tapering atenolol dose

[soupbean]

My grandmother has end stage CHF. She is a DNR, at home on Home Health and great family support. She has been in acute CHF this week and we increased her lasix slightly for 2 days, trying to get the fluid off, but still protect the kidney function. She did improve very much and is feeling better. However, her b/p is like 80/50 at times. She is on coreg 6.25 bid and lasix 20 mg 1 po one day and 40 mg po the next. We were thinking of decreasing the coreg to daily. Would this be the right thing to do? The dr wants us to bring her in to hospital , but we just want to keep her comfortable. Please advise.          Thank You

[Bhupinder Kaur, MD]

Hi,

The BP should remain above 90mm Hg systolic as a low BP leads to an impairment of functioning of the other organs like liver, kidney etc. For the same, you can decrease the dose of coreg to 3.125 mg twice a day instead of giving it 6.25 mg once a day as it has got a short half life and stops acting after 12 hrs. The other option is to decrease the dose of lasix to 20 mg daily.

Please make sure that she’s not taking any extra salt apart from the salt in her food like any salt on the salad, in the curd etc.

However, a decrease in BP could be a manifestation of the worsening of the function of the heart.

I hope that helps. Please do keep me posted. Kind Regards.

[Encephalomalcia]

At end stage heart failure, the person can go into cardiac shock which is where all the organs shut down.  The lungs will not function, the liver and kidneys will start failing, and the intestines can give out.  If the intestines give out, the doctors have told me that blood will run out throw the rectum.  My mom was removed from life support because of this and the doctors were so afraid that if she was kept on life support that this would happen because the intestines were starting to deteriorate and she was losing a little blood through rectum.  The hospital was very scared of this happening and she would bleed to death, so keeping her at home may be traumatic for you and the people around you.  My opinion is she should be in the hospital where they can better deal with what is happening.