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    Suggest treatment for occasional dizziness while having atrial fibrillation

Posted on Fri, 3 Jun 2016 in Hypertension and Heart Disease
Question: I have been on a beta blocker Sotolol for 2 years for atrial fibrillation that developed about 9 years after aortic valve replacement St. Jude's mechanical). For the past few months, I have been experiencing occassional dizziness episodes lasting only 3-5 seconds, with a kind of electric shock sensation(mild)-like a mild electric current. Then total recovery. I can sense it coming on and , if I tense up and concentrate, I can stop it from occurring apparently. Primary care provider says it's just a side effect of the beta blocker Sotolol. Dose is fairly low 80 mg and 60 mg at 3 pm and 3 am. Just took a dose about half-hour before the above episode . Fainted or fell over , very brief or no loss of consciousness. Just toppled over. A little sweating, possibly an anxiety, but that stopped in about 5 minutes. Heart rate normal sinus rhythm. I am concerned since this is first time actually fell over. Recovered quickly but what if this happens while driving?
Answered by Dr. Arnab Banerjee 58 minutes later
Brief Answer:
need further investigations..

Detailed Answer:
Dear XXXX, Welcome to HCM,

I've gone through your query and understand your concern,

To start with , I'd like to tell you to rethink for any kind of change in the dose of Sotalol in past few months since you've started experiencing these symptoms..

Your symptoms are pointing towards some specific disorders like Syncope/TIA/Drug induced Hypotension/Tachycardia-Bradycardia sypmtoms or can be Carotid Sinus hypersensitivity(very unlikely in this case)..

Did you ever experience any of this symptoms during shaving or immediately while turning around suddenly ?

Now to narrow it down , there needs to be further investigations , i.e. 12 Lead lead EKG, B/L Carotid Doppler study with cautions monitoring of heart rate as well as Blood pressure , a 24 Hour Holter monitoring to get the thorough analysis , Electrolytes , Thyroid function(if not done already) and lastly 2D-Echo cardiography to check the current cardiac morphology as well as the Prosthetic valves status..

Now these may sound like a lot but trust it's needed to actually pin-point the condition and off course treating accordingly..

Also in the meanwhile take the sotalol in sitting possible and don't get up immediately after taking it or don't get into any strenuous activities within the next 2 hours..

Now these are significant symptoms and I totally disagree with your PCP who simply ignored it by saying side effect of Sotalol(which you're already on since past 2 years).. So further evaluation is a must in this regard and at this point I think it'd be appropriate to get hold of another Cardiologist instead of the PCP regarding this ..

If required the dose of Sotalol can be further titrated but to do so it's needed to be identified at first..

Meanwhile please start to maintain a serial BP and HR chart with 2-3 Hrs interval in relaxed sitting position starting from around 8 am till 10 pm and observe specifically after the first 2 hrs of Sotalol intake.. It'll be better if some else (medical/paramedical professional) takes it..Look for the changes in the BP as well as HR range if BP Systolic drop of > 30mmhg and Diastolic drop 20 mmhg happens abruptly after sotalol intake then the doses might need to be reduced or may be time to consider another agent (depends on the findings)..

No driving is not safe for you at this moment, please avoid it under any circumstances..And that's why you need to get investigated thoroughly before anything further worsening..

I've hope I'm able to clarify your doubt in this short frame , feel free to ask if anything's unclear..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
Answered by
Dr. Arnab Banerjee

Critical Care Specialist

Practicing since :2012

Answered : 1320 Questions


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