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Dr. Andrew Rynne

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Suggest treatment for numbness in the arms

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Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1717 Questions

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Posted on Wed, 15 Mar 2017 in Hypertension and Heart Disease
Question: Continuing question for Dr. Makonde-
New update. Patient has been much more active today on the Drs. Recmendation. She has been making laps around the ward. After each session she has her BP and heart rate checked.
After each session her BP raises by approx. 20 points- her heart rate , however, is remaining at 40- 45.
My question is- can she be put on a pacemaker to help with the arrthymia's and to increase her heart rate. At the same time can she keep taking the beta blockers as it has helped the ectopics. If she had the pacemaker the heart rate could be increased to help with the numbness in the arms and at the same time help the energy level. Is that possible? Dr. Gillrie
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Answered by Dr. Sagar Makode 53 minutes later
Brief Answer:
See the description

Detailed Answer:
It's not advisable because we have better alternatives. Beta blockers reduce blood pressure and pulse rate along with suppression of ectopics, so what she needs most is dose optimization. I guess her pulse rate prior to starting beta blockers was normal, if yes pacemaker will not be very useful.
Firstly, as I advised previously optimization of dose at which ectopics will be under control or have few ectopics, and heart rate will be in a range of 50-60 and bp readings more than 100 systolic is acceptable. Numbness, dizziness, is because of two reasons one is low bp and secondly low pulse rate. So decreasing beta blockers dose slightly will address both the issues, it will increase pulse rate and blood pressure and also suppress the ectopics. Once dose of beta blockers is changed it may take 2-3 days to wean off its effect.
The option which you gave serve the same purpose as that of reducing the beta blockers dose. Secondly, pacemaker or ICD won't treat ectopics, it will give shocks if she has ventricular tachycardia or fibrillation, which we are not expecting. And giving pacemaker and beta blockers togetherly, is not suitable because beta blockers are not very effective in suppression of ectopics and they may lose their efficacy of suppression of ectopics and we may need some other drugs later. So the very purpose of putting pacemaker will be lost.
Also, putting the patient at a risk of surgery, possible complications of pacemaker insertion like infection, periodic battery changing, in future she may be a candidate for different kind of pacemaker like ICD, so all these are there. Also, mere suppression of ectopics will give symptomatic benefit but will not change the prognosis as such. So taking this much risk is not worth. So all efforts should be taken to manage the things with drugs.
Also, more importantly her heart is functioning normal, so blood pressure more than 100 will be sufficient blood pressure according to her needs. so we should chase her blood pressure much, we ll just focus on symptoms. Resolution of symptoms will be our end point.
Heart rate not rising if because of beta blockers. Blood pressure rise is normal thing and good sign. Yes she should do activities and exercise, there is no contraindication as such. so get back if you have more doubts. All the best.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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