How to manage MS symptoms along with cardiovascular disease?

Question

Hello doctor,

I have been living with multiple sclerosis for several years. Recently, I was diagnosed with cardiovascular disease as well. My doctor has prescribed several medications for both conditions, including MS disease-modifying therapies and medications for heart health, such as blood pressure and cholesterol medications. I am concerned about how these medications might interact with each other. Lately, I have been feeling more fatigued than usual, and my heart sometimes races, especially when I get up or walk.

I also experience occasional dizziness and shortness of breath, which I am not sure whether it is related to my heart condition or MS. Additionally, I have noticed some swelling in my legs, and I am unsure if it is due to my cardiovascular issues or side effects from the medications. I would like to know if I should be worried about these symptoms, and whether my treatment plan for both MS and heart disease is safe and effective for my situation. How can I manage both conditions without causing harm to my overall health?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Managing multiple sclerosis (MS) and cardiovascular disease (CVD) simultaneously requires a delicate balance between addressing each condition effectively and minimizing medication interactions or side effects.

Symptoms of MS include fatigue, racing heart, dizziness, and swelling.

Fatigue is common in MS but may also result from cardiovascular disease or medication side effects. Discuss adjusting MS medications if fatigue worsens after starting new treatments. Rule out anemia or thyroid issues, which can also cause fatigue. Incorporate energy-conservation techniques, such as pacing activities and short rest breaks.
Racing heart and dizziness may indicate postural orthostatic tachycardia syndrome (POTS - abnormal heart rate during change of posture), common in MS, or side effects of blood pressure medications. Strategies include monitoring heart rate and blood pressure regularly. Stay hydrated and increase salt intake (if safe for your heart condition). Consult your doctor about adjusting blood pressure medications if dizziness occurs frequently.
Shortness of breath: This could be linked to heart health (for example, fluid retention or heart failure) or deconditioning due to MS. Discuss with your cardiologist; consider an echocardiogram or chest X-ray to assess heart function. Gentle, low-impact exercises like seated yoga or water therapy can improve stamina.
Leg swelling: This is likely due to fluid retention from cardiovascular issues or side effects of medications like calcium channel blockers. Management includes elevating legs when sitting and wearing compression stockings. Review medications with your doctor. Some Diuretics may be safe and effective.

Review potential medication interactions:

MS disease-modifying therapies (DMTs): Some, like Beta interferons or Siponimod, affect heart rate or liver function. Ensure regular cardiac and liver monitoring as recommended by your neurologist. Blood
Pressure and Cholesterol Medications: Statins are generally safe but may cause muscle pain or fatigue, which can overlap with MS symptoms. Beta-blockers may worsen fatigue or dizziness. Discuss alternatives like ACE (Angiotensin-converting enzyme) inhibitors or ARBs (Angiotensin II receptor blockers).
Anti-inflammatory approach: Cardiovascular disease and MS both involve inflammation. Medications targeting inflammation, like omega-3 supplements or specific biologics, may benefit both conditions.
Coordinate care between specialists: Ensure your neurologist and cardiologist communicate about your treatment plan. Share a complete list of medications and supplements with both doctors to avoid interactions. If available, consider consulting a clinical pharmacist to optimize medication management.

Lifestyle adjustments

Diet: Follow a heart-healthy and anti-inflammatory diet (for example, DASH (dietary approach to stop hypertension) and blood glucose levels).

When to seek immediate medical attention?

Worsening shortness of breath, persistent chest pain, or significant leg swelling could indicate serious cardiovascular issues. Sudden or severe MS symptoms, like loss of vision or mobility, may require emergency care.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.