Brief Answer:
ECG , Wait till 48-72 hours post extraction . Avoid atenolol

Detailed Answer:
Hello Mr XXXX, I am Dr. Mody and I would be addressing your concern .
I will be precise to avoid confusion, you may if any clarification needed .

1) No doubt you have a tendency for hypertension and continuing anti hypertensive at present is the best way along with the life style modifications you are on .
2)alongside I presume , blood pressure was controlled with olmesartan before the extraction itself , and the symptoms of dizziness and low pulse was a long after dental extraction

To me the procedure results is stimulation of vagus nerve which had caused dizziness and low pulse . However it's very common and transient complication of dental extraction and you would Be fine withen 48 to 72 hours .

Now importantly atenolol is an anti hypertensive which will itself decrease your pulse rate and so should be avoided by all means .

Also if your initial pressure were 158/84 . Only 20 mg olmesartan should be enough to start with and if needed can up titrate the dose and if you already taking olmesartan 40 mg continue the same .

Also considering your age a ecg may be considered to know what the baseline rhythm a , if it's sinus bradycardia, we may wait and watch .
you can upload the ecg for my review.

Let me know if any help needed .
Regards Dr Priyank Mody

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Brief Answer:
ecg is S. bradycardia( normal). 24 Holter , thyroid profile is way forward

Detailed Answer:
Hello Mr XXXX,
I went through the ecg .
It's plain sinus bradycardia, nothing to worry in that context.
Now have your pulse always been in this range or it has decreased suddenly post the procedure ?

Do you have an atheletic life ?
Any other medication apart from olmesartan do you consume ?

If the pulse was always in this range not to worry as the ecg has stable rhythm and it should be not cause the symptoms of vertigo .
Also if you regularly exercise and have a fit body habitus, many a times the baseline pulse may be on lower side . This is rather a sign of healthy heart .

However considering your age I would suggest you to go for
1) thyroid profile.
2) 24 hour Holter monitoring as this will give us an insight into your pulse when you perform all your daily activities and if any transient heart block/ arrythmia is present or nit when you have the vertigo like feeling

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Brief Answer:
thyroid is normal , lipids borderline high . no medication for the same

Detailed Answer:
Hello sir ,
The thyroid profile is normal . It's important to rule that out as hypothyroidism is most common cause of lower pulse rate .
The lipid profile is just borderline and I would suggest no medication for the same . However continue 45 mins of exercise per day atleast 5 days a week and food modifications.
There is a high possibility that you may have baseline pulse rate always on the lower side , than there is nothing to worry . It's may be your normal physiology.
Now as a cardiologist I can suggest 2 things to make sure everything is ok .
1) 24 hour Holter. ( let me know which city you are so if I can try arranging or else any good hospital with cardiology department will have the facility . The charges are 2000- 2500 )
2) a treadmill stress test for chronotropic competence.
Here they make you wall on the treadmill and along with other parameters they check whether the heart rate increases proportionately to exercise. If yes nothing to worry .

Both the tests are not urgent and can be done at your convenience , also not doing the same test would not harm, it's just on this forum I can best suggest standard of care in such circumstances for 100 % surety.
Lastly if you ever have dizziness , blackouts after resolution of this episode ,Always consider checking your pulse and ecg sos .

Let me know if any clarification is needed.
Do rate for others reference
Regards Dr Priyank Mody

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Brief Answer:
Be reassured all the reports attached are normal

Detailed Answer:
Hello ,
Sorry for the delay . I went through all the reports .
As I start I would like to reassure you that all the reports attached are in normal range .
Sir you have to understand that pulse is a vital of our body , it's never fixed for and individual. It always changes with the need of the body , the reason we are alive . When we are sleeping the need of body is less so our pulse is on lower side , when we are exercising our pulse rate would increase proportionally .
The variation you have mentioned are normal and you should not be worried for the same.
Also the holter doesn't show anything that would cause dizziness.
So yes we should consider evaluating extra cardiac causes for the symptoms.
Two common reasons
1) orthostatic hypotension .
When you suddenly change position there is transiently decreased blood to the brain causing giddiness .
2) More commonly the ear is at cause .
A trial of tab Vertin 8 mg thrice a day for a week may be considered if symptoms persist.
You may continue with the blood pressure medication, and the blood pressure and pulse rate mentioned are in normal range.
Let me know if any clarification needed. I would be happy to help .
Also if you can upload the doctors recommendation and his observation sheet .
Regards Dr Priyank Mody

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Brief Answer:
Yes an ENT consult would be better so he can examine the ear in person

Detailed Answer:
Hello Sir .

As I had said the pulse rate you had mentioned are considered normal for healthy humans.

For sure the ear discharge can cause giddiness and even sometimes lower pulse because of vagus nerve stimulation which is just near the inner ear , Though most likely you may have inherently lower pulse rate

A ENT consult is better as examination of inner ear is better here .

You may start with Tab VERTIN(BETAHISTINE) 8 mg three times a day and consider an antibiotic .
Tab CEFTUM 500 mg twice a day for 5 days should be good enough.

The medanta consult is suggestive of no active cardiac reason for your symptoms.

Let me know if any further help ever.
Regards Dr Priyank Mody.
( Lilavati hospital, XXXXXXX )

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