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Would an Dobutamine Stress Echocardiogram be advisable when BP has dropped despite consistently taking Dilzem?

Answered by
Dr.
Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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Posted on Mon, 12 Aug 2019 in General Health
Question: Hello Doc,

Request your expert advice here

My mom is a hypertention patent from past 8 months with fast heart beat . she has been put on calcium channel blocker from past 6 months now that is Dilzem CD and now chnaged to Dilzem SR 90 mg. Her BP was not under control even after taking these medications it was on the higher side always like 140 /150 145 and daistolic pressure of 85 90 and so on.

We got various tests like ambulatory bp tests and all , i am attaching the report for your reference . But the doc said let her continue delizem SR 90 mg only. In the Ambulatory tests the diastolic pressure has even reached 52 / 58 and all which is considerably low .

My mom has asthma , iron deficiency anemia and beta thalasemia.
For Asthma, she takes budecort inhaler which cases palpitation in her and her heart rate goes up to 120 at times .

Now the concern is her blood pressure has suddenly dropped from past 1 week . The monitor always shows 110/115 120 and diastolic pressure of 65/70 and all.

My worry is that being a hypertension patient even after taking dilzem 90 mg from past 6 months bp was not under that control but all of a sudden bp has dropped .

what could be the possible reason ?
Any other investigation related to heart should be done ?

Can she go for dobutamine stress echo and are there any kind of side effects from the IV they use .

1. As she is asthamtic even if she uses budecart she gets high palpiatations
2. she has got urinary tract infection recently
3. She has irritable bowel syndrome

Her symptoms with low bp are weakness and dizziness not that much but yes
her blood sugar before fasting is 100 and post one is 123 .
Please advice if we can do dobutamine stress echo tests and it is safe to do as i understand it might trigger stress in here and increase the palpoiation and all
Please advice



regards
doctor
Answered by Dr. Rishu Saxena 3 hours later
Brief Answer:
Explained as follows.

Detailed Answer:

Hi,

Blood pressure 140-150/90 m of hg would not be considered high for a 60 years old woman.Our target is to get it at 140/90 only.
Again 115-129mm and 60 to 70 mm diastolic is considered normal unless patient is symptomatic.

She has a number of ailments and is on number of medications each and every external chemical given has effect on b.p cardiac system. So on an old patient on various medicines its not possible to get a stable blood pressure.However both the ranges mentioned by you are with in normal limits.

Have seen all details her heart is fine echo TMT are normal and variation of blood pressure is also under normal limits. Personally i don't feel that we need to worry at all until and unless she is symptomatic.

Echo and TMT are about 85% sensitive for ruling out cardiac disease however better option then stress echo is a stress thallium.A thallium stress test is a nuclear imaging test that shows how well blood flows into your heart while you're exercising or at rest. This test is also called a cardiac or nuclear stress test.A radioactive isotope is used for this study and its almost 100% sensitive in practical scenario.

I won't suggest her to go for dobutamine test as it may precipitate palpitation. Much better and non invasive test stress thallium is there for her.

Hope I have answered your query.

Thank you.

Regards,
Dr. Rishu Saxena
Cardiologist
Above answer was peer-reviewed by : Dr. Kampana
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