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Angiography done. Started getting faint and syncope attack. Holter test done. Safe remedy?

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Hi, my father got angiography and detected few blockages like double vessel coronary disease and treated with angioplasty PTCA to RCA done with Pronova stent 3.5X28mm on 9th august 2011 but angioplasty to LCX is not done (PCTA-LCX). Recently he is getting faint and having syncope attack in last 2years four times. The holter monitor done couple of times but it's was fine till the last holter got some bad points. below is the description :-
This time father was admitted to hospital on 31/12/2012
Holter moniter shows the basic rhythm to sinus. The XXXXXXX and min heart rates were 112 at 7.40am and 32 at 7.46am with an average heart rate of 75bp. Few tachy XXXXXXX episodes with short sinus pauses(max- 2.4sec at 7.46am) noted. Complete heart blockage also noted (7.47am to 7.48am)- 1min. Few isolated ventricular ectopics noted. No significant ST-T changes observed. Patient had no symptom while holter monitoring. All the blood reports like CBC are normal with a little high on potassium and little less on sodium noted. There was a chest infection treated with antibiotics tajact injection. Chest x-ray is also clear. my dad is looking little tired and feeling drowsiness most of the time. Is it something really serious, I am really tensed doctor. ECG also done on XXXXXXX 2nd it's normal with limits.
He is taking the medicines given below:-
Deplat -A 150
Rozavel 20
Olsar H40
Prolomet XL 100
Pantocid DSR
Last BP recorded was 130/80 on 25/1/2013
Please help me I am worried and tensed
Posted Sun, 3 Mar 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 8 hours later
Hi friend,
Welcome to Health Care Magic

The event monitor is highly suggestive of Sick Sinus Syndrome.
Cardiologist / particularly sub-specialist Electro-physiologist / will do this. It is a rather simple procedure.

New ischemia is less likely – but it can not be ruled out completely.
It can be investigated later, when he is stable.

Prolomet XL 100 is Metoprolol – it is a beta blocker and can reduce the heart rate.
Olsar H40 is Olmesartan and hydro-chloro-thiazide – thiazide is a diuretic and can lead to electrolyte disturbances – especially low sodium and potassium / Sartan can retain potassium / these may lead to arrhythmia
Pantoperazole is lately attracting attention in interfering with effects of anti-platelet drugs.
-     Check electrolytes again
-     Omit Pantocid DSR if he has no ‘stomach’ symptoms
-     Reduce the dose of Prolomet (It should not be stopped suddenly because of possible rebound)
DO NOT DO BY YOURSELF. Discuss with your doctor and he will guide properly.

His kidney function is impaired. There is no immediate danger, but it is better to seek the help of Nephrologist – for long term management.

In general - he needs aggressive management.
The outlook is not at all bad.

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Angiography done. Started getting faint and syncope attack. Holter test done. Safe remedy? 39 hours later
Hi Doctor,

Thanks for your response. Well is it pacemaker only solution can he stable with medicines? Only once it is recorded in Holter Monitor, Do you suggest it for one more time.
How serious is he is it can wait for few as my father is shocked listening to this.
Do you have any reference of cardiac specialist who can do it in kolkata?
I will be going to an cardiac specialist to show him the reports. Which sort of Pace maker needed?

Answered by Dr. Anantharamakrishnan 1 hour later

It is very unlikely to be corrected by medicines alone.
In all probability, a pace maker will be necessary.

No need to repeat the Holter.
It is repeated only when the first one does not document anything.

It is serious. Complete Heart Block or Ventricular tachycardia may have serious consequences.

It needs attention, as soon as possible. Waiting serves no purpose and may entail risk.

I do not know any specific person or hospital in Kolkata – it is a big metropolis / there must be several big Institutions and specialists. The sort of pacemaker is decided by the treating cardiologist, who is directly examining the patient and results of electro-physiological testing – dual chamber machine likely

Above answer was peer-reviewed by
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