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Diagnosed With Essential Hypertension. Prescribed Losar-H. Have Cervical Spondylities. ECG Showed Sinus Tachycardia

Posted on Thu, 12 Sep 2013

Question: Sir, I was diagnosed with essential hypertension at age of 32. I was prescribed losar-H which I have been taking for last 10 years. My BP was under control with this medicine . I took some vitamin b 12 tables also recently suffering from cervical spondylities . 10 days back, my ECG showed sinus tachycardia ( heart rate of about 115 bpm and I was feeling short breathlessness and some anxiety. ) My doctor has now prescribed me Olmezest beta 20/25.My stress test was negative. I am taking this medicine for last 10 days.My bp is now around 110/70 and i am feeling lethargic and also some short of double vision in the morning. Now my heart rate varies between 75 to 85.. My fasting /PP sugar is 105/125 respectively .MY TSH is 3.19 and haemoglobin is 13.2. Is the change of medicine ok for me or I should lower the power of medicine or should take some other medicines. Will this medicine cause early onset of diabetes.kindly advise .thanks and regards.

Answered by Dr. Pankaj Malhan (40 minutes later)

Hi

Thanks for asking .

I think you are prescribed a beta blocker along with the angiotensin converting enzyme inhibitor.

Beta blockers helps in reducing the tachycardia along with controlling the heart rate,That is he reason your heart rate is now with in the normal range which was too high initially.Even the blood pressure is well controlled.

Most of the times body takes time to adjust to the medications,so the feeling of tiredness and lethargy should get better with time.

Some beta blockers have side effect of disturbing the sugar levels, you need to keep an eye by regular testing.

If your symptoms do not resolve consult your doctor to see if the change of medication is needed.

Thanks.

Please let me know if you need further information.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (2 hours later)

Thank you doctor for the answer.

When is the ideal time to take this medicine ? when I told my doctor about lethargies etc he asked me to take the medicine after Dinner instead of after
breakfast. When is the ideal time to take these anti-hypertensive medicines ?

Secondly my stress test was stopped at 3minutes and 30 seconds on pretext of everything is absolutely normal. I m told that stress test is continued for 12 minutes. Do I need to repeat stress test?

Lastly, I am suffering from hypertension since long and from young age of 32 .Does that mean that it will ne much more difficult to control by BP at later stage?

Thanks and regards.

Answered by Dr. Pankaj Malhan (11 minutes later)

There is no good or bad time as the tabs work for 24 hours , you can take them any time.

Stress test measures the heart rate, when ever it reaches the target heart rate , it is stopped.

Yes , long standing hypertension is difficult to control to start with after that it behaves individually.

Above answer was peer-reviewed by : Dr. Vasanth

Follow up: Dr. Pankaj Malhan (27 hours later)

Thank you Doctor for the answer.

my prescribed medicine Olmezest beta 25 has two parts

Metoprlol -25 m+ Olmesartan - 20 mg , my pharmacist told me that it is lowest power available in this combination. However lower power of 12.5 mg and 10 mg are available individually.

I am told In case my pulse rate falls below 60 or BP remains constantly below 110/70. Medicine will be lowered.

my heart rate now is about 64-68 bpm .BP 110/70.

in such a case , will I need to take lower power medicine or another medicine all together to be reviewed may be after a month or so.

thanks and regards

Answered by Dr. Pankaj Malhan (7 minutes later)

Your blood pressure and pulse is fine with your current medicines, and you do not need to change it.

Above answer was peer-reviewed by : Dr. Vasanth

Follow up: Dr. Pankaj Malhan (5 days later)

Dear Doctor ,
For about last 15 days I have switched from losar -50 to taking omlezest 25(20). I tried to take the medicine at night, the following day I had rapid heart rate 0f 100 bpm at around 1 pm in after noon and was not feeling well then I have continued to taking medicine in morning with breakfast at around 9 am.
The side effects are not improving. At the moment I am feeling the following ( not sure all these are side effects):
1)     My heart rate is now around 80 most of times .BP around 120/80 or 110/80. But at times heart rate is around 90 bpm.
2)     Some time I am feeling as if gas is trapped in my heart and sometime I feel some sound in my heart a bit loud, but heart rate is not surely high at these times.
3)     Dizziness
4) dreaming almost every night nowadays
4)     Last 3 days – 2 -3 times loose motion with a lot of gas
5)     Very Mild chest pain sometime
6)     Not feeling well overall
How long it will take for things to stabilize. I am a bit worried .
Kindly advise what should I do?

Thanks and regards.

Answered by Dr. Pankaj Malhan (21 minutes later)

I think your body is not getting adjusted to the new tablets.

Please consult your doctor for the potential change of the antihypertensive medication.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (2 days later)

Sir ,
As advise by you I consulted my doctor.During the check up my my heart rate was 90 bpm , BP120/80 and ECG within normal limits.Doctor said not to get anxious.

My doctor has reduced the medicine to Metoprolol -25 m only.

The diziness has decreased by 60 % but has not gone all together.Hope its get improves further with time?

I am feeling some sensation (hot/cold )in my heart sometime.Is it normal?

Sir I was taking losar-H for about 10 years and didnot have any problem untill a case of sinus tachycardic recently.

Does sinus tachycardia treatment in my case will require beta blocker life long?

Thanks and regards

Follow up: Dr. Pankaj Malhan (2 hours later)

Dear Sir

Kindly also tell me if I should be alert for any warning sign ?
as I write my pulse rate is 56 bpm (1945 hours) . I am taking Prolomet XL 25 since last two days in morning.

Thanks and regards

Answered by Dr. Pankaj Malhan (11 minutes later)

It is absolutely normal to have pulse rate around 50 with the beta blockers and it is no way harmful to the body.

With 25 mg metoprolol it is unlikely to go down any further, so you need not worry about it.

Metoprolol has effect on both the blood pressure and heart rate, if both are well controlled with it, there is no need to change it for long period.

Do not worry too much,I do not see anything alarming in your case.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (2 days later)

Dear Sir ,

Dizziness seems to be settling down, however not gone 100%. Hear rate is normally between 70 to 80.However I am not feeling 100 % well. I have tried not to think about it. But some sensation in heart seems to be bothering now and then, after some time I feel cooling sensation in heart n feel OK.Is it Normal to feel some sensation because of beta blockers ? or is it because of gas ? Can the dizziness be because of some other reason like cervical spondolysis or weakness etc?

thanks n regards

Answered by Dr. Pankaj Malhan (3 minutes later)

It is very unlikely to be because of the cervical spondylosis as it is settling down with the change of medication.

Please give it somw time , it should be fine.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (15 hours later)

Thanks for your reassurance. Sorry for bothering you again.

Sir , I do understand that Beta blockers control heart rate as well blood pressure and thus is correct medicine for me and side effects will settle sooner or later Or may be I will have to tolerate the side effects to some extent.

Sir , perhaps I am not able to explain my sensation feeling in my heart that is why I am not getting any answer from you in this regards. Gas/cold sensation/fluttering etc are some of the sensation. They come and go .

I am also having dry cough, stomach upset, fullness,gas for last two days .I am also having heart rate of around 100 since yesterday night.

I understand with beta blockers some episodes of low and fast heart rate is normal?

Is above symptoms normal?

My physician has prescribed me Becadexmine, vitamin D3 and b12 tables , can I take it ?

Thanks and regards

Answered by Dr. Pankaj Malhan (3 minutes later)

I do not think so that the sensation of hot and cold along with gaseous distension is related the beta blockers.

Acid peptic disease or the gastroesophageal reflux can perhaps explain some part of it, you may need some anti -reflux medication in the form of omeprazole added to your drugs.

Please discuss this with your treating doctor.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (2 days later)

Sir ,

My cardilogist is out of town.I may be able to see him this weekend.

I consulted physician.He has ruled out Acid peptic disease or the gastroesophageal reflux and asvised me to not to take milk which I was taking evrery day.He also advised me to take dinner at least 2 hours before sleep.This seems to have helped for last 2-3days.

Diziness has almost gone.My pulse rate is normally between 84 to 96 bpm.
But in morning between say 8 amto 11am it is around 96-108 bpm.Is there anything to worry?

I am also having sore throrat with redness ( no fever), mild cough,congestion,
I am taking home remedies ,should i take antibotics/cough syrup?

Thanks and Regards

Answered by Dr. Pankaj Malhan (15 minutes later)

Nice to know that your problems are settling down.

Occasional increase in pulse to around 90- 100 is not a cause of concern.

Very hard to decide whether antibiotics are neede or not without actually examining a patient.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (7 days later)

Dear Sir

I was feeling ok for last one week. However, or last 3 to 4 days, I m having a sensation feeling as if ants are crawling at different points in my body including legs, head , face. The feeling come and goes and is very minor.

Is it something to worry about? Why it is ? Is it because of beta blocker or spondolysis ?

For last two weeks- I am also taking Vitamin D ( weekly ) D-rise 60 and Tab Secnid Febrile 2 tabs weekly . They are prescribed for 8 weeks and 4 weeks respectively.

Yesterday my blood pressure was 140/100 and I had mild headache .But today morning it is 130/90. My heart rate normally varies between 80 to 90 . But occasionally goes above 100 ( up to 110) also.

When I was taking losar-H , my nerves were not prominent and now my nerves are prominent. How often I should get my BP checked? Is new medicine not controlling by BP?
Kindly advice.

Thank and regards

Answered by Dr. Pankaj Malhan (3 hours later)

Brief Answer:
130/90 is a very good blood pressure.

Detailed Answer:
Hi

I think your blood pressure is well controlled ,130/90 is as good as it can get.

You probably need to get your blood pressure checked every 2-3 weeks from now,and may be a bit longer after that.

Ants crawling over the body can be sign of neuropathy secondary to spondylosis.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (2 days later)

Dear Sir ,
I got following test done on advise of my doctor .My readings are as under
Electrolytes
sodium 147.7 mmol/L
Potassium 4.2mmol/L
Chloride 105.6 mmol/L
Vitamin b12 - 333.4 pg/ML
25 Hydroxy(OH) Vit D- 29.83 ng/ML
FBS 93.0 mg/dl ( on earlier occasions in Dec/March - it was 105 or so)
PBS 111.0 mg/dl( on earlier occasion in Dec/March - it was 125 or so)

haemoglobin 15.2 gm %

Spine X-rays shows - C4-C5 space narrowing. There is no neck pain or stiffness as of now ,I had neck stiffness a month ago.

Sir , I am feeling weak especially in the evening and not over all well being.
The ant crawling feeling ( more like touching sensation) is still there and it is more when in sitting position.

Do I need further investigation ? or it is just part of anxiety and will pass away with time.

Thanks and regards

Answered by Dr. Pankaj Malhan (4 hours later)

All your tests are with in normal range.

You need MRI of the spine to rule out any serious pathology of spine , if tingling and numbness is not getting better..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (23 hours later)

Thanks for a reply.
Sir ,
Now I am facing more tingling in my face especially left side and is more frequent and I am also feeling weak .I am stressed.
By any chance could it be beacuse of Beta Blockers ?
I am going for MRI tommorrow.DO I need to get more test done ?

Thanks and regards

Answered by Dr. Pankaj Malhan (1 hour later)

I do not think that it is because of beta blockers.

Please do the MRI and share with me the report.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (5 days later)

Sir
Got MRI report just now. The conclusion of report is as under
i)     Hard Disc is seen at C4-5 and C-5 level, impinging left C5 nerve root and compressing right C6 nerve root .
ii) Subtle T2 hyperintensity is seen right half cord without obvious volume loss suggestive of cord edema at C5-C6 disc level .

Sir , there is no facial tingling following hot water application to neck since friday. Does MRI show s a serious problem? What are treatment options?

Further I am having following additional problem since last 3-4 days
1)     Stomach upset – sometime loss motion, once every after meal .
2)     Mild Chest pain on left side( slight up n right of nipple) – The pain was coming and going , earlier but now it is almost constant . The pain is also sometime on right side also and back of chest .

My doctor says pain is likely due to acidity has prescribed me omez for 10 days( twice a day) .Should I take it ?Should I continue vit D3 tablets (weekly)?

Sir, it is frustrating to find new problem every now and then. My muscle tone is also poor.

Sir , your diagnosis is quite apt .
Kindly advise .

Thanks and regards

Answered by Dr. Pankaj Malhan (17 minutes later)

Brief Answer:
Not very serious

Detailed Answer:
I think your MRI report is not very serious, please consult a orthopedic specialist to organise physiotherapy as exercise should help with mild nerve impingement.

You should take omez as prescribed by your doctor as I also think it is because of gastritis ( acidity).

You should continue to take vit -D.

Mild stomach upset is very common , usually self limiting and needing no treatment.

Thanks and Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (45 hours later)

Sir,
I contacted orthopedic surgeon .He has prescribed me for 15 days vitamin b12, calcium with vitamin d3 and folic acid (CCM) , pantocid and nise gel. He has asked me to do some exercises. In case of pain he said physiotherapy ( SWD) would be required.

He said tingling would go away with vitamin b12 and I have large Disc protrusion at C5-C6 and treatment would depends how it behaves .I should not get anxious.

Sir should I take physiotherapy now or wait ? Can I apply hot water application on daily basis? ( I forget to ask this to my doctor)

Regarding chest pain he said it may be due to spondoloysis and he found some swelling in that area. He has asked me to apply nise gel.

As of now I donot have any tingling . However pain in chest area is still there. At one point if I press I feel the pain more.

Earlier I was taking Omez ( twice daily ) and D-rise (weekly) . Should I stop them in view of CCM and pantocid ?
Thanks as always .Regards

Answered by Dr. Pankaj Malhan (10 minutes later)

Brief Answer:
Wait for the acute phase to get over

Detailed Answer:
Please wait while the acute phase is getting settled,then you can go for physiotherapy.

You can take hot water application on daily basis.

Pantocid and omez are of nearly equal efficacy so you can take either of them.you can continue to take calcium with vit D3 along with the weekly cholecalciferol.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pankaj Malhan (2 days later)

Dear Sir ,

Thank you very much for yr advice.

I am keen to give my feed back on you.But sir I wish that in future also my queries should be refered to you only. If I close discussion. I am afraid I will be refered to another doctor .

Most of the symptoms seems to be settling.Except pain in chest area left side, that too is better, it is more on left side. but i do have simliar pain on right side sometime.
can be it be due to spondylosis ?
Sir , is it ok to take isbagol -husk every night with water ?

Thanks and regards

Answered by Dr. Pankaj Malhan (19 hours later)

Brief Answer:
Can ask me directly

Detailed Answer:
You can take the isabgol-husk for long periods, it does not have too many side effects.

You can always ask me directly on

WWW.WWWW.WW
Regards

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar