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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44379
Experience:  Board Certified Physician
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Cardiac Consultant Please: My mother is 87 and has experienced

Customer Question

Cardiac Consultant Please: My mother is 87 and has experienced a vasal vagal twice now. She has hypetension and currently is on 50mg of Atenolol daily and takes it in the morning. Both episodes were in the morning but before she took the Atenolol. Her blood pressure is currently 176/68 and her pulse rate is between 56 and 60 BPM which is regular. She has borderline heart failure, her kidney function and cholesterol is stable. I have suggested to her doctor that maybe her Atenolol could be reduced to 25mg as this could be the cause of her collapses. She also appears to suffer with other side effects which is dizziness, nausea and weak muscles, she has no SOB or chest pain. However, I am wondering if it would be better to remain as 50mg but split the dose to 25mg in the morning and 25mg at night so its a less of a shock to her body. She is also on a low dose of diuretic and vitamin D. If she is to gradually come off Atenolol, what is the best alternative? She is otherwise generally fit and well and has always been active.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
Dr. David :

This is Dr. David

Dr. David :

I am sorry about your mother.

Dr. David :

it sounds like her heart is very very weak.

Dr. David :

a very weak heart in the morning can cause sometimes fainting or passing out episodes.

Dr. David :

yes, do talk to the doctor about splitting the atenolol dose to 25mg twice a day that could help.

Dr. David :

it is tough for her to drink more fluid as well, because you don't want her to go into fluid overload if her heart is weak.

Dr. David :

beta blockers are good to take stress off of the heart.

Dr. David :

she should also be on an ACE inhibitor as well like lisinopril

Dr. David :

which will help take pressure off the heart and lower blood pressure and increase blood flow to the kidneys.

JACUSTOMER-e4fvl6ks- :

She only drinks a litre a day and I asked the doctor regards ***** ***** she said that she didn't feel it would hurt if she had more fluids based on her blood results. I was concerned that she wasn't flushing out the toxins from her medications. She was on Ramipril but it made her feel terrible so the doctor discontinued it. I'm concerned about her low pulse rate as much as her high systolic and it's getting her pulse up and her systolic down which is the aim.

Dr. David :

maybe she can try lisinopril

Dr. David :

and she will tolerate that better than the ramipril.

Dr. David :

low pulse rate is good for her heart to not over tax the heart.

JACUSTOMER-e4fvl6ks- :

Yes that sounds sensible. I may have missed that she is actually on an Ace inhibitor, so if she is, what would be the best course of action

Dr. David :

yes, ACE is shown to help patients live longer with a weak heart.

Dr. David :

and keep the kidneys working as well as possible.

Dr. David :

but splitting the beta blocker to twice a day could help.

JACUSTOMER-e4fvl6ks- :

Yes maybe try splitting it and hope her systolic reduces but it's if it doesn't then I shall be worried as the Atenalol has awful side effects and she's not happy on it. Shes on simvastatin as well btw, she had it reduced to 20mg. Although I thought it needed to be 40mg to have any benefits!

Dr. David :

that depends on her cholesterol levels.

Dr. David :

if her cholesterol levels are coming down on 20, then she can be on twenty.

JACUSTOMER-e4fvl6ks- :

what is the best alternative to Atenalol if both lisinopril and Atenalol together isn't effective?

Dr. David :

she can be on a diuretic like lasix or hydrochorothiazide.

JACUSTOMER-e4fvl6ks- :

shes on a diuretic at the moment

Dr. David :

and an ABR agent like losartan to help her blood pressure

Dr. David :

also calcium channel blockers can help like amlodipine to help lower blood pressure.

JACUSTOMER-e4fvl6ks- :

When is it best to monitor her BP?

Dr. David :

a blood pressure cuff for her arm. taken twice a day.

JACUSTOMER-e4fvl6ks- :

morning and evening?

Dr. David :

yes.

JACUSTOMER-e4fvl6ks- :

the electronic one shows error occasionally and I was worried about her being in AF, but her pulse is regular thank goodness. I'm going to use a manual from now on...they are more accurate!

JACUSTOMER-e4fvl6ks- :

sometimes the electronic ones cannot read properly when the heart rate is irregular

Dr. David :

yes, the manual cuff most likely would be better

Dr. David :

good luck to you and her.

Dr. David :

let me know if you have other questions.

Dr. David :

if done for now, please leave positive feedback below.

JACUSTOMER-e4fvl6ks- :

yes thank you very much! sorry to keep you.

Dr. David :

thanks for using JustAnswer.com

Dr. David :

no problem.

Dr. David :

thanks for using JustAnswer.com

Dr. David :

do you see the ratings area below?

Dr. David :

thanks.

Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44379
Experience: Board Certified Physician
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