Afib, Cardizem, Discomfort after meals

Aaron said:

Hi,

Short version: otherwise healthy male, 31, with only high blood
pressure (previously regulated with Avapro), had an episode of Afib
about 4 weeks ago. Woke me from sleep. No previous afib experiences
although I have had what I believe are "benign PAC" or what my doc
calls "extra beats" for several years. Figured I was dying, went to
hospital and was not able to be converted with drips (CCB and
Betablocker), eventually converted with small electric shock. No
problems with that. Approximately 12 hours length of entire episode
before successful conversion. During this time numerous tests were
done and all EKG/echo readings were pronounced completely normal.

No acute stimulants present night of event (no alcohol, caffeine,
etc.), theories started to point to stress/anxiety, which has been a
big factor esp. for 4-5 months prior (career changes, relationships,
etc). ICU doctors had me drop the Avapro in favor of Metaprolol --
next 4-5 days were a living hell, not from the arrythmia (which has
not returned) but from the Metaprolol -- faint, zombie-like,
half-alive feeling. Primary care doc took me off Metaprolol and
switched me to Cardizem.

Have been on Cardizem about 3 weeks, recently increased dosage to
240mg once daily (CD version). As indicated in side effects,
constipation/regularity has been an issue. But even more of an issue
is serious discomfort after normal sized meals.

To put it quite simply, after eating a normal meal I feel as if I've
just stumbled away from stuffing myself at a buffet

Perhaps your "normal" meal is excessive.

Quoted message said:

-- leads to major
shortness of breath and labored breathing, increased pulse, increased
feeling of anxiousness. Takes 45min-1 hour to subside into relief.
This is not a pleasant experience to look forward to at mealtime.

Any ideas?

Cardizem can worsen reflux. If you are overweight, perhaps eating less is
the solution. This should be discussed with your doctor.

Quoted message said:

I am assuming this is related to the digestive disruption
caused by the cardizem, because I have no history of this experience.
I haven't found much info on the net about it other than constipation,
and my primary care doc didn't take it as seriously as I do.

Print this discussion out and hand it to your doctor when you next meet.

Quoted message said:

A very light meal does not trigger this effect, but a "normal" meal
feels twice its size and leads to this suffering. Aside from the
post-meal trauma I've been feeling quite good -- relaxation
techniques, counseling, daily cardio exercise, no problems with any of
those, all very helpful.

Advice appreciated!
Aaron

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Quoted message said:

Subject: Re: Afib, Cardizem, Discomfort after meals

Blood Flow to Heart Hampered After High-Fat Meal
Mon Apr 1, 5:54 PM ET

NEW YORK (Reuters Health) - While a lifetime of fatty meals can lead to a heart
attack, a study released Monday suggests that chowing down on just one high-fat
meal can interfere with blood flow to the heart in healthy young men.

In the study, 15 healthy men in their 20s or early 30s consumed a shake
containing a whopping 1,200 calories and 100 grams of fat--roughly the
equivalent of eating a fast-food meal plus dessert. All of the men underwent a
heart test and had blood samples taken before and after consuming the liquid
meal.

The researchers, led by Dr. Takeshi Hozuml of Osaka City University in Japan,
found that 5 hours after the high-fat meal, the ability of heart arteries to
expand and increase blood flow to the muscle--a measure known as coronary flow
reserve--dropped by 18%.

In addition, five men underwent the same tests after consuming a low-fat 1,200
calorie meal that contained only 10 grams of fat. In that case, the men did not
have a drop in coronary flow reserve after consuming the meal, according to the
report in the April issue of the Annals of Internal Medicine.

The findings suggest that coronary microcirculation--the tiny blood vessels
that provide oxygen-rich blood to heart muscle--can be impaired by a high-fat
meal. Although the study did not include people with heart disease, the results
could explain why those with heart disease-related chest pain, known as angina
(news - web sites), can have increased pain after a high-fat meal. The pain of
angina is thought to be due to a reduction in blood flow to the heart.

The heart, the body's blood pumping organ, requires its own blood supply to
function properly. Coronary arteries are the main blood vessels that supply the
blood to the heart, and if a blockage occurs the surrounding vessels compensate
by expanding in size to keep the proper amount of blood flowing to the heart.

Doctors have know that a high-fat meals, which increase the amount of fatty
substances in the blood such as triglycerides, can over time lead to artery
clogging and eventually heart attacks. In the new study, the investigators
found that triglyceride levels jumped from 140 milligrams per deciliter of
blood (mg/dL) after the high-fat meal, but only 10 mg/dL after the low-fat
meal.

While the researchers were not able to determine if the increase in
triglyceride levels was responsible for the decrease in the heart's blood flow
reserve, the authors say the findings suggest implications for patients with
heart disease.

SOURCE: Annals of Internal Medicine 2002;136:523-528.

Who loves ya.
Tom
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Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking

Not going to make the Atkins people very happy.

(doe) said:

Quoted message said:

Subject: Re: Afib, Cardizem, Discomfort after meals

Blood Flow to Heart Hampered After High-Fat Meal
Mon Apr 1, 5:54 PM ET

NEW YORK (Reuters Health) - While a lifetime of fatty meals can lead to a heart
attack, a study released Monday suggests that chowing down on just one high-fat
meal can interfere with blood flow to the heart in healthy young men.

In the study, 15 healthy men in their 20s or early 30s consumed a shake
containing a whopping 1,200 calories and 100 grams of fat--roughly the
equivalent of eating a fast-food meal plus dessert. All of the men underwent a
heart test and had blood samples taken before and after consuming the liquid
meal.

The researchers, led by Dr. Takeshi Hozuml of Osaka City University in Japan,
found that 5 hours after the high-fat meal, the ability of heart arteries to
expand and increase blood flow to the muscle--a measure known as coronary flow
reserve--dropped by 18%.

In addition, five men underwent the same tests after consuming a low-fat 1,200
calorie meal that contained only 10 grams of fat. In that case, the men did not
have a drop in coronary flow reserve after consuming the meal, according to the
report in the April issue of the Annals of Internal Medicine.

The findings suggest that coronary microcirculation--the tiny blood vessels
that provide oxygen-rich blood to heart muscle--can be impaired by a high-fat
meal. Although the study did not include people with heart disease, the results
could explain why those with heart disease-related chest pain, known as angina
(news - web sites), can have increased pain after a high-fat meal. The pain of
angina is thought to be due to a reduction in blood flow to the heart.

The heart, the body's blood pumping organ, requires its own blood supply to
function properly. Coronary arteries are the main blood vessels that supply the
blood to the heart, and if a blockage occurs the surrounding vessels compensate
by expanding in size to keep the proper amount of blood flowing to the heart.

Doctors have know that a high-fat meals, which increase the amount of fatty
substances in the blood such as triglycerides, can over time lead to artery
clogging and eventually heart attacks. In the new study, the investigators
found that triglyceride levels jumped from 140 milligrams per deciliter of
blood (mg/dL) after the high-fat meal, but only 10 mg/dL after the low-fat
meal.

While the researchers were not able to determine if the increase in
triglyceride levels was responsible for the decrease in the heart's blood flow
reserve, the authors say the findings suggest implications for patients with
heart disease.

SOURCE: Annals of Internal Medicine 2002;136:523-528.

Who loves ya.
Tom
- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking

While I appreciate both of the replies to my original post, this is
not exactly my problem. Both responses assumed that I'm somehow
pigging out and gorging myself. The issue I described has nothing to
do with the composition of my meal -- it is purely a function of how
"filling" the food is. For example -- and this nicely illustrates my
point -- I can begin to feel the pressure develop from eating only two
apples (and nothing else). Yet, I can eat a serving of chicken or pork
just fine. Add some rice along with the mix -- the bloating and
pressure begins.

What I wanted to know is what/how the cardizem is causing this
inability to consume food that is "filling" (including fiber such as
apples). It is certainly a function of the cardizem because it only
began with the prescription.

Unfortunately, doctors do not seem to take this report very seriously
and even the good doctor's response to my original post blamed the
patient and assumed excess.

thanks
Aaron

[email hidden] (doe) wrote in message news:<[email hidden]>...

Quoted message said:

Quoted message said:

Subject: Re: Afib, Cardizem, Discomfort after meals

Blood Flow to Heart Hampered After High-Fat Meal
Mon Apr 1, 5:54 PM ET

NEW YORK (Reuters Health) - While a lifetime of fatty meals can lead to a heart
attack, a study released Monday suggests that chowing down on just one high-fat
meal can interfere with blood flow to the heart in healthy young men.

In the study, 15 healthy men in their 20s or early 30s consumed a shake
containing a whopping 1,200 calories and 100 grams of fat--roughly the
equivalent of eating a fast-food meal plus dessert. All of the men underwent a
heart test and had blood samples taken before and after consuming the liquid
meal.

The researchers, led by Dr. Takeshi Hozuml of Osaka City University in Japan,
found that 5 hours after the high-fat meal, the ability of heart arteries to
expand and increase blood flow to the muscle--a measure known as coronary flow
reserve--dropped by 18%.

In addition, five men underwent the same tests after consuming a low-fat 1,200
calorie meal that contained only 10 grams of fat. In that case, the men did not
have a drop in coronary flow reserve after consuming the meal, according to the
report in the April issue of the Annals of Internal Medicine.

The findings suggest that coronary microcirculation--the tiny blood vessels
that provide oxygen-rich blood to heart muscle--can be impaired by a high-fat
meal. Although the study did not include people with heart disease, the results
could explain why those with heart disease-related chest pain, known as angina
(news - web sites), can have increased pain after a high-fat meal. The pain of
angina is thought to be due to a reduction in blood flow to the heart.

The heart, the body's blood pumping organ, requires its own blood supply to
function properly. Coronary arteries are the main blood vessels that supply the
blood to the heart, and if a blockage occurs the surrounding vessels compensate
by expanding in size to keep the proper amount of blood flowing to the heart.

Doctors have know that a high-fat meals, which increase the amount of fatty
substances in the blood such as triglycerides, can over time lead to artery
clogging and eventually heart attacks. In the new study, the investigators
found that triglyceride levels jumped from 140 milligrams per deciliter of
blood (mg/dL) after the high-fat meal, but only 10 mg/dL after the low-fat
meal.

While the researchers were not able to determine if the increase in
triglyceride levels was responsible for the decrease in the heart's blood flow
reserve, the authors say the findings suggest implications for patients with
heart disease.

SOURCE: Annals of Internal Medicine 2002;136:523-528.

Who loves ya.
Tom
- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking

I wanted to add, in addition to my previous follow-up, that even
accepting the results of the posted study, this does not explain why
Cardizem would worsen the situation.

In fact, my understanding is that the mechanism by which Cardizem
works is to dilate the coronary arteries so that blood flow to the
heart is increased (thus slowing it down and reducing BP). In that
case it almost sounds as if Cardizem would mitigate the phenomenon
described in that study. Again, none of this really addresses my issue
which is not caused by high-fat meals per se, but a point I wanted to
add.

thanks
Aaron

Aaron said:

While I appreciate both of the replies to my original post, this is
not exactly my problem. Both responses assumed that I'm somehow
pigging out and gorging myself. The issue I described has nothing to
do with the composition of my meal -- it is purely a function of how
"filling" the food is.

You mean amount, don't you?

Quoted message said:

For example -- and this nicely illustrates my
point -- I can begin to feel the pressure develop from eating only two
apples (and nothing else).

Two large apples can be quite substantial.

Quoted message said:

Yet, I can eat a serving of chicken or pork
just fine.

That may very well be less food than the two apples (especially if the apples are large).

Quoted message said:

Add some rice along with the mix -- the bloating and
pressure begins.

More food.

Quoted message said:

What I wanted to know is what/how the cardizem is causing this
inability to consume food that is "filling" (including fiber such as
apples).

The lower esophageal sphincter (LES) can be "over-relaxed" by calcium channel blockers such as cardizem.

Quoted message said:

It is certainly a function of the cardizem because it only
began with the prescription.

It is a known potential side effect of cardizem.

Quoted message said:

Unfortunately, doctors do not seem to take this report very seriously

that would depend on the doctor(s).

Quoted message said:

and even the good doctor's response to my original post blamed the
patient and assumed excess.

perhaps you should read my post again.

Quoted message said:

thanks
Aaron

You are still welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Aaron said:

I wanted to add, in addition to my previous follow-up, that even
accepting the results of the posted study, this does not explain why
Cardizem would worsen the situation.

Correct, it doesn't.

Quoted message said:

In fact, my understanding is that the mechanism by which Cardizem
works is to dilate the coronary arteries so that blood flow to the
heart is increased (thus slowing it down and reducing BP).

That is not how Cardizem does either.

Quoted message said:

In that
case it almost sounds as if Cardizem would mitigate the phenomenon
described in that study. Again, none of this really addresses my issue
which is not caused by high-fat meals per se, but a point I wanted to
add.

thanks
Aaron

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Quoted message said:

Subject: Re: Afib, Cardizem, Discomfort after meals
From: [email hidden] (Aaron)
Date: 9/28/2003 10:10 AM Mountain Daylight Time
Message-id: <[email hidden]>

I wanted to add, in addition to my previous follow-up, that even
accepting the results of the posted study, this does not explain why
Cardizem would worsen the situation.

In fact, my understanding is that the mechanism by which Cardizem
works is to dilate the coronary arteries so that blood flow to the
heart is increased (thus slowing it down and reducing BP). In that
case it almost sounds as if Cardizem would mitigate the phenomenon
described in that study. Again, none of this really addresses my issue
which is not caused by high-fat meals per se, but a point I wanted to
add.

Seems to be a bit MORE to the 'action' of calcium channel blockers ..

http://www.sciencedaily.com/releases/2003/09/030918093327.htm

Who loves ya.
Tom
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://pages.ivillage.com/ironjustice/manisaherbivore
DEAD PEOPLE WALKING http://pages.ivillage.com/ironjustice/deadpeoplewalking

Again, thank you for the response. Yes, the ultimate issue here is one
of quantity, but as I've described, quantities that were not an issue
before (and they were actually quite small cox orange apples ;-) are
now. Your information about the LES relaxation is useful and
appreciated.

The situation is not limited to periods of eating. For example, I
recently completed my workout which includes abdominal crunches. For
about 30 minutes afterwards I can feel a bit of "backup" up the
esophagus as if one were about to get sick, although it does not get
to that point and eventually subsides.

The logical question is, since I may well be experiencing over-relaxed
LES due to the cardizem -- is there anything I can do about it while
remaining on the cardizem? The obvious answer, "eat less," is indeed
logically true, but it is akin to the old joke where the patient says
"it hurts when I do this" and the doctor says "don't do that." Perhaps
that's the only answer, I don't know.

thanks
Aaron

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Aaron said:

While I appreciate both of the replies to my original post, this is
not exactly my problem. Both responses assumed that I'm somehow
pigging out and gorging myself. The issue I described has nothing to
do with the composition of my meal -- it is purely a function of how
"filling" the food is.

You mean amount, don't you?

Quoted message said:

For example -- and this nicely illustrates my
point -- I can begin to feel the pressure develop from eating only two
apples (and nothing else).

Two large apples can be quite substantial.

Quoted message said:

Yet, I can eat a serving of chicken or pork
just fine.

That may very well be less food than the two apples (especially if the apples are large).

Quoted message said:

Add some rice along with the mix -- the bloating and
pressure begins.

More food.

Quoted message said:

What I wanted to know is what/how the cardizem is causing this
inability to consume food that is "filling" (including fiber such as
apples).

The lower esophageal sphincter (LES) can be "over-relaxed" by calcium channel blockers such as cardizem.

Quoted message said:

It is certainly a function of the cardizem because it only
began with the prescription.

It is a known potential side effect of cardizem.

Aaron said:

Again, thank you for the response. Yes, the ultimate issue here is one
of quantity, but as I've described, quantities that were not an issue
before (and they were actually quite small cox orange apples ;-) are
now. Your information about the LES relaxation is useful and
appreciated.

You are welcome.

Quoted message said:

The situation is not limited to periods of eating. For example, I
recently completed my workout which includes abdominal crunches. For
about 30 minutes afterwards I can feel a bit of "backup" up the
esophagus as if one were about to get sick, although it does not get
to that point and eventually subsides.

The logical question is, since I may well be experiencing over-relaxed
LES due to the cardizem -- is there anything I can do about it while
remaining on the cardizem?

You should consult with your doctor. S/he probably would like to do some testing to exclude other possible causes from underlying
pathology prior to commencing treatment of acid reflux.

Quoted message said:

The obvious answer, "eat less," is indeed
logically true, but it is akin to the old joke where the patient says
"it hurts when I do this" and the doctor says "don't do that." Perhaps
that's the only answer, I don't know.

Losing weight if you are overweight will help ameliorate acid reflux (by lowering intraabdominal pressure).

Quoted message said:

thanks
Aaron

You are welcome :-)

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com