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Experiencing Fluctuation In Blood Pressure. Impaired LV Relaxation Shown In Echo And Doppler Test. What Do You Recommend?

Posted on Fri, 22 Nov 2013

Question: My blood pressure is very low at rest, see below., same as heartrate, but when I stand up, it goes higher, much higher. Same thing when im moving around and sit down and take my blood pressure its on the high side. Then minutes later its low. My heart rate is always faster then normal moving around, in the 120-135 bpm range but at rest its below 60. As low as 44bpm. I heard of pots but this seems opposite. Tests done and results Echo and doppler: norm echo doppler trans flow suggests impaired LV relaxation 6 ekg normal 2 stress tests normal CTA chest and Xrays all normal MRI Brain multiple lesions under investigation MRI Spine Ankylosing Spondylitis I will attach blood pressure readings below. Resting/standing order. I see a new doctor in a few weeks. No doctor at emerg will take me seriously.

Answered by Dr. Pratap VGM (4 hours later)

Brief Answer: Autonomic dysfunction Detailed Answer: Dear sir Welcome to healthcare magic I thoroughly reviewed your case, I saw all the pictures. What I noticed is your heart rate varies with your activity... which we call it as postural hypotension in our language. You also told in your query that you have complaints of ankylosing spondylosis when MRI is done. There are two types of nerve supply to your heart mainly your heart rate is controlled by pace maker which is controlled by both voluntary and involuntary nerve fibers.. If you are getting very low heart rate on resting it might be due to increased involuntary inhibition of the heart or it it might be due to pace maker problems which really needs immediate attention from cardiologist. I really suggest you to visit cardiologist and put your questions in this direction so that he will suggest you some proper investigations.. Hope information is helpful Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Pratap VGM (18 minutes later)

Sorry i should edit profile. Im 40 year old female. Ive seen a cardiologist and all he did was a stress test and said im fine. Ive had 2 stress tests and echos an many ekg's. ive had an EEG done also. Wouldnt that have showed up in tests?

Answered by Dr. Pratap VGM (9 minutes later)

Brief Answer: Yes indeed it will show up Detailed Answer: Dear madam Thanks for writing back, Stress test will only detect the variations in the heart rate and changes ascending physical activity. But it will some times fail to detect low heart rate. Low heart rate is very XXXXXXX when compared to high one Resting EKG will pick up a lot of things and including low heart rate. If your EKG is normal then it is ok. Echo test will only tell us about the mechanical activity of heart, so it is of less significance here. Usually what is important in all parameters is your resting heart rate because what ever activity you do but at the end it should come to resting rate between 60 to 80 beats per minute. As you have done most of the tests and with good results so don't worry but keep all the points that I have told you so that next time when it happens you will have certain picture Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Pratap VGM (25 minutes later)

Here are some results. Holter showed hr resting at 44 bpm but they write normal holter. Its scary because i can tell when my heart drops to 50's i feel skipped beats. Ive had a loop recorder too. They always say its normal.

Answered by Dr. Pratap VGM (14 minutes later)

Brief Answer: vagal inhibition Detailed Answer: Dear madam A resting EKG will reveal lot of details even for slow heart rates. You can make out bradycardias, missed beats , ectopics beat, zome other conduction defects or heart blocks. So dont worry as your EKG analysis is correct, it has no problems Secondly at sleep our heart rate falls upto 50 beats per minute.. but if you are getting less than that then one thing, left ventricle contractility might have issues. Like impaired relaxation. Thirdly strong vagal inhibition. So consult a neurologist once. Becasue vagus controls most of the involuntary movements of the body Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Pratap VGM (17 minutes later)

Ok i see my neurologist XXXXXXX 7. He actually sent me for that holter and is investigating me for ms because of brain lesions. Is this something serious that needs to be addressed this week?

Answered by Dr. Pratap VGM (7 hours later)

Brief Answer: nothing Serious Detailed Answer: Dear madam There is nothing serious. It's a routine check up that's all; so don't worry. Thanks

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Above answer was peer-reviewed by : Dr. Prasad