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What Causes Severe Shortness Of Breath After Increasing The Dosage Of Carvedilol?
Question: my 93 yr old mother switched from clonidine to carvedilol about 3 weeks ago. with the initial 12 mg/2xs a day dose her blood pressure was still high so she was put on 25mg 2xs a day. She is also taking 40 mg furosemide, pot cl, and diltiazem. this brought her bp down to normal levels. then she started to have more leg swelling and towards the end of last week developed shortness of breath. The visiting nurse noted this and low oxygen levels and called the cardiologist. He recommended doubling the diuretic. today the shortness of breath is worse. I called the doc and asked if it could be a side effect of the higher dose of the carvedilol. he said he didn't think so, i said that she will be seeing the visiting nurse on mon and we have an office appt on wed in his office, is it ok to wait? He said to do what I want and to take her to the emergency room if I'm worried about it. I again asked if he felt i should worry about it and he said I should decide for myself. So my mom and i talked about it and decided that since she is doubling up on the diuretic we will try going back to the 12mg dose of Carvedilol and closely monitor her bp. if anything changes we will go to the ER. I'm not a doctor!!!! Does this make sense?
Brief Answer:
You may try treatment as prescribed at home, should take her to Er sos
Detailed Answer:
Hello, it am Dr. XXXXXXX Mody and I would be addressing your concern.
Some reports I would like to review are 2d echo, electrolytes, s creatinine for the basics.
As I start I will presume that your mother has ejection fraction which is on the lower side or maybe diastolic dysfunction , the reason she might be on diuretic,
I will be brief and to the point to avoid confusion.
As your mother is on dilzem and such high of beta blocker carvedilol has decompensated her heart pumping leading to failure, which I presume due to swelling in legs, shortness of breath moat probably due to fluid accumulation in the lungs.
This is not an ideal combination and most coardiogist avoid giving them particularly in old age as your mother. Do discuss the same with your doctor
Treatment I recommend.
Head end elevation to atleast 60 degree even at night.
Restrict water to 1 litre.
Decrease dose of dilzem or carvedilol for tmt ime being.
Increase diuretic. Maintain strict input output chart.
Oxygen at home if needed to maintain saturation minimum at 90%.
Review complete medication as soon as possible with your doctor.
To go to Er and consider strongly consider admission if oxygen Saturation stays low, she is breathlessness, urine output is low, any chest heaviness Or fall in blood pressure or increase in pulse rate or breathing rate, at the earliest.
Respected sir the condition described is chronic, need to review in more detail for exact diagnosis and optimum management.
Regards Dr XXXXXXX mody
You may try treatment as prescribed at home, should take her to Er sos
Detailed Answer:
Hello, it am Dr. XXXXXXX Mody and I would be addressing your concern.
Some reports I would like to review are 2d echo, electrolytes, s creatinine for the basics.
As I start I will presume that your mother has ejection fraction which is on the lower side or maybe diastolic dysfunction , the reason she might be on diuretic,
I will be brief and to the point to avoid confusion.
As your mother is on dilzem and such high of beta blocker carvedilol has decompensated her heart pumping leading to failure, which I presume due to swelling in legs, shortness of breath moat probably due to fluid accumulation in the lungs.
This is not an ideal combination and most coardiogist avoid giving them particularly in old age as your mother. Do discuss the same with your doctor
Treatment I recommend.
Head end elevation to atleast 60 degree even at night.
Restrict water to 1 litre.
Decrease dose of dilzem or carvedilol for tmt ime being.
Increase diuretic. Maintain strict input output chart.
Oxygen at home if needed to maintain saturation minimum at 90%.
Review complete medication as soon as possible with your doctor.
To go to Er and consider strongly consider admission if oxygen Saturation stays low, she is breathlessness, urine output is low, any chest heaviness Or fall in blood pressure or increase in pulse rate or breathing rate, at the earliest.
Respected sir the condition described is chronic, need to review in more detail for exact diagnosis and optimum management.
Regards Dr XXXXXXX mody
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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