Thank you. However, in this scenario would the added diagnosis of severe pulmonary hypertension require any additional medication or would it be enough to keep the patient on bisoprolol (presuming that administration of the medication had not ceased), O2 and a diuretic? What do you think of the use of digoxin (lanoxin) in the hypothesised circumstances? Presume, too, that there is severe mitral regurgitation and severe tricuspid regurgitation.
Thank you very much. Would blood pressures of, say, 115/64,126/69, 124/74, 114/70, 109/72, and 107/69 be too low for this treatment?
Dear Dr Phil, I hope that you retain the previous questions and answers. I neglected to ask why the administration of bisoprolol should not have been ceased. Are there serious risks in doing so? Should a cardiologist have been consulted first? Is it all right to cease bisoprolol if at the same time the dosage of frusemide is increased from 40 mg twice daily to 120 mg twice daily? I understand that frusemide is sometimes used to treat CCF. However, it is also possible that the peural effusion became worse at about the same time.
I'm happy to rate.
With the increased furosemide, what sort of low BP would rule out continuing bisoprolol?
Also, would you say that it is unwise to make such changes without consulting a cardiologist first?
Excellent service, as usual. I shall rate you accordingly. Goodnight (I take it that it is night-time where you are.