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What Causes Low Blood Pressure?

Posted on Fri, 5 Sep 2014

Question: My husband has extremely low blood pressure. What causes this? He has had high blood pressure
for at least 10 years . The cardiologist took him off all meds and now its too low. He is very weak
and feint most of the time.

Answered by Dr. Rakesh Madhyastha (5 hours later)

Brief Answer:
Hypotension

Detailed Answer:
Hello

Thanks for the query

I understand that your husband was previously hypertensive and now he is off all medications because of low blood pressure. I need to know a few more details in order to help you better

1. What was his blood pressure reading in the doctor's office?
2. What medications was he taking for the blood pressure?
3. Is he a diabetic as well?
4. Please furnish the latest blood reports if you have them?
5. Is the fainting more when he is sitting or standing position compared to supine position?

Please get back to me, I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (16 hours later)

IN the doctors office it is quite normal as he gets very nervous. (maybe 140/80)
He was taking flecinide, atenolol, spirolactone. He is now diabetic ever.
HIs blood work seems normal. He feels faint when he stands and walks around.
He take caffeinated coffee or cokes when it is very low. It has been as low as
60/40.

Answered by Dr. Rakesh Madhyastha (8 hours later)

Brief Answer:
Postural Hypotension

Detailed Answer:
Hello

Thanks for getting back, I am sorry for the short delay in my response, I was on call at my hospital.

From the history you have given me it is possible that he is having postural hypotension. It is usually seen in diabetics with autonomic neuropathy. This is what he must do

1. Take a little more salt in the diet than usual
2. When the blood pressure drops below 80 mmg systolic, he must lie down flat on the ground with leg end elevated above the heart. This will improve is blood pressure. He must remain in a leg end elevated position atleast for 10 min
3. He must get a cardiac evaluation done with ECHO and Thread mill test. If this is normal then he must have a tilt table test to rule out autonomic dysfunction
4. Anti hypertensives that cause postural drop like spironolactone and atenolol must be stopped. Calcium channel blockers like amlodipine is the best.
5. Keep the patient well hydrated with plenty of water. Avoid caffeine.

I hope I was of help, if you have any further queries/ doubts please get back to me

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (15 hours later)

My typing isn't the best. He does not have diabetes, he had an ECHO and
it is fine. He will ask his dr. about amlodipine. Thank you

Answered by Dr. Rakesh Madhyastha (6 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

In the follow up answer you had mentioned 'he has now diabetic ever', maybe you meant 'he is not a diabetic ever'. Please go for a tilt table test nonetheless in order to rule out autonomic dysfunction.

If the discussion with me was useful, please write me a review, it makes me happy

I wish your family

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (55 minutes later)

I forgot he has had the smaller surgery for atrial fibrillation. Another Dr. wasn't
sure he had a-fib. Many thanks.

Answered by Dr. Rakesh Madhyastha (27 hours later)

Brief Answer:
Atrial fibrillation

Detailed Answer:
Hello

Thanks for getting back

Atrial fibrillation might be the cause for these symptoms. What surgery did he undergo for this? Does he have an intra cardiac device now to prevent further episodes of atrial fibrillation?
Please ask for a 24 hours holter monitoring to rule out episodes of silent atrial fibrillation.It is a small EKG device attached to the chest, it will monitor his ECG 24 hours and see for changes.
Do not ignore this any further

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (33 hours later)

The surgery was about 1 hour long and was for atrial flutter. He has worn a
monitor twice and it showed nothing, Do you think a pacemaker would keep
his blood pressure steady? Thank you

Answered by Dr. Rakesh Madhyastha (12 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

Pacemaker will not help in improving blood pressure, it will only help in keeping the rhythm of the heart at a normal pace.
For improving the blood pressure please follow the steps I have given you in my previous response.

Regards

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar