Managing Low Blood Pressure After Heart Stent Surgery: What You Need to Know

What can be done for low blood pressure? Are there methods to treat and improve it?

Grandfather has severe coronary artery blockage (due to untreated blocked vessels, he has developed stable chronic heart failure stage II).
He was recently hospitalized for stent placement, but before the procedure, he was able to eat and walk (engage in outdoor activities).
After the stent placement, however, his heart function has deteriorated, making it difficult for him to swallow (weakness), and he can only consume liquids (drinking too quickly causes shortness of breath).
Aside from walking to the bathroom for urination, he spends the rest of his time lying in bed.
It has been over twenty days now, and getting out of bed is very strenuous for him.
The stent placement procedure utilized the Rotablator rotational atherectomy system due to severe vascular calcification.
The family is very distressed; they initially thought that after the stent placement, everything would improve, but instead, his condition has worsened.
This is a summary of Grandfather's situation (thank you, doctor, for your previous response).

Currently, his medications are:
1.
Apixaban sustained-release film-coated tablets, half a tablet once daily
2.
Isosorbide dinitrate, one tablet once daily
3.
Clopidogrel, one tablet once daily
4.
Bisoprolol, two tablets daily, one each time
5.
Atorvastatin, two tablets daily, one each time
I would like to ask the doctor:
1.
I heard from a friend that patients with stents must take two types of antiplatelet medications, Clopidogrel and Aspirin, but my grandfather seems to be taking only Clopidogrel.
Should I raise this concern with the attending physician?
2.
Grandfather's blood pressure is usually more stable around 7 AM, with systolic pressure around 100 and diastolic pressure in the low 60s.
However, it seems to drop after noon, with systolic pressure in the 80s and diastolic pressure in the 50s.
Sometimes it falls to systolic pressure in the 60s or 70s and diastolic pressure in the 40s.
What should we do? The family is also confused; when blood pressure drops this low, should we take him to the hospital? (Currently, blood pressure is 60/38 with a heart rate of 72.)
3.
His blood pressure is consistently low; are there any methods to improve this condition?

A-Dai, 30~39 year old female. Ask Date: 2021/04/11

Dr. He Dongjin reply Cardiology

Hello, patients who have undergone stent implantation typically take two antiplatelet medications due to considerations of age and bleeding risk.
This can be discussed with your attending physician.
Jian An Xin (健安心) is used to treat heart failure but can also lower blood pressure, so if you notice a continuous drop in blood pressure after taking it, and if you do not feel unwell, you may choose to monitor it first.
If the blood pressure drops too low, you can temporarily stop the medication and return for a follow-up discussion with your attending physician.
Changhua Hospital cares about your well-being.

Reply Date: 2021/04/11

More Info

Managing low blood pressure after heart stent surgery can be a complex issue, especially in elderly patients with pre-existing conditions such as chronic heart failure. Your grandfather's situation, characterized by severe coronary artery blockage and subsequent stenting, raises several important considerations regarding his recovery and ongoing management.

Understanding Low Blood Pressure Post-Stenting
After a stent is placed, it is not uncommon for patients to experience fluctuations in blood pressure. This can be attributed to several factors, including the heart's ability to pump effectively, the medications prescribed, and the overall health status of the patient. In your grandfather's case, the use of a rotablator system during the stenting procedure indicates that his coronary arteries were significantly calcified, which can complicate recovery and may lead to further cardiac dysfunction.

Medication Management
1. Antiplatelet Therapy: It is standard practice for patients who have undergone stent placement to be prescribed dual antiplatelet therapy (DAPT), which typically includes aspirin and another antiplatelet medication, such as clopidogrel (Plavix) or ticagrelor (Brilinta). If your grandfather is only taking "保栓通" (which I assume is a form of clopidogrel), it would be prudent to discuss with his physician whether he should also be on aspirin. This is crucial for preventing stent thrombosis and ensuring optimal recovery.

2. Blood Pressure Medications: The medications your grandfather is currently taking may also influence his blood pressure. Some heart medications can lead to lower blood pressure, especially in older adults. It is essential to review these medications with his healthcare provider to determine if any adjustments are necessary.

Monitoring Blood Pressure
Your grandfather's blood pressure readings indicate significant variability, particularly with lower readings in the afternoon. Here are some steps to consider:
- Regular Monitoring: Keep a log of his blood pressure readings at different times of the day. This information will be valuable for his healthcare team to assess patterns and make necessary adjustments to his treatment plan.

- Hydration and Nutrition: Ensure that he is adequately hydrated and consuming a balanced diet. Dehydration can contribute to low blood pressure, especially in older adults.

- Position Changes: Encourage him to rise slowly from sitting or lying positions to prevent orthostatic hypotension, which can cause dizziness and falls.

When to Seek Medical Attention
If your grandfather's blood pressure drops significantly (e.g., systolic below 70 mmHg or diastolic below 40 mmHg), or if he exhibits symptoms such as confusion, severe dizziness, or fainting, it is crucial to seek immediate medical attention. Given his current blood pressure of 60/38, this is a concerning situation that warrants urgent evaluation.

Improving Blood Pressure
To address the persistent low blood pressure, consider the following strategies:
- Medication Review: As mentioned, a thorough review of his current medications with his healthcare provider is essential. Adjustments may be needed to optimize his blood pressure.

- Physical Activity: If he is able, gentle physical activity, as tolerated, can help improve circulation and blood pressure. However, this should be done under the guidance of a healthcare professional.

- Compression Stockings: In some cases, wearing compression stockings can help improve venous return and may assist in stabilizing blood pressure.

Conclusion
Your grandfather's recovery after stent placement is critical, and managing his low blood pressure is a key component of his care. Open communication with his healthcare team is essential to ensure that he receives the appropriate medications and monitoring. Encourage family discussions with his doctor regarding his medication regimen, blood pressure management, and any concerning symptoms. With proper management and support, there is potential for improvement in his condition.

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