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What Causes Low BP And Fatigue In A CHF Patient?
Question: My mom is 91. Five feet tall, weight 112. Has htn and Takes the following meds daily... Morning: 30 mg nefedipine, 180mg of Diovan, 400 mg of Multaq.... Afternoon meds180mg Diovan ; evening meds : 25mg hctz, 30mg nefedipine, 50 mg metoprolol, 400 mg Multaq. Also takes over the counter 2000 iu vit D, Co Q 10, 500 miligram cranberry extract. She has one kidney. Often the blood pressure bottom number is as low as 50. Her cardio is aware of low number. She has a fib and cong heart failure which seem to be controlled. She wants to know if the meds contribute to her being sleepy throughout the day... Often after eating? She complains of lack of energy.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I carefully passed through your question and would explain that her clinical situation and the chronic fatigue could be related to different causes:
1- Low blood pressure could cause chronic fatigue. If her systolic blood pressure is normal and her dyastolic blood pressure is low, this would indicate a high pulse pressure, which is not a matter of concern. This is a common finding in elderly patients. What are her actual blood pressure values (systolic and diastolic)? If both systolic and dyastolic blood pressure are low, this would be more indicative of low blood pressure (probably related to her actual anti-hypertensive therapy).
2- Chronic anemia, could lead to chronic fatigue and sleepiness. Low renal function (she has only one kidney) is also associated to chronic anemia. What are her actual Hb values? What about her renal function tests?
3- Electrolyte imbalances like high potassium levels can lead to chronic fatigue and sleepiness. Diovan can increase potassium levels as well.
4- Heart failure can lead to chronic fatigue and sleepiness resulting from a low cardiac function, resulting to a chronic low blood supply to the brain.
5- Multaq is an anti-arrhythmic drug which is known to cause fatigue and weakness. What are her actual hear rate values?
So, her clinical situation it is a little complicated and it is necessary performing a careful differential diagnosis between the above mentioned possible causes.
I would recommend consulting with her attending physician and performing some tests:
- a resting ECG and cardiac ultrasound to examine her cardiac function
- complete blood count for anemia
- liver and kidney function tests
- blood electrolytes
- fasting glucose
Meanwhile, I recommend you to closely monitor her blood pressure (systolic and dyastolic) and refer the values to her doctor. If both systolic and dyastolic blood pressure are low, you should discuss with her doctor on the possibility of making some changes to her actual anti-hypertensive therapy, in order to avoid possible low blood pressure, which could aggravate her clinical situation.
Hope to have been helpful!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I carefully passed through your question and would explain that her clinical situation and the chronic fatigue could be related to different causes:
1- Low blood pressure could cause chronic fatigue. If her systolic blood pressure is normal and her dyastolic blood pressure is low, this would indicate a high pulse pressure, which is not a matter of concern. This is a common finding in elderly patients. What are her actual blood pressure values (systolic and diastolic)? If both systolic and dyastolic blood pressure are low, this would be more indicative of low blood pressure (probably related to her actual anti-hypertensive therapy).
2- Chronic anemia, could lead to chronic fatigue and sleepiness. Low renal function (she has only one kidney) is also associated to chronic anemia. What are her actual Hb values? What about her renal function tests?
3- Electrolyte imbalances like high potassium levels can lead to chronic fatigue and sleepiness. Diovan can increase potassium levels as well.
4- Heart failure can lead to chronic fatigue and sleepiness resulting from a low cardiac function, resulting to a chronic low blood supply to the brain.
5- Multaq is an anti-arrhythmic drug which is known to cause fatigue and weakness. What are her actual hear rate values?
So, her clinical situation it is a little complicated and it is necessary performing a careful differential diagnosis between the above mentioned possible causes.
I would recommend consulting with her attending physician and performing some tests:
- a resting ECG and cardiac ultrasound to examine her cardiac function
- complete blood count for anemia
- liver and kidney function tests
- blood electrolytes
- fasting glucose
Meanwhile, I recommend you to closely monitor her blood pressure (systolic and dyastolic) and refer the values to her doctor. If both systolic and dyastolic blood pressure are low, you should discuss with her doctor on the possibility of making some changes to her actual anti-hypertensive therapy, in order to avoid possible low blood pressure, which could aggravate her clinical situation.
Hope to have been helpful!
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
Answered by
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