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What Are The Risks Of Getting Fluid Overloaded Post Withdrawal From Heart Medications?
Question: Dear Dr Iliri,
My apologies for seeking your advice yet again...
We are snowed in and as I was diagnosed last winter, I am being haunted by the words of my then doctor who said I should not drive, walk alone, take baths, long showers, walk at night, and especially not walk in snow as I would "likely go into cardiac arrest". This fear is exacerbated as this doctor told me that my EP would "believe he cured me" then take me off medication but then I would quickly deteriorate, get fluid overloaded, and die. As I have been off medication for over a month now, I am very scared.
My last echo was in Novrmber and next one is scheduled for April. I feel I will be too terrified to do anything until then although I am vigilant about daily exercise. However I am careful to not exert to point of sweating too much as of course, fluid issues worry me so much. Already I am so scared that I seem to need to urinate less frequently than people around me. But I don't have visible edema, breathing problems, or other symptoms.
The rapid heartbeat I have noticed seems only to be after a very hot shower in a very cold room.
I am in therapy, as is obviously needed, but it seems to not help much. Only frequent testing reassures me briefly but sometimes I am afraid to be upright, remembering being hospitalized and told to lie still. I feel so trapped by this body which seemed to betray me so badly. I have always been so productive and positive and ambitious, traveling the world,and I've become a ghost of my former self. Surely this trauma will fade someday?
Thank you Dr Iliri.
XXXX
My apologies for seeking your advice yet again...
We are snowed in and as I was diagnosed last winter, I am being haunted by the words of my then doctor who said I should not drive, walk alone, take baths, long showers, walk at night, and especially not walk in snow as I would "likely go into cardiac arrest". This fear is exacerbated as this doctor told me that my EP would "believe he cured me" then take me off medication but then I would quickly deteriorate, get fluid overloaded, and die. As I have been off medication for over a month now, I am very scared.
My last echo was in Novrmber and next one is scheduled for April. I feel I will be too terrified to do anything until then although I am vigilant about daily exercise. However I am careful to not exert to point of sweating too much as of course, fluid issues worry me so much. Already I am so scared that I seem to need to urinate less frequently than people around me. But I don't have visible edema, breathing problems, or other symptoms.
The rapid heartbeat I have noticed seems only to be after a very hot shower in a very cold room.
I am in therapy, as is obviously needed, but it seems to not help much. Only frequent testing reassures me briefly but sometimes I am afraid to be upright, remembering being hospitalized and told to lie still. I feel so trapped by this body which seemed to betray me so badly. I have always been so productive and positive and ambitious, traveling the world,and I've become a ghost of my former self. Surely this trauma will fade someday?
Thank you Dr Iliri.
XXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Dear XXXXXXX
It’s nice to hear you again on HCM!
You have nothing to apology for! I am always happy to answer all your uncertainties.
I can understand the way you feel, but I can reassure you that arrhythmia and arrhythmia-induced cardiomiopathy are just a history of the past. The risk of fluid overload is inexistent.
You should try to move on and do not worry about it any more.
Some repeated cardiac tests tests, can do nothing but good in your situation. As they can make you feel better and reassure that you are OK, it is recommended performing them.
But, your life should not depend on these periodically scheduled tests. They are just a routine in medicine, while you are feeling normally, with a normal physical performance.
I would recommend you to try to have a normal physical activity, even in these cold days.
You can walk on the snow, without being afraid. Nothing is going to happen! You can try doing this for short periods of time (10minutes) and then longer periods. You will see that nothing will happen.
It is true that winter, the cold weather, the limited sunlight during the day, can aggravate anxiety.
But you should try to have some more recreational activities. For example go in a sport club, or swimming pool. This will help you keep busy and also relax.
You should keep in mind that you are normal. If the bad thoughts and your fears come into your mind, try to think about another thing (for example a dear person of your family, and how you are blessed to have them). It will make you feel better.
You should try not to counter the times you go to the toilet. That is useless and also tiring. It won’t help you. You should keep in mind that you are normal. You can not compare yourself to the others, as you can not count the times the others go to the bathroom (they don’t do this either!).
Try to read some funny books or watch your preferred films or TV shows. This will also help you keep busy, while you are at home and it is a way of holding your mind away from your irrational fears.
Hope to have been helpful!
Don’t hesitate to ask me for any other uncertainties.
Kind regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear XXXXXXX
It’s nice to hear you again on HCM!
You have nothing to apology for! I am always happy to answer all your uncertainties.
I can understand the way you feel, but I can reassure you that arrhythmia and arrhythmia-induced cardiomiopathy are just a history of the past. The risk of fluid overload is inexistent.
You should try to move on and do not worry about it any more.
Some repeated cardiac tests tests, can do nothing but good in your situation. As they can make you feel better and reassure that you are OK, it is recommended performing them.
But, your life should not depend on these periodically scheduled tests. They are just a routine in medicine, while you are feeling normally, with a normal physical performance.
I would recommend you to try to have a normal physical activity, even in these cold days.
You can walk on the snow, without being afraid. Nothing is going to happen! You can try doing this for short periods of time (10minutes) and then longer periods. You will see that nothing will happen.
It is true that winter, the cold weather, the limited sunlight during the day, can aggravate anxiety.
But you should try to have some more recreational activities. For example go in a sport club, or swimming pool. This will help you keep busy and also relax.
You should keep in mind that you are normal. If the bad thoughts and your fears come into your mind, try to think about another thing (for example a dear person of your family, and how you are blessed to have them). It will make you feel better.
You should try not to counter the times you go to the toilet. That is useless and also tiring. It won’t help you. You should keep in mind that you are normal. You can not compare yourself to the others, as you can not count the times the others go to the bathroom (they don’t do this either!).
Try to read some funny books or watch your preferred films or TV shows. This will also help you keep busy, while you are at home and it is a way of holding your mind away from your irrational fears.
Hope to have been helpful!
Don’t hesitate to ask me for any other uncertainties.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
As always, thank you so much, Dr. Iliri. Despite my continued anxiety state and OCD, I am better most of the time.
You are quite sure I will remain ok without carvedilol? I just keep thinking of my former doctor's words telling me I would die as soon as I stopped meds.
As far as our earlier conversation about being recumbent and urinating more- is the difference minimal and normal? Sometimes I am reluctant to move much after I've had a lot to drink (never alcohol, I have an allergy) because at
The hospital I was told not to get up. I am highly energetic and it makes life difficult.
I am hoping after my next echo I will be better but I know I cant always rely just on tests.
Relieved I didn't need a transplant but keep reliving the nightmare.
Thanks so much, dear Dr Iliri
.
You are quite sure I will remain ok without carvedilol? I just keep thinking of my former doctor's words telling me I would die as soon as I stopped meds.
As far as our earlier conversation about being recumbent and urinating more- is the difference minimal and normal? Sometimes I am reluctant to move much after I've had a lot to drink (never alcohol, I have an allergy) because at
The hospital I was told not to get up. I am highly energetic and it makes life difficult.
I am hoping after my next echo I will be better but I know I cant always rely just on tests.
Relieved I didn't need a transplant but keep reliving the nightmare.
Thanks so much, dear Dr Iliri
.
Brief Answer:
Everything is going to be OK.
Detailed Answer:
Dear XXXXXXX
I assure you that carvedilol is not keeping you alive and you are not going to die if you stop taking it. It is not such a powerful drug!
So relax and do not worry about that!
Regarding the medical advises given at the hospital, you should understand that your medical condition was not as it now. That is old history and you should try to move on.
In general the advices given in a certain medical condition are not valuable, when you recover from that condition.
So try not to think about your hospital memories. You are not at that clinical situation any more.
From the other hand, I am sure that your next ultrasound will be OK.
Until that, you should just live a normal life, with a normal physical activity, without too many limitations.
I am always here, at anytime, ready to discuss any other uncertainties.
Greetings,
Dr. Iliri
Everything is going to be OK.
Detailed Answer:
Dear XXXXXXX
I assure you that carvedilol is not keeping you alive and you are not going to die if you stop taking it. It is not such a powerful drug!
So relax and do not worry about that!
Regarding the medical advises given at the hospital, you should understand that your medical condition was not as it now. That is old history and you should try to move on.
In general the advices given in a certain medical condition are not valuable, when you recover from that condition.
So try not to think about your hospital memories. You are not at that clinical situation any more.
From the other hand, I am sure that your next ultrasound will be OK.
Until that, you should just live a normal life, with a normal physical activity, without too many limitations.
I am always here, at anytime, ready to discuss any other uncertainties.
Greetings,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, dear Dr Iliri. I have been off of the carvedilol for two months now. Generally speaking, my pulse remains in the 50-60 range but as I'd told you before, sometimes it goes up higher, into 80s ans 90s, after showers and eating, but not predictably, not always. Of course I only really started to notice after getting the iphone heart rate monitor. Attaching an image of the app screen. I know you will find it funny, not accurate at all.
Is it possible that nearly two months after stopping carvedilol, I am having heart rate issues only now? Is this much variation normal? It is only with the monitor that I've noticed anything. I don't have shortness of breath or palpitations or feel PVCs.
I am also stopping prozac as I believe strongly that it is affecting my metabolism and weight. I have not gained, but my diet and exercise are set to where I should be loosing weight- 1000-1200 calories only and daily cardio of at least 30 minutes. I am very very slowly withdrawing with psychiatrist's help but he believes I should continue. Even with weight issues I would continue it if It helped at all with my OCD but it hasnt. I went from 20mg to 10 mg and now am taking 10 every other day and will continue to space it out further. If not for my excessive worry for my heart, and starting an arrhythmia, I would not be worried about stopping prozac. I have slight worry because PVCs started when I switched from prozac to another drug almost two years ago.
I feel ok, but all day I worry that I will drink something and start to swell up. My weight was stable even at EF 25 and I never took diuretics. My belief that I could suddenly stop urinating comes from that one doctor only but he put so many terrible thoughts into my head. I hope these fears will go away someday. I read that one returns to normal after trauma within two years. I have been recovered for a year so I hope I will feel like myself again soon.
Hope you are having a great weekend. Thank you so much, wonderful doctor.
XXXX
Is it possible that nearly two months after stopping carvedilol, I am having heart rate issues only now? Is this much variation normal? It is only with the monitor that I've noticed anything. I don't have shortness of breath or palpitations or feel PVCs.
I am also stopping prozac as I believe strongly that it is affecting my metabolism and weight. I have not gained, but my diet and exercise are set to where I should be loosing weight- 1000-1200 calories only and daily cardio of at least 30 minutes. I am very very slowly withdrawing with psychiatrist's help but he believes I should continue. Even with weight issues I would continue it if It helped at all with my OCD but it hasnt. I went from 20mg to 10 mg and now am taking 10 every other day and will continue to space it out further. If not for my excessive worry for my heart, and starting an arrhythmia, I would not be worried about stopping prozac. I have slight worry because PVCs started when I switched from prozac to another drug almost two years ago.
I feel ok, but all day I worry that I will drink something and start to swell up. My weight was stable even at EF 25 and I never took diuretics. My belief that I could suddenly stop urinating comes from that one doctor only but he put so many terrible thoughts into my head. I hope these fears will go away someday. I read that one returns to normal after trauma within two years. I have been recovered for a year so I hope I will feel like myself again soon.
Hope you are having a great weekend. Thank you so much, wonderful doctor.
XXXX
Brief Answer:
You are actually more realistic and thinking more positively.
Detailed Answer:
Dear XXXX,
Regarding your heart rate issue, I could say that your heart rate variation is quite normal.
Getting from 50 or 60 bpm to 80 – 90 bpm and even higher is quite normally physiologic in several situations (after eating, bathing, standing up, in physically or mentally stressful conditions).
I am not disturbed by such a flexible heart rate variations. I would be in case of its absence.
Carvedilol has nothing to do with your normal heart rate variation.
On the contrary beta-blockers could diminish this normal physiological mechanism and are not preferred in healthy and physically young individuals, as you are actually.
So, nothing to worry about this issue.
Meanwhile, when dealing with Prozac stopping, I strongly recommend being in continuous harmony with your psychiatrist advice.
The applied Prozac withdrawing scheme seems to be OK. After about two weeks of taking Prozac 10 mg every other day stopping the drug would be quite possible.
You shouldn’t worry about potential adverse cardiac effects (such as arrhythmia, etc.) as it is quite unlikely at those decreased doses.
Persistent fears on a possible heart failure relapse and fluid retention within the body are not justified by your actual normal health condition, but they should be taken into account before deciding to withdraw Prozac.
Now, more than a year after recovering from your cardiomyopathy things are quite better; also your way of thinking is more optimistic.
And this is very important: to start thinking what you really are, a normal healthy individual with a few persisting fears from your past.
Wishing a pleasant weekend,
Kind regards,
Dr. Iliri
You are actually more realistic and thinking more positively.
Detailed Answer:
Dear XXXX,
Regarding your heart rate issue, I could say that your heart rate variation is quite normal.
Getting from 50 or 60 bpm to 80 – 90 bpm and even higher is quite normally physiologic in several situations (after eating, bathing, standing up, in physically or mentally stressful conditions).
I am not disturbed by such a flexible heart rate variations. I would be in case of its absence.
Carvedilol has nothing to do with your normal heart rate variation.
On the contrary beta-blockers could diminish this normal physiological mechanism and are not preferred in healthy and physically young individuals, as you are actually.
So, nothing to worry about this issue.
Meanwhile, when dealing with Prozac stopping, I strongly recommend being in continuous harmony with your psychiatrist advice.
The applied Prozac withdrawing scheme seems to be OK. After about two weeks of taking Prozac 10 mg every other day stopping the drug would be quite possible.
You shouldn’t worry about potential adverse cardiac effects (such as arrhythmia, etc.) as it is quite unlikely at those decreased doses.
Persistent fears on a possible heart failure relapse and fluid retention within the body are not justified by your actual normal health condition, but they should be taken into account before deciding to withdraw Prozac.
Now, more than a year after recovering from your cardiomyopathy things are quite better; also your way of thinking is more optimistic.
And this is very important: to start thinking what you really are, a normal healthy individual with a few persisting fears from your past.
Wishing a pleasant weekend,
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again, dear Dr Iliri.
Something has come up in my career and my medical history has become quite significant. I work for a very large tech company with a big research division. I have been asked if I want to be part of a team exploring how technology changes the lives of women all over the world and how some countries badly need the resources to invest in technology. Anyway, the point is that I would be taking 7 trips over the next year to places all over the world. Some places will be very modern, like Finland and Seoul, but others like Cambodia will have limited healthcare. I will need to have security and medical clearance. On the medical forms, some disqualifying conditions include arrhythmias, heart failure, and any heart condition which requires medication or medical supervision. I know at present I seem to be healthy but it also states that "a history" of these things can also be disqualifying.
I do not want to lie about my previous conditions but feel I can probably do this job. It isnt physically strenuous although I will be doing things like wiring school buildings for Internet.
Do you think if I have recent tests and a letter from my cardiologist I can explain that I had a transient form of cardiomyopathy which shouldnt present any problem for travel?
Do you think its safe for me to take such a job? I have been off of carvedilol for 2 months- is that long enough to know if being off meds would cause some sort of relapse?
Thank you so much, as always.
XXXX
Something has come up in my career and my medical history has become quite significant. I work for a very large tech company with a big research division. I have been asked if I want to be part of a team exploring how technology changes the lives of women all over the world and how some countries badly need the resources to invest in technology. Anyway, the point is that I would be taking 7 trips over the next year to places all over the world. Some places will be very modern, like Finland and Seoul, but others like Cambodia will have limited healthcare. I will need to have security and medical clearance. On the medical forms, some disqualifying conditions include arrhythmias, heart failure, and any heart condition which requires medication or medical supervision. I know at present I seem to be healthy but it also states that "a history" of these things can also be disqualifying.
I do not want to lie about my previous conditions but feel I can probably do this job. It isnt physically strenuous although I will be doing things like wiring school buildings for Internet.
Do you think if I have recent tests and a letter from my cardiologist I can explain that I had a transient form of cardiomyopathy which shouldnt present any problem for travel?
Do you think its safe for me to take such a job? I have been off of carvedilol for 2 months- is that long enough to know if being off meds would cause some sort of relapse?
Thank you so much, as always.
XXXX
Brief Answer:
There is nothing to worry about.
Detailed Answer:
Hello again dear XXXXXXX
First, I would like to explain that the carvedilol withdrawal has been done correctly and there is no risk of cardiomyopathy or heart failure relapse due to its stopping.
Your past medical history does not impose any higher risk for any cardiac events in the future.
I reassure you that nothing is going to happen.
As I already explained you before, you seem to have completely recovered from those problems and they are not going to repeat.
You can be considered a healthy individual and you can have a normal life like all the other normal persons. There is nothing to worry about!
I encourage you to take this job, because nothing bad is going to happen to you. You will not need any specialized medical help, because everything is going to be OK.
Hope you will find this answer helpful!
If you have any other uncertainties, please don’t hesitate to ask me!
Greetings!
Dr. Iliri
There is nothing to worry about.
Detailed Answer:
Hello again dear XXXXXXX
First, I would like to explain that the carvedilol withdrawal has been done correctly and there is no risk of cardiomyopathy or heart failure relapse due to its stopping.
Your past medical history does not impose any higher risk for any cardiac events in the future.
I reassure you that nothing is going to happen.
As I already explained you before, you seem to have completely recovered from those problems and they are not going to repeat.
You can be considered a healthy individual and you can have a normal life like all the other normal persons. There is nothing to worry about!
I encourage you to take this job, because nothing bad is going to happen to you. You will not need any specialized medical help, because everything is going to be OK.
Hope you will find this answer helpful!
If you have any other uncertainties, please don’t hesitate to ask me!
Greetings!
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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