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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Cardiology
Satisfied Customers: 58756
Experience:  Cardiology Expert
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I had a heart attack in February 2009, when I was started on

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I had a heart attack in February 2009, when I was started on 1.25mg of Ramipril (to prevent cardiac remodelling). I was also started on all the other post ACS medications.The Ramipril was increased to the target dose of 10mg daily, which I have been on for years. My GP has now decided that this Ramipril dose is the cause of low blood pressure and has reduced my dosage to 5mg. However, I have always had low blood pressure (pre-heart attack systolic was around 110mmHg). I would feel happier if a consultant cardiologist had proposed the Ramipril reduction rather than a general practitioner. I also take Bisoprolol 2.5mg. I also have a prostate problem (this is relevant to the cardiology query!) and have taken Combodart (dutasteride/tamsulosin) for about two years and before that tamsulosin on its own for a short period. It seems to me that, if my low blood pressure is a serious issue (?), tamsulosin might have been the first suspect rather than the Ramipril. At the time of writing this my BP is 99/64 and pulse 60. It is not uncommon for me to have readings of under 90/60. Since my heart attack I have suffered from orthostatic hypotension. In the past seven days I have experienced pre-syncope twice (so symptoms less than daily). The reason I went to see my GP was because of lightheadedness, breathlessness, tiredness and an increased awareness of my heartbeat and feelings that my heart is doing a "flip-flop". My pulse often seems to skip a beat if I feel my pulse and is not regular.My recent 12 lead ECG was normal except showing a historical heart attack. I am awaiting an echo and the results of a 24 hour tape. All of my blood tests (full blood count, U&Es, TFTs, BNP) are normal.I would appreciate your opinion on the management of the ramipril, and if I should now be referred back to a cardiologist in light of having a previous heart attack.***** *****

Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

what meds do you take?

Customer: replied 7 months ago.
Aspirin, Bisoprolol, Ramipril and Atorvastatin

I agree with you that the tamsulosin should be reduced instead

the ramipril has cardiac benefit

are your prostate symptoms tolerable without tamsulosin?

Customer: replied 7 months ago.
I originally went to the doctor with a urinary infection and that led to the GP prescribing tamsulosin after a rectal examination. I was then referred to a consultant urologist and he recommended the combination dutasteride/tamsulosin known as Combodart (although he was doubtful that the GP would agree to prescribe it). Surprisingly, the GP did. At this time, I don't feel that I have any prostate problems - but then I do take the Combodart every day. I don't know how things would be without tamsulosin. I have heard of an American procedure called UroLift, which is beginning to become more widely available in the UK. I would be very interested in undergoing that rather than taking the drugs. I really have no idea how serious my original prostate problem except that I do remember the urologist saying that my prostate was "slightly enlarged" - which didn't sound too serious.

I would ask to go off the tamsulosin and see what happens. If the symptoms get worse then go back on it. It is worth a try

let me know if you have other questions.

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Customer: replied 7 months ago.
Thank you. You have been most helpful. I need to be quite clear about the Ramipril, though. Is it your opinion that I should stay on the 10mg daily dose for the reasons of "cardiac benefit"?

that is correct

Dr. Phil, MD and other Cardiology Specialists are ready to help you
Customer: replied 7 months ago.
Thank you Dr Phil

welcome :)