AboutDavid Richardson Expertise Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.
Experience Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.
Organizations Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..
Publications Circulation, American Heart Journal, Hypertension.
Education/Credentials M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.
Awards and Honors Gold Heartt Award from American Heart Association in 1995.
Question Dear David,
I am writing on behalf of my mother, Joan. Joan is 77 and diagnosed with persistent afib in 2006. On a range of meds beginning with amioderone and warfarin. Amioderone was making her feel most unwell and she changed to Flecaniade, later backed up with diltiazem to slow the heart rate. She is now taking Verapamil (instead of diltiazem), 20 mg x 3 daily, Flecanaide, 50 mg x 2 daily and warfarin. It's been trial and error with the drug dosages with good periods of stability and occasional heart failure. She is still excercising walking up hills etc and on strict whole food regime backed up with mag taurate and hawthorn. The latest occurrence leading to my query is sudden decrease in heart rate from approx 78 to 105/9 during excercise to 62 during excercise and dropping to 50 and below at rest. She visited hospital three weeks ago and they deliberated about her reducing verapamil to get heart rate up saying not concerned unless it stayed below 50 bpm. Although at text book level they are not concerned, breathlessness, tight chest and generally feeling tired/unwell is accompaying this slower heart rate. Intial reduction of Veramapil from 80 x 3 daily to 60 x 3 daily upped bpm, lessened chest tightness and improved energy levels. The rate has lowered again with return of symtoms and she has reduced to 20 mg Verapmil x 3 times daily. A recent ecg showed nil acute but yesterday ectopic beats have suddenly increased from approx five times a day to about two per minute her rate and bp still on low side. She self moniters rate, bp, Inr and keeps her gp informed. I will take her to our hospital tonight but would be grateful of your thoughts on this. I am also concerned that the Hawthorn is kicking in and potentiating her heart drugs
Thank you for your attention
Helen
Answer Dear Helen,
Please tell me what Hawthorne is supposed to help and what its ill effects are.
Verapamil is not supposed to suppress ectopic beats, but seems to in your mother? My inclination is to stop the verapamil, try diltiazem again,and if the ectopic beats continue, increase the flecainide. 300 mg a day is the maximum dose, tho of course try 75 twice a day, then 100 twice a day,, I wouldn't go higher than that at her age.
Please write back if this note doesn't answer all your questions, and please keep me informed on her progress.
