Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

Regarding your concerns, I would like to explain as follows:

- When blood pressure drops to extremely low values, there appear symptoms and signs of systemic blood hypo-perfusion; that is, extreme fatigue, drowsiness, lightheadedness, vertigo, nausea and even near fainting feeling.

This is for values of systolic blood pressure of less than 100-90 mmHg.

But, if systolic blood pressure is much lower than the above values, then the risk of cardiovascular collapse (systolic BP less than 85-70 mmHg) is quite possible.

In such case, the individual may become physically passive (unable to get upright from seated or lying positions, or if he tries to do it, may experience syncope [abrupt loss of conscience]). Also, he may experience profound tiredness, shortness of breath, chest discomfort, blurred vision, headache, tingling, etc.

When looking at such a person, he will appear pale, diaphoretic (excessively sweating), cold skin and if hypotension is persistent for hours it will lead to a decreased urine output, tachycardia, increase of respiratory rate, sense of thirst.

If the reason of hypotension is a decreased cardiac performance, pulmonary congestion (revealed by auscultation or chest X ray study) or systemic congestion (peripheral edema) may be present.

If hypotension is the result of dehydration, then dry skin, tongue and of other mucous surfaces may appear (this may be due to fluid losses from excessive diarrhea, vomiting, sweating, etc.).

Coming to this point, it is very important to identify the exact reason of hypotension, because the treatment is mainly directed at correcting the responsible causes and restoration of an adequate circulating blood volume and cardiac output.

If the reason of hypotension is excessive effect of antihypertensive therapy, then immediate stop of such drugs and prompt infusions of intravenous fluids with the person on the lying position are the first preliminary measures.

Intravenous fluids infusion are also needed in the case of dehydration. It may be combined with oral fluids intake too (fresh nonalcoholic drinks).

If the reason of hypotension is impaired cardiac performance, then optimization of heart failure therapy is necessary. In such case a cardiac ultrasound (echo) would be necessary to adequately address this issue. In the first moments any cardiac inotropes or blood vessel constrictor drugs would be utilized (in-hospital settings).

- Regarding triple bundle branch block, I would explain that it imposes a great risk for higher degree atrio-ventricular block and is necessary to closely monitor periodically the heart rhythm.

In this condition, if the cardiac conductance disturbance progresses, episodes of fainting of syncope may happen.

It may also be complicated with prolonged AV block and cardiac arrest.

So, coming to this point, what I would recommend is first to avoid negative chronotropic drugs, such as beta-blockers (including Coreg).

Also, ambulatory heart rhythm monitoring (Holter or event recording) is necessary to definitely clarify the conductance disorder status.

In severe cases, pacemaker implantation is recommended.

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
You are welcome

Detailed Answer:
Dear XXXX,

I am glad to have been helpful to you!

You can ask me directly at any time if you have any other uncertainties on the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Best wishes,

Dr. Iliri

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