Chest Pain And Low Bp After Squats- Same Old?

[mkoven]

So, being a compliant physical therapy patient, I was doing some exercises to build up my lower body. Some squats, actually. I felt pretty much okay during, but after had chest pain, chest heaviness. Immediately after my bp was a little low, for someone exercising-- 100/60. Now it's 86/39. And that's after a dose of midodrine 90 minutes ago. I feel a little better, less chest pain, but still chest heaviness and so tired.

I had a normal stress test 1.5 years ago, an echo 6wks ago, an event recorder in December-January, and bloodwork. The only thing that shows up "objectively" is that my bp drops when I stand. Sometimes a lot within the first minute. I don't usually get tachy. (Never had a ttt, but since my systolic dropped 24 points , and my diastolic 8 within 45 seconds of standing, the doc felt pretty confident there was something going on.)

I think this is same old same old, and really want to avoid the er. I just get nervous when exertion brings it on. Ususally I feel bad if I've been sitting for a while-- not moving. and I know at the er they don't know enough about ncs to know it can cause chest pain and sob. they just think fainting. so if i go in saying chest pain following exercise, they'll call in all the dogs to check out heart disease. (I know this from experience! They don't know what to make of me. Before my diagnosis, I was kept over to rule out exercise-induced angina. I DON"T want to go there again unnecessarily. it's stressful, expensive, and time-consuming for what has always turned out to be ncs.) It's just hard to know with autonomic symptoms when to chalk it up to dysautonomia and when to declare an emergency.

but any reason why squatting would bring it on? I can get my heart rate up to the same level walking, and it doesn't make me feel as bad. So just the act of going up and down? and doesn't normal people's bp increase with exertion?

[mvdula]

sorry i can't offer an explanation - just wanted to share that i have the same questions about why certain activities make me feel worse than others - even with the same heartrate. it is very odd. i don't have your low bp symptom - but still have many weird episodes that make me want to go to the er. I don't usually go though bc I know it will be a lot of waiting, tests, etc - and the er is not a relaxing place - I would rather be at home! just wanted to say i sympathize and sorry i can't offer more answers - not sure anyone can - dysautonomia is so weird!

[morgan617]

I've always been under the impression that squats are hard on the cardiovascular system. I couldn't do them for love or money, so I'm impressed, but I think anything you do that makes you feel a lot crummier, is probably not in your best interest to do. I just don't know, the last time I tried P.T., they fired me...twice, saying I wasn't in any shape for P.T. Har, how pathetic is that? But I remember as a kid when other kids did squats then stood up really fast and took several deep breaths and it MADE them faint.

And these were healthy kids, so I am back where I started. I'd do the stuff that doesn't make me feel like death warmed over over and go as slowly as we do on meds...good luck sweetie! morgan

[mkoven]

Thanks, you guys. Sometimes it's so hard to know, when I don't feel bad till afterwards! I took a little more midodrine than usual after. Besides the low bp and a brewing headache, I seem to be okay.

It's just so hard to know with autonomic stuff when the regular rules of "go to the er asap" do and don't apply. The symptoms are so strange and disconcerting. Then there's the fact that it's unpleasant to go, takes forever, and that I feel like a fool.

if I'm confident that what I feel is what I've felt in the past that's turned out to be ncs, that's one thing. but there are always new twists and sensations! So I don't want to go unnecessarily, but I don't want to blow off something potentially new and serious.

but no one in the er really knows what to do for this. the thing they can do is rule out the standard scary stuff. but how many times does one have to have that ruled out? oy.

[darren]

I can not do squats at all. I have the exact same problems you have, I'm fine while doing them but later I pay a heavy price sometimes a couple days. I have all sorts of theories for all of my symptoms but here is my squatting theory.

The leg muscles are the largest muscle group in the body. When any muscle is exercised it needs allot more blood flow. Not just during the exercise but during the recovery. Since resistance training is essentially creating micro tears or damage to the muscle fiber in order to build them stronger there is more blood in your legs during recovery. Add to that the blood has to work against gravity to return to the heart (our biggest problem).

Here is another interesting part of that theory. Glycogen is stored mainly in the liver and muscle groups, its the reserve carbohydrate source for the body. Glycogen also has a heavy bond with water. Meaning to convert the carbs you eat to glycogen it needs to bond with water. Well now you've depleted your glycogen stores and the body has to build it back up. It takes the water from your blood circulation to convert and store that glycogen. Less water in the blood stream means a lower volume of blood. Lower blood volume is a lower cardiac output this = bad day for us.

The reason why you probably feel fine during the exercise is the fact that resistance training bumps up orthostatic tension in a big way while your working out.

I wrote about my working out theory here.

Like most of my ideas I'm sure there are holes in them but it keeps my mind at ease to at least try to think of reasons why this happens. I have not found a way around this squating issue, which I hate because I really miss my leg work outs.

[yogini]

I think any kind of exercise can bring on POTS symptoms, and worse, there is often a delayed reaction. It makes it hard to know what our boundaries are! I know the type of exercise has made a big difference for me. There are some exercises I just can't do, and others are much easier. Squats are particularly hard on us because of the rapid positional change. Maybe your therapist could adjust the exercises so that you are sitting or lying flat.

[sarct]

I have this same issue with squats and leg presses. I also do this with bench presses as well. Anything where I have to really expell air to do the exercise. Anything done laying on the ground is out of the question as well. I can really only exercise 5 minutes at a time several times a day. It *****, because working out is somethign I really enjoy doing. Not anymore.

[Miriam Poorman-Knox]

Hi,

]The best exercises are the floor ones. We can do most every muscle group on the floor. That prevents some of the problems. It is true that chest pains and squats can go hand in hand. I don't know how your doing them, the problen often is that the body is not "square" and there is more pressure on the upper body. Plus we tend to hold our breath during these. As Morgan said these are the hardest type for dysauto. folks. Congratulations on exercising though. good luck...Miriam

[Ernie]

Hi,

I don't know the medical reason but when I squat I faint automatically. So I just don't do it.

[jump]

I also can't do squats without fainting. It causes NCS-like symtpoms in me (low bp upon standing, etc) even though I do not have NCS (just POTS w/out the bp changes). Every once in a while I forget, and I'll sit down on my heels to pick something up, and then I always regret it....

Although it is hard to tell when something is serious when you have something chronic, I also think that, generally speaking, people know their own bodies best. If something feels "weirder than usual" or you think maybe it isn't the same old same old, then go with that intuition. Even though it's a hassle it's not worth the risk to ignore something that might be important. If there's a part of you that thinks something's really not quite right, you should get it checked out.

Jump

[Megan]

This is interesting to me, because when I was diagnosed at Mayo, squats were one of the exercises they suggested I do every day. (I don't....) That squats cause so many people trouble makes me wonder why they suggested them for POTS.

Meg

[mrsdavidson8605]

This is interesting to me, because when I was diagnosed at Mayo, squats were one of the exercises they suggested I do every day. (I don't....) That squats cause so many people trouble makes me wonder why they suggested them for POTS.

Meg

WOW! they suggested squats????? that would be deathly hard for me to do.. infact, just THINKING about it makes me weak! my hat is off to those of you who CAN or are even WILLING to do squats. I feel like i'm gonna pass out just bending down to pick up my daughter!!

[green]

This thread looks like its dead, but I wanted to add a remark:

I was looking for a post on squats. I've been trying to build up my lower body (actually, my whole body) to reduce my OI symptoms. A few days ago I was doing squats and my neck and the back of my head started to hurt. I could feel blood rushing through the arteries in my neck, and my skull felt like I had just bumped it on something.

I've been to the gym twice since then, and whenever I go an anaerobic exercise that raises my HR, I get a headache. I've never been prone to headaches in the past despite having had OI for several years. I had taken some midodrine that day, but it was more than 4 hours prior, so I thought I was safe from risking high BP. Now I wonder if I stressed a blood vessel.

[jump]

Oh, you know what! I talked to my doctor about this since this thread was more "active," and she said that all weight-bearing leg exercises temporarily increase the blood flow to the legs, and that squats are the WORST because you have both gravity and muscle tension causing extra blood -- essentially like blood pooling. So for someone who struggles with maintaining a regular blood pressure upon standing, squats are pretty much the devil.

It's ironic, because of course leg strengthening exercises help us long-term with the whole blood-pooling issue. But my doc said you should always do them on the floor with your legs over your head (like a leg press scenerio) instead of squats, and that it's better to do many reps of a low weight than a few reps of a high weight. I guess this gives the legs the same long-term benefits without the short-term bp problems. She also told me that any time I do any strength exercise with my legs, I should stand up/change position slowly afterward.

jump

[MightyMouse]

I can't and wont do squats. My trainer learned quickly that it was a bad idea to even let me try them because of what it did to my bp and hr.

Nina

[JenniferInOhio]

I can't and wont do squats. My trainer learned quickly that it was a bad idea to even let me try them because of what it did to my bp and hr.

Nina

How high did your heart rate go? I've been doing them and get up to 150ish. Did your bp drop or elevate?

[ajw4790]

Hi,

I just wanted to add to make sure that you concentrate on making sure to breathe, and not hold your breath when exercising. Also, try and make sure that you are not doing a Valsalva maneuver with it, because this can cause the change in BP, HR, and temporaily decrease O2 to the brain (likely causing that pain in your neck you describe). But, all in all squats are not likely ideal for most of us.

[mkoven]

After doing some cardiac rehab, I find that even using cardio machines that are too leg intensive, even seated, will drop my bp. A bike or a nustep makes me feel worse than walking. I think indeed it sends all the blood to my legs. in rehab, they would start me off with a seated arm machine to keep the blood up north.

[bgsu4]

The people who have been posting about the blood pooling theory?? are right. Essentially lots of blood is being sent to the muscles of the leg and the muscle groups of the femur are the largest (quads, hamstrings in relation to your body. Add in the lower leg and all those little stabilizers and deep muscles, well you get the point. Now exercise is supposed to create a "muscle pump" that helps to push the blood back to the heart. This does occur but it is such a large volume of blood and we have blood flow problems even at rest, it tends to pool in the legs.

For those of us who have trouble with exercise I think of it this way. Our bodies don't correctly adjust to postural changes (stressor), weather (stressor), anxiety (stressor), even eating, resting and going to the bathroom at times. Exercise puts an enormous strain on our already "haywire' nervous system. It's trying to adapt to normal everyday things like standing or walking a few hundred feet and then throw in exercise on top of that... you get the point. After your done with exercise your blood pressure does drop. Thats why cool downs are so important.

Doctors mention leg exercises in the hopes that we will keep our muscles strong and help to rework the neural pathways etc. Some people with our syndrome can still manage exercise and Doctors probably hear feedback. Other Doctors, and this is from experience, other Doctors (not all Doctors) don't have a clue of what exercise can do to the body. There are many physiological changes that occur.

I can get quite more detailed than this but I hate typing. There are things to consider like Valsalva Maneuver (make sure your breathing correctly) but I really feel the blood pooling coupled with our already "haywire" systems is the culprit. Try swimming and doing leg exercises in the water, the hydrostatic pressure from the water does a very good job of moving the blood. The water helps you to work at a lower heart rate and steadier blood pressure. Water jogging is an excellent way to strengthen your legs. Start out slow and it's quite enjoyable. I haven't been able to stand that long without symptoms for a long time.