Would really appreciate medical advice over father's loss of consciousness

[Twinklestein]

Sorry this will be a bit long, I need to give his past history as context for the current question.

My father is 77, his mitral valve was repaired about 15 years ago, the repair has held thus far but he's never been quite the same. Recently he has suffered from bouts of atrial fibrillation, for which he had an ablation which seems to have worked for the moment.

He is with a professor of cardiology whom, while an excellent doctor, he finds unsympathetic and unapproachable.

Prior to the mitral valve issue he always tended towards low blood pressure, after the surgery he has had high blood pressure which is treated with ace inhibitors and beta blockers. He has always (ie his whole life) had phases when his blood pressure would suddenly drop, he would feel faint and need to be fed and given brandy.

Even during the last 15 years while he has been treated for high blood pressure, he has still has these sudden drops of blood pressure. They seem to be getting worse - as in dropping lower and making him feel more ill than formerly.

Now one obvious reason is that he is taking drugs to lower his blood pressure, which obviously would exacerbate the any tendency to low BP.
However, I am wondering if these drops may also be related to the mitral valve issue, and whether latterly they may be symptomatic of heart failure in general.

FFW to last week: my mother found him slumped and unresponsive. She couldnt get him round by slapping his face, his eyes were rolling and he could only grunt not speak. She called an ambulance, he came round, his BP was 75 over 50. He was checked out in A and E, was found not to have had a stroke nor apparently a heart attack.

We still don't know exactly what happened though, whether it was a faint or a loss of consciousness, the doctors didn't know. He did not feel faint immediately before, he says, it felt more like he was 'falling asleep' - except he wasn't asleep.

I am asking here because we cannot get him to contact his cardiologist, and his GP hasn't been much use. We still don't know want caused the incident and have no idea whether it's safe to leave him alone.

I would really appreciate if anyone with medical knowledge could advise me as to the possibilities of what occurred. At the moment I'm rather inclined to contact his cardiologist over his head as it were. But in order to do so I need to feel it's sufficiently serious to warrant it.

Thanks in advance for any response.

It does sound very worrying for you all, but unfortunately I don't think anyone is going to be able to give you specific medical answers here either. I think your consideration to go over his head to the cardiologist is sensible under the circumstances. He/She will not be able to discuss your father's medical history with you due to confidentiality, but if you make your concerns known and ask them to perhaps contact your father as a "matter of routine" type situation to encourage him to attend the clinic that way then hopefully you can move forwards with getting him checked out more thoroughly from here.

I hope all works out well for you all.

No doubt you're right that no-one can help me, it was a long shot.

He's due for a checkup with the cardiologist, but he won't even go for that.

I don't need to discuss his medical history I just need to tell the cardiologist what happened. But even if he calls my father in I doubt he'd go.

I meant to say thanks for talking the time to respond.

I have no medical background at all, just family experience: my mum also had a history of mitral valve insufficiency. After she had an artificial valve installed her meds were miscalculated - she ended up I think on beta blockers AND ACE inhibitors together, and it pushed her heart rate down to such a low rate that she would occasionally lose consciousness. It came out of nowhere - one second she'd be talking like normal and the next she'd just fall down unconscious. It only became apparent when it happened in front of me one day and we got her into hospital. Her heart rate was going down to around 30 bpm I recall. Her meds were adjusted at that point which led to an improvement, but the doctors also discovered then that her heart had been permanently damaged by the amount of time she'd had to wait for the transplant - she'd been on a waiting list for over 6 years (in the 1990s). She kept going after that with gradual deterioration for a decade, and then died from heart-related organ failure two years ago aged 78.

So yes, your dad's cardiologist really needs to check if he has chronic heart failure. The earlier it's caught the better.

I'm sorry I can't help, but I think the issue here is that the professor of cardiology, or his/her sidekick, needs to tell you what is going on. Regardless of how unapproachable they are, it is their job to tell you, in layman terms, what has happened; it is what they are paid to do. I hope you find out an answer . I have, on occasion, gone above my own father's head with questions he was not prepared to ask, for his own interest.

Ah, having re-read your OP I can see your dad is also on ACE inhibitors and beta blockers - it's possible the dosage is just too high and needs adjusting, and only his cardiologist can assess that. I think you need to give him one last chance to contact the cardiologist himself and then tell him you're going to do it in his best interest. Older people can be totally bloody-minded at times - which can be a good thing sometimes, but other times it's potentially fatal.

Thanks so much everyone for your advice, it's all been really helpful.

Archangel, I'm so sorry to hear about your mother, it sounds very similar.
When he has these low BP episodes, he was advised to stop the beta blockers for a bit, then his BP eventually goes high again and he has to resume them. I agree the dose needs to be reassessed, in the light of the most recent episode. Like your mother I have seen a slow deterioration in him over the last 15 years, which has suddenly escalated in the last couple of years particularly.

FabULouse, it's really helpful to have a doctor's perspective, I will contact his cardiologist on Monday, and go from there. He seems a perfectly nice chap to me, my father just can't admit he's ill and needs help.

That's fine, you're highly qualified in the relevant area and your advice was really helpful.

Thanks once again to everyone who took the time to reply.

Good luck Twinkle and Twinkles father, I hope you get some answers.