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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Sylvia77 on December 6, 2018, at 1:52:48
Hello,
I was briefly on this site in 2007 when I was struggling with debilitating depression and the insomnia of starting parnate. It was my last resort as my depression was treatment-resistant and I had tried nearly everything. I found this community to be extremely helpful as my Doc (who is now retired) had never prescribed an MAOI. Once I acclimated to the drug it worked beautifully! for 11 years I have been Depression (w a capital D) free. Then the day before Thanksgiving I had a cardiac situation. Unprecedented chest pain, difficulty breathing, nausea, cold sweats, and pain in my jaw, back, neck and arms. Within an hour I had rounded a corner though and was painting by bathroom. The next day I told my sister about it and she convinced me to go to the ER, but I was embarrassed because I no longer had symptoms. Through a blood test they discovered elevated Troponin - a molecule that is released upon injury to the heart. It was on the low end .38 and they don't quantify a full-on heart attack unless it's at least .41. Regardless, I spend 3 days in the cardiac unit as they monitored my heart, as well as conducted a echocardiogram and CAT scan. Thankfully the tests determined that my heart is apparently in perfect health. No damage and no calcium/plaque in my arteries. I am a 40 yr old female, do not eat meat, exercise regularly, and have low cholesterol BUT I do take 40 mg of Parnate daily. I know literally no one who has ever taken or prescribed Parnate, so this community is my only hope. Obviously I do not want to stop taking a medication that has no doubt saved my life, and as you know there is no easy way to conduct a test as it would take me months to titrate off of it, and relapsing into Depression is not an option for me.
I also take .15mg of Florinef for Neurally Mediated Hypotension / Fibromyalgia which has been immensely effective for chronic pain and fatigue. I feel like I've found a cocktail that has stabilized me for years, but can't deny either/both of these meds may have played a role in my mini heart attack.
What do you think? I welcome any thoughts any of you may have based on your own experience and expertise.
Thank you.
Posted by Hugh on December 6, 2018, at 14:57:27
In reply to Parnate mini heart attack., posted by Sylvia77 on December 6, 2018, at 1:52:48
MAO inhibitors could have a protective effect on the heart.
https://www.internationaljournalofcardiology.com/article/S0167-5273(17)34029-9/abstract
It could be that Florinef is the culprit instead. But you should certainly speak to a cardiologist about this.
One thing you can do for your heart right away, and that's free, is this:
Posted by linkadge on December 6, 2018, at 19:04:32
In reply to Re: Parnate mini heart attack., posted by Hugh on December 6, 2018, at 14:57:27
Hmm. Parnate is known (rarely?) to cause spontaneous hypertensive crisis (i.e. symptoms similar to eating tyramine without eating tyramine). I had some BP spikes about 2 months after starting Parnate and had to come off (unfortunately, because it was really helping).
You may want to get a 24h blood pressure monitoring system (in consultation with a cardiologist) to see if there are any irregularities throughout the day. Never hesitate to go to the hospital / call 911 for anything heart related.
I would just want to ensure that it isn't somehow related to parnate and that it doesn't occur again.
Have you ever taken nardil? It may be an alternative (I know parnate, for some reason, can cause strange BP swings even in the seeming absence of tyramine. But, I don't know the incidence and/or triggers).
Linkadge
Posted by baseball55 on December 7, 2018, at 17:18:09
In reply to Parnate mini heart attack., posted by Sylvia77 on December 6, 2018, at 1:52:48
Posted by baseball55 on December 7, 2018, at 17:32:15
In reply to Parnate mini heart attack., posted by Sylvia77 on December 6, 2018, at 1:52:48
Why, if you have been taking these drugs for years without incident, do you assume the problem was caused by the drugs?
And why, if they found there was nothing wrong with your heart, do you assume you had a heart attack?
I went recently to the ER with chest pain and shortness of breath that had lasted for some time (and I was 61). They found nothing wrong. Maybe a panic attack? I don't know. They didn't know. It happens.
Sometimes it is stomach related, especially if it's short lived. I frequently get severe chest pain with pain in my jaw and shoulder. The first time it happened, I was trapped in heavy traffic (pre cell phones) and sure I was going to die of a heart attack. Then I burped loudly and the pain stopped. This happens to me regularly, every couple of weeks and I know now to gulp water until I burp. Apparently, air bubbles can get stuck in your esophagus.
Posted by Sylvia77 on December 8, 2018, at 16:28:46
In reply to Re: Parnate mini heart attack., posted by baseball55 on December 7, 2018, at 17:32:15
> Why, if you have been taking these drugs for years without incident, do you assume the problem was caused by the drugs?
> And why, if they found there was nothing wrong with your heart, do you assume you had a heart attack?
> I went recently to the ER with chest pain and shortness of breath that had lasted for some time (and I was 61). They found nothing wrong. Maybe a panic attack? I don't know. They didn't know. It happens.
> Sometimes it is stomach related, especially if it's short lived. I frequently get severe chest pain with pain in my jaw and shoulder. The first time it happened, I was trapped in heavy traffic (pre cell phones) and sure I was going to die of a heart attack. Then I burped loudly and the pain stopped. This happens to me regularly, every couple of weeks and I know now to gulp water until I burp. Apparently, air bubbles can get stuck in your esophagus.Hi Baseball55, The fact that my Troponin levels were elevated - a molecule that is released only upon injury to the heart, ruled out panic attack and/or heart burn. I suspected the Parnate may have something to do w/ the incident because I'm only 40 years old and have no known risk factors for a heart problem and my tests came back normal. Just trying to demystify the situation and ensure that it doesnt happen again.
Posted by SLS on December 9, 2018, at 9:09:27
In reply to Parnate mini heart attack., posted by Sylvia77 on December 6, 2018, at 1:52:48
Hi.
> I was briefly on this site in 2007 when I was struggling with debilitating depression and the insomnia of starting parnate. It was my last resort as my depression was treatment-resistant and I had tried nearly everything. I found this community to be extremely helpful as my Doc (who is now retired) had never prescribed an MAOI. Once I acclimated to the drug it worked beautifully! for 11 years I have been Depression (w a capital D) free. Then the day before Thanksgiving I had a cardiac situation. Unprecedented chest pain, difficulty breathing, nausea, cold sweats, and pain in my jaw, back, neck and arms. Within an hour I had rounded a corner though and was painting by bathroom. The next day I told my sister about it and she convinced me to go to the ER, but I was embarrassed because I no longer had symptoms. Through a blood test they discovered elevated Troponin - a molecule that is released upon injury to the heart. It was on the low end .38 and they don't quantify a full-on heart attack unless it's at least .41. Regardless, I spend 3 days in the cardiac unit as they monitored my heart, as well as conducted a echocardiogram and CAT scan. Thankfully the tests determined that my heart is apparently in perfect health. No damage and no calcium/plaque in my arteries. I am a 40 yr old female, do not eat meat, exercise regularly, and have low cholesterol BUT I do take 40 mg of Parnate daily. I know literally no one who has ever taken or prescribed Parnate, so this community is my only hope. Obviously I do not want to stop taking a medication that has no doubt saved my life, and as you know there is no easy way to conduct a test as it would take me months to titrate off of it, and relapsing into Depression is not an option for me.
>
> I also take .15mg of Florinef for Neurally Mediated Hypotension / Fibromyalgia which has been immensely effective for chronic pain and fatigue. I feel like I've found a cocktail that has stabilized me for years, but can't deny either/both of these meds may have played a role in my mini heart attack.
>
> What do you think? I welcome any thoughts any of you may have based on your own experience and expertise.I have no expertise, but I do have some experience using Parnate. Hypertensive events, whether precipitated by tyramine ingestion or occuring spontaneously, does place an extra load on the heart. Heart palpitations are not uncommon as a side effect, but are not usually the results of serious alterations in heart function. That being said there have been reports of myocardial infarction in association with Parnate. I doubt that it happens often, though. I should think that it would see more of it otherwise.
This article deals with Parnate use, mycardial infarction, and troponin release.
https://www.ncbi.nlm.nih.gov/pubmed/30083815
- Scott
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