Heart attack and Naproxen

[BigEndBob]

Took naproxen for a week, 500mg twice a day for Tendonitis.

On the seventh day had a heart attack and now grounded.
Have no family or personal history of anything linked to heart disease, normal BP, sugar, not overweight, never smoked, almost vegitarian, hardly drink.

Is taking this drug more than coincidence?

Angio showed a 50% stenosis. Awaiting other test results.

Looks like all test results have to go to my AME and not direct to CAA med.

[gingernut]

The naproxen could have been a "trigger." The 50% atheroma has probably took a little longer to build up.


NSAID's (Ibuprofen/Naproxen/Diclofenac) work very well, but do result in lowering of kidney function and increased BP.

It's a difficult call,they do work very well,(being awake all night with knee pain is also dangerous to the body,) but NSAID's are associated with increased risk of CHS/CVA/Kidney Disease. There is a "ladder" of risk, probably in the order I've highlighted.

I hope your feeling okay, and recovery is uneventful.

[goudie]

I was prescribed naproxen 9 months ago for gout. It worked very well, too well in fact because it banished all my aches and pains, especially my knees, so I regularly took it. However my Doctor has now called a halt because it clashes with my hypertension tablets and can affect kidney function etc. Am awaiting the results of a blood test before proceeding further.

[gingernut]

NSAID's (Ibuprofen/Naproxen/Diclofenac) work very well, but do result in lowering of kidney function and increased BP.

sorry "can."

Judicious use is the way forward.

[Chris Opperman]

Of the NSAIDs, Naproxen has the lowest cardiovascular risk, but the risk is not zero. From a pharmacology view point you probably had a critical lesion in the coronary vasculature and it was unlikely due to the use of naproxen. Was an angiogram performed?

[BigEndBob]

Yes, have had everything done.
Test results today from treadmill ecg and echocardio show ecg all normal and told heart was functioning better than many non HA patients!
The only test that says i have had a HA was the 12hour enzyme or protein test which was high.
So all good news.

Seems all a bit of a mystery to the docs envoled?

[Radgirl]

CO is spot on. On the balance of probability the NSAID was a coincidence

Kidney and stomach issuesarewell known but the heart risk isstarting to worry us. It is both time and dose dependant so I wouldnt worry about sing these drugs occasionally. However unless you take them regularly - ie against the clock as opposed to 'as necessary' and for an inflammatory disease, they are no better than the much safer paracetamol. Most NSAIDs can be changed to paracetamol. We still use them after operations, but short term

[gingernut]

As to the mechanics of your event, big end, I'm happy to bow down to the expertise of my learned colleagues who have spoken. Some interesting stuff here:

Cardiovascular safety of Cox-2 inhibitors and non-selective NSAIDs : MHRA (http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice-A-F/CardiovascularsafetyofCOX-2inhibitorsandnon-selectiveNSAIDs/)

Some stuff here, learning point for me, these suggest Naproxen is let off the hook...

High-dose NSAID painkiller heart risk: small but significant - Health News - NHS Choices (http://www.nhs.uk/news/2013/05May/Pages/high-dose-nsaid-painkiller-heart-risk-small-significant.aspx)



NSAID's have long been associated with difficulties, I seem to remember hearing that they were responsible for about 2000 deaths ("silent bleeds") in the elderly as long ago as 1986.

Then came along the all singing, all dancing "COX2 inhibitors" which basically killed people, so we all prescribed diclofenac, which, killed people.

So we prescribed ibuprofen, which interestingly is usually taken at a sub-therpaeutic level, it would seem that there is some iddle ground with naproxen.

In total agreement with Radgirl, Paracetamol is a much underrated, and underused effective painkiller. The key, of course, is to make sure that patients take it regularly and at the correct dose- all to often, prescribers are often too willing to "climb the analgesic" ladder, before exploring and exhausting the paracetamol route.

The problem with all this, is, that NSAId's do actually work very well at relieving pain and symptoms of inflammation- as my nurse prescribing tutor used to drum into us, rubor, calor, tumor, dolor.

In reality, prescribers do have to make some sort of compromise as their patient, (who never sem to fit into the nice boxes that medicines management and NICE type people have in their protocols and flowcharts), sits in front of you with his sore, throbbing, excruciatingly painful toe, his notes revealing that his eGFR is slightly low for a man of his age, and he does take the odd bit of omeprazole for indigestion. Or the elderly lady who's allergic to codeine, and finds her Rheumatic Arthritis ruins her life unless she takes her twice daily naproxen.

As ever, you can never say never, and never say always :-)

[BigEndBob]

Well to be honest, i've given up on all the drugs prescribed.

At my last referral i asked the nurse if it was ok to take fish oil supplement as i wasn't taking the Statin. He agreed my cholesterol wasn't high and that would be a good idea. I tell him about any reaction i had read with the tablets i was already taking.

So i took a fish oil tablet. Next day ended up with a very itchy inflammation around my privates and later on my arms.
Also my hands became very sensitive to dust and became itchy.

So had enough, i've stopped taking all my tablets. Fed up of the itchy, scratchy, occasional dry cough, tender spots on muscles.

Never been a tablet taker. If a piece of chocolate brings me out in spots, what are all these drugs doing.

[BigEndBob]

Looks familier, but not to that extent.

[gingernut]

Why are you not taking statin ?

[BigEndBob]

Because they gave me severe nightmares.
Initially i had to sit up in bed for an hour as i had the sensation that i had to think about breathing in and out, or i would die. Went to low dose Simvastin. First night felt i was flying in a low level jet, with a voice beckoning me to the pearly gates!

Prior to the heart attack for six months i had recurring back ache and leg problems.
Me being convinced it was a dvt in the right leg.
I have a tendancy to sleep on my right with left leg on the right leg.
Started with regular cramping of my right leg when in bed.
Then pulling my back about once a month. Which after seeing a chiropracter, became tedonitis in the right leg. With stiff calf muscle and sciatica through the right buttock.
Became very difficult to get in and out of car and Cessna 152. But standing and walking gave relief.

Last chiropracter visit with tendonitis, she tried to massage a small lump just below my calf, she gave it a name. To me it felt like dvt. The leg vein above was bulging out which i have never seen before.
Then saw the doctor and prescribed Naproxen.
Week later heart attack.
After leaving hospital all the leg and back problems went away.
Convinced the Herapin belly injections had cured the dvt. I felt like a spring chicken.
The day i entered hospital i told the doctor my leg history and could it be a dvt that had moved to the heart, he thought not. But i am convinced this is what happened.
Leg and heart fine since. Last exercise ecg showed no after effects and echocardiogram showed i had healthier heart than normally seen.
Just need to know what brought on the dvt, if it was the cause.
I only spend an 3-4 hours a day or so in light aircraft teaching, but this type of thing might be more significant for anyone sat for several hours.
Any leg cramping, get it investigated.
p.s.
Had sudden realisation a possible cause of dvt at the centre of my leg problem, occured around a spot i have injured when i have stepped back a few times against the sharp corner of my cooker door, when it has been opened and lowered. The tummy injections given in hospital possibly Heparin, cleared the leg problem.