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Raised blood pressure on sitting after CARDIAC STENT PLACEMENT.

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My 78-year-old father suffered a cardiac arrest 5 years ago; luckily they saved him and his brain was intact. They installed a cardiac stent
Since then he was on plavix, lipitor, aspirin and lopressor
Generally was doing good, driving car, a little weak legs when walking, co-ordination good
4 months ago his cardiologist removed plavix, and added lisinopril

A couple months after that he started to get episodes of confusion. Always in the evening after dinner. Often after falling asleep head down forward. Often after climbing 2 sets of stairs (upstairs bedroom). Sometimes just after leaning forward. The episodes started to happen even without exertion

This is what happens: his legs start to buckle, he may fall down. His breathing is suddenly audible. He does not respond for like 5-10 seconds. When he is back, he feels completely normal. His blood pressure can sometimes falls to 70/40. When this episodes happen, I could not detect wrist pulse, it may be too weak, and when I measure blood pressure it is low, but not too bad (maybe already recovered)

I removed lisinopril. Now he could get 150/90 during the day, but the episodes stopped. Then I switched him to 1/2 doze. Was ok for some time, then the episodes returned

His blood pressure when sitted immediately rises to 20 points - this is typical. When standing up it drops

Question - is this because of low blood pressure, his stent is having trouble or it is a small clot? neck/vertebral artery issue?

Category: Cardiologist

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Category: Cardiologist
 31 Doctors Online


Thank you for choosing DoctorSpring.

I have analysed your fathers symptoms and there are two obvious concerns here :
1. Hypotension , possibly drug induced - which now corrected.
2. A set of neurological symptoms which includes confusion, intermittent loss of consciousness & possible leg weakness.

The neurological symptoms are not due to low blood pressure. Even though certain symptoms can overlap there is a significant set of neuro-symptoms which has to be evaluated. A CT scan of the head is strongly recommended along with a thorough neurological examination to be safe. Possibilities are a stoke (or a mini stroke) which could be in the vertebral artery / a blood clot inside or ourside covering of the brain SDH.
Regarding the blood pressure you might need to better titrate the medication to get adequate control. HOWEVER I would strongly suggest you to get the neuro evaluation and not to attempt tiration of the medications by yourself.
I would like to know whether he has any urinary symptoms . Any history of nausea or vomiting recently ?
You can reply as a followup
Thank you Regards

Patient replied :

Thanks Doctor!
>I would like to know whether he has any urinary symptoms . Any history of nausea or vomiting recently ?
No urinary symptoms; slight nausea in one of the recent episodes. BTW episodes are not spread evenly: sometimes 2 weeks without any problem, sometimes every other day
Is this time sensitive, e.g. should I wait for neurologist appointment or bring him to ER?

Hello Julian,
If a Neurologist appointment is going take time, consider checking with your GP - he/she can do a quick assesment (clinical examination) which can rule out a stroke. It is better if your father gets an appoinment in less than 1-2 days. If the delay is more and the symptoms recurr you should go the ER.
Absece of a urinary symptoms is a good sign. But again as I mentioned he had "clots" in his hear blood vessels, that means there is a risk that he can have "blood clots" in his cerebral blood vessels too.
Take care. Feel free to ask followups.

Thank you

Dr. Vivek Mahajan
Category: Cardiologist
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
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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