Brief Answer:
need further investigations..

Detailed Answer:
Dear XXXX, Welcome to HCM,

I've gone through your query and understand your concern,

To start with , I'd like to tell you to rethink for any kind of change in the dose of Sotalol in past few months since you've started experiencing these symptoms..

Your symptoms are pointing towards some specific disorders like Syncope/TIA/Drug induced Hypotension/Tachycardia-Bradycardia sypmtoms or can be Carotid Sinus hypersensitivity(very unlikely in this case)..

Did you ever experience any of this symptoms during shaving or immediately while turning around suddenly ?

Now to narrow it down , there needs to be further investigations , i.e. 12 Lead lead EKG, B/L Carotid Doppler study with cautions monitoring of heart rate as well as Blood pressure , a 24 Hour Holter monitoring to get the thorough analysis , Electrolytes , Thyroid function(if not done already) and lastly 2D-Echo cardiography to check the current cardiac morphology as well as the Prosthetic valves status..

Now these may sound like a lot but trust it's needed to actually pin-point the condition and off course treating accordingly..

Also in the meanwhile take the sotalol in sitting possible and don't get up immediately after taking it or don't get into any strenuous activities within the next 2 hours..

Now these are significant symptoms and I totally disagree with your PCP who simply ignored it by saying side effect of Sotalol(which you're already on since past 2 years).. So further evaluation is a must in this regard and at this point I think it'd be appropriate to get hold of another Cardiologist instead of the PCP regarding this ..

If required the dose of Sotalol can be further titrated but to do so it's needed to be identified at first..

Meanwhile please start to maintain a serial BP and HR chart with 2-3 Hrs interval in relaxed sitting position starting from around 8 am till 10 pm and observe specifically after the first 2 hrs of Sotalol intake.. It'll be better if some else (medical/paramedical professional) takes it..Look for the changes in the BP as well as HR range if BP Systolic drop of > 30mmhg and Diastolic drop 20 mmhg happens abruptly after sotalol intake then the doses might need to be reduced or may be time to consider another agent (depends on the findings)..

No driving is not safe for you at this moment, please avoid it under any circumstances..And that's why you need to get investigated thoroughly before anything further worsening..

I've hope I'm able to clarify your doubt in this short frame , feel free to ask if anything's unclear..


Take Care
Kind Regards

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