was 30% and now it seems to have gone up but i understand LVEf is just an indicator. Also the report has global longitudinal peak strain measure of -20% what does that indicate.
Request you to please advise.
Brief Answer:
LVEF is a parameter not an indicator.
Detailed Answer:
Hi,
Breathlessness is because of low ejection fraction now. When the amount of blood pumped by the heart decreases, it start to regurgitate back into the lungs causing breathlessness. Your father should follow strict 1 litre fluid restriction. Trimetazidine should be added to the regimen to increase ejection fraction.
He should try to sleep at 30 degree head above legs. Mild dilation of the aorta and other artery are age related changes and they can be observed in old patients.
If breathlessness is more, a potassium sparing diuretic can also be added it prevent cardiac remodelling as well as increase the ejection fraction of the heart.
Peak strain measure may be some parameter (we don't do it in our hospital).
Basically the thing is that his ejection fraction is low and doctor should add Spironolactone and Trimetazidine, and he has to follow strict 1 to 1.5 litre fluid restriction per day.
Cardivas doses would be increased to 12.5 mg twice daily slowly.
Hope I have answered your query. Feel free to follow up.
Thank you.
Regards,
Dr. Rishu Saxena
Cardiologist
LVEF is a parameter not an indicator.
Detailed Answer:
Hi,
Breathlessness is because of low ejection fraction now. When the amount of blood pumped by the heart decreases, it start to regurgitate back into the lungs causing breathlessness. Your father should follow strict 1 litre fluid restriction. Trimetazidine should be added to the regimen to increase ejection fraction.
He should try to sleep at 30 degree head above legs. Mild dilation of the aorta and other artery are age related changes and they can be observed in old patients.
If breathlessness is more, a potassium sparing diuretic can also be added it prevent cardiac remodelling as well as increase the ejection fraction of the heart.
Peak strain measure may be some parameter (we don't do it in our hospital).
Basically the thing is that his ejection fraction is low and doctor should add Spironolactone and Trimetazidine, and he has to follow strict 1 to 1.5 litre fluid restriction per day.
Cardivas doses would be increased to 12.5 mg twice daily slowly.
Hope I have answered your query. Feel free to follow up.
Thank you.
Regards,
Dr. Rishu Saxena
Cardiologist
Above answer was peer-reviewed by :
Dr. Kampana
Hello Doc,
2 questions here, his lvef was 30 - 35 % in the month of DEc 2017, but now if you see LVEF has changed to 40% in both the reports as of 26th March2018 . So in a way it has improved right?
You are referring that the LVEF has reduced but it has gone up hence I am actually confused
Regards,
2 questions here, his lvef was 30 - 35 % in the month of DEc 2017, but now if you see LVEF has changed to 40% in both the reports as of 26th March2018 . So in a way it has improved right?
You are referring that the LVEF has reduced but it has gone up hence I am actually confused
Regards,
Brief Answer:
Answer to query.
Detailed Answer:
Hi,
LVEF is catagorised in 3 ranges:
* Normal more then 55%
* Mild deranged less then 45%
* Moderate deranged less then 30%
* Gross deranged less then 20%
Echo is done by eye balling method which means that usually a guess is made based on the experience and muscles motility by a technician.
Clinically more then 30% and less then 45% are the same, whether one writes 35% or 40%.
Add Trimetazidine. Spironolactone and see difference in Ef yourself.
Next time get a echo done at another hospital and don't show them any previous reports or EF etc.
Hope I have answered your query.
Thank you.
Regards,
Dr. Rishu Saxena
Cardiologist
Answer to query.
Detailed Answer:
Hi,
LVEF is catagorised in 3 ranges:
* Normal more then 55%
* Mild deranged less then 45%
* Moderate deranged less then 30%
* Gross deranged less then 20%
Echo is done by eye balling method which means that usually a guess is made based on the experience and muscles motility by a technician.
Clinically more then 30% and less then 45% are the same, whether one writes 35% or 40%.
Add Trimetazidine. Spironolactone and see difference in Ef yourself.
Next time get a echo done at another hospital and don't show them any previous reports or EF etc.
Hope I have answered your query.
Thank you.
Regards,
Dr. Rishu Saxena
Cardiologist
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Above answer was peer-reviewed by :
Dr. Kampana
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