Patient's Query
Hello doctor,
My 59-year-old father has had hypertension for the past nine years and an acidity problem. He got an acute MI last month. Before this, he had been suffering from low blood pressure for the past ten days, and our family doctor asked him to stop the BP tablet for a few days. At morning 5 AM, he got high acidity and chest pain, but we thought it was acidity and gave him Rantac and other home remedies. But he started sweating and got severe pain in the chest. We took him to a nearby hospital, and the doctor immediately did the angiography and found the main coronary artery was 100 percent blocked, which had to be stented immediately. But, he said it is very risky as you have reached late. The damage has already happened. He proceeded with the angioplasty. There were a total of three blockages on the left side. Two were done via balloon, and the 100 percent blockage one was stented.
Post the surgery, on the next day, my dad started feeling high acidity, big burps, and heaviness in the chest, and his heart rate was very high. From then on, we were in the hospital for ten days until his heart rate, BP, and other things got normal. He had little breathlessness, also. Post returning home, he felt very weak, and again a week later, he got readmitted for low blood pressure as my dad fainted at home. Again, we checked the BP was very low, so we got him to the hospital.
The doctors admitted him to the ICU and started giving fluids to raise his BP. The doctors said low BP was due to dehydration as my father had gone for motions thrice that morning and since the intake of fluids is restricted to 0.396 gallons max. Previous medication when we got discharged: Cardivas, Ivabrad, Ecosprin, Brilinta, Restyl for sleep and now since my dad complained of breathlessness, they have changed the medication, and now they have discontinued Cardivas completely and increased the dose of Ivabrad and asked to stop Brilinta and take Prax 10 mg.
My query is should one discontinue Cardivas abruptly in between? Also, his heart rate fluctuates, and his respiratory rate reaches 25 to 30 at times. His LVEF on the day of discharge was 30 to 35 percent, but on the day when he got readmitted, his LVEF was 25 to 30 percent. Is the heart muscle becoming too weak? What could be the reason for the same?
Please advise.
Hello,
Welcome to icliniq.com.
Your father presented to the hospital late after experiencing an episode of acute myocardial infarction (MI) with total occlusion. As a result, a significant portion of his anterior heart muscle was damaged even before the intervention. Despite undergoing angioplasty, his condition deteriorated, and he is now suffering from heart failure with reduced ejection fraction. According to recent guidelines, he should ideally take the following medications:
The beta-blocker must be continued at a reduced dose and adjusted in conjunction with Ivabradine. Please send a recent electrocardiogram (ECG) of your father. Consult a specialist doctor, discuss the treatment with them, and take the medications with their consent.
Patient's Query
Hello doctor,
Thanks for the response.
Today, he was discharged from the hospital. I am attaching the discharge summary and the recent ECG. Could you please guide me on whether there are any changes in the ECG compared to the previous one after the angioplasty? Was he readmitted due to a heart episode, or was it because of low blood pressure? Additionally, could you kindly provide advice on the prescribed medications?
Hello,
Welcome back to icliniq.com.
I have reviewed the reports (attachment removed to protect patient identity). The ECG (electrocardiogram) shows evolving changes indicative of anterior myocardial infarction (MI). You should keep him under close observation for any further fainting attacks, as these may be signs of ventricular arrhythmia, which could necessitate an implantable cardioverter-defibrillator (ICD) after 40 days post-event. The low blood pressure is likely due to the low left ventricular ejection fraction (LVEF). Regarding medications, I stand by my previously suggested drugs. Please perform an ECG every week and urgently after any fainting attack. Additionally, monitor the blood pressure and maintain an intake-output chart.
I hope this helps you.
Thank you.
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Answered byDr. Talapatra Ritendra Nath
Medically reviewed byDr. K. Shobana
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