Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'd like to welcome you to my podcast and videocast station. Today what I'd like to talk about is do you have to take medications forever? I get patients asking me that all the time and the long and the short of it is it depends on why you're taking the medications. Are you taking them because you've had a heart attack or a stent or have you had a bypass? or atrial fibrillation or a new valve or cardiac failure or elevated blood pressure it depends on what the reason is you're on medication for let's start with if you've had a heart attack more often than not you'll almost certainly be on aspirin which is a blood thinner and you'll be on a cholesterol lowering agent there's no question in the long term that those two medications will be for life. We've got robust evidence to tell us that in high-risk patients that lowering cholesterol and thinning the blood by making the platelets less sticky so they're less likely to cause a clot is valuable for that individual in the long term. If, as part of your heart attack, you've received what we call a stent, which is a mesh-like structure, that literally opens up the arteries like a scaffold and holds it open then that mesh-like structure can increase the likelihood of a clot or thrombus forming on that structure and so individuals who receive a stent will not only have aspirin and cholesterol lowering therapy but they'll also get an extra what we call anti-platelet agent and so you'll be on dual antiplatelet therapy we call that D-A-P-T DAPT dual antiplatelet therapy well currently and the guidelines continue to change a little bit currently we run people on dual antiplatelet therapy for about about a year there are certain situations where we might end it a little bit sooner and if other clinical situations arise then we may need to make an adjustment but that's something you do with your cardiologist so if it comes to a stent there's a good chance you might be able to come off one of your medications at one year if we think about someone who's had bypass grafting these are people who again will benefit without question by being on aspirin an antiplatelet and cholesterol lowering medication for life see you You're not going to duck any medication there, but many patients, a good percentage, have issues surrounding the surgery of coronary artery bypass grafting. So some patients might come out and require an antibiotic for a period of time because they have a skin lesion. That antibiotic, of course, will be temporary. rhythm called atrial fibrillation. Some patients will come out of hospital after their bypass grafting on a tablet to reduce the risk of them developing atrial fibrillation again. Well this tablet may not be needed in the longer term because the stress and the strain of surgery increases the risk and when you're through that you may return to a more normal risk of rhythm control and you may not need that antiarrhythmic agent in the longer term. For patients with atrial fibrillation without any history of surgery then some of those patients will almost certainly need to remain on medications long term. We often use heart rate regulating medications. You'll need to speak with your doctor but generally they're going to be required. If you've got atrial fibrillation that's there all the time and is never going to go away, then being on an antiarrhythmic agent, which you may have been on up until the time that that atrial fibrillation became permanent, could be an agent that could be dropped. Because there's no point remaining on a tablet that will keep you in normal rhythm. if you now have progressed to a stage where you're going to remain in atrial fibrillation permanently. So that's a medication that could be dropped. When it comes to anticoagulants and atrial fibrillation, you're pretty well stuck with them forever. Some of these are really specific questions for your doctor based on your situation, but generally we want to make sure we control the heart rate and reduce the risk of blood clotting so people will be on blood thinners and... In many cases, we try and keep people in normal rhythm using antiarrhythmic agents, agents to stop the arrhythmia. But if you've developed permanent atrial fibrillation, you won't need those in the longer term. If you've got a valve that's a bit tight or a bit narrowed, generally there's nothing specific we do while it's one of your native valves, but we do replace valves. And we can do that with a mechanical valve or with a... tissue valve if we use a mechanical valve then we use full-blown anticoagulation to make sure that no clots form on that valve and you'll be stuck with warfarin for life when it comes to a tissue valve and these are becoming smarter and smarter and sometimes we can even put these tissue valves in without major surgery can deploy them through a special catheter or tube technique from the leg which is pretty amazing But with these tissue valves sometimes in certain situations you'll be on a blood thinner for a short period of time and then aspirin ongoing or just aspirin straight off the go or sometimes dual antiplatelet therapy for a short period of time and then one agent. If you've found yourself in that situation then please talk to your specialist about it because this is really very much dependent on you as an individual and the exact device that's been put in so follow that up. If you have cardiac failure we know that there are certain drugs that are standard in cardiac failure things like the ACE inhibitors and the beta blockers and we like to run people on spironolactone and sometimes we'll swap one of those agents in and include one of the naprolysin inhibitors and sometimes we also use diuretics to help move fluid out of the body? Well, there was a study that informed us fairly recently that for people whose hearts come back to normal after cardiac failure, if we withdraw some of those supportive drugs, then about a third of those patients will develop cardiac failure again. So our current belief is if you've had cardiac failure, that's a heart that's not working properly because it's big and saggy for some reason, Even if it recovers, we believe you're best off on those preventative medications long term. Again, you have to speak with your doctor about this for your particular situation. When it comes to the diuretic therapy though, we don't believe that that's necessarily required to keep you healthy in the long term. What we do know is that's really good for symptoms and so that might be an agent. that could be withdrawn and added back in on an as-needs basis. So please speak with your doctor about that. One of the really important issues about taking medication long-term is high blood pressure. And really, we know that high blood pressure is such a problem left unattended in the long term. It's associated with increased risk of heart attack. It's associated with increased risk of stroke. closely linked to development of cardiac failure and closely linked to the development of atrial fibrillation so we've got to look after blood pressure so if your blood pressure's been up for a while and you treat it and it comes down i'm afraid you just can't come off your therapy there is a suggestion on the horizon that a particular technique where we ablate or damage the nerves that run to the kidneys The nerves that run along the renal arteries, we call this renal artery denervation, renal artery denervation. This can lower blood pressure, but generally of its own, it's not a standalone treatment. It's normally a supportive treatment. So if you have blood pressure issues, I'm afraid you're stuck with your antihypertensives for life. Some people have palpitations as well. and depends on the palpitations and that's a complicated topic of its own but some palpitations we've already mentioned atrial fibrillation let's move to other palpitations some palpitations may require therapy ongoing and if you come off the therapy then the palpitation will come back but there are certain situations where a palpitation may be present where the patient takes a medication which not only deals with the palpitation but for example deals with blood pressure and so it's a tablet that would be taken anyway so not really any negative side to that but there are also situations where a patient may have a palpitation may take a tablet for it but has no other reason to take that medication and in that situation there may be the opportunity for that rhythm disturbance to be addressed by what we call physio electrophysiological techniques which is where we literally put catheters or tubes into the heart find where that electrical short circuit is and eradicate it. Very cool. So do you need to take your medications forever? Look more often than not you're stuck with something but there are a number of situations where that's not the case. I hope you found this interesting. I hope it informs you a little bit and helps you have the conversations you need with your doctor. If you have any questions please drop us a note at info at drWarrickbishop.online or members at drWarrickbishop.online and if you have any suggestions for future podcasts, of course, also let us know. Till next time, I'd like to thank you for joining us. I'd like to wish you the very best and please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
