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Suggest Treatment For Dizziness, Profound Weakness And Leg Edema While Having Atrial Fibrillation
Question: I already have a pacemaker for bradycardia. I am a woman 73 years of age. I have high blood pressure which is under control with medication. I have left ventricular hypertrophy. I recently developed AF. I am waiting to have heart ablation.
I am taking 250mg of digoxin.50mg of blood pressure tablet. 40mg of frusemide and 5mg of Apixaban twice a day.
I now feel so I'll. I have dizzy spells round the clock at frequent intervals. My vision is blurred whilst I am dizzy. I have become weak and am sometimes confused. My feet and lower legs are often swollen.
Any advice would be appreciated.
Thank you
XXXX
I am taking 250mg of digoxin.50mg of blood pressure tablet. 40mg of frusemide and 5mg of Apixaban twice a day.
I now feel so I'll. I have dizzy spells round the clock at frequent intervals. My vision is blurred whilst I am dizzy. I have become weak and am sometimes confused. My feet and lower legs are often swollen.
Any advice would be appreciated.
Thank you
XXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello XXXXXXX
Welcome and thank you for asking on HCM!
I passed carefully through you medical history and would like to explain that:
- Your recent complaints (dizziness, profound weakness, lower limbs edema, etc) seem to be compatible with heart failure symptomatology.
Atrial fibrillation is a frequent arrhythmia in the setting of heart failure, but also triggered by ventricular pacing.
In such case, it is important to review your overall cardiac performance especially left ventricular ejection fraction (LVEF), any possible valvular dysfunctions, pulmonary artery pressures, etc. This can be achieved by performing a careful cardiac ultrasound (ECHO). If your have performed one recently, please it here for a direct review.
- Dizziness and blurred vision may be clinical signs of possible digoxin toxicity. It is important to investigate for possible renal dysfunction, electrolytes imbalances (especially abnormally decreased blood potassium levels), increased plasmatic digoxin levels. I recommend performing:
a) renal function tests (BUN, creatinine),
b) liver function tests,
d) blood electrolytes levels,
c) plasma digoxin level,
- As you have left ventricular hypertrophy and hypertension, probably digoxin would not be the right choice for controlling atrial fibrillation (ventricular rate). Other alternatives like calcium channel blockers or beta-blockers could be more suitable to your clinical scenario.
At the end, I would like to advise you discussing with your attending cardiologist on the above mentioned issues, and possibly optimize your atrial fibrillation and heart failure treatment 9including diuretics).
I remain at your disposal for further discussions whenever you need.
Wishing you a Happy New Year!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello XXXXXXX
Welcome and thank you for asking on HCM!
I passed carefully through you medical history and would like to explain that:
- Your recent complaints (dizziness, profound weakness, lower limbs edema, etc) seem to be compatible with heart failure symptomatology.
Atrial fibrillation is a frequent arrhythmia in the setting of heart failure, but also triggered by ventricular pacing.
In such case, it is important to review your overall cardiac performance especially left ventricular ejection fraction (LVEF), any possible valvular dysfunctions, pulmonary artery pressures, etc. This can be achieved by performing a careful cardiac ultrasound (ECHO). If your have performed one recently, please it here for a direct review.
- Dizziness and blurred vision may be clinical signs of possible digoxin toxicity. It is important to investigate for possible renal dysfunction, electrolytes imbalances (especially abnormally decreased blood potassium levels), increased plasmatic digoxin levels. I recommend performing:
a) renal function tests (BUN, creatinine),
b) liver function tests,
d) blood electrolytes levels,
c) plasma digoxin level,
- As you have left ventricular hypertrophy and hypertension, probably digoxin would not be the right choice for controlling atrial fibrillation (ventricular rate). Other alternatives like calcium channel blockers or beta-blockers could be more suitable to your clinical scenario.
At the end, I would like to advise you discussing with your attending cardiologist on the above mentioned issues, and possibly optimize your atrial fibrillation and heart failure treatment 9including diuretics).
I remain at your disposal for further discussions whenever you need.
Wishing you a Happy New Year!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Opinion as follows:
Detailed Answer:
Dear XXXXXXX
Even if digoxin toxicity would be the cause of dizziness and blurred vision, we can't wait such a fast improvement after stopping the drug.
There is an inter-relation between the kidneys, the liver, blood hydro-electrolytic balance (especially potassium level), when a predisposition for digoxin toxicity exists.
It is necessary to perform the above mentioned lab tests to clarify this issue.
Atrial fibrillation may be a cause for your complains, by decompensating heart failure symptomatology.
But, as you are on holidays now, the only possible action you could follow is to ask medical assistance to the nearest ER service (if the complains become quite disturbing).
After your holidays, an ambulatory 24 to 48 hours ECG monitoring (Holter), a cardiac ECHO and the above recommended lab tests would be necessary to properly address your problems.
Wishing you the best for the New Year!
Hope you are having pleasant Holidays!
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Dear XXXXXXX
Even if digoxin toxicity would be the cause of dizziness and blurred vision, we can't wait such a fast improvement after stopping the drug.
There is an inter-relation between the kidneys, the liver, blood hydro-electrolytic balance (especially potassium level), when a predisposition for digoxin toxicity exists.
It is necessary to perform the above mentioned lab tests to clarify this issue.
Atrial fibrillation may be a cause for your complains, by decompensating heart failure symptomatology.
But, as you are on holidays now, the only possible action you could follow is to ask medical assistance to the nearest ER service (if the complains become quite disturbing).
After your holidays, an ambulatory 24 to 48 hours ECG monitoring (Holter), a cardiac ECHO and the above recommended lab tests would be necessary to properly address your problems.
Wishing you the best for the New Year!
Hope you are having pleasant Holidays!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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