Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Low Blood Pressure And Extreme Tiredness
Question: I am an active 42 year old female. I am always (yes always) exhausted, even if I get plenty of sleep. I am easily irritated. Last year I was a size 6. I am now a size 10-12. I want to exercise, but I'm too tired. I have little to no energy most days. I have been to my dr & several others. They have tried numerous things, like vitamins & supplements, even Rx melds, but none have helped. The only way for me to get through the day is to drink an energy drink or two. And I know that's bad for me, but if I don't, I'll lay in bed all day. I have been diagnosed with low blood pressure & a pfo. They won't do surgery on my pfo unless I have a stroke or seizure (because I don't have any of the symptoms for them to say I need the surgery). I have already spent tens of thousands on tests & nothing is helping. Please help me
Brief Answer:
I would explain as follows:
Detailed Answer:
I would explain as follows:
Hello!
Thank you for asking on HCM!
Regarding your concern, I would like to explain that your chronic tiredness needs to be thoroughly investigated.
A comprehensive differential diagnosis should be done to find the responsible disorder behind your clinical symptomatology.
First of all, I would recommend to rule out/in a possible orthostatic hypotension.
As you refer you are diagnosed with low blood pressure, your complains are more pronounced when active, and you need to lie down to feel better, the first possible disorder to investigate is orthostatic hypotension (expression of autonomic dysfunction).
I would recommend a Head Up Tilt table testing for this purpose.
I believe that your PFO implications on heart structure and function are thoroughly investigated by your attending doctors. They have excluded enough severity to indicate a surgical correction of this congenital disorder.
But, could you upload you cardiac ultrasound reports and other additional cardiac tests, just for another recent review of your actual therapy.
There are alternative treatment options for correcting PFO other then surgery (for example transcatheter device closure). You could discuss with your cardiologist if it is feasible.
Other health disorders to investigate for the above purpose is to check thyroid and adrenal hormone levels, as well as possible hydro electrolytic disorders, as their deficiency may lead to increased tiredness, orthostatic hypotension and general exhaustion.
Also, a complete blood count to exclude anemia, and blood glucose curve should be done to exclude possible hypoglycemia.
To explore a possible neuro-muscular junction disorder and myasthenia I would recommend to perform an EMG.
Chronic fatigue syndrome should be also sought, as it may be responsible for your clinical scenario.
I believe many of the above mentioned tests have been already performed by your attending physician.
Nevertheless, if everything has resulted normal and your arterial hypotension is excluded as an etiological reason for your tiredness, I would recommend to consult with your psychiatrist to review the possibility of starting any antidepressants, which may improve your symptomatology and return your normal functionality.
At the end, I would define all this diagnostic work up as a diagnosis by exclusion.
I strongly recommend to avoid those energy drink!!
Hope to have been helpful!
Feel free to ask me whenever you need. Greetings! Dr. Iliri
I would explain as follows:
Detailed Answer:
I would explain as follows:
Hello!
Thank you for asking on HCM!
Regarding your concern, I would like to explain that your chronic tiredness needs to be thoroughly investigated.
A comprehensive differential diagnosis should be done to find the responsible disorder behind your clinical symptomatology.
First of all, I would recommend to rule out/in a possible orthostatic hypotension.
As you refer you are diagnosed with low blood pressure, your complains are more pronounced when active, and you need to lie down to feel better, the first possible disorder to investigate is orthostatic hypotension (expression of autonomic dysfunction).
I would recommend a Head Up Tilt table testing for this purpose.
I believe that your PFO implications on heart structure and function are thoroughly investigated by your attending doctors. They have excluded enough severity to indicate a surgical correction of this congenital disorder.
But, could you upload you cardiac ultrasound reports and other additional cardiac tests, just for another recent review of your actual therapy.
There are alternative treatment options for correcting PFO other then surgery (for example transcatheter device closure). You could discuss with your cardiologist if it is feasible.
Other health disorders to investigate for the above purpose is to check thyroid and adrenal hormone levels, as well as possible hydro electrolytic disorders, as their deficiency may lead to increased tiredness, orthostatic hypotension and general exhaustion.
Also, a complete blood count to exclude anemia, and blood glucose curve should be done to exclude possible hypoglycemia.
To explore a possible neuro-muscular junction disorder and myasthenia I would recommend to perform an EMG.
Chronic fatigue syndrome should be also sought, as it may be responsible for your clinical scenario.
I believe many of the above mentioned tests have been already performed by your attending physician.
Nevertheless, if everything has resulted normal and your arterial hypotension is excluded as an etiological reason for your tiredness, I would recommend to consult with your psychiatrist to review the possibility of starting any antidepressants, which may improve your symptomatology and return your normal functionality.
At the end, I would define all this diagnostic work up as a diagnosis by exclusion.
I strongly recommend to avoid those energy drink!!
Hope to have been helpful!
Feel free to ask me whenever you need. Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
They did a tilt table test and it was positive. They said i have vasovagal syncope. But the more i exercise & eat right, the more i pass out. They checked my thyroid levels & did tons of blood work. Everything came back within normal levels. I was diagnosed with depression & put on antidepressants. But i have been off them for a couple months now. I actually havent noticed much difference with energy on or off the antidepressants, just that i am more irritable. The only tests they havent done for my heart are an CATSCAN & an MRI. Sorry, I dont have the test results to send to you. The Dr tried several Rx meds to try to raise my blood pressure, but they did nothing. There are no meds to raise blood pressure, but he tried different ones that have a side effect of raising it, they didnt work. They say no sugar or caffeine because of my heart, but they say yes to caffeine because of my low blood pressure. They also said more salt intake, ive done that, but dont notice a difference.
I also get really swollen ankles (especially the left one) when i stand or walk alot or when i sit for too long. I thought it was just because of the low blood pressure. Ive tried & done everything, but still have no energy
They did an extensive stress test. They had me hooked up to just about everything. They had an arterial line in my arm. They found out that when i exercise, my lactic acid goes from zero to 15 in less than 10 minutes. The dr has worked in her field for almost 20 years, and she said she had NEVER seen it go that high. The highest she had seen it go was to 12 $ that was a super fit athlete guy. But when they sent the results to the cardiologist, he didnt address it. He said it was normal results. Im at a loss of what to do next, or who to go to. Ive even tried other avenues. Like natural things & homeopathy. Nothing is helping.
I also get really swollen ankles (especially the left one) when i stand or walk alot or when i sit for too long. I thought it was just because of the low blood pressure. Ive tried & done everything, but still have no energy
They did an extensive stress test. They had me hooked up to just about everything. They had an arterial line in my arm. They found out that when i exercise, my lactic acid goes from zero to 15 in less than 10 minutes. The dr has worked in her field for almost 20 years, and she said she had NEVER seen it go that high. The highest she had seen it go was to 12 $ that was a super fit athlete guy. But when they sent the results to the cardiologist, he didnt address it. He said it was normal results. Im at a loss of what to do next, or who to go to. Ive even tried other avenues. Like natural things & homeopathy. Nothing is helping.
Brief Answer:
You need a comprehensive neurological evaluation.
Detailed Answer:
Hello again!
As you are diagnosed with orthostatic hypotension syndrome, and the preliminary treatment options have almost failed, further diagnostic work up are necessary to differentiate a primary autonomic failure from other forms of generalized autonomic failure (like autoimmune autonomic neuropathy, multiple system atrophy, etc).
I recommend you to consult a specialized neurologist on this field (autonomic dysfunctions), as a comprehensive neurological status examination coupled with many several sophisticated medical tests will be necessary to define the right syndrome responsible for your complains.
Regards! Dr. Iliri
You need a comprehensive neurological evaluation.
Detailed Answer:
Hello again!
As you are diagnosed with orthostatic hypotension syndrome, and the preliminary treatment options have almost failed, further diagnostic work up are necessary to differentiate a primary autonomic failure from other forms of generalized autonomic failure (like autoimmune autonomic neuropathy, multiple system atrophy, etc).
I recommend you to consult a specialized neurologist on this field (autonomic dysfunctions), as a comprehensive neurological status examination coupled with many several sophisticated medical tests will be necessary to define the right syndrome responsible for your complains.
Regards! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you
Brief Answer:
You are welcome!
Detailed Answer:
You are welcome!
You are welcome!
Detailed Answer:
You are welcome!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I looked online about the autonomic dysfunctions. They have tested me for these & found everything normal. Any other ideas?
Brief Answer:
Your provocative orthostatic test has resulted positive.
Detailed Answer:
Dear Miss!
As you have resulted positive on Tilt table test, there exists an autonomic insufficiency.
The important issue is to identify the exact clinical presentation (syndrome) of this dysfunction.
I would recommend to discuss with your doctor about the above suggestions.
Probably a further clinical investigation, would lead to an appropriate therapeutical management.
Regards! Dr. Iliri
Your provocative orthostatic test has resulted positive.
Detailed Answer:
Dear Miss!
As you have resulted positive on Tilt table test, there exists an autonomic insufficiency.
The important issue is to identify the exact clinical presentation (syndrome) of this dysfunction.
I would recommend to discuss with your doctor about the above suggestions.
Probably a further clinical investigation, would lead to an appropriate therapeutical management.
Regards! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
