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Have high blood pressure controlled by medication. Feeling light headed and not feeling good. Love dancing. What to do?

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Cardiologist
Practicing since : 1998
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Hi there i have high blood pressue controlled well with medication, diet controlled diabetic, and bone spurs on my neck (Still to see nurologist re this) my problem is I love to go dancing (jazz tap) have done it for 6 years its very strenous excerise... lately i notice when i do it its for 3 hours straight i get really lighheaded and just not feel good.... i also get this same lightheaded feeling when i am standing up for to awhile ie standing talking to someone but fine when sitting down... what can this be and how do i stop it when i am dancing.. i was thinking my BSL might be dropping to low but have tested it during and after and it is fine....
Posted Mon, 30 Sep 2013 in Hypertension and Heart Disease
 
 
Answered by Dr. Sukhvinder Singh 32 minutes later
Brief Answer:
This may be postural hypotension

Detailed Answer:
Respected Ma'm
1. If someone gets lightheaded on standing up, postural hypotension is first thing to be evaluated. Postural hypotension is a more than usual (normal) fall in blood pressure on standing. A physician can check your blood pressure while lying down (after about 5-10 minutes of rest in lying down position) and then after ~2 minutes of standing. A fall of more than 20 mmHg in systolic (higher) blood pressure and a fall of more than 10 mmHg in diastolic (lower) blood pressure is considered significant. A usual cause is blood pressure medication in many cases. Diabetes is also a common culprit in such cases.
2. This tendency is precipitated by less than required intake of fluids, excessive strenuous activity (like prolonged dancing), many drugs, neuropathic illnesses, low hemoglobin, being in hot dry climate for long periods or anything which dehydrates your body. Beside brain and heart related disorders can cause this but seem unusual from your history.
3. No doubts, you will have to consult a physician for confirming the diagnosis and thorough evaluation for a possible cause, and , may be a neurologist for same but there are certain helpful measures. Avoid getting dehydrated, take adequate fluids, do not expose your self to dry hot weather for long periods, avoid alcohol & avoid large carbohydrates based meals. Try to shake your legs a bit before getting up from sitting or recumbent position.
4. Your blood pressure medication may be changed and you may be assessed for diabetic neuropathy.
Hope this helps.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Have high blood pressure controlled by medication. Feeling light headed and not feeling good. Love dancing. What to do? 17 hours later
i have my own blood pressure machine and i have tested it it only droped by about 2 on top and 5 on bottom so no major change. i am fine when i first get up its standing for a period of time even 5 mins and of course my dance is longer i will be fine when i start dancing it is later into my classes i get dizzy. i drink alot of water for eg yesterday i dramp two 750ml bottles before class and would have drunk at least one during so i cant see dehydration being a cause but having said that my body seems to dehydrate more then most lips etc always dry... what could cause this and how to avoid it.
 
 
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
please see following details.

Detailed Answer:
Respected Ma'm
1. If you feel the lightheadedness only transiently and it does not force you to stop & sit down or lie down, then likelihood of postural hypotension is less. Because in case of postural hypotension the episode will force you to sit down most of the time; else you will fall. I can not rule out postural hypotension entirely without a work-up. Moreover, since you have noticed the tendency to "dry-up" quickly, this still remains a possibility. Are you sure that your diabetes is under control? Uncontrolled diabetes with excessive urination predisposes to such symptoms. Affliction of nerves in long standing diabetes may also be responsible for such symptoms.Your physician may still like to go for tests to rule this out. In our set-up we go for HUTT (head-up tilt test) in such circumstances.
2. Two other major possibilities that of a heart disorder and a brain disorder can also be there but as I told you historically it is less likely. A transient rhythm disorder of heart may be responsible for symptoms in certain number of patients. A transient decrease in blood supply to brain may also be responsible for similar episodes.
3. A cervical spine issue has been mentioned as a cause of such transient episodes of lightheadedness or more of dizziness but they are not common culprits in such scenarios, especially at your age.
4. I understand that we are not able to reach a conclusive diagnosis through this chat but that's the limitation when we can not examine the subject. Please follow the precautions mentioned in my first reply and do see your physician for full examination. Only after a complete examination further work-up can be decided. Feel free to write further if there is anything else you would like to share. If you can share more details of the episode and how long it last and how it terminates and what else you feel. This perhaps may help me in understanding the pathophysiology more.
Sincerely
Sukhvinder XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Have high blood pressure controlled by medication. Feeling light headed and not feeling good. Love dancing. What to do? 3 hours later
1. Yes it is transitional and doe not require me to stop and sit down i also do suffer alot with not sure how to classify it.. breathless ie cant take a deep breath but normal breathing is fine... yes I am sure my diabeties is under control my what do you call it H..3 monthly tests are all brilliant and my normal BSL during the day are all good my GP is pleased with it... I dont have excessive uriniation. i have had the stress test on my heart with the treadmill all good and a Ultrasound of heart all good and a CT of brain all it found was the bone spurs on the neck.. I was thinking maybe some sort of preformance anxity when dancing and/or maybe some sort of endocrine problem with the dryness my son as a rare adrenal deficency and i am a carrier of the CAH he has and weather this could be a problem although my last blood tests a few months back on electrolytes showed all ok...
 
 
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
Please see details below.

Detailed Answer:
Respected Ma'm
Since you are only a carrier of CAH, it is unlikely to contribute to your problem, However a full blown adrenal deficiency would have contributed to postural hypotension.
Yes, a performance anxiety can behave in a similar fashion but why it will come up after 3 hours of dancing and not at the beginning.
All your tests for brain and heart are normal. If your neurophysician also does not find any problem of postural hypotension on clinical examination and your autonomic nervous system is also normal on examination, then hopefully there is nothing serious about it. Then, this may be only a reaction of your body to excessive exercise/ fatigue/ dehydration or a particular situation (with element of anxiety).
Hope this provides some insight into the issue.
Sincerely
Sukhvinder Singh
Above answer was peer-reviewed by
 
Follow-up: Have high blood pressure controlled by medication. Feeling light headed and not feeling good. Love dancing. What to do? 4 days later
I had a GP check up the other day, and he is now thinking Postural Hypotension but I dont seem to get it as soon as I stand up it seems to develop over time, ie when walking or standing talking to someone or dancing. he says nothing can be done about it,, but I dont want to be like this for the rest of my life I am getting quiet depressed from feeling ill evey day some are of course worse then others... can you suggest any ways to treat this problem either in medication or natural ways
 
 
Answered by Dr. Sukhvinder Singh 7 minutes later
Brief Answer:
please see details.

Detailed Answer:
Respected Ma'm
1. If it indeed turns out to be so, postural hypotension is well treatable in a number of cases. Many a times medicines for blood pressure are responsible for the same. In our country we also take a neurophysician opinion in such cases once we are done with adjusting drugs and have done cardiac work-up. You can discuss it out with your cardiologist and then neurophysician. Once your GP writes "postural hypotension" as a possibility on your prescription, he will not be hesitant in seeking a referral.
2. Take small frequent meals. Drink a lot of fluids. Shake your legs for a while before standing up. Get the timings of your hypertension medication adjusted towards evening (discuss it out with your physician).
Hope this helps.
Sincerely
Sukhvinder Singh
Above answer was peer-reviewed by
 
Follow-up: Have high blood pressure controlled by medication. Feeling light headed and not feeling good. Love dancing. What to do? 14 minutes later
I am on Coverram blood pressure medication at the moment i take 1 tab a day but 1/2 being at night and 1/2 in the morning do you think it might be better to take 1 tab at night maybe worth a try?. in australia there is a huge weightlist to see nurologist and cardiologist anyways i have a nurologist appointment but not till mid dec... i want to try and do something now about this I do drink alot of water
 
 
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
yes, you can have a prescription for same.

Detailed Answer:
Respected Ma'm
1. The tablet coveram contains amlodipine and perindopril. Both these drugs can be taken as once daily dosage. Standard dose of coveram, as prescribed in literature, is one tablet once daily only.
2. We usually prescribe this combination in once daily dose, preferably at bed time. Moreover, Whenever we give high blood pressure medicines as once daily dose, we always prefer it to be taken at bed time.
3. You can have a prescription of same from your GP.
Hope this helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
Follow-up: Have high blood pressure controlled by medication. Feeling light headed and not feeling good. Love dancing. What to do? 22 minutes later
can coverram cause Postural hypotention?. can low B12 cause it?. as I am tried alot of the time to, I dont eat correctly as I am a fussy eater and dont eat red meat at all last year i had the low B12 and had injections I am wondering is it worth trying to take my coveram in one go one tablet at night and try a B12 pill to try this out...

are there any other vitamins/minerals deficiencies that could casue the hypotension?
 
 
Answered by Dr. Sukhvinder Singh 12 minutes later
Brief Answer:
please see details.

Detailed Answer:
Respected Mam
1. Most common cause of postural hypotension are medicines and blood pressure lowering drugs are foremost among them. Hence answer is yes. Coveram has potential to cause postural hypotension.
2. peripheral neuropathy. This may also involve autonomic nervous system. Autonomic neuropathies can result in postural hypotension. Some studies implicate Vitmain E deficiency in neuropathies but data is not very strong.
3. Vitamin B12 therapy should be taken only when a deficiency is proved. Regarding coveram, I already elaborated in last answer.
If your neurologist is not available, you can get prescriptions for same from the GP.
Sincerely
Sukhvinder
Above answer was peer-reviewed by
 
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