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What Causes Chronic Fatigue In An Elderly Person?
Question: Mom is 91... 5 ft tall. 113 lbs ....has Congest heart failure diagnosed( controlled) and afib (controllled). Has one kidney. Has high blood pressure...Usually runs 140/50.....or close to it....She has been prescribed and takes the following... Morning--diovan 160...nifedipine 30 mg... Multaq 400... Noon: diovan 160....... VitE... Coq10...Evening: metoprolol 50.... Nifedipine 30mg...Multaq 400....hctz 25....(all vmilligrams)....The question is-->She is tired if taking so many pills. Would like to be treated with fewer pills. What do you think of the combination of medication that is listed???Too much?? Not enough???
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
Regarding your concern, I would explain that her chronic fatigue can be related to different causes (medication adverse effects, her age, electrolytes imbalances, congestive heart failure with a low cardiac function, low renal function, etc.).
So before making any changes to her actual therapy, it is necessary performing some tests to investigate for the possible cause of her chronic fatigue:
- a cardiac ultrasound to examine her cardiac function.
- I would also recommend performing NT Pro BNP levels for the evaluation of congestive heart failure. The optimization of heart failure therapy, can lead to improvement of the symptomatology in patients with a low cardiac function.
- blood electrolytes, to exclude possible electrolyte imbalance. Diovan in patients with an impaired renal function can lead to increase potassium levels, which can cause chronic fatigue. Have you checked her potassium levels lately?
- complete blood count for chronic anemia. Congestive heart failure and chronic renal disease can lead to chronic anemia, which is one of the main causes of chronic fatigue in elderly patients. Have you checked her blood count lately? If anemia is diagnosed, it should be treated properly.
- Renal function. The fact that she is with only one kidney may lead to increased levels of BUN and creatinine and electrolyte imbalance. I would recommend checking her renal function tests, liver function tests and blood electrolytes.
Regarding her actual medication, as her blood pressure values are within the normal ranges, I would not recommend making any changes to her anti-hypertensive therapy (diovan, nifedipine, hydroclorothiazide). Unless, if high potassium levels are found, the dose of diovan should be reduced, but it should also be substituted to another drug, in order to have a better control of her blood pressure (as it is now).
Regarding her antiarrhythmic drugs (Multaq and Metoprolol), I would like to know her actual heart rate values. You can try to reduce the doses or even stop metoprolol (betablockers are known to cause chronic fatigue and reduced muscular performance as a common adverse effect), in her heart rate values is not high.
I would also like to know if she has shortness of breath or leg swelling. This would be a sign of fluid retention. In such case, I would recommend adding a diuretic (furasemid) to her actual therapy, in order to improve her clinical situation.
Hope to have been helpful!
Feel free to ask any other questions whenever you need!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
Regarding your concern, I would explain that her chronic fatigue can be related to different causes (medication adverse effects, her age, electrolytes imbalances, congestive heart failure with a low cardiac function, low renal function, etc.).
So before making any changes to her actual therapy, it is necessary performing some tests to investigate for the possible cause of her chronic fatigue:
- a cardiac ultrasound to examine her cardiac function.
- I would also recommend performing NT Pro BNP levels for the evaluation of congestive heart failure. The optimization of heart failure therapy, can lead to improvement of the symptomatology in patients with a low cardiac function.
- blood electrolytes, to exclude possible electrolyte imbalance. Diovan in patients with an impaired renal function can lead to increase potassium levels, which can cause chronic fatigue. Have you checked her potassium levels lately?
- complete blood count for chronic anemia. Congestive heart failure and chronic renal disease can lead to chronic anemia, which is one of the main causes of chronic fatigue in elderly patients. Have you checked her blood count lately? If anemia is diagnosed, it should be treated properly.
- Renal function. The fact that she is with only one kidney may lead to increased levels of BUN and creatinine and electrolyte imbalance. I would recommend checking her renal function tests, liver function tests and blood electrolytes.
Regarding her actual medication, as her blood pressure values are within the normal ranges, I would not recommend making any changes to her anti-hypertensive therapy (diovan, nifedipine, hydroclorothiazide). Unless, if high potassium levels are found, the dose of diovan should be reduced, but it should also be substituted to another drug, in order to have a better control of her blood pressure (as it is now).
Regarding her antiarrhythmic drugs (Multaq and Metoprolol), I would like to know her actual heart rate values. You can try to reduce the doses or even stop metoprolol (betablockers are known to cause chronic fatigue and reduced muscular performance as a common adverse effect), in her heart rate values is not high.
I would also like to know if she has shortness of breath or leg swelling. This would be a sign of fluid retention. In such case, I would recommend adding a diuretic (furasemid) to her actual therapy, in order to improve her clinical situation.
Hope to have been helpful!
Feel free to ask any other questions whenever you need!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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