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Hi! I Would Like To Know What It Means When

Posted on Tue, 19 Feb 2019

Question: Hi! I would like to know what it means when someone ( 83 female, advanced COPD,) has a low o2 sat level AND a low heart rate

Answered by Dr. Anders Mark Christensen (11 minutes later)

Brief Answer:
The two may not be linked

Detailed Answer:
Hi Lewisbarry92,

A low O2 sat for a person with COPD can easily be normal, and not reflect an exacerbation of their lung disease. However, low O2 sat combined with a high CO2 level on an arterial blood test suggest a COPD exacerbation, that often require hospitalization. The low heart rate is difficult to comment on; I would need to know just how low it is. Considering her age, it may simply be a side effect to much of the medicine older persons receive, e.g. beta-blockers, calcium antagonists.

Looking forward to hearing from you again.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Anders Mark Christensen (14 hours later)

She has drops in O2 level with minor activity, walking across the room etc. Her sats drop into the low 70's and sometimes the high 60's. Normally when sitting her sats are in the low to mid 90's. Her heart rate resting is in the 70's as well. Normally her heart rate goes up with the drop in O2...sometimes into the 100 to 120 range. And to me that is normal and expected. The heart rate drops withing a few minutes and the sats come up. But every now and then BOTH the sats and the heart ratte are low....low 70's for a sat and 50-60-70 on a heart rate.

Answered by Dr. Anders Mark Christensen (6 hours later)

Brief Answer:
Those measures are only secondary

Detailed Answer:
Hi again,

The Sats, heart rate, and O2 levels are only secondary measures, and primarily of importance if she feels ill when they go down. If she is not affected by it, it is OK.

What other types of illnesses does she have besides COPD?

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Anders Mark Christensen (3 hours later)

Hi Doc!!

Thanks for taking the time to talk to me! To answer your questions. Mom's history and ongoing treatments:
COPD - 2 liters constant O2, Advair 100/50, Spiriva 18 mcg, Duoneb treatments as needed
Hypertension - Attenolol 50mg, Losartan 20mg
High cholesterol and PAD - Simvastatin 40
She had a mild heart attack in 2006 with very minor damage and has a stent.

Mom has not had an exacerbation to the point of needing the ambulance yet. She is just recovering from being ill with either a bad cold or the flu (mild). Her COPD flares when she gets sick and we have to take stronger measures. However, the COPD is severe enough that it is beginning to impede her daily activities and she gets very short of breath. It is then, during these "episodes" that her O2 sats drop and the heart rate either goes up or down. Upon sitting and resting she recovers within a few minutes.

Maybe, I'm looking at the wrong indicators to determine when it's time to call the ambulance. My wife died from COPD a few years ago, but her heart rate was always high when her sats dropped...the sometimes low heart rate is new to me...and I don't know how to handle it. It seems like a bad thing to me and has me ready to push the panic button.

Answered by Dr. Anders Mark Christensen (33 hours later)

Brief Answer:
I would not worry about the low heart rate

Detailed Answer:
Hi again,

I would not worry about the low heart rate alone, and if you mother isn't bothered by it (lightheadedness, nausea, fainting) it is of no significance. It may be related to her antihypertensive treatment with atenolol, that in itself can decrease the heart rate. If she does have symptoms of low heart rate as mentioned above, I suggest you try another antihypertensive treatment, e.g. a calcium channel blocker (amlodipine) or a diuretic (furosemide) that do not affect the heart rate to the same extent as atenolol. And at all times: If she feels very ill to the point were you are uneasy about it, call an ambulance.

Best wishes.

Above answer was peer-reviewed by : Dr. Kampana