Calcium Channel Blockers

[gjensen]

Does anyone have any practical experience with Calcium Channel Blockers?

[Katybug]

I am on Verapamil. I do well on it. It doesn't slow my heart rate as well as the beta blocker did but since I have mcas and the bb was interfering with my breathing, I had to switch. I don't have any side effects. It didn't lower my bp which was a concern. Overall it's been a decent drug for me.

[gjensen]

Thank you Katie.

I have been prescribed it for misc. arrhythmias, SVTs, and "coronary vasospasms". That is what they are calling my chest pains.

My main concern is how much it drops my resting HR. My Hr can drop as low as 45 at night. Usually in the 50s. In the mornings it is from 55-65. Later in the day it is 65-70. In flares it trends much higher. These low HRs are new to me.

Can I ask you how much it dropped your resting HR?

I have not been able to tolerate beta blockers either. They diagnosed me with COPD, from overnight oximetry and pulmonary testing. Ironically 7 months ago my pulmonary testing was called "super normal". I do not want to doubt their judgment, but I doubt that I developed COPD in seven months. Anyways, that is why it is said that I am unable to tolerate beta blockers.

Apparently the Calcium Channel Blockers are better for coronary vasospasms anyways. The chest pains may be my largest concern of the three. They can be pretty severe, and have triggered SVTs. I am convinced the more severe "crushing" pains are vasospasms, but not certain all that I experience is.

[Katybug]

My resting hr didn't change at all (lying or sitting). Only my standing hr has come down a bit. Interestingly, the reason why ccb's are not first line treatment for POTS is because they can actually cause an increase in hr in some people.

Now that you mention it (I truly never pieced it together before), I don't have nearly the amount of chest pain (frequency or severity) as I used to have. I chalked it up to the breathing being better now that I'm off the bb's. But maybe it is a direct result of the verapamil since your docs say it helps spasms.

I hope you have good luck with this.

[gjensen]

Apparently it is the go to drug (CCBs) for coronary vasospasms.

It does not surprise me that it can raise HR since it relaxes blood vessels. We know how that goes.

I appreciate your input, and it was encouraging. I am going to call the EP tomorrow and make sure he knows about my low HRs. If he is comfortable with me trying it, I may. I am just not certain that I want to reduce cardiac output, with my HR getting so low.

Thank you a lot. I hope all is well with you.

[shan1212]

I tried Verapamil and kept having to lie with my feet up (including in a large pile of bird poop at the zoo!) due to sudden wooziness and the feeling that oxygen wasn't reaching my brain. My cardiologist who put me on it didn't tell me to monitor my BP or HR so I don't know how that was affected. I dropped both the Verapamil and the doctor shortly thereafter! I take 12.5mg of Metoprolol (beta blocker) daily and tolerate it OK.

[gjensen]

I do not tolerate the beta blockers at all, though I wish that I did.

I am not enjoying the calcium cannel blocker, but so far I have been able to tolerate it. I see no measurable effect on my HR yet.

[statesof]

I'm on verapamil also, I'm on a 40mg dose, I've been on it for 6 months +. I tolerate it pretty well and don't notice a real change in bp or hr. Some days, and definately when I first started I would notice my hands and feet were freezing which felt like they weren't getting alot of bloodflow, but that happens pretty rarely now. And its the only thing that would help my chest tightness, so thats a huge plus for me, other than that I don't even notice I'm taking it. Also I could not tolerate beta blockers at all, like i was on 12.5mg (bascially 25mg cut in half), of atenolol and I just felt like I was more set back in a cloud all day, so I'm very sensative to different meds, but verapamil has been one of the few that has been positive for me, but everyone's different.

[gjensen]

I'm on verapamil also, I'm on a 40mg dose, I've been on it for 6 months +. I tolerate it pretty well and don't notice a real change in bp or hr. Some days, and definately when I first started I would notice my hands and feet were freezing which felt like they weren't getting alot of bloodflow, but that happens pretty rarely now. And its the only thing that would help my chest tightness, so thats a huge plus for me, other than that I don't even notice I'm taking it. Also I could not tolerate beta blockers at all, like i was on 12.5mg (bascially 25mg cut in half), of atenolol and I just felt like I was more set back in a cloud all day, so I'm very sensative to different meds, but verapamil has been one of the few that has been positive for me, but everyone's different.

I am glad that you found a drug that is helpful and that you tolerate.

I am on Diltiazem 30mg 3x per day, but have been splitting the doses up.

I am tolerating it ok, and that is getting better. I have been working myself into it. I have become cautious about meds.

I did wake up with a huge amount of chest pain this morning. Frustratingly enough, waking up is one of my triggers, but no SVTs. It may be that I will need a slow release form. I am going to try to get taking it as I should before I comment. 30mg 3x per day is a light dose, but is a lot for me right now.

A plus is that my standing HR has been tempered. It seams so anyways. It will take some time to know. I fluctuate. I go from mild to severe, and everywhere in between.

[gjensen]

Too early to make a judgment, but Diltiazem has substantially decreased my postural tachycardia.

[Raisin]

So glad to hear that! It is always an adventure with these meds. And with Pots.

[gjensen]

It is. Now if I can just get a grip on these chest pains.

[Raisin]

I read something somewhere about esophageal pressure as in an actual swelling and / or pressure coming from the esophagus that can cause chest pain/ discomfort. I thought of you and those discussing chest pains. This can usually be picked up, though, by a chest X-ray. And, I would suppose that a radiologist may not note this in a chest X-ray unless it was pretty substantial. I don't know. Just thinking.....and thinking...and thinking. Lol

[gjensen]

Thank you Raisin. I have had the entire area checked out. Unfortunately, it is vasospasms. It becomes more and more obvious every day.

The CCB does help, but has not eliminated them. I need more than the starter dose. At this point I cannot. My resting HR is at it's limit, and even my standing HR can be too low for me. If not for the vasospasms, this drug might have been a good option for me. A very low dose. 15mg 3x per day would be helpful for the postural tachycardia. 30mg 3x per day is a little too much for the tachycardia, but not enough for the vasospasms. I am at a loss on what to do next. I may need some nitro as a rescue option. Nitro makes me nervous though.

I do have other pains, but I am not certain what to attribute them to yet. I had considered an SSRI, but see that serotonin can be a trigger for vasospasms.

I am wondering if addressing the cause of the vasospasms would be my best hope. Is it neurological? It seams that it is. The arteries are essentially doing the opposite of what they should do. When I lay down, instead of relaxing, they constrict. Immediately after waking up, they start constricting, and it is very painful. I read about avoiding triggers. Well . . my two biggest most reliable triggers is lying down, and waking up. That is not good for someone with POTS. I always have to lye down.

[Katybug]

Have you considered just trying a different ccb with your doc? Sometimes even trying a different drug in the same class will yield a slightly different result.

[statesof]

gjenson, for me the cc blockers took a little while to really stop the chest pressure symptoms of mine. I think like after 2-3 days i could tell that it was helping those sympomts, but it wasn't until after a few weeks that the chest pressure was for the most part controlled. Now i still get breakthroughs of chest pressure from time to time, but most days its pretty controlled by the cc blockers.

[gjensen]

Katy, I want to give it some more time. Unfortunately this is an especially bad flare of this. I keep hoping that this flare will subside. It would buy me some more time. There are more drugs in this class that are more specific to the vessels and/or heart rhythm. This drug has a dual action, and is used for arrhythmias and vasospasms. I hope that we can make this one work. It certainly has an effect on my HR. I also have ad no bad runs of SVTs. I normally do get them, when these get bad.

I see a doctor on Sept. 5 that is supposed to be an "expert" in this stuff. As it is, I cannot wait that long for better.

statesof, thank you for your input. That is what I am hoping. As it is, I cannot tolerate much more.

[Raisin]

Is there any way you can contact the experts nurse to see if you can get in sooner and/or be on a fill in list for cancellations? Hang in there!

[gjensen]

Raisin, I am going to put some pressure on my local cardiologist Tuesday. I do not know why I have to drive that far for this. I realize that this is not common, but certainly someone in this State can get this done. What I want is for it to be officially diagnosed or ruled out. I do not want to speculate on this one. Then if it is diagnosed, I want to see if the "why" can be identified.

I am going to make a big deal out of it. Apparently they can be especially problematic (fatal) if they go long enough and get bad enough. As bad as these have gotten for me, I want to know.

I suspect all of us deal with this to some extent or another. I wonder why mine as gotten so bad. When everything goes black on me, and my heart reacts by doing odd things, I am going to take it seriously. The only good thing about this is that they have not always been this bad. It may be that I get another break, which I will look forward to.

[Raisin]

Good for you re Tuesday. I noticed that sometimes I live with things that if they came out of nowhere, I would be heading to the ER. Your SVTs are obviously causing you great concern and t think it is great that you will be letting them know this. We know our bodies the best. I am thinking of asking the doctors, if this were happening to you...what would you do? I don't mean that in a disrespectful way. I think it may just provide a different perspective and then hopefully more answers/help coming your way. Hang in.

[gjensen]

Thank you Raisin.

The SVTs on their own, do not bother me much anymore. They certainly have. Especially when I first experienced them. I still do not like them, but I do not get too excited. Sometimes they are intense enough and last long enough to concern me. When I start getting dizzy and everything starts getting dark, I get concerned. What I especially do not like is the combination of issues that I have been having. I am not 100% certain what is happening, but I do know that it is not good. I am making the judgment based on what it does to me.

Fortunately, I had a better afternoon than what I have been having. That is where I will most likely mess up seeing the doctor. It will not be bothering me as much then, and I will not push the issue as much.