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Dr. Andrew Rynne
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Can decreasing Isosorbide Mononitrate dosage lead to frequent urination and sleeplessness?

Answered by
Dr.
Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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Posted on Mon, 9 Oct 2017 in Hypertension and Heart Disease
Question: I have been seeing a dr for heart tests. I have has test that showed no blockages of the heart. I had an echo but no results yet. I had asked the dr if I could stop the Isosorb Mono 10 mg.. He said not. Why if the heart was OK.
Things I did notice taking this drug. Can you explain these things to me:
1) whille on 10 mg I did not have to get up and go to the bathroom multi times only once per night. has been up 5 of 6 times. 2) I was not as out of breath at the top of my stairs 13 steps. 3) had really bad headache 3 hrs after each does.
Call the decreased it to 5 mg and the things mention above trturned up all night goinf to bathroon 5 or 6 times and short of breath going up stairs.
doctor
Answered by Dr. Rishu Saxena 1 hour later
Brief Answer:
If you are relieved by nitrates most likely there is blockage.

Detailed Answer:
Hi,
Thanks for query dear.
I have gone through your details.

Answers are as follows-
2)Nitrates are venodilators hence they reduce the amount of blood returning back to the heart.Hence it reduces the pooling of blood in heart.In patients with weak heart usually blood pools in heart and returns back to lung causes breathlessness as nitrate reduces venous blood pooling hence stanated blood is cleared from heart.

3)severe headache is one of the most common side effect of nitate therapy.My suggestion is that of iso. mono is giving you headaches switch over to Nitocontin 2.6 mg twice daily and see if it suits you.

Minimum optimal doses of Iso.Mono is 10 mg when you reduce it to 5 mg the dose is suboptimal and has no effect hence breathlessness starts again.

1)As venous return is decresed heart pumps less blood to various organs involving kidney also hence amount of water filtered from blood decreases(this can be the only possible explaination to this very rare effect).


By heart tests please mention the name of tests for eg stress test and 2 d echo combined together have sensitivity less then 70% while angiogram is more then 99% sensitive.
So please mention the name of tests.


Thanks!
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Rishu Saxena 11 hours later
EKG. Angogram an Echo test that's all I know.
doctor
Answered by Dr. Rishu Saxena 6 hours later
Brief Answer:
follow up.

Detailed Answer:
Hi,
As your angiogram is normal dear.
Thhe only possibility left is pulmonary artery hypertension which could be cleared after reports of echo are there.
Relief in breathlessness is suggestive of PAH.
As angiogram is normal there can't be any blockage.

Follow up with report.

Thanks!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Rishu Saxena 15 hours later
what is mlld concentric left ventricular hypertrophy? left ventricular cavity is small? regional wall motion abnormalities?borderline right atrial enlargement? Aortic valve is trileaflet? Anterior fat pad versus pericardial effusion?

I asked the questions above. What do the mean? it has been a day and no answer?
doctor
Answered by Dr. Rishu Saxena 28 hours later
Brief Answer:
follow up.

Detailed Answer:
Hi again,
Left ventricular hypertrophy (LVH) is a condition in which the muscle wall of heart's left pumping chamber (ventricle) becomes thickened (hypertrophy). Due to hypertension or lipid deposition in blood vessels heart has to pump blood against increased pressure causing increase in muscle size termed as concentric hypertrophy.
As muscle size increases size of chamber decreases hence blood storage and pumping capacity decreases.

RWMA-Blood to heart is supplied by artery called coronary artery.When one of these arteries are blocked the part of heart supplied by that artery gets damaged termed medically as regional motion wall abnormality.

You echo and angiogram are absolutely opposite which is not possible.
Kindly attach angiogram reports.It can't be normal.

Aortic valve is normal and is tricuspid.

Atrial hypertrophy is secondary to ventricle hypertrophy.

Pericardial effusion means fluid around heart and can be suggestive of recent heart attack.

Please attach reports of angiogram it can't be normal.

Waiting!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Rishu Saxena 12 hours later
I do not have access to the Angiogram. wish I did! The items I listed were on the echo test only.
He just told my sons that I had a teenager heart. So dont know do not see him for over a month. Dont know why so far off. Think I will call and see if I can get to see him sooner. I am going to let you go. You seemed tohave done a great job with the information I was able to give to you.
doctor
Answered by Dr. Rishu Saxena 16 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
Thank you so much.
If you have no access to angiogram then at least start conservative management of your problem.

Few medications that should be started asap as per your echo reports are-
A beta blocker like Carvedilol should be started in 12.5 mg twice daily doses.
A AT 1 antagonist like Losartan 25 mg to help with motion abnormality of heart.
A potassium sparing diuretic like Aldactone (to prevent cardiac remodelling).
Aspirin 81 mg once daily(Baby aspirin)
A statin like Rosuvastatin 10 mg once daily at bed time.

Get a prescription from your GP.

Wish you a good health.

Regards!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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