Can My Father Continue Heart Medications Despite New Symptoms?

If a patient with a history of heart failure and anticoagulant therapy suddenly experiences symptoms such as shortness of breath, palpitations, chest discomfort, hypotension, and dizziness, it is crucial to seek immediate medical attention. Continuing medication without consulting a healthcare professional is not advisable, as these symptoms may indicate a serious condition that requires evaluation and possible adjustment of treatment?

Hello doctor, my father is 55 years old and has a history of left ventricular hypertrophy and poor cardiac function.
He has been regularly seeing a doctor and taking medication.
Three months ago, he followed the physician's advice and was hospitalized for a dose of a positive inotropic agent, which the doctor said would last for three months.
During a recent follow-up, the doctor indicated that there were no abnormalities and that he could temporarily stop using the medication, continuing only with oral medications.
However, for the past two days, my father has experienced shortness of breath, palpitations, and chest tightness after getting up in the morning.
I assisted in measuring his blood pressure, which was 84-80/70-60, and his heart rate ranged from 98 to 120.
He also feels dizzy.
Given that he is taking Apixaban, Aspirin, Spironolactone 25 mg, Entresto 50 mg twice daily, and Syntrend 6.25 mg/tab half a tablet twice daily, can he continue taking these medications while experiencing these symptoms? I am concerned about the side effect of hypotension mentioned and whether he should continue the medications.

Ms. Huang, 20~29 year old female. Ask Date: 2020/04/20

Dr. Wu Xueming reply Cardiology

If blood pressure is low due to medication, it may be necessary to consult the prescribing physician to evaluate the situation and adjust the medication dosage.
Do not discontinue the medication on your own.

Reply Date: 2020/04/20

More Info

It sounds like your father is experiencing some concerning symptoms that warrant careful consideration regarding his heart medications. Given his history of heart disease, including left ventricular hypertrophy and compromised cardiac function, it's crucial to approach this situation with caution.

Firstly, the medications your father is currently taking—Apixaban, Aspirin, Spironolactone, Entresto, and Syntrend—are commonly prescribed for patients with heart conditions. Each of these medications serves a specific purpose:
1. Apixaban is an anticoagulant that helps prevent blood clots, which is particularly important for patients with certain types of heart disease.

2. Aspirin is often used for its antiplatelet effects, reducing the risk of heart attacks and strokes.

3. Spironolactone is a diuretic that can help manage fluid retention and lower blood pressure, which is beneficial in heart failure.

4. Entresto is a combination of sacubitril and valsartan, used to treat heart failure by helping the heart pump more efficiently and reducing the strain on it.

5. Syntrend (likely a beta-blocker) helps manage heart rate and blood pressure.

The symptoms your father is experiencing—shortness of breath, palpitations, chest tightness, and dizziness—could be indicative of several issues, including potential medication side effects, worsening heart function, or even dehydration. The blood pressure readings you provided (84-80/70-60) are concerningly low, especially in conjunction with a heart rate of 98-120 beats per minute. This combination suggests that he may be experiencing hypotension (low blood pressure), which can be exacerbated by medications like Spironolactone and Entresto.

Given these symptoms, it is crucial to consult with his healthcare provider immediately. Here are some steps you can take:
1. Contact His Doctor: It's essential to inform his physician about the new symptoms and the low blood pressure readings. The doctor may want to adjust his medications or perform further evaluations to determine the cause of these symptoms.

2. Monitor Symptoms: Keep a close eye on his symptoms, especially if they worsen. Note any changes in his breathing, heart rate, or overall condition, as this information will be valuable for his healthcare provider.

3. Medication Review: While it may be tempting to stop medications, do not do so without consulting his doctor. Abruptly stopping heart medications can lead to serious complications. The physician may decide to adjust dosages or switch medications based on his current health status.

4. Lifestyle Adjustments: Encourage your father to stay hydrated, as dehydration can contribute to low blood pressure. Additionally, he should avoid sudden changes in position (like standing up quickly) to minimize dizziness.

5. Emergency Care: If your father experiences severe symptoms such as chest pain, severe shortness of breath, or fainting, seek emergency medical attention immediately.

In summary, while your father may need to continue his heart medications, the new symptoms and low blood pressure readings are concerning and should be addressed promptly with his healthcare provider. Regular follow-ups and open communication with his medical team are vital in managing his heart condition effectively.

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