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Management of fluctuating BP - Nebistar SA, ECG, Echo, TMT 20

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I am 45 yrs old. I usually had a BP ranging from 120/80 to 130/85 but sometimes i used to have a BP ranging from 135/90 to 145/100 (rarely). For the last 4 to 5 months i am seeing a change in the range. It remains between 105/65 to 120/80 and most of the time it is 110/70. Also my pulse rate remains between 60 to 76 and most of the time it is between 65 and 74. I am taking a BP medicine (Nebistar SA). Two days back i observed my pulse rate between 49 and 55 for an hour or so and i stopped my BP medicine. For last 2 days i am not taking BP medicine but i observed my Pulse rate at 60 today. Could you please tell me what would be the reason and if i should visit the doctor and get some tests done. I have already done ECG, Echo and TMT 20 to 25 days back which are normal


Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.



Thank you for your query at doctorspring.com.

The slow heart rate is probably due to nebivolol. It is a well known side effect. Stopping nebivolol for 2 days has increased the heart rate to 60 and probably will increase further as the effect of the drug is likely to last for 2 to 3 days. Did you have symptom when your heart rate was down to 45? You should get an ecg done to rule out other types of bradycardia. The dose of nebistar sa needs reduction. Probably you could take half of the previous dose.





Regards

Dr Vivek Mahajan

DM Cardiology



Patient replied :

Hi Doctor, Thanks for your reply! I went to my doctor on Saturday and he has changed my medicine, he has given me nebicard 2.5 mg. Now my BP is 116/76 and my pulse remains in the range of 72 and 80. I hope things are ok now. However answer to your query for symptoms when my heart rate went down to 45 is that i felt uneasiness. I usually have that feeling but then after the release of gas, it comes back to normal. I hope it is due to gastric problem that i am having since past so many years after my gallblader was removed. Regarding ECG, i have done ECG many many times before but the reading is always normal. But this uneasy feeling comes and goes and all of a sudden my pulse rate increases. I think it must be due to anxiety, do i need to go for any further tests to clear any doubts? Please suggest
Regards
Sunil Fotedar


Expert:  Dr. Vivek Mahajan replied 3 Days.

Good to know that the suggestion have helped you.

This uneasy feeling with increased pulse rate that you attribute to anxiety hasn't been mentioned before by you. Is it a palpitation like sensation. You could tell me more about it. Also you could get a 24 hour holter test if the episodes occur almost daily to find out what the cardiac rhythm is like during episodes of uneasiness with increased heart rate



Do post additional queries.

Regards

Dr Vivek Mahajan



Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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