Is the heart muscle becoming too weak?

Q. Is the heart muscle becoming too weak?

Answered by
Dr. Talapatra Ritendra Nath
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Feb 11, 2018 and last reviewed on: Jun 09, 2023

Hello doctor,

My 59-year-old father has had hypertension for the past nine years and an acidity problem. He got an acute MI last month. Before this, he had been suffering from low blood pressure for the past ten days, and our family doctor asked him to stop the BP tablet for a few days. At morning 5 AM, he got high acidity and chest pain, but we thought it was acidity and gave him Rantac and other home remedies. But he started sweating and got severe pain in the chest. We took him to a nearby hospital, and the doctor immediately did the angiography and found the main coronary artery was 100 % blocked, which had to be stented immediately. But, he said it is very risky as you have reached late. The damage has already happened. He processed with the angioplasty. There were a total of three blockages on the left side. Two were done via balloon, and the 100 % blockage one was stented. Post the surgery, on the next day, my dad started feeling high acidity, big burps, and heaviness in the chest, and his heart rate was very high. From then, we were in the hospital for ten days until his heart rate, BP, and other things got normal. He had little breathlessness, also. Post returning home, he felt very weak, and again a week later, he got readmitted for low blood pressure as my dad fainted at home. Again, we checked the BP was very low, so we got him to the hospital. The doctors admitted him to the ICU and started giving fluids to raise his BP. The doctors said low BP was due to dehydration as my father had gone for motions thrice that morning and since the intake of fluids is restricted to 1.5 liters max. Previous medication when we got discharged: Cardivas, Ivabrad, Ecosprin, Brilinta, Restyl for sleep and now since my dad complained of breathlessness, they have changed the medication, and now they have discontinued Cardivas completely and increased the dose of Ivabrad and asked to stop Brilinta and take Prax 10 mg. My query is should one discontinue Cardivas abruptly in between? Also, his heart rate fluctuates, and his respiratory rate reaches 25 to 30 at times. And his LVEF on the day of discharge was 30 to 35 %, but on the day when he got readmitted, his LVEF was 25 to 30 %. Is the heart muscle becoming too weak? What could be the reason for the same? Please advice.



Welcome to

Your father presented to the hospital late after the episode of acute MI (myocardial infarction) with a total occlusion. So, before intervention itself, a major part of his anterior heart muscle was damaged. Even after angioplasty, his condition deteriorated and your father is now suffering from heart failure with reduced ejection fraction. Ideally, according to the recent guidelines, these medicines should be taken as advised below. Take Tablet Ecosprin 75 (Aspirin low strength) once daily, Tablet Prax 10 (Prasugrel) once daily, Tablet Storvas 40 (Atorvastatin) once daily, Tablet Cardace 1.25 (Ramipril) once daily, Tablet Cardivas 3.125 (Carvedilol) once daily, Tablet Ivabrad 2.5 (Ivabradine) twice daily and Tablet Dytor Plus (Spironolactone and Torasemide). So beta-blocker must be continued at a reduced dose and to be adjusted with Ivabradine. Send a recent ECG (electrocardiogram) of your father. Consult a specialist doctor, discuss with them, and take medicines with their consent.

Hello doctor,

Thanks for the response.

Today he got discharged from the hospital. I am attaching the discharge summary and recent ECG. Can you please guide me if there are any ECG changes from earlier one post the angioplasty? Was there any heart episode due to which he got readmitted or was it because of low blood pressure? Also, kindly advice on the tablets prescribed.



Welcome back to

I have seen the reports (attachment removed to protect patient identity). ECG (electrocardiogram) shows an evolving change of anterior MI (myocardial infarction). You should keep him under close observation for any more fainting attacks. That may be signs of ventricular arrhythmia and may need ICD (implantable cardioverter-defibrillator) after 40 days post-event. Low BP definitely due to low LVEF (left ventricular ejection fraction). As for medications, I stand by my last suggested drugs. Do ECG every week and urgently after any fainting attack. Monitor BP (blood pressure) chart and intake-output chart.

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