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High BP, low pulse rate, was untreated, dizziness, fatigue, cold, breathlessness. ECG. Possibilities?

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I am a 37 year old male, 5,9 and 150lbs. I have had untreated BP for around 8 years, 140/90 up to 150/100. I have a pulse rate as low as 41. My BP is now getting addressed in recent weeks with pills. I do not have any form of exercise within an average day. I do eat well daily, low salt and fresh food not processed. I do not drink much alcohol, 3 or 4 drinks once or twice a month.

In the past its been my BP i have always spoken to my gp about. At times I get dizzy and feel unwell, fatigue, cold and sometimes a slight shortness in breathing and sometimes a weasing when breathing in. My concern is my pulse rate. My doctors have readings of high 50s from past ECG with my pulse rate. I have monitored my pulse for the last week, getting an average of 47. 

What is the most likely condition and reasons of high BP, low pulse and the above symptoms? In addition what is the best way forward for myself in terms of speaking with my gp regarding pulse and treatment?
Tue, 22 May 2012 in Heart Rate and Rhythm Disorders
Answered by Dr. Prasad 4 hours later

Thanks for posting your query on XXXXXXX

Pulse rate of 41 is indeed low. The symptoms of dizziness, shortness of breath, fatigue, feeling of unwell, about to pass out are the usual symptoms of low pulse rate - referred to as 'Bradycardia' in medical terms.

What I would want to know is - Do you develop these symptoms following a particular event such as changing position (getting up from bed) / during a bout of cough / while passing urine? If yes, then it could be indication of 'vasovagal syncope'. This is not a very concerning problem and can be addressed efficiently with few modifications/medications.

[Or] Is the pulse always this low?

If your answer is yes to the later question, then it needs to be addressed.

A few conditions that can cause bradycardia are
1. Medications - Some anti hypertensive medications such as betablocker, sleeping/anxiety pills cause bradycardia.
2. Hormonal changes - Hypothyroidism is common associated with bradycardia.
3. Heart problems such as conduction blocks, Sino-atrial node dysfunctions coronary artery disease and so on.
4. Fluid and electrolyte imbalance.

A complete physical examination, including battery of tests, ECG, Echocardiogram is entailed to find the rooot cause and treatment is based on it. The tests can be done under guidance of a cardiologist.

Hope my answer was both adequate and informative. Should you have any more concern, I am available to clarify them.

Above answer was peer-reviewed by
Follow-up: High BP, low pulse rate, was untreated, dizziness, fatigue, cold, breathlessness. ECG. Possibilities? 2 hours later

Thanks for your informative reply. My lightness in my head can always be there but worse on occasions when I stand up.

What I have noticed is my pulse in the evening can be around 52. The lowest readings of 41 are usually before 4pm. Is there any explanation for this?

Is it possible for people that have not got much physical activity in their life to have a low health pulse. Or is the likelihood an underlying issue that you've mentioned?

Can depression or stress lower the pulse? If so can you explain? And finally, is there a most common problem with high BP and lower pulse readings?

Thank you in advance,

Answered by Dr. Prasad 21 hours later
Hi and thanks again,

1. Significant postural variations of pulse rate and blood pressure are known to occur in a few individuals. This can explain the worsening of symptoms on standing. If the symptoms are severe and worse on standing, it needs further probing.

2. Pulse and heart rate variations can occur on a single day. Usually the highest recordings are found early in the morning as you wake up, slowly reduce during the day and lowest when you sleep. Such variations occur due to hormones and changes in the neuronal activity. You have reported pulse being the lowest before 4pm. I cannot explain this.
Perhaps a cardiologist after examining and investigating may be able to explain it.

I would also be interested to know, if the antihypertensive drugs that you are currently on are causing the changes.

Consult a cardiologist and discuss with him.

3. Sedentary activity is strongly associated with many medical illnesses - Hypertension and Coronary Artery disease being one of them.
I wish you do not have any heart illness. But if one is found, I would blame the inactivity.

Change in the lifestyle is very important and essential now.

4. Depression and stress again can play a role in increasing pulse rate. However medical drugs used to treat depression can lower pulse rate.

5. Lastly, hypertension and bradycardia could be due to independent symptoms. They could also be related to a common cause which can be found only by evaluation.

Hence I recommend that you make an appointment with a cardiologist.

Hope my answer is both adequate and appreciable.

Wish you good health.

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