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Suggest Treatment For Pneumonia And Cardiac Arrhythmia After Remicade Infusion
Question: my father is 86 after his third remicade infusion he developed bardycardia was hospitalized with diagnosis of heart failure and bigeyminey(spell) , they released him, he is on Benicar, pentasa, budesonide, coreg 6.25. advair. Spiriva, asa 81 mg, Lasix 40, hydrochlorahizade 25, he also has pneumonia now and is on antibiotics, he is home, cant get his docs to do anything , 2 weeks on coreg, still XXXXXXX with pvc's, hx of copd, hypertension.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your medical father history and would explain that remicade infusion has not been related to cardiac arrhythmia as possible adverse effect. Neither heart failure. But in some rare cases it has shown to induce myocardial ischemia, which could be the cause of your father medical situation.
There are also other factors like copd and hypertension which have precipitated heart failure.
What is his actual heart rate? What about his blood pressure values?
Coreg as a betablocker can lead to bradycardia, as it is known to reduce heart rate, even though it has a good effect in preventing PVCs.
If his heart rate is too low, I would recommend reducing the dose of coreg.
I would also recommend performing blood electrolytes, to exclude possible electrolyte imbalances, which can trigger cardiac arrhythmia or bradycardia.
Hope to have been helpful!
Feel free to ask any other questions whenever you need.
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your medical father history and would explain that remicade infusion has not been related to cardiac arrhythmia as possible adverse effect. Neither heart failure. But in some rare cases it has shown to induce myocardial ischemia, which could be the cause of your father medical situation.
There are also other factors like copd and hypertension which have precipitated heart failure.
What is his actual heart rate? What about his blood pressure values?
Coreg as a betablocker can lead to bradycardia, as it is known to reduce heart rate, even though it has a good effect in preventing PVCs.
If his heart rate is too low, I would recommend reducing the dose of coreg.
I would also recommend performing blood electrolytes, to exclude possible electrolyte imbalances, which can trigger cardiac arrhythmia or bradycardia.
Hope to have been helpful!
Feel free to ask any other questions whenever you need.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My dads bp runs 120-140 systolic and diastolic 50-60, he was bradycadic before the coreg. with the pvcs, his rate is in the 70's. The docs put him on the coreg for a reduction in ef from 45% to 35%, I feel the pvcs are the hearts way of giving him some cardiac output. He is extremely exhausted, I cannot tell if its from the coreg or the heart.without pvcs rate 40, with rate 70-80.My dads bp runs 120-140 systolic and diastolic 50-60, he was bradycadic before the coreg. with the pvcs, his rate is in the 70's. The docs put him on the coreg for a reduction in ef from 45% to 35%, I feel the pvcs are the are some form of cardiac output. he is extremely fatigued all the time not sure if this is the heart of side effect of Coreg. his rate without pvcs 40's with 70s
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again,
It seems that the most likely cause of his PVCs is heart failure (decreased cardiac function). The worse the heart failure functional class the more prominent will be extra-systolic arrhythmia (PVCs).
So, I believe the best way to reduce PVCs is to optimize heart failure therapy (properly adjust diuretics doses, beta-blocker doses) and avoid potential triggering factors of heart failure deterioration (such as infection, chronic pulmonary disease, anemia, or also a brady-arrhythmia, etc.).
Regarding his heart rate, 70’s is quite normal, but 40’s while on Coreg is quite low and may be a source of fatigue deterioration and also of PVCs triggering.
In such case, I recommend consulting with his prescribing doctor on the possible Coreg daily dose reduction or even its complete withdrawal.
I would also recommend performing pulmonary function tests to investigate the severity of COPD in order to optimize the underlying therapy (avoiding such way a potential severe hypoxemia, which may be a trigger for PVCs).
Hope to have been helpful!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again,
It seems that the most likely cause of his PVCs is heart failure (decreased cardiac function). The worse the heart failure functional class the more prominent will be extra-systolic arrhythmia (PVCs).
So, I believe the best way to reduce PVCs is to optimize heart failure therapy (properly adjust diuretics doses, beta-blocker doses) and avoid potential triggering factors of heart failure deterioration (such as infection, chronic pulmonary disease, anemia, or also a brady-arrhythmia, etc.).
Regarding his heart rate, 70’s is quite normal, but 40’s while on Coreg is quite low and may be a source of fatigue deterioration and also of PVCs triggering.
In such case, I recommend consulting with his prescribing doctor on the possible Coreg daily dose reduction or even its complete withdrawal.
I would also recommend performing pulmonary function tests to investigate the severity of COPD in order to optimize the underlying therapy (avoiding such way a potential severe hypoxemia, which may be a trigger for PVCs).
Hope to have been helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank-you.
Brief Answer:
You are welcome!
Detailed Answer:
I am glad to have been helpful!
If you will have any other questions in the future, you can ask me directly at any time on the above link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
You are welcome!
Detailed Answer:
I am glad to have been helpful!
If you will have any other questions in the future, you can ask me directly at any time on the above link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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