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Suggest Ways To Manage Hypertension Post A Hip Replacement Surgery
Posted on
Sun, 6 Nov 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 6 Nov 2016
Answered on
Wed, 23 Nov 2016
Last reviewed on
Question : My wife is four weeks post hip replacement, age 64. She is 5'7' 225lbs and has mild high blood pressure for which she was medicated.
They had difficulty keeping her BP up afterwards and gave her blood both during the surgery and day after. For the past week she has been feeling weak and dizzy on standing.
Her BP has been running 95/60 and was dropping further when she would stand.
Saw her general practitioner who did complete blood work, found nothing, and had her discontinue her Bewnazapril. Now her resting BP is the same but goes up ten points higher on both numbers.
They did NOT do an ECG. Should I take her to the ER and ask them to do so?
They had difficulty keeping her BP up afterwards and gave her blood both during the surgery and day after. For the past week she has been feeling weak and dizzy on standing.
Her BP has been running 95/60 and was dropping further when she would stand.
Saw her general practitioner who did complete blood work, found nothing, and had her discontinue her Bewnazapril. Now her resting BP is the same but goes up ten points higher on both numbers.
They did NOT do an ECG. Should I take her to the ER and ask them to do so?
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that her low blood pressure could be related to different causes:
- chronic anemia. What are her Hb and Hct levels now (considering the surgery)?
- an electrolyte imbalance
- dehydration
- Benazepril.
I agree with her attending physician advise to cut of Benazepril.
From the other hand the fact that her blood pressure drops during standing up position, indicates orthostatic hypotension.
I recommend consulting with her doctor and performing a Head Up Tilt test to rule in/out possible orthostatic hypotension.
Meanwhile, there is no need to go to the ER. Her situation does not seem to be an emergency.
I recommend having some rest, increase salt and caffeine intake and take plenty of fluids to remain well hydrated. She should avoid prolonged standing up position for some days and avoid staying in hot places (which can cause further dehydration by sweating).
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that her low blood pressure could be related to different causes:
- chronic anemia. What are her Hb and Hct levels now (considering the surgery)?
- an electrolyte imbalance
- dehydration
- Benazepril.
I agree with her attending physician advise to cut of Benazepril.
From the other hand the fact that her blood pressure drops during standing up position, indicates orthostatic hypotension.
I recommend consulting with her doctor and performing a Head Up Tilt test to rule in/out possible orthostatic hypotension.
Meanwhile, there is no need to go to the ER. Her situation does not seem to be an emergency.
I recommend having some rest, increase salt and caffeine intake and take plenty of fluids to remain well hydrated. She should avoid prolonged standing up position for some days and avoid staying in hot places (which can cause further dehydration by sweating).
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
And NO anemia was found in her blood work end of last week.
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
What are her actual heart rate values? Is her heart rhythm regular or irregular.
Cardiac arrhythmia means that her heart rhythm is irregular. Cardiac arrhythmia is usually perceived as palpitations, shortness of breath coupled with an irregular heart rhythm measured on her pulse or directly on the chest.
Anyway, her symptoms are not suggestive of cardiac arrhythmia. They are more suggestive of orthostatic intolerance.
You should talk about this with her doctor.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
What are her actual heart rate values? Is her heart rhythm regular or irregular.
Cardiac arrhythmia means that her heart rhythm is irregular. Cardiac arrhythmia is usually perceived as palpitations, shortness of breath coupled with an irregular heart rhythm measured on her pulse or directly on the chest.
Anyway, her symptoms are not suggestive of cardiac arrhythmia. They are more suggestive of orthostatic intolerance.
You should talk about this with her doctor.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Seems to get worse with exertion. Is that consistent with Orthostatic Hypotension. She had to quit her last post-surgery physical therapy after just a few minutes.
And, do I just take her back to her general practitioner, or to a specialist?
And, do I just take her back to her general practitioner, or to a specialist?
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
Yes, physical activity can exacerbate orthostatic hypotension.
During orthostatic hypotension, the blood pressure drops more than 20mmHg during standing up position compared to sitting or laying down. This means that during standing up or physical activity, the blood flow to the brain and muscles decreases. This makes the situation worsen. She may also fall during these activities.
Reviewing also her current medication, I noticed that she is also taking magnesium, potassium and temazepam. I would recommend stopping them because magnesium and potassium can lower blood pressure further. From the other hand temazepam can cause dizziness and fatigue as a common adverse effect. Besides, temazepam can cause also addiction and tolerance and should be used only for short periods of time.
If her situation does not improve even after following the above recommendations, I would advice consulting with her GP first. Only after a careful physical exam, if suspicions of orthostatic hypotension are raised, a Head Up Tilt Test should be done.
Other tests to consider would be:
- cortisol plasma levels for possible adrenal gland dysfunction
- blood electrolytes for possible imbalance
- a cardiac ultrasound to examine her heart function and structure.
Hope you will find this answer helpful!
Wishing all the best,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
Yes, physical activity can exacerbate orthostatic hypotension.
During orthostatic hypotension, the blood pressure drops more than 20mmHg during standing up position compared to sitting or laying down. This means that during standing up or physical activity, the blood flow to the brain and muscles decreases. This makes the situation worsen. She may also fall during these activities.
Reviewing also her current medication, I noticed that she is also taking magnesium, potassium and temazepam. I would recommend stopping them because magnesium and potassium can lower blood pressure further. From the other hand temazepam can cause dizziness and fatigue as a common adverse effect. Besides, temazepam can cause also addiction and tolerance and should be used only for short periods of time.
If her situation does not improve even after following the above recommendations, I would advice consulting with her GP first. Only after a careful physical exam, if suspicions of orthostatic hypotension are raised, a Head Up Tilt Test should be done.
Other tests to consider would be:
- cortisol plasma levels for possible adrenal gland dysfunction
- blood electrolytes for possible imbalance
- a cardiac ultrasound to examine her heart function and structure.
Hope you will find this answer helpful!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I promise... last questions (you have been very patient, thorough, and helpful.
The reason I was asking about taking her to the emergency room is that even when she shift position in her chair or goes to use the restroom, she is finding herself short of breath (and yet, they ruled out anemia) so isn't this an indication of lack of Oxygen?
Thanks you for all your advice.
The reason I was asking about taking her to the emergency room is that even when she shift position in her chair or goes to use the restroom, she is finding herself short of breath (and yet, they ruled out anemia) so isn't this an indication of lack of Oxygen?
Thanks you for all your advice.
Brief Answer:
I recommend bringing her to the ER to exclude a possible lung disorder.
Detailed Answer:
Hello again!
Coming to this point, I recommend bringing her to the ER for a physical exam and some tests to exclude other possible causes of this clinical scenario:
- a resting ECG
- an arterial blood gas analysis
- a chest X ray study
- D-dimmer levels
- blood electrolytes
- kidney and liver function tests.
A chest CT scan with perfusion to exclude possible blood clots in the lungs may be necessary if suspicions of such disorder are raised during physical exam and the above test results.
Hope to have been helpful!
Kind regards,
Dr. Iliri
I recommend bringing her to the ER to exclude a possible lung disorder.
Detailed Answer:
Hello again!
Coming to this point, I recommend bringing her to the ER for a physical exam and some tests to exclude other possible causes of this clinical scenario:
- a resting ECG
- an arterial blood gas analysis
- a chest X ray study
- D-dimmer levels
- blood electrolytes
- kidney and liver function tests.
A chest CT scan with perfusion to exclude possible blood clots in the lungs may be necessary if suspicions of such disorder are raised during physical exam and the above test results.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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