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Dr. Andrew Rynne

Family Physician

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Can increasing Labetalol dosage cause breathlessness, chest pain and nasal congestion?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5761 Questions

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Posted on Sat, 2 Jun 2018 in Hypertension and Heart Disease
Question: I am 8 weeks postpartum and was treated for post partum pre-eclampsia. I had chest presssure and shortness of breath and pitting edema but was resolved after hospitalization. I have been on 200mg labetalol 2x/day since that treatmet. I had an echocardiagram that showed my EF was 59% and my LV was enlarged (57). After 5 weeks on labetalol i was instructed to reduce my dose to 100mg 2x/day but that if my blood pressure increased to go back to 200mg. I did this for 5 days and blood pressure began to creep up into the 130s-140s/90s-100 range. I then went back to 200mg 2x/day. The next day i experience severe chest pain and shortness of breath. I slept elevated. i went to the ER the next day and my ntprobnp was 496. A chest xray and CT scan were clear. I was sent home and told to follow up with PCP and cardiologist. I had a repeat echocardiagram and while my LV is now in normal range my EF went down to 50%. My cardiologist doesn't seem to be concerned. My blood pressure had been a little low so my PCP told me to go down to 150mg labetalol 2x/day. However, I am still experience chest pressure, dry cough, nasal congestion, and shortness of breath and no one can tell me why. I feel like my cardiologist is annoyed with me and hasnt returned my emails. I have a second opinion appointment in a few weeks but am worried about postpartum cardiomyopathy. My
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Answered by Dr. Ilir Sharka 47 minutes later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello!

Welcome back on HCM!

I passed carefully through your question and would explain that even if postpartum cardiomyopathy can not be excluded, the good news is that your cardiac function is well preserved (your EF is within the normal limits).

You should know that increased NT pro BNP levels are quite normal during pregnancy and are more prominent during pre-eclampsia or post-partum cardiomyopathy.

The main concerning issue in your clinical situation is high blood pressure, which can compromise the cardiac function.

In this regard, I would recommend adding an ACEI (ramipril, enalapril, etc.) and a diuretic if necessary in order to help control your blood pressure values and also the edema or shortness of breath.

As the chest CT scan has resulted normal, a chest disorder including tromboembolism has been excluded.

I would also advice evaluate your renal and kidney function. It is necessary checking your NT-pro BNP in order to investigate for any possible progression.

You should discuss with your doctor on the above issues.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 2 hours later
Thank you. I am seeing another cardiologist but not for 2 weeks. If my EF is normal why do I still have these symptoms? I am still short of breath and experiencing chest pressure. Will labetelol keep me stable for 2 weeks until my appointment? Should I go to the ER?
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

In order to properly evaluate the anti-hyperntesive treatment efficacy it is necessary to frequently monitor your blood pressure values as no ideal medications scheme exists and the only indicator of a good treatment result is correct blood pressure control.

So, you just have to check this issue.

I understand that such disturbing complaints like shortness of breath and chest pressure, could make your day heart, but as your medical tests (cardiac ultrasound, chest CT scan) have concluded satisfactory results, no dangerous cardiac disorders that could threaten your health during these two weeks until the scheduled appointment seem likely.

But in order to properly explore the real nature of chest pain and shortness of breath, further tests would be necessary including:

- cardiac enzymes
- D-Dimmer levels
- a pulmonary angio CT scan
- a repeated cardiac ultrasound
- serial NT-pro BNP measurements
- complete blood count to exclude an anemia, etc..

In case your blood pressure presents with severe exacerbation values, you should ask medical assistance to the nearest ER service at any time.

Meanwhile, I recommend continuing to monitor your blood pressure values and refer them to your doctor during your appointment.

Hope to have clarified some of your uncertainties!

Wishing a Happy New Year,

Dr. Iliri




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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