### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
1.Am a 65 yrs old man from India. I underwent bypass surgery in 2007 & implantation of AICD in 2008.a replacement AICD was implanted in 2013. I was taking cardorone 150/xarb 150/cardivas12.5mg/storvas 20mg/ ecosprin 150. In January xarb was taken off and I was told to take cilicar 10 mg sos if BP goes beyond 150/90. 2. Today morning my BP shot up to 167/95 & I was feeling throbbing in left shoulder( 3 inches from implantation site of AICD. A second reading within 30 mins gave reading of 155/87. I have taken cilicar as advised about one hour back. 3. Is it a serious medical condition? Pulse is 60. Regards Brigadier Sunil Arora Mumbai India

### output:

Respected sir, The most probable cause of pain you describe is fluctuations in BP, I am personally not in favor of taking BP medication on sos' basis.  It has to be continued as per the titration of your BP, to be taken on daily basis to maintain a plateau.  Also, if you can call the company guy of the pacemaker, whether Medtronic/St. Jude/bio and ask them to retrieve data to know any fluctuations in pacing at that point of time. Lastly the reason why you on carb, wouldn't be cardiac, so why was it given and then tapered would be something I would like to know to complete the clinical picture.  Regards Chat Doctor. 