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Dr. Stan
Dr. Stan, Medical Physician and Surgeon
Category: Medical
Satisfied Customers: 2701
Experience:  Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon
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My dad has congestive heart failure and is completely

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My dad has congestive heart failure and is completely bedridden as a result of going into full cardiac arrest nearly five years ago. He also has kidney and bladder stones. His doctor has him on Captopril, Atenolol, and Amiodarone, and his blood pressure normally runs from 90 to 100 and his heart rate is in the mid 60s. However, for the past month or so, his blood pressure frequently drops below 90, and occasionally below 80. Also, his heart rate is frequently elevated, he runs low temperatures, his blood sugar is usually over 160, and his daily urine output has gone from 900 mL to 700 mL. He has also experienced labored breathing, although that has improved lately. Doctors have run urine, sputum, and blood tests, and they've treated him with different antibiotics, but he's still experiencing these symptoms. What else should we consider as possible causes of these symptoms? We appreciate any guidance you can provide!
Submitted: 7 years ago.
Category: Medical
Expert:  Dr. Stan replied 7 years ago.

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The continued symptom of lower blood pressure despite increasing his fluid intake is likely due worsening/weakening of his heart pumping force and output into the rest of the body. I suggest that his doctor consider starting a medication to increase his heart output such as digoxin or other ionotropic(increase heart pumping force) medication. While the dehydration due to poor intake may contribute to the lower blood pressure, the inability for the heart to generate enough force to expel adequate blood into the blood vessels seem to play more role in this case. In response to the lowering of the blood pressure the heart tends to contract faster with increased rate. I also suggest that his doctor closely evaluate the extent of the effect of the kidney insufficiency and lungs (as evident in the difficult breathing) on his renin and angiotensin system by checking his blood renin/angiotensin ratio. This renin-angiotensin system plays a central role in the maintenance of blood pressure. It is possible that the usage or dosage of captopril may need to be re-evaluated at this time.

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