March 13, 2012
Well, we now know that dose is not sufficient to control his arrhythmia. It came back with a vengeance last night. On a scale of 1-10 for the severity of crisis (10 being oh shit!), it was about a 4. They gave more metoprolol but it didnt respond. Give more? Can't. His bp was getting uncomfortably low. Crisis number starting to creep up. Digitalis time? Wait, his serum potassium levels were already out of whack. Corrected that and they had to give digoxin to cardiovert his heart back into normal rhythm. He was close to being transferred to the ICU (intensive care unit) but fortunately the digitalis worked. It was a rough night for him, which is an understatement.
Now the challenge moving forward will be finding that sweet spot of a metoprolol dose which controls the arrhythmia but allows him sufficient blood pressure and heart rate that is compatible with remaining upright and coherent. His heart rate was running in the 50s today and that was after his exercise. He's continuing to walk that razor's edge and conquer each crisis.