Dr. Muhammad Zohaib Siddiq
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My 82-year-old husband was recently diagnosed with CHF. We had no idea that he had it. We went to the hospital as his blood pressure was 200/100 mm of Hg. He did not have any health problems and was in good health. Currently, he is using a beta blocker tablet Cardevilol 3 mg twice daily, tablet Lisinopril 2.5 mg, and tablet Atorvastatin 20 mg. He is feeling extremely tired after taking the medications. Is it because of the beta blockers? Kindly suggest.
Hello,
Welcome to icliniq.com.
I understand your concern. If the heart rate is 38 bpm, tablet Carvedilol should not be taken as it reduces the heart rate. Low heart rate can cause tiredness and fatigue. How is his blood pressure now? Also, what is his ejection fraction on echocardiography? Please share his recent ECG (echocardiogram) and echocardiography reports. I hope this helps. Thank you.
Patient's Query
Hello doctor,
His heart rate is between 44 to 50 beats per minute. His blood pressure is fine, and he also has a pacemaker.
Hello,
Welcome back to icliniq.com.
The heart rate should be between 60 to 70 beats per minute. If the heart rate is 38 beats per minute, the pacemaker is not functioning. Which type of pacemaker was implanted and when? Was it a dual chamber, single chamber, ICD (implantable cardioverter defibrillator), or biventricular? Does he have co-morbidities like diabetes, hypertension, kidney or thyroid problems? Did he have an angiography and echocardiography done in the past? Since how long does he have heart failure? Does he have breathlessness? Share all his relevant investigations and current symptoms. Thank you.
Patient's Query
Hello doctor,
His reports read as below. Left ventricle: The cavity size is normal, wall thickness is mildly hypertrophied, systolic function is moderately reduced, estimated ejection fraction is 35 to 40%, there is severe apical hypokinesis. Heart disease (balloting) with the rest of LV showing mild hypokinesis. Cannot rule out ischemic heart disease in lad territory's Taktosubo (stress) cardiomyopathy. Clinical correlation is advised. Left ventricular diastolic function parameters are indeterminate. Left atrium: Normal in size, mitral valve thickness is normal, there is no evidence of stenosis, the pulmonary valve is normal, the tricuspid valve is normal, the aorta is mildly dilated, and inferior vena cava are normal in size. Blood pressure is 134/80 mm of Hg, and pulse is 70 beats per minute. Is the medication making him tired? Kindly advise.
Hello,
Welcome back to icliniq.com.
His left ventricle's function is 35 %, which is low. He should continue taking medicines. These medicines do not make him tired. If the heart rate decreases or blood pressure becomes low, this may cause symptoms. If blood pressure and heart rate are normal, then it is fine. If his renal function is normal, I suggest he undergo an angiography and viability study. If the heart muscle is viable and the artery has a blockage, then angioplasty should be done. Medicines should be continued in both cases. If he has shortness of breath and his chest is congested, he should also take diuretic medication to increase the urine output. I hope this helps. Thank you.
Patient's Query
Hello doctor,
He had an angiogram there are no blocks. Also, there is no shortness of breath. He has had a lot of anxiety. He never had heart problems. What is making him so tired? I read that the beta blocker could make you tired? Is that true?
Hello,
Welcome back to icliniq.com.
If he has recently developed symptoms, it may be due to takotsubo cardiomyopathy, also called stress-induced cardiomyopathy, which occurs during sudden intense emotional stress. Stress-induced cardiomyopathy is reversible in most cases. Tablet Carvedilol and other beta blockers can cause tiredness and fatigue if the heart rate is below 60 beats per minute. 125 mg twice daily is a very low dose and should not cause symptoms. Statins can also cause fatigue and muscular pain. For muscle pain, liver function tests and CPK levels must be done. Also, check the blood sugar levels if if he is conservative in his diet. Has he suffered a recent viral infection, as viral infections can cause body aches and fatigue? I hope this helps. Thank you.
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Cardiology
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