Hi Katherine,
Firstly, let me tell you about an "anxiety loop" that can get you into big trouble. Measuring BP is fine, I do it regularly, but don't become too preoccupied with your changes in BP, it can make you anxious and increase your awareness of what your heart is doing. Many Cardiologists have explained to me at great length that "Palpitations" (By their true medical definition) are your "increased awareness" of what your heart is, or may be doing. There may or may not be underlying issues.
With increased awareness comes increased vigilance, you may check BP more often than you need to, leading to anxiety about what your heart is doing.
Anxiety makes your heart behave differently, then you pay it more attention, measure BP again, only to see different readings that raise anxiety levels, etc etc.
Around and around it can go. I did this catch 22 for 2 years and ended up on Xanax for anxiety before I was able to break the loop of "Oh no! What is my heart doing?".
Watch out for domestic grade BP monitors, I get false/erratic readings all the time.
I have obtained far more accurate BP information (and peace of mind) and ECG information by staying in hospital for 4 hours and having my Obs monitored on their more accurate equipment. A 24hr ECG using a halter monitor helped me get an accurate picture of what my heart was doing.
http://en.wikipedia.org/wiki/Holter_monitor
When I was on Verapamil, my heart started working harder and beating erratically, to keep up with the BP drop.
It would get slower and slower, then fibrillate. Then slow again...
Caused me no end of trouble...
I no longer use Verapamil.
Since using Verapamil, I now have to take Atenolol to keep my heart rhythm steady.
My heart rate sits at 55-60 BPM.
My BP sits between 110/70 - 135/85, but stays regulated by Atenolol these days.
Nursing staff show concern whenever my BP goes below 100, or my heart rate below 55 BPM. Some athletes have heart rates as low as 35 BPM and still function fine.
"Only" 240mg, is the top end of the dose range, for the purpose for which the drug was originally intended. Remember, there can be a fine line between finding dose efficacy and toxicity. Dose ranges for CH exceeding 240mg are "off label" or "experimental use" and should be treated as such; with caution (and ECGs).
Verapamil use should ALWAYS be checked with ECG monitoring.
Typically, around 20% of CHers will experience tolerance problems with Verapamil.
I will let Pr Goadsby fill you in on that one.
Pr. Goadsby on Verapamil @ 3:10 into the video.
http://www.youtube.com/watch?v=f66RxrBm6_4&feature=related
They are throwing the stuff around, in my opinion.
Latest news I heard coming out of Goadsby's team was that Verapamil does not cross the blood-brain barrier as well as first thought. Their solution - already "Industrial quantities" of Verapamil are now going up to doses over 1000mg in CH treatment.
When used in such high doses - it needs to be monitored more closely. Routine ECGs were not performed on me whilst I used the drug. I was left with a permanent heart rhythm issue after ramping up Verapamil to only 360mg per day. My heart nearly ground to a halt. This is outside the limits of my medical understanding, but I believe the "P-R" and/or "Q-A" intervals, as seen on my ECG were abnormal at the time, after unmonitored treatment with Verapamil.
A "baseline" or "control" ECG should be carried out before using Verapamil to see your normal heart function. An ECG is required every time you escalate dosages. (Please check with your Dr for routine tests and protocols, I am not a Doctor).
It has been over 6 years since I trialled Verapamil and my heart rhythm has been given the all clear by a CVIU, so long as I stay on Atenolol (Noten) to keep it ticking regularly like a clock. If you are on Verapamil for CH, INSIST that a routine ECG be carried out on a regular basis, or you could be stuck on another drug FOR LIFE to attenuate heart rhythm, as I am. I am 37 years old. An alternative that is overlooked often here, is Verapamil's distant cousin - Diltiazem, this may be worth investigating.
If Verapamil has reduced your CH attack frequency, this shows that there are options for you. Lithium, Topamax etc. I stuck with Verapamil, as I was determined it would be the drug that worked for me, it was a big mistake.
Don't panic - it makes side effects worse.
Just know your drug well and take solace in the all clear from ECG results.
Verapamil may not be the drug for you, unfortunately.
Ceasing use of a drug when not tolerated can feel like a big blow, I know, I have done this well over 60 times. But, persistence cost me dearly, so make sure those Docs do their ECGs.
No, I did not get belted with CH when I withdrew Verapamil.
In fact, I had fewer attacks. I think this was due to Verapamil wearing off between doses, I could set my watch to the rebound attacks every 8 hours when I was taking it.
By the way, did I mention ECGs?
Cheers, Ben.
This post was edited on 29/08/2012 at 10:01 am
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