Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXX!

I carefully passed through your question and would explain that in your cardiac conditions (dilated cardiomyopathy with chronic atrial fibrillation) the three main targets to achieve are:

1- A proper control of atrial fibrillation rate (ventricular response). This is achieved by using metoprolol.

2- An adequate anticoagulation to prevent possible cardio-embolic events. As you know atrial fibrillation especially in a dilated cardiomyopathy is a risk factor for blood clot formation, which may travel throughout your arterial system threatening for serious complications such as stroke, pulmonary embolism, limbs ischemia or mesenteric thrombosis. This is why you are taking eliquis, which is an anticoagulant used to prevent blood clotting.

3- To better control your blood pressure and relieve from fluid overload, your doctor has prescribed you hydroclorthiazide, which is an anti-hypertensive drug with diuretic effects.

Now returning to your main concern : Amiodarone, as you have a chronic condition of atrial fibrillation, it will not be helpful in regard to a possible atrial fibrillation conversion to sinus rhythm.

So your doctor has not prescribed you this anti-arrhythmic drug (Amiodarone) with any intention to convert your atrial fibrillation, as it would be almost impossible in chronic arrhythmia conditions with obvious heart structural changes.

But the main reason of Amiodarone prescription remains eventual prevention of ventricular complex arrhythmia (such as ventricular tachycardia), etc., which is a common complication in dilated cardiomyopathy.

So to conclude, I would explain that you are actually having two alternatives for dealing with dangerous ventricular arrhythmias, which are:

a) implanted defibrillator
b) Amiodarone.

It is true that Amiodarone may exert serious adverse effects, but in your condition if properly monitored it may yield more beneficial than adverse effects.

It is recommended that you check your liver and renal function tests as well as a yearly chest X ray study (film), to control for possible pulmonary fibrosis.

The periodically check up from your ophthalmologist for possible corneal depositions is also recommended.

Hope to have been helpful!

Kind regards,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again, dear XXXX!

I would explain that Benicar (Olmesartan) is a vasodilator drug used as an antihypertensive and in heart failure patients.

It exerts its properties by blocking certain receptors (angiotensin type II receptors) located in muscular walls of the blood vessels, leading to relaxation and consequent blood pressure lowering.

When using Benicar it is important to consider frequent blood pressure values monitoring to prevent and avoid hypotension; also renal function tests (BUN and creatinine) should be periodically checked.

Wishing you a pleasant weekend!

Regards,

Dr. Iliri

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