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Have HBP. Prescribed medicine for AF. Should I continue medicine or go through electric shock treatment?

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Practicing since : 1966
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my wife aged 57 + suffering from high blood pressure last 14yrs BP still ranging beteen 156/94 to 140/74 pulse 78 to 56 ,most of the time 56-64.recently diagnosed suffering with AF and doctor prescribed to take dilzem sr 90 with other medicine Telema AM ,Telema 40,Zolfresh, GSTAB.but when i consulted other cardiologist the suggested to take Paradox a medicine for blood thinning with continuing medicine deleting Dilzem sr 90 and they also advised for TEE test and Electric shock pl advise what should i do - should continue medicine deleting Dilzem or with dilzem or should go to electric shock treatment and is it safe. though apparently no sign of heart problem as in case of blockage are mentioned .Now heart palpitation is there . Any precaution should be taken.
Posted Mon, 25 Feb 2013 in Heart Rate and Rhythm Disorders
Answered by Dr. Anantharamakrishnan 1 hour later
Hi friend,
Welcome to Health Care Magic

There are several interconnected issues.
The best person to solve will be the one handling the case.
However, some general points can be suggested.

It is wise to have TEE – to exclude thrombus (clot) in LA (Left Atrium)

Embolism (thrombus moving out) is the major threat in Atrial Fibrillation (AF).
So, anticoagulation – unless specifically contraindicated – is generally given.

It is necessary to tackle the arrhythmia
RHYTHM CONTROL is the primary aim. Especially, if the onset is recent.
A shock may help to revert to normal rhythm. It may revert – especially, if the atrium is large or diseased...
These are advanced techniques of increasing complexity – Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / source and spread of irregularity isolated or ablated and so on... Though the test is the gold standard, it is INVASIVE and has a risk (though minimal). This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation.

When rate control is not feasible or in cases of recurrence, RATE CONTROL is aimed at. Diltiazem is useful in in this regard, as also pressure control.

Ischemia is possible – in the setting of long standing Blood pressure and age / and it is not always symptomatic. Coronary angiography is the gold standard and can be done at the same time as EPS.

To sum up – There are quite a few technical issues involved and the decision should be done by the treating cardiologist. Seeing different doctors may end up in same medicines in different names and forms and interaction. The best option may be to admit her in a super speciality Tertiary Care Centre / investigate / treat.

Take care
Wishing speedy recovery
God bless
Good luck
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