Is it a disease or not?

August 5, 2008 6:26 PM

Is antiphospholipid syndrome considered a cardiovascular disease?

My doctor recently prescribed me Nortriptyline for the prevention of headaches. While researching the medicine before I started taking it, I noticed that many sited advise using caution while taking this drug if you have a history of cardiovascular disease.

I have had two pulmonary embolisms (emboli?) I am currently taking coumadin (INR ~3.5).

Would this be considered a cardiovascular disease. I have been told that antiphosphlipid syndrome was a problem with the immune system and not really a disease, and I can't seem to find any clarification on the web.

posted by ryanissuper to Health & Fitness (2 answers total)

IANAD* nor have I ever heard of this antiphospholipid syndrome (aPL), but doing some reading (William's Hematology) shows that this is mainly autoimmune and hematological in nature and thus not technically defined as a cardiovascular disease. However, apparently a portion of people with aPL can get valvular problems and so should have echocardiography to check on heart function. Have you had this done?
The contraindications or at least medical aspects that attention should be given to with respect to the cardiovascular system are: "Second or third degree heart block, severe ischaemic heart disease, cardiac instability (eg after myocardial infarction)" (Australian Medicines Handbook). This is nothing that you have, assuming your valves are functioning well.
In terms of adverse effects of nortriptyline (and other tricyclics) there is standard stuff, with orthostatic hypotension being the only cardiovascular side effect that is in the "common" category (this is when your blood pressure rapidly decreases upon standing up and there's risk of faint - I don't think that's necessarily exacerbated by your condition).
The only thing that would make me think a bit is in terms of liver function and clearance, being on Warfarin and this drug at the same time. Presumably your doctor knows that you're on warfarin and surely knows more than I do about drug interactions.
So in summary: no, aPL is not really a cardiovascular disease. You are probably fine taking the medication but be sure to pay attention to your INR and perhaps get a liver function test the next time you go to see the doctor. And of course, bring up any of these worries!


*I am a second year medical student with access to textbooks
posted by shokod at 5:27 AM on August 6, 2008

Antiphospholipid syndrome is a rheumatological condition. Nortriptyline is a TCA that can add stress to the heart (make it work harder), which obviously you wouldn't want to do if it's not in good shape. It can do this by increasing catecholamine activity and also via orthostatic hypotension leading to tachycardia. Ischemic heart events are certainly possible with antiphospholipid syndrome, whether or not you've ever had one I have no idea. An ECG would be a good start to answering that question, and having had 2 PEs, I'm sure you've had several ECGs. There is a possibility for drug interaction between Warfarin and Nortriptyline although small. I'm sure your doctor will be watching the levels of those drugs as you start the treatment.
posted by sero_venientibus_ossa at 8:14 AM on August 6, 2008