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Dr. Saleem
Dr. Saleem, Other
Category: Cardiology
Satisfied Customers: 2310
Experience:  I am resident cardiologist and have 03 years experience of working in all the domains of cardiology
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My mom has Afib. She has been in and out of the hospital due

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My mom has Afib. She has been in and out of the hospital due to heart rate and high blood pressure. This has been going on since November 2016. She also has COPD and 2 strokes. She is having serve anxiety attacks and even to the point where she is waking up at night for them.Her heart doctor keeps telling us her heart is healthy. She is in the hospital right now with SOB, high bp and high heart rate. That they are not able to control. We have thought of changing heart doctor but don't know what to do because we are being told she has the best one in town. I feel there is an underlying problem and it has not been figure out yet. Please just need some advice.

Hello and welcome to JA. Dr Saleem here. Will be answering you shortly

Customer: replied 6 months ago.
Thank you

I would like to know the list of her heart and COPD medications.

Any tests/ reports on the state of her heart recently ? Can you share it preferably if she had an echocardiogram .

Customer: replied 6 months ago.
Buspironl 10mg
Dilitiazem 30mg
Escitalopram 10mg
Lisinopril 40mg
Levothtroxine 0.025
Carvedilol 12.5mg
Enocaparin 80mg
Warfarin 2.5 and 5mg
Potassium 40mg
Clonidine 0.1
Diltiazem 30mg
They did ekg and echo came back ok. They always did lot of blood work.

What does she take for her COPD? Is her Blood pressure generally well controlled with lisinopril and diltiazem ?

Customer: replied 6 months ago.
That's all her medicines. No we have been fighting her bp since November. It will do good for a while and then it's out of control again.

Well if it isnt helping then i would recommend her to switch to Losartan-hydrochlorothiazide combination instead of lisinopril 40mg.

Lisinopril an ACE inhibitor although is very effective generally but with a COPD patient it can exacerbate cough and breathing issues. Moreover a thiazide alongwith ARB ( losartan / HCT) would help in achieving a better control of her blood pressure too. Prognostically both ACE Inhibitors and ARBs are equally beneficial.

Why is she using both enoxaparin and warfarin ,it can potentially lead to a fatal bleed. Use one of them.

hope it was helpful.

Please click 5 stars visible on your screen for an excellent rating for my work.

Feel free to ask any more queries

Has she been recently put on warfarin ? As they can start it with an overlap of enoxaparin till the INR target is achieved. Its ok in that case.

Customer: replied 6 months ago.
She has been on warfarin for a few yrs now. Her blood got to thick and that's why they started the injections. She has a nurse that comes out every week and test her blood.

Ok well the two together are seldom recommended . If warfarin isnt doing the job then some other anticoagulant could be tried like riveroxaban, apixaban etc. Your doctor might have advised it for a short term may be. You need to discuss this with her definitely if its her longterm plan.

Do discuss with her the possibility of switching from lisinopril to losartan- hydrochlorothiazide for uncontrolled blood pressure.

Hope it was helpful.

Customer: replied 6 months ago.
thank you so much. We are seeing the dr tonight at the hospital.

You are welcome.

Would like to know what she has to say on these suggestions .

Please do reward my work with a positive 5 stars rating if it helped.

Kind regards

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