doctors and blood pressure

[rodknock]

i have been on carvedilol 3.125 twice a day, spironolactone 25mg. 1 a day and lasix 40mg. 2 a day for diuretic for 9years. in the past 6 months i have been exercising on a daily bases. i have lost 9kilos.

i have had a reduction in my blood pressure, to the point that i am worried. at times if i jump up, i get dizzy.

i went to a cardiologist at Bkk. hospital with 4 months history of blood pressure. i explained to him what was going on and he told me to get up slow. he declined to make any changes to my meds.

i am considering cutting back the carvedilol 3.125 to one a day and see if there are any changes.

b/p readings;

97/56,97/71,99/65,86/55,90/56. they are consistanly low.

i would appreciate it if any one had a suggestion and if a reduction in the caredilol would help.

i really do not want to play"chase the doctor".

[mommysboy]

Well you probably need to see a doctor like it or not. Hypo-tension can be dangerous. You have low pressure readings but that is not definitive until your normal blood pressure is known. One optimistic asessment is that you have become very fit and really need no medication at all, quite the contrary. Don't delay off to the docs, don't undo all the good work.

[rodknock]

can some one suggest a good cardiac doctor.

like i said i saw the one in Bkk. hospital and he was no help.

i do not mind going as long as i can see a reputable doctor. i do not want to play the doctor shuffle.

[Sheryl]

First of all, what exactly is your cardiac history? Hypertension alone can be managed by an internist. But from the sounds of your meds more than that is present. Do you have congestive heart failure? Please clarify, it makes a difference.

you do definitely need a med adjustment with such low readings. It is not unusual after losing wt and getting more fit.

[rodknock]

a report from 2009,echo, diastolic dtsfunction of heart. 56%ejection fraction but significant diastolic dysfunction.

17-01-2556 had health check up in Bkk. had echo, poor echo window, ef=54%

no RWMA, abnormal relaxation

no further consultations were suggested and told to continue current meds.

[Sheryl]

Clearly you have a cardiac problem though I cannot determine what it is from the info provided. I suggest you consult Dr. Taworn at Bkk Christian Hospital. He is an excellent and very conscientious cardiologist. He is only there on Saturday motnings and in great demand so get there as early as possible. It's first come, first see. You don't need an appointment but call the day before to be sure he'll be there as sometimes he travels for conferences etc. Bring all your records with you inc. All echos.

[rodknock]

thank you for your help. i agree i need to see a doc.

will advise when i know something.

thank you,sheryl!!

[rodknock]

follow up, saw a cardiologist at Sukhumvit hospital today. took all records. doctor suggested stopping carvedilol. between the two echo-cardiograms doc, did not see a problem. the one thing she felt was i was taking such a small amount of the carvedilol that we should suspend it, and just keep track of my bp and how i feel. if there are any issues i will go back.

FYI, Dr. Taworn is listed at Sukhumvit Hospital on Sat. afternoon.

[Sheryl]

Thanks - I did not know that and it is good to know.

Since you went today I expect you saw Prof. Nithi Mahanonda.

Did she say there was no significant change between the 2 echos , or that the echo results are fine? Because they seem to suggest diastolic heart failure, which would explain why you were put on such heavy duty diuretics, which would not be normal approach to simple hypertension.

[rodknock]

i was put on direutics a couple of years before any thing else happened for bad edema. the doctors have just continued me on it over the years. after my dvt i was wearing x-l compression stockings and now have to wear large as x-l will not work and i wear them every day. i saw a dr. juthathip at Sukhumvit Hospital.

will moniter and she if there are any bad changes. i do plan on getting another echo after the 1st. of the year.

thanks for all your help and ideas. you guy's are the best!!

[Sheryl]

The "bad edema" was likely due to congestive heart failure.

[lopburi3]

Unfortunately congestive heart failure is a bad term for us non-medical readers - it does not mean we are dead (as Heart Failure would appear to most of us) but only that capacity is reduced.

And indeed I had a lot of edema in my lower legs and feet when had several CAD blockages of 80-90% which ended when stents placed 3 1/2 years ago - current blockage is 50% but no change from that time and edema has not returned.

[Sheryl]

Yes, the term sounds scary. Should not be confused with cardiac arrest. It is really an impairment/sub-optimal functioning rather than "failure" but for whatever reason, failure is what it is called.

In fact many older people have chronic heart failure and live many years with it, can usually be well managed with medication (though it does depend on the underlying cause).

I am concerned however that the OP does not seem to know much about his cardiac condition. It is a very important part of his medical history.

In his case, seems to be diastolic heart failure.

This is a good overview of heart failure in general. http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/causes/con-20029801