Cardiovascular Symptoms: Expert Insights on Treatment and Management

Inquiry Consultation

Dear Dr.
He,
I would like to express my gratitude for your previous guidance regarding my mother's health concerns.
I have some additional questions I would like to ask you.
To provide a brief overview of my mother's condition: she is 68 years old and had blood tests done at the end of February this year, which showed normal values (including normal cardiac enzyme levels).
An electrocardiogram (ECG) also indicated normal results.
Last April, she underwent a brain CT scan and a myocardial perfusion scan, both of which were normal.

My mother experiences discomfort starting with a sensation of unease in the central lower part of her chest.
This is followed by a feeling of "strong heartbeat," although her heart rate does not increase significantly, remaining around 60 beats per minute at most.
Subsequently, her blood pressure rises, with systolic readings exceeding 200.
During these episodes, she experiences symptoms such as shortness of breath, instability when standing, fatigue, cold and trembling extremities, and tingling in her scalp.
If she takes "Labetalol 200mg," she experiences gradual relief within a few hours; however, "Valsartan 160mg" appears to be almost completely ineffective.
I have the following questions for you:
Q1: Is "Labetalol 200mg" suitable for regular and long-term use? While this medication provides immediate relief for my mother's discomfort, the packaging indicates that it should be taken only as needed.
Can you clarify whether "Labetalol 200mg" is intended solely for short-term and emergency use, or can it be safely used as a regular and long-term treatment?
Q2: Based on the sequence of my mother's symptoms: 1.
Discomfort in the central lower chest.
2.
Strong heartbeat (but not rapid).
3.
Gradual increase in systolic blood pressure to over 200.
4.
Symptoms of shortness of breath, instability, fatigue, cold and trembling extremities, and tingling in the scalp.
These symptoms typically occur when she is preparing to sleep, after getting up (with changes in posture), after long phone conversations (due to auditory stimulation), and when physically exhausted.
Taking a whole or half tablet of "Labetalol 200mg" provides immediate relief.
In your opinion, what do you believe is the most likely cause of these symptoms? Could it be autonomic nervous system dysfunction, or is there another underlying issue?
Q3: Generally speaking, can patients with autonomic nervous system dysfunction rely on self-management and lifestyle adjustments to heal or alleviate their symptoms, or is medical treatment necessary? Additionally, which specialty should be consulted for the best treatment of autonomic nervous system dysfunction?
Thank you for your assistance, Dr.
He.

Axiang, 40~49 year old female. Ask Date: 2023/05/05

Dr. He Dongjin reply Cardiology

Hello, the symptoms you are experiencing are typical of autonomic nervous system dysfunction.
Labtal has therapeutic effects on the autonomic nervous system and can be used regularly and long-term.
However, Diovan 160mg does not have effects on the autonomic nervous system, which is why it was ineffective at that time.
You may still consult a cardiologist for further evaluation.
Changhua Hospital cares about your well-being.

Reply Date: 2023/05/05

More Info

Understanding cardiovascular symptoms, especially in older adults, is crucial for effective treatment and management. Your mother's symptoms and medical history provide valuable insights into her condition, and I appreciate the detailed information you've shared. Let's address your questions one by one.

Q1: Long-term Use of Labtal (Labetalol)
Labetalol is a medication that combines both alpha and beta-blocking properties, primarily used to manage hypertension. While it can provide immediate relief for elevated blood pressure, its long-term use should be carefully considered. The warning on the medication indicating that it should be taken "as needed" suggests that it is not typically intended for routine long-term use without medical supervision.
For your mother, if she experiences significant relief from her symptoms with Labetalol, it may be worth discussing with her healthcare provider the possibility of a long-term management plan. This could involve regular monitoring of her blood pressure and heart rate, as well as assessing for any potential side effects of prolonged use. It’s essential to have a healthcare professional evaluate her overall cardiovascular health and determine the most appropriate treatment regimen.

Q2: Possible Causes of Symptoms
The sequence of symptoms your mother experiences—chest discomfort, strong but not rapid heartbeat, elevated blood pressure, and accompanying sensations like cold extremities and tingling—could suggest several underlying issues. One possibility is autonomic dysfunction, which can lead to symptoms like orthostatic hypotension (a drop in blood pressure upon standing) and increased heart rate variability.
Additionally, these symptoms could be indicative of anxiety or panic attacks, especially if they occur during specific situations like preparing for sleep or after prolonged phone conversations. Stress and fatigue can exacerbate these conditions, leading to heightened sympathetic nervous system activity, which may explain the increased heart rate and blood pressure.

It is also essential to rule out any cardiovascular issues, such as arrhythmias or heart disease, given her age and symptomatology. A thorough evaluation by a cardiologist, including an assessment of her heart's electrical activity and structure, would be prudent.

Q3: Self-Management of Autonomic Dysfunction
Patients with autonomic dysfunction can often benefit from lifestyle modifications and stress management techniques. Regular exercise, a balanced diet, adequate hydration, and good sleep hygiene can help regulate autonomic function. Mindfulness practices, such as yoga or meditation, may also alleviate symptoms by reducing stress and improving overall well-being.

However, while self-management strategies can be beneficial, they may not be sufficient for everyone. If symptoms persist or worsen, medical intervention may be necessary. A healthcare provider specializing in neurology or cardiology would be best suited to evaluate her condition and recommend appropriate treatments.
In conclusion, your mother's symptoms warrant a comprehensive evaluation to rule out serious cardiovascular issues and to explore potential autonomic dysfunction. Collaboration with her healthcare team will be vital in developing a tailored management plan that addresses her specific needs and concerns. Regular follow-ups and open communication with her doctors will ensure that her treatment remains effective and safe.

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