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Could Poor Physical Health Cause Slower BP Recovery Without Heart Disease?

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Posted on Mon, 17 Jan 2022
Question: Possible cardiac issues? I have been experiencing weird shoulder discomfort on the left side that comes and goes. Recently I've also started to experience same type of discomfort in my jaw. Rarely does these feelings come with direct chest pain, however I have felt chest discomfort too. I had echo which was otherwise normal but showed mitral valve prolapse but doc said shouldn't cause any issues. I also had an exercise stress test. It did not show any ST segment depression nor did I have chest pain during it. However, I had three PVCs during the recovery period and felt very dizzy, ALSO, I found this study;
https://www.aafp.org/afp/1998/1001/p1126.html

"The three-minute systolic blood pressure ratio, another important indicator of significant coronary artery disease, is a useful and readily obtainable measure that can be applied in all patients who are undergoing stress testing for the evaluation of known or suspected ischemic heart disease. The ratio is calculated by dividing the systolic blood pressure three minutes into the recovery phase of a treadmill exercise test by the systolic blood pressure at peak exercise. A three-minute systolic blood pressure ratio greater than 0.90 is considered abnormal and has a diagnostic accuracy of approximately 75 percent for the detection of coronary artery disease (i.e., an accuracy comparable to that of ST-segment depression). Higher values for the ratio are associated with more extensive coronary artery disease, as well as an adverse prognosis after myocardial infarction."

My peak exercise systolic value was 182 and 3 minute into recovery it was 168. This makes the ratio for me; 0.92. Should I be concerned and ask for further testing? Could poor physichal health cause slower BP recovery without heart disease?
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello,

I would explain that based on this study, your three minutes blood pressure ratio is borderline, but this does not necessarily mean that you suffer from coronary artery disease.

Low physical activity may also influence in these test results.

I would like to know your age and past medical history.
Do you suffer from asthma, high blood pressure or diabetes?
Are you obese?
Do you exercise regularly (walking, running, aerobics, sports, etc.?

Coming to this point, considering your symptomatology, I would recommend performing a coronary angio CT scan, which is a non invasive cardiac test with a higher sensibility and specificity for coronary artery disease compared to the exercise cardiac stress test.

I would also recommend performing a shoulder X ray study and a cervical spine X ray study in order to exclude any possible joint problems, which can lead to your complaints.

If your symptoms are modulated by shoulder movements, arm movements, it is more likely to be a musculo-skeletal pan, not related to the heart.

Hope you will find this answer helpful!

If you have any other questions, please don't hesitate to ask me again!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (3 days later)
Hey,

Thanks for the response.

I am 22 years old and yes, judging by the age only it would be highly unlikely that one would suffer from CAD but my shoulder pain is not affected by any type of moving motion in any direction. Its not even a clear pain per se, more of an annoying squeezing/tightness type of issue. I don't have high BP, it was 120/70 at baseline during rest. It rose to peak value of systolic BP 182. During the recovery period it actually increased to 186 during the 1st minute, 168 during 3rd minute and 140 during the 6th mark.

There is strong family history of heart disease. Also my lifestyle is not/was not very healthy. I have few years history of smoking regularly although I quit some time ago. Plus binge drinking heavily during weekends for years which I've cut back on now. Hangovers gives me really scary chest pains. I am not obese, but I have fasting glucose at the very top end of the reference range and my fasting insulin was 11, I think that could indicate some form of insulin resistance? Cholesterol/triglycerides otherwise normal, LDL slightly elevated. I have hard time dealing with even moderate amounts of stress. I don't do any heavy exercise, just walking mostly.

I've had mitral valve prolapse diagnosed but shouldn't cause any issues according to doctor. Only X-ray I have got was chest X-ray so that probably won't show the type of possible issues in my joints etc.

Thanks.
doctor
Answered by Dr. Ilir Sharka (10 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello,

Your symptoms is suggestive of a muscle pain (possible muscular spasm).

Anyway, considering your exercise test results, your past history for smoking and alcohol intake and your family history for coronary artery disease, I would recommend performing a coronary angio CT scan, just to be sure that everything is OK with your heart.

Regarding the fasting glucose, I would recommend performing HbA1C levels, to exclude diabetes.

It is also important performing regular physical exercise (aerobics, swimming, etc.) in order to help improve your physical performance and reduce the muscular spasms.

Hope you will find this answer helpful!

Wishing all the best,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9037 Questions

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Could Poor Physical Health Cause Slower BP Recovery Without Heart Disease?

Brief Answer: I would explain as follows: Detailed Answer: Hello, I would explain that based on this study, your three minutes blood pressure ratio is borderline, but this does not necessarily mean that you suffer from coronary artery disease. Low physical activity may also influence in these test results. I would like to know your age and past medical history. Do you suffer from asthma, high blood pressure or diabetes? Are you obese? Do you exercise regularly (walking, running, aerobics, sports, etc.? Coming to this point, considering your symptomatology, I would recommend performing a coronary angio CT scan, which is a non invasive cardiac test with a higher sensibility and specificity for coronary artery disease compared to the exercise cardiac stress test. I would also recommend performing a shoulder X ray study and a cervical spine X ray study in order to exclude any possible joint problems, which can lead to your complaints. If your symptoms are modulated by shoulder movements, arm movements, it is more likely to be a musculo-skeletal pan, not related to the heart. Hope you will find this answer helpful! If you have any other questions, please don't hesitate to ask me again! Kind regards, Dr. Iliri