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Rise in pulse rate during early hours, orthostatic hypo tension - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3631 Questions
User :   My heart rate goes to 100 when I get up in the morning and start moving around, even a little. I have arthritis in my neck and what I think are pressure-tension headaches in my temples pretty much all day. I feel like I have to put my head down until about 10 am. Afternoon/evening pulse is 60-70. Should I be concerned?
Two years ago I had a rare (pleomorphic neuro-endocrine) tumor of the pancreas removed in a Whipple (horrible operation) with 1/3 or pancreas removed also my gall bladder (which I wish the doctor hadn't removed, since it was normal), a foot of my intestine. It took a year, as he said it would, to recover. It was, hopefully, benign. No evidence of any spread. No diabetes. My previously healthy bowels still work great. My pancreas surgeon doesn't see any connection.
One year ago I had minimally invasive neck surgery to free a nerve which had suddenly affected my L hand when I attempted to play racquetball after the year of healing.They also did an ablation of nerves on both sides, esp. R C2, which has more arthritis and perhaps other changes than the other neck areas. I've had a lot of muscle pain since then, R suboccipital area (C2?) radiating into my R eyeball/temple, which I guess may be causing my temporal headaches. Also, trapezius soreness. But what is going on in the mornings with my pulse and head discomfort?
Doctor :   hi
Doctor :   let me read the query.
User :   What do you think?
Doctor :   May I know your age and gender?
Doctor :   Do you have palpitations?
User :   65 now, female
Doctor :   Do you have palpitations?
User :   no, my blood pressure has always been low though
Doctor :   Do you any history of heart problems in the past?
User :   no
Doctor :   Do you have diabetes/thyroid problems in the past?
Doctor :   Do you have sweating/tremors of the limbs?
User :   I did have a saliva test which showed my cortisol is low in the morning, but I went to an endocrinologist, who said my cortisol is normal (had 24 hour). No diabetes or thyroid problems.
Doctor :   Ok
Doctor :   Are you on any regular medications?
User :   intermittent low dose xanax to sleep (0.25 mg) and vitamins
Doctor :   Ok
Doctor :   let me guide you.
Doctor :   Before explaining about it, I would like to inform you that, a heart rate of 60 to 100 is considered under normal limits.
Doctor :   A heart rate above 100 is considered to be tachycardia.
Doctor :   With this information, I shall proceed further.
User :   but why is it so fast in the am? and I feel like I have to lay my head down, and it's better (60-70) later?
Doctor :   Pulse/heart rate are controlled by a few factors such as endocrine factors, stress factors, usage of certain drugs and so on.
User :   ok, me?
User :   lots of stress, but why heart rate faster in am?
Doctor :   Based on the history that you have provided to me, you do not seems to have both hormonal causes nor any drugs induced increase in the heart rate.
User :   that leaves?
Doctor :   However, the other factors such as stress, cardiac factors have to be evaluated.
Doctor :   I suggest you these measures.
Doctor :   1. To check the pulses in both hands simultaneously -
Doctor :   if the pulses are different in both the limbs then you may have areas of obstruction in the arteries of the limbs, which may need further evaluation
Doctor :   2. Adequate nutrition and stress reducing measures.
Doctor :   3. And a cardiac evaluation, that includes getting an EKG
Doctor :   Have you followed what I have suggested?
User :   pulses the same. I eat very healthy. I had an EKG one and two years ago, extensive cardiac testing two years ago
Doctor :   May I know the results of the Cardiac evaluations?
User :   normal
Doctor :   were they normal?
User :   I did have one measured orthstatic hypotension, but in the hospital I was always lying down
Doctor :   Ok, are you still known to have orthostatic hypotension.
User :   ?
Doctor :   A transient drop in BP can cause rise in the pulse rate.
User :   we're back. But I don't feel good for several hours.
Doctor :   Orthostatic hypotension is a condition where there is a BP drop when the postion of the body is changed.
Doctor :   In simple terms, the is a BP drop when a person stands from a lying down position.
User :   Once I'm standing, shouldn't I start to feel better fairly soon?
User :   I do feel pressure in my temples, too
User :   I had MRI's of the brain 2 years ago and spine, normal
Doctor :   The body's response to the low BP are rise in the pulse rate.
User :   Is my low BP normal?
Doctor :   Probably this may explain the Pulse rise you have early in the morning.
User :   It's often taken at 120-130/65-80
User :   Could this explain why it takes hours to feel better?
Doctor :   If the BP drop is more than 20mmHG ( the diastolic readings), then its considered as significant orthostatic hypotension.
User :   Why could I have this?
Doctor :   Usually this drop can occur in all individuals as a part of normal mechanism.
Doctor :   However in a few individuals, this can take time.
User :   So, I need to get to work at 8 am, which is very uncomfortable. Is it safe to just get through it?
User :   Could just stress cause this?
Doctor :   If the fall in BP is significant and you have symptoms of hypotension, symptoms such as giddiness, nausea, you may need medical drugs.
Doctor :   Stress factors are one of the factors, but the diagnosis of stress induced changes are considered when no other possible causes are found.
User :   What I have is a sense of pressure in my head (temporal), but I have that sense of pressure much of the day, when my pulse is normal.
User :   Could stress cause this just in the morning?
Doctor :   The increased pulse rate may or may not be causing the headaches.
Doctor :   The headaches that you have are probably due to stress related tension headaches as you already know.
User :   could be a combination of stress and orthostatic hypotension perhaps
Doctor :   Yes, the could be.
User :   any other thoughts as to etiology?
Doctor :   Are you know to have cervical spondylitis?
User :   spondylithiasis perhaps
Doctor :   Cervical spondylosis can contribute to orthostatic hypotension though not completely but to a some extent.
User :   in the am only?
Doctor :   Since I cannot examine you, I cannot predict the contribution of cervical spondylosis or any other factors that may be contributing to the condition.
Doctor :   I suggest you to get a BP recordings done to look for orthostatic hypotension.
User :   Well, I guess that's the pretty complete rule out. I appreciate it. It is very frustrating, you know. Do you think it's safe to just plow through it and function in the am (work)?
Doctor :   If you have a significant drop as mentioned earlier, you may have to consult your doctor for further evaluation.
Doctor :   Do you have any other query?
User :   no, thank you.
Doctor :   Thanks for consulting me. Bye for now. Please refer your friends to our service.
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