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Have severe nosebleeds and high bp. History of stroke and heart attack. Cause and required treatment?

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Internal Medicine Specialist
Practicing since : 1996
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Hi,
My dad has been having severe nosebleeds since last Wednesday, March 20. We have gone to the emergency room every night since it first began. They keep putting a large gauze thing into his nose to stop the bleeding. We returned two days later and it was removed. That night his nose started to bleed again. We went to the emergency room, and this process continued for many more nights including last night and this morning. They burnt a vein, I believe, trying to stop the blood a few days ago but that did not help either. The doctors have no idea what is wrong and have been absolutely no help. He has an appointment with his GP on Friday, but this has all taken a toll on him. He has had a stroke and a heart attack in the past, and I am worried that it might occur again. Any idea what this could be and how to stop it? He also has high blood pressure, and is taking medication for it.
Thanks
Posted Tue, 16 Apr 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Prasad Akole 41 minutes later
Dear friend, welcome and thanks for entrusting your query here at Healthcaremagic!
I am Dr. Prasad Akole (Critical Care Expert- http://bit.ly/Dr-Prasad-Akole) and am glad to address to your query here.

By ‘chronic nose bleeds’, do you mean long old problem of frequent nose bleeds or the recent episodes?
High blood pressure is the commonest cause of nose bleed (epistaxis).
Other causes are local trauma including trivial one like nose-picking.
Clotting abnormalities and bleeding disorders are others and vascular anomalies, local tumors are rarer ones.
Could you please mention if his BP is really high these days despite BP medications?
Does he nose-pick?
With history of stroke and heart attack, is he on blood thinners (aspirin or warfarin like drugs)?
Was the stroke a brain hemorrhage or ischemic (stoppage of blood supply)?
Could you list all the medicines he has been taking?
Is his BP controlled now? Has clotting been tested in the last few visits?
If local cauterization has not helped, we need to look at all these possibilities.
I would be able to answer more specifically once I get the details.
I would advise a detailed evaluation by an ENT specialist, testing for hemoglobin, coagulation profile, drug review, tight control of BP (including admission and IV medicines if too high).

Nose is packed by the ENT and removed if bleed stops. Sometimes a balloon tamponade is needed if there is posterior epistaxis (bleed into the back of the throat). Cauterization is the next resort. they have already done this.
Uncommonly facial artery ligation (tying) is done as the last resort. An angiography may be ordered sometimes.

I hope to have answered your query satisfactorily. I would be glad to answer any further queries.
Take care and please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
Good Luck! Thank you!!

Above answer was peer-reviewed by
 
Follow-up: Have severe nosebleeds and high bp. History of stroke and heart attack. Cause and required treatment? 1 hour later
Hi,

By ‘chronic nose bleeds’, do you mean long old problem of frequent nose bleeds or the recent episodes?
It has been a week that he gets severe nose bleeds that won't stop.

High blood pressure is the commonest cause of nose bleed (epistaxis).
His blood pressure has been high after the bleeding starts, but sometimes even before the bleeding as
well.

Other causes are local trauma including trivial one like nose-picking.
He does pick his nose at times, but he claims that he wasn't picking before the first episode of bleeding.

Clotting abnormalities and bleeding disorders are others and vascular anomalies, local tumors are rarer ones.
Blood work indicated that his clotting factors were ok.

Could you please mention if his BP is really high these days despite BP medications?
Yes his bp is sometimes around 190, 178, 156 ...

Does he nose-pick?
Yes habitually when watching TV. He does not notice when he is picking.

With history of stroke and heart attack, is he on blood thinners (aspirin or warfarin like drugs)?
He takes Aspirin, but he has stopped it for a week now.

Was the stroke a brain hemorrhage or ischemic (stoppage of
blood supply)?

Could you list all the medicines he has been taking?
Atenolol 12.5mg per day, metformin 500mg bid, amoldopine besylate 2.5 mg per day, aspirin 8mg per day, Hydrochlorothiazide 12.5 mg one per day, ranitidine 150 mg as needed.

Is his BP controlled now? Has clotting been tested in the last few visits?
yes he has been clotting. His blood pressure is normal when taking medications.

If local cauterization has not helped, we need to look at all these possibilities.
He has two spots cauterized, but bled the next day. I am not sure if it was from the same spots or another.


Thank you
 
 
Answered by Dr. Prasad Akole 1 hour later
Thanks for the update.

I see that he had high BP and nose picking.
His BP needs to be tightly controlled. BP medication may need to be increased in consultation with your doctor.
Aspirin may increase the bleeds and is appropriately stopped.
Cauterization seems not to be working.

Please ask him to take all efforts not to pick/ touch the nostril. It removes any scab forming and re-bleeds. The area may be kept lubricated with medical grade liquid paraffin.

Nasal packing and sometimes balloon tamponade helps.
Last resorts could be as mentioned in my earlier reply which you may ask your treating doctor (but generally reserved for serious life threatening bleeding).
I think BP control (with increased atenolol or amlodipine ) and stopping nose-picking trauma may stop his bleeds.

Stoppage of aspirin puts him at risk of cardio-vascular complications. Ask your doctor when can aspirin be re-started after bleed stops or use other cardio-protectants.
He should bend forward and pinch the nose while breathing through the mouth, if he gets small re bleeds.

Keep follow up with the ENT expert.

I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Please ask for any clarifications before closing and rating this answer.

Take care and please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
All the best!
Above answer was peer-reviewed by
 
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