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What Causes Lightheadedness And Shortness Of Breath When Treating Left-sided Heart Dysfunction

Posted on Mon, 12 Jan 2015

Question: Hello Doctor Bhashvar,

Its been sometime since we communicated about left sided heart dysfunction.
I started the diuretics and I am getting lightheaded all the time I still have some shortness of breath.
I addition after eating my heartbeats 105 beats a minute and there is also a blood pressure is there anything you think I should do like betablockers or another medication for left sided failure.

Answered by Dr. Drkaushal85 (56 minutes later)

Brief Answer:
yes, you can start beta blockers.

Detailed Answer:
Hello dear, thanks for your question on HCM.
I want to ask you few questions first.
1. Which diuretic you are using?
2. How much is your Ejection Fraction (EF) in 2D Echo report.

And yes you can definitely start betablockers. Start a cardio selective beta blocker for instance metoprolol.

You can also start oral inotropic drug (digoxin) to improve force of contraction of heart. So it actually improves pumping and increase ejection Fraction.

Please remember that these are prescription medications and you should discuss their use with your Primary Care Doctor. You will need to get the prescription for these medications from them. You should be monitored at regular intervals once you start BetaBlokcers and you should avoid skipping the medications once you have started as it may make your heart rate go faster than it should.

So let me know answers of above questions. So that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Drkaushal85 (25 minutes later)

i use the dieretic Hydrochlorothiazide is there another one you recommend. so I wont get dizzy.
would beta blockers interfere with the left heart function?

In a question a month ago I told you it the echo was normal but ace inhibitor enaleparol and tadalafil there was a substantial improvement. you tiold me to rty a diuretric and a calcium chanel blocker.

Answered by Dr. Drkaushal85 (23 minutes later)

Brief Answer:
use aldosterone receptor antagonist.

Detailed Answer:
Hello dear, thanks for your follow up question.
Since your ejection Fraction is good, no need to start oral inotropic drug.
You are taking thiazide group of diuretic.
This can cause electrolyte disturbance and may cause dizziness.
Instead of this you can try aldosterone receptor antagonist (type of diuretic). It will not cause much electrolyte disturbance and dizziness.
And betablockers are actually cardio protective. So it will not interfere with left heart function. There are certain side effects with beta blockers So consult your cardiologist and discuss all these before starting.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Drkaushal85 (3 hours later)

What type of aldosterone receptor antagonist?

Answered by Dr. Drkaushal85 (3 hours later)

Brief Answer:
spironolactone.

Detailed Answer:
Helo dear, thanks for your follow up question.
Spironolactone is the aldosterone receptor antagonist ( type of diuretic ). But since it is a prescribed drug, you need to consult cardiologist and discuss about this before starting.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Drkaushal85 (3 days later)

should I take a beta blocker egularly or only when my heart is beating fast?

Answered by Dr. Drkaushal85 (21 minutes later)

Brief Answer:
you should take regularly.

Detailed Answer:
Hello dear, thanks for your follow up question.
For optimal effect of cardio selective beta blocker, you should take it daily.
Since it is a prescribed drug, you need to consult cardiologist first before starting.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Drkaushal85 (2 days later)

Hello i have not started the beta blockers, but i am able to excercise 2 miles on the treadmill because the medication has improved my breathing
but now I have lightheaded-ness and dizziness especially when I get up and my heart neat is at 50 beats a minute
do you have any ideas of what I should do

Answered by Dr. Drkaushal85 (29 minutes later)

Brief Answer:
no need to start beta blocker at present.

Detailed Answer:
Hello dear, thanks for your follow up question.
No need to start beta blocker at present. As your heart rate is 50 only. This is contraindication for beta blocker use.
I want to ask you few questions first.
1. How much is your daily fluid intake?
2. How much is your urine output In 24 hours?
3. Have you checked for sodium level?
Need to know these things so that I can answer your question about morning dizziness and light headedness.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Drkaushal85 (43 minutes later)

my liquid intake is around a third to half of a gallon it appears i urinate as much as i drink
I have not checked my sodium but in past blood tests it was low.

My blood pressure is 60\95 before eating and 77\118 after eating a meal.

Answered by Dr. Drkaushal85 (26 minutes later)

Brief Answer:
get done sodium level.

Detailed Answer:
Hello dear, thanks for your follow up question.
I advice you to get done sodium level.
In my opinion it will come low only.
Since your urine output is adequate with low fluid intake, I think diuretic dose should be reduced.
Now tell me which diuretic you are taking?. And dose and timing too?
I will be happy to help you further.
Wish you good health.
Thanks.

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj