Bp Dropping During Exercise

[mkoven]

Multiple times over the past several years I've gone to the ER with chest pain/shortness of breath/lightheadedness associated with exercise. Of course, this always sets alarms bells off--with fears it is heart attack, as exertion related chest pain, shortness of breath, dizziness is a typical sign.

. Classically, it seems ncs (my diagnosis, not pots. I really never get tachy. Just strange blood pressure falls and spikes) is taken off the table as a possible cause, as the doctor's thinking is that if you're using leg muscles, they should be working to circulate blood, and bp should increase with exercise. For them, only a structural problem with the heart would cause this.

I've had stress echo, event monitor, regular echo, chest xrays, cardiac enzymes. My strange bp is the only thing that's ever been off.

Well, during these episodes, I hadn't previously been able to record my bp because I was usually out and about, and also, if you're moving too much, you can't get a reading. Until Friday, when the numbers were finally documented DURING an episode.

Friday, I started a "cardiac rehab" program, and I had them measure my bp during exercise. I was seated on a recumbent bike. I started at 110/52, went to 90/40, then to 72/38. After I stopped, it went back to 112/65. And I felt pretty bad. I'm sure this has happned many times before (as the sensation was very familiar), but first time documented.

I don't know what to think. they don't know what to think. they've never worked with someone like me before, and for them, a significant drop in bp DURING exercise means severe structural heart disease. They won't continue with me until they know more/I know more.

My last stress test was 18 mos ago (dobutamine stress echo). Normal. Should I ask for a new one? Anyone know how long they are good for? There are days when I am able to exercise without symptoms, but other times when I feel terrible.

Can anyone explain why this would happen? Are there other tests? T

he people at the rehab place almost insisted on sending me to the er, and said that unless this is all explained to them, and everything is ruled out, they would send me to the er every time this happened. (I didn't go. I've been many times, including a month ago with these exact symptoms. they end up keeping me overnight. subjecting me to all that that entails. and finding nothing.) How do I know for absolute certain heart disease is ruled out and it's just autonomic dysfunction?

Is it just that my body sometimes doesn't know how to respond to the demands of activity, and ramps down instead of up?

My doctor is impossible to reach. May ans doc even harder. If I have some ideas of what to suggest in terms of testing that may help move things along. Someone else suggested I look into cortisol insufficiency. I haven't had a full acth challenge, but a straight up cortisol reading was 6 at noon, which is normal, but low normal. My acth was 10-- again normal, but low normal. My only ans drug now is midodrine, and I'd taken it about an hour before exercise. I was also premenstrual. And we all know that can have a big impact.

[Ernie]

Hi,

When we exercise it vasodilates the blood vessels. If we have a problem with vasodilation it lowers our blood pressure. In normal people their body can compensate.

[helen.t]

hi there, I know my bp drops quite a lot imediately following exercise but I'm not sure about during it. I think it's ok but I do get a lot of chest pain and angina like pain during exercise as well as just sitting up and standing. My bp is usually elevated after sitting for a while then standing but then drops. I don't know how my bp works either because it goes up quite high but can also be quite low and I'm symptomatic with both. Also the tachy and heartbeat varies a lot as well. I have POTS but doctors not sure whether all my symptoms are all POTS related and although I've had a lot of heart tests done already, I have to get a CT angiogram to rule out any vascular probs. around my heart. Sorry I can't be of much help but I suppose if you eliminate all other possible causes then your mind will be at rest that it is autonomic dysfunction. Helen

[mkoven]

thanks, you guys. When I looked up exertion-induced hypotension, the typical causes seem to be scary ones--like hypertrophic cardiomyopathy, valve problems, and serious blockage of coronary arteries.

I'm not a doctor, but I imagine that my normal echo in January rules out the first 2. I don't know if I have gunk in my arteries. I had a normal dobutamine stress echo 18 mos ago. I don't know how conclusive that is. I did find one article : Exercise induced vasodepressor syncope, which would fit with an autonomic cause. But it seems like that's not the typical cause. But then when have I been typical of late!?!

So I just want to make sure that this is just autonomic strangeness and no hidden heart disease.

The only heart tests I"ve never had: I've never had an angiogram, and don't think I really want one if at all avoidable, a CT of the heart vessels sounds like a lot of radiation, but less invasive. Again, I imagine my docs would have to be pretty concerned/suspicious. And no one has recommended that. As of two years ago my lipids were pretty normal. My good cholesterol is low-normal.

It's just so hard when our symptoms sound like something else that is life-threatening, even if ans stuff usually isn't! And when the cardiac rehab person said she's only seen bp drop like that in the middle of exercise in a severely compromised heart.

How to be calmed down/reassured by that???

[helen.t]

Hi, I think doctors always err on the cautious side when it comes to heart attack/ stroke symptoms and since atonomic dysfunction gives these exact symptoms a lot of the time then it can be confusing and very alarming for both patient and doctor. I think when the tests come back ok then we can be reassured that nothing really bad is going to happen even though it feels the opposite at the time of experiencing them. I feel as if I'm about to die quite often and it is very disturbing so I know how you feel when you think something might be getting missed. The fact that I have survived huge swings in BP and tachy, assures me that my heart is very strong but I'm not so certain about my blood vessels.

I hope whatever tests you get in the future will help you understand more of what is going on with your body and that you will get some meds to help. I think very slow graduated exercise is best with people having to cope with this illness as our bodies react different day by day and even hour by hour depending on the environment around us, food and all sorts of other stressors which we might not be aware of. Take care and hugs Helen