I have dizziness with fluctuating BP. Are my medicines right?

Question

Hello doctor,

I can sleep for four hours and wake up with no issue, but when I lie down again and sleep for about 30 minutes during the same night, I will suddenly wake up breathless and need to urinate.

When I am reviewed by my cardiologist during the day, everything seems to be normal. But the problem is that when I sleep, I wake up breathless, dehydrated, even after I drank a minimum of three liters of water during the day.

Unusual activities and murmurs around the abdomen and chest as if activities are going on there, with mild headache and dizziness at times when I stand up. My BP is 178/95 and goes down to 135/73 unless I sleep again.

Before this, I used to have this episode once in three months, then once every week, but now daily.

Currently, I am taking Entresto 200 mg, twice a day, Carvedilol 12.5 mg, twice daily, Spironolactone 25 mg once, Furosemide 20 mg once, and Dapaglifozin.

Earlier, I was taking Amiodarone and Amlodipine for the same.

I did a routine blood work.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns.

Based on the history you provided, you had myocarditis and were started on medication for heart failure. Your CT (computed tomography) angiogram was normal, and your cardiac MRI (magnetic resonance imaging) showed basal septal hypertrophy of 18 mm, consistent with asymmetrical hypertrophic cardiomyopathy.

Your implantable loop recorder has not shown any arrhythmia, yet you have symptoms of nocturnal dyspnea. Both your MRI and recent echocardiogram showed a normal ejection fraction. I am wondering why your medication was not reduced if your heart function is within the normal range now. Please talk to your cardiologist to optimise your medication after proper clinical evaluation.

I have also read in your record that you have frequent lower urinary tract symptoms and an enlarged prostate. I would emphasize seeing a urologist for treatment and to rule out a urinary tract infection, as your medication Dapagliflozin cannot be continued while you have a urinary tract infection.

Regarding your symptoms, please follow the suggestions below for prompt management:

If you do not have signs of fluid overload, there is no need to continue Furosemide 20mg, as it will cause dehydration, which is not recommended in cases of hypertrophic cardiomyopathy.
Another thing is your blood pressure, which is elevated even on Entresto 200mg twice daily.
I recommend lifestyle modifications such as a low-salt diet, daily walks, and avoiding junk, precooked, canned, and preserved foods that are high in salt.
Consider adding a salt substitute to your diet.
You can also start taking Amlodipine 5 mg in the morning; this can be increased to 10 mg if your blood pressure is still not in the ideal range.
Lastly, you should not have any symptoms with normal heart function and non-obstructive hypertrophic cardiomyopathy.

To properly diagnose your symptoms, I would suggest a bike stress ECHO (bicycle stress echocardiogram). Please talk to your local healthcare provider to arrange for this test to diagnose and treat the cause of symptoms if needed.

I hope this information is helpful. Please do not hesitate to contact me if you need to know anything else. I would be happy to answer.

Regards.