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High pulse rate, fluctuating BP. Taking cepodem200, metoprolol. What is the best course of medication?

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Practicing since : 1981
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My father is 81 years old. He is having healthy liver and kidney. For last 30 days he is having high pulse rate varying from 100-125. He seems to have mild infection and is having cepodem200 twice daily. For Blood pressure he is taking metrolol 150 mg in divided doses. presently his blood pressure is varying from 80-to 100 and upper one from 130-160. What is best course of medication
Posted Fri, 6 Jul 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 1 hour later

Thank you for writing in.

The cause of increased heart rate is 'mild infection'. I would like to know what is this infection. Though with prostrate problem, it appears to be antibiotic after urine culture has been sent will be best course of action. He needs to be seen by a cardiologist if not seen so far.

If this heart rate s due to his infection, it is definitely not a mild infection.
As far as the variation in the blood pressure is concerned, his age and method of recording can explain it. Also, I would like to point out that he is taking rather unusual dose of Metoprolol (usual dose is 100mg extended release tablet once a day or 50 mg tablet twice a day).
With relevance to the heart disease, I would like to know has his EKG and echocardiography been done.

I hope he is being treated by competent doctors you have in Lucknow. There are excellent cardiology departments in your city; one in local Government Medical College and 10 KM from the heart of city is XXXXXXX XXXXXXX Post Graduate Institute. I would suggest you take him to either one of these places and consult a properly trained cardiologist
If you have any follow up query, please write, I will be most happy to answer.

With Best Wishes,

Dr Anil Grover MD, DM (Cardiology)
Above answer was peer-reviewed by
Follow-up: High pulse rate, fluctuating BP. Taking cepodem200, metoprolol. What is the best course of medication? 44 hours later
We got bood test and ultra sound:
Blood report: Typhoid IgG IgM
Anti Salmonella M (Typhoid IgM) is Positive

Ultrasound of Complete Abdomen:
Mild Hepatomegaly with thickened gall bladder walls
Chest XRAY: Clear - no infection
Liver and Kidney profile from reputed pathology seems almost normal
Current STATUS: fever around 99.5-100.5
Loss of appetite
Blood pressure medicines have been change as:
Amlopres At in morning
Prasopres XL at bed time
Blood pressure varies in range(65-80) and upper(115-125)
Pulse is varying from 105-120
Please suggest medications for typhoid base on ultra sound opinion.
Answered by Dr. Anil Grover 6 hours later
Good Morning,
Thanks for writing back. I am glad that major worry is resolved.

Health Care Portal cannot prescribe individual medicines; it can comment on the medicines to be given by the local doctor for it is his/her prerogative.

You must have been prescribed the antibiotic I would urge you that to continue to take full course. Usually, fever comes down within 48-72 hours. As long term complications of incomplete treatment had been see which include
1. Localisation of Salmonella in gall bladder
2. Relapse of the disease
3. Rarely, but no so uncommon in elderly people: Infective Endocarditis of Aortic Valve.

He should take rest for two weeks and keep watch on his bowel movements. Passing blood in stool is rare but a possible complication.

Good thing about infective illnesses like typhoid is once the course is complete you are cured and you can be back to what you are doing best.

Ultrasound findings do not tell us about histopathology. Your XXXXXXX medicine specialist may like to do CT abdomen or CT guided aspiration cytology to find out the nature of lesion and treatment can begin. Rarely para aotric lymph nodes can be enlarged in Salmonella infections if that be the case after treatment course for Typhoid, a repeat ultrasound can be good way to evaluate.

With Best Wishes.

Anil Grover
Above answer was peer-reviewed by
Follow-up: High pulse rate, fluctuating BP. Taking cepodem200, metoprolol. What is the best course of medication? 3 hours later
Many-many thanks for reply. We are greatly relieved after your opinion. You are doing great service.
Answered by Dr. Anil Grover 4 minutes later
Dear Mr Tyagi,

Thank you for your pertinent questions. Please close the question and give your review comments.

You may wish to ask me a query at this link in future.

Dr Anil Grover
Above answer was peer-reviewed by
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