Viagra and Toprol XL

[JohnZen]

When I was in yesterday for an Echo Stress Test I forgot to ask my Cardiologist about taking Viagra with Toprol XL. Anyone know of any reason why I should not?



JohnZen

[Reenie]

Viagra isn't recommended for people with HCM because of the potential drop in blood pressure. I would discuss this very carefully with your doctor before you take it.

Reenie

[JohnZen]

Thanks. It will be my next question to the doctor.

[Lisa Salberg]

Viagra is a vasodilator - it opens up the blood flow. In HCM we have limited chamber size and blood volume is important to maintain - the use of vasodilators can cause blood pressure to drop rapidly and this is a very bad thing for an HCM heart.

In some case on a case by case basis a doctor may permit this class of medication but I would advise against it in the majority as I have heard many cases of severe chest pain, cardiogenic shock and nearly fatal outcomes from the use of these medications in those with HCM.

Best wishes,
Lisa

[Chuck]

I've seen this repeated here quite a bit ("don't"), but I'm wondering if that is in fact "universal" advice for all w/ HCM...or just for some?

found this: "...In patients with erectile dysfunction, phosphodiesterase inhibitors should be used with the awareness that a mild afterload reducing effect may be deleterious in patients with resting or provocable obstruction...."
from the following paper from the ACC : http://www.acc.org/qualityandscience/clinical/consensus/cardiomyopathy/VIII_symptoms.htm

what if you don't have an obstruction?

also wondering if these wonderful side effects of the beta-blockers can have a tendancy to "sneak up" on ya...rather than be apparent immediately. I've been on other b-blockers before, also ccbs...never caused much trouble in that department in years past. Been on Toprol now for a year or more, and overall, I think I have less b-blocker "couch potatoe" effects. But, um...lately...um... :o well, maybe its just old age sneakin up on me. Or the cumulative effects of toprol +other things.

[Lisa Salberg]

Chuck you are very careful in your post but we hear you loud and clear. The truth is no it is not a universal NO NO...but it is a general NO NO and here is one of the tricky catch 22 issues... even if you do not have obstruction at "rest" you may have a provocable obstruction (new article in Circulation this week about this very point and an editorial too - I will post it tomorrow) If you obstructe with 'activity' what is to say what form of 'activity' will cause you to obstruct... I do not think that you will be able to re-create this activity in an echo lab to see if you obstruct in this exact situation but a good ole stress test may do the trick ;-)
So if this is really an issue and you want to be safe go talk to your doctor and have a stress echo and discuss your options.


Hey be careful out there;-)

Lisa

[Chuck]

Chuck you are very careful in your post but we hear you loud and clear. The truth is no it is not a universal NO NO...but it is a general NO NO and here is one of the tricky catch 22 issues... even if you do not have obstruction at "rest" you may have a provocable obstruction (new article in Circulation this week about this very point and an editorial too - I will post it tomorrow)
I know if I make a fist, or "valsalvate" (is that a word?), it changes the sound of the murmur. does that indicate anything?


I do not think that you will be able to re-create this activity in an echo lab to see if you obstruct in this exact situation...

you know, the ladies at the echo lab have always been very nice, and friendly. But I do think that there are limits.... :-D

[Lisa Salberg]

It is amazing how much you can say without saying a word ;-)

If your murmur changes with 'stress' I would venture to guess you are obstructed to some degree... head back to the doctor and have the testing.

Hang in there Chuck!

Lisa

[Chuck]

If your murmur changes with 'stress' I would venture to guess you are obstructed to some degree...
I thought we all were, "to some degree". isn't "HOCM" synonymous for HCM? or no?
This guy I work with has some other form of CM...can't remember specifically what it is, (had his aortic valve replaced not long ago)...but one time I remember him commenting about going to the gym. I asked him, "...they let you do that???", and he said, "oh, yeah. no problem". That made me curious, so I mentioned it to the doc, and asked why my friend with "heart problem x" could lift weights, etc, and his response was simple: "his problem is "static"; yours is "dynamic","... meaning that it changes w/ stress. I thought that was pretty much "universal" with hcm.


head back to the doctor and have the testing.

which testing? I get my anual echo's...(no change in any measurements in 15+ years).

[Lisa Salberg]

Chuck,

NO not all HCM is obstructive, about 30% of us are obstructed at rest and up to 70% will obstruct with exercise so that leaves about 30% that will never obstruct. To know if you obstruct or not you need a GOOD stress echo at a center that KNOWS HCM. It is a tricky measurement to get and therefore a general cardiologist is likely to measure incorrectly as they simply do not see HCM that often.
Boston is one of the best areas for HCM care today you have 2 great centers that really understand HCM that can help you - NEMC and Brigham (Dr. Ho). One of our recent HCM families found out about the diagnosis of HCM due to taking viagra and having a very dangerous side effect, he has since moved on to myectomy and is currently recovering. You may be able to take the drug a few times with no problem, but then it could hit you and it could be life threatening --- please get tested and discuss your options with an HCM professional.

Take care!
Lisa

[Chuck]

Never had a "stress echo"...at least I don't think I did. How do they do that?
I've had "stress tests" on the treadmill; only attached to ekg. And echo-cardiograms. I would imagine it would be hard to hold that wand steady while you're marching on a treadmill...
oh, also had a couple of trans-esophogeal u/s. fun, fun, fun, that was.

Yeah, I've been meaning to get a once-over from the people at NEMC. I have a friend with another type of heart condition that goes there. had a whole valve replacement done. He knows some of the people pictured here in the galleries...says that they are the "bee's knees". a-#1

[Ken Brennan]

Let me add my 2 cents to this, If you are having a problem and need viagra, chances are your heart needs repair. Guys, it kinda like fixin a pump! After my Myectomy, it's like being eighteen again!!!! :cool:
Ken