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Customer reply replied 4 months ago
My mum had a heart bypass 2 years ago. She is is medication for high blood pressure.
She has been tracking hr pulse in the last few weeks and sometimes it seems very low. As low as 45-47.
Other times it is in the 50s.
I know blood pressure medication can lower the heart rate, but is this too low?
I think she takes it after sitting still for some time (5-10 minutes plus) and her GP said that is too long to sit down before taking it. The GP said it was a "satisfactory" result. But I would like to double check, as the same GP told her for years that 140/90 was a normal blood pressure, which is how she ended up needing the bypass.
Customer reply replied 4 months ago
This question is only for Dr Ali, please. ******
Answered in 15 minutes by:
3/31/2018
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 10,345
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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Hello,
Welcome back and thanks for requesting me. Can I ask what is the name of her bp medication? Also does she experience any symptoms during these spells like shortness of breath, sweating, dizziness etc?
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Customer reply replied 4 months ago
I don't know that they are "spells " as such.
She was asked to check her BP and pulse for a few weeks while sitting down and those were the results
The GP just said it was okay.
She doesn't have any symptoms.
I think the medication is called Ramipril.

Ramipril should not cause a heart rate to fall down to this level, the reason being that ramipril acts by reducing a certain enzyme in the body. It does not directly act on the heart and thus would not cause the heart rate to drop to this level. It may indirectly cause this to happen but that again is not a common side effect.

Now if she is not experiencing any symptoms during the time her heart rate drops to 45-47 then I would not be worried HOWEVER I would certainly get a 24-hour Holter monitor test done IF the frequency of this event is several times a day. This means that if her heart rate drops to this level quite frequently then the holter should be done in order to exclude heart blocks which patients with a history of heart disease have a propensity to develop. A Holter monitor is a device which she can wear at home for a period fo 24-48 hours after which the data would be analyzed to see what her heart rate was and more importantly what the rhythm was.

I think while this is not likely to be anything serious BUT given her past history, I would get the holter done to be on the safe side.

Do you have any more questions?

I sincerely ***** ***** I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!. You can also ask questions from me directly by going to the link below,

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Customer reply replied 4 months ago
Thank you for your reply.
What are heart blocks?
Is she in potential danger here?
The GP did not seem at all concerned, but I am worried.
Customer reply replied 4 months ago
It is possible she may also be on a beta blocker - I will ask her.
If she is on a beta blocker, would this heart rate be to be expected?

Actually if she is on a beta blocker then YES this heart rate is to be expected, patients on beta blockers especially patients above the age of 60 have a tendency to have heart rates between 45 to 55 commonly and in that case, as long as there are no symptoms then this is not worrisome.

Heart blocks are basically arrhythmias in which the electrical current of the heart is not being properly conducted from the atria to the ventricles (upper chambers to lower chambers) which can lead to difficulty in pumping the blood. It would be dangerous if she had symptoms but since she does not then it is not likely to be dangerous.

Do you have any more questions?

I sincerely ***** ***** I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!. You can also ask questions from me directly by going to the link below,

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Customer reply replied 4 months ago
Thank you very much.
I will check about the beta blockers and go from there.
If she is on beta blockers, would you say this does not need checking with a Holter?
I am quite shocked at how little follow-up there has been since her op. That is the UK health system for you!

In case she is on beta blockers and this is not a frequent issue AND she has no symptoms then the holter can be withheld for some time, if the symptoms worsen then you should go ahead with the holter.

Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 10,345
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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Customer reply replied 4 months ago
Thank you very much.
Much appreciated, as always.
Customer reply replied 4 months ago
I just checked, and apparently she takes Bisoprol. This is a beta blocker, right? So it would explain the low pulse?

Yes that is a beta blocker, bisoprolol is a commonly used beta blocker post bypass and this would certainly explain the low pulse.

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Customer reply replied 4 months ago
Okay. Thank you.

You are welcome.

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