Suggest Treatment For Low Heart Rate After Quadruple Bypass Surgery

Posted on Fri, 18 Sep 2015

Question: My father had quadruple bypass surgery 20 years ago while on vacation in Alaska and since then has had absolutely no problems. The cardiologists he has seen since then, in So. California, are amazed. Over the last couple of months he has has some lightheadedness usually when getting up from breakfast table. He eats breakfast immediately after rising. The little device he puts on his finger daily to measure oxygen level and heart rate (name?) has been indicating very low heart rate (30's-40's) for several weeks. One urgent care doctor said to get off one of the meds he's on, which he recently cut back to half, after doing all the tests possible to see how his heart is (EKG, treadmill, xray) passings everything. His cardiologist has no answers. He went to ER today, frustrated for lack of answers, they did everything, again, nothing. The blood test however indicated low troponin level (0.79) so they want him to stay overnight. Any ideas? Please have cardiologist answer me.

Answered by Dr. Saumya Mittal (7 minutes later)

Brief Answer:
Consider carotid stenosis

Detailed Answer:
Hi
I am Dr Mittal.
I have read your message.
I think I can help you.
The symptoms of the query are quite indicative that your ER doctor was right.
Heart rate of 30 to 40 is low. it's called bradycardia. And is a significant cause of vertigo and dizziness specially on changing position.
Heart patients have traditionally been put on a group of medicines called beta blockers. These cause low heart rate. The dose needs to be modified if not entirely stopped.

However, I would also consider another possibility -carotid stenosis. It's common in patients of heart disease. The blood flow to brain is restricted. Thus causing vertigo.
A simple CV Doppler caN identify the condition.
An evaluation by a neurologist may help.

I have tried to make it as simple as possible. I hope that the information contained in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Saumya Mittal (21 minutes later)

Thank you for your answer. Upon further discussion with my dad, I find he stopped taking the beta blocker the urgent care dr. thought was causing the problem but that was only 5 days ago. He said his lightheadedness only lasts 10-15 seconds and is just once a day as I previously stated, not an ongoing vertigo. I am concerned with the elevated (not low) tropanin level. 0.02-0.04 is the range and he is at 0.79. Thoughts?

Answered by Dr. Saumya Mittal (5 minutes later)

Brief Answer:
Not high enough to worry

Detailed Answer:
The triponin levels are not as high so as to indicate a cardiac issue. Also, many things can cause raised troponin. And I am assuming his ekg and echo are normal. So I would not worry about the troponin.

I think you should request for a neurological evaluation.

I hope that the information contained in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar