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Low BP, skipped heart beats. What kind of tests are required for diagnosis and symptoms?

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My blood pressure is very low what can I do? My heart has been skipping and my heart felt like it was beating a little fast and very hard. I was on the computer and was leaning my ear on my hand and actually heard my heart skip beats, not double beat, but skip. That concerns me. The dr. has always told me it doesn't actually skip, but beats an extra beat and the thing that actually feels like a skipped beat is just a pause because of the extra beat. But, I actually heard it skip and when taking my pulse felt it skip. I took my blood pressure and heartrate and bp was 77 over 40. That is lower than I have ever had it. My heart rate was in the 90's. What does this mean, and what kind of tests do I need to have done. The dr's around where I live are not very good and I really would like to know what kind of tests to have. I also would like to know all the causes that would cause these symptoms. I do have svt and have had it since age 23. I also have mvp mile to moderate and have a yearly echo.
Posted Sun, 8 Jul 2012 in Heart Rate and Rhythm Disorders
Answered by Dr. Anil Grover 41 minutes later

Thank you for writing in.

I am a cardiologist and read your mail with diligence.

Coming straight to your queries.

1.     Low blood pressure is a misleading term. Anybody who had been asymptomatic at systolic blood pressure of 106 mm Hg and Diastolic blood pressure of 70 mm of Hg. Hypothetically, if he loses blood and his BP falls to 80/60 mm Hg this will be situation of low BP.

Similarly a person asymptomatic at his normal BP of 130/85 loses blood and his BP falls to 106/70 with symptoms of giddiness will be called having low BP. Thus what is normal in one situation is low in another situation. If you do not get giddiness, blackout or syncope and your doctor says it is not low BP then it is normal BP for you.

2. SVT (usually paroxysmal supra ventricular tachycardia) starts suddenly like a bolt from blue and ends as abruptly as it began and you return to your normal rate. This rhythm is interpreted by your brain as skipped beat. Other times an abnormal beats comes earlier than normal beat and initiate tachycardia, it is again interpreted as missed beat. Combination of ectopic beats induced pauses is interpreted as skipped beats. The description of pause which you inferred from the doctor and elaborated is the most correct description. Unfortunately, the BP monitors which are available for home use are not capable of monitoring BP correctly when Heart Rate is higher than 160. You would have seen in the hospital during the attack of SVT BP is measured by palpation of pulse distal to manometer.

3. The idea of the above paragraph was not to undermine your illness but give a perspective to it. PSVT is common illness; it is very rarely XXXXXXX responds to one or other parental drug when oral drugs fail. This is commonly associated with MVP.

4. Similarly, aneurysm of atrial septal defect is benign condition. Its rupture within heart does not produce any catastrophic event. It is prone to thrombus formation so you ought to be on blood thinners your doctor would have prescribed aspirin and clopidogrel for this.

5. PSVT is kept under usual control with prescription drugs like verapamil and diltiazem. If frequency still remains high, radio frequency ablation is the method of choice.

If you have any further query I will be most happy to answer.

Best Wishes

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Low BP, skipped heart beats. What kind of tests are required for diagnosis and symptoms? 5 hours later
Thank you for ur answers, even though u kinda lost me at times. Last night when my heart was in the 90's, I know that wasn't SVT, but my hear was skipping alot and just was bothering me, and I could feel my heart beating harder than usual and then like I said, I actually heard it miss a beat or skip a beat. It didn't do an early beat like I have felt at times, but really did skip a beat. It was like it just quit for a second then beat again and felt really scary. It did this several times. I have had the extra beats and felt them do an eary beat and then pause, but this was different. I really don't understand why my BP was so low and remained that way all night. I went to bed and was freezing and couldn't get warm. This isn't normal for me, and my BP usually doesn't run in the 40's on the bottom. If I had had a realy case of SVT and had to take extra tenormin then I could understand, but actually I hadn't taken any all day, so don't understand why it is so low. I did take a little after it started skipping, but not much. I don't think it is normal for me to have a BP this low and would like to know why it is running so very low. The other day it even went down at one time on the bottom when my heart rate was about 109 to 130 over 30. The bottom being 30 scared me to death. Then last night for it to be in the 40's just isn't right.
Answered by Dr. Anil Grover 34 minutes later

Thanks for writing in.

I am sorry if my answer was not clear to you. I will try again, taking your figures again.

About BP you mentioned that it was 109-130/40 and your doctor has not found any other abnormality except MVP in you. This is normal. So is 100/40. The difference between upper one that is systolic and lower one that is diastolic is 60-70 mm Hg. It can be said that normal pulse pressure is 40 so your pulse pressure is wide. Nonetheless, both systolic and diastolic BP is normal.

Causes of wide pulse pressure include leakage of aortic valve (which, or any other heart lesion would have been picked by the doctor who diagnosed MVP) and anaemia. Therefore, I would suggest getting your Haemoglobin checked.

Yes, your description means that ectopic heart beats are more frequent or these are troubling you more than you should. Personally, I would think if told your doctor about everything he would do two things:

a). Order a Holter examination and would show you what is happening to your heart when you are skipping the beats.
b). B blocker or tenormin the drug you are taking is not that effective so he will try considering prescribing verapamil or diltiazem.

Please show this to your medical practitioner he might have some other ideas but those will be in your interest. You had written that you are having this problem for years. So obviously it cannot be that XXXXXXX You can discuss Radiofrequency ablation, event monitor and pacemaker in your case. These are types of treatment which you might (or might not) need. Please write back the part which is ambiguous, I will try once again.
With Best Wishes

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Low BP, skipped heart beats. What kind of tests are required for diagnosis and symptoms? 1 hour later
I have worn the event recorder in the past and also holter monitor several times. The top of my blood pressure last night was in the 70's and 80's. It usually runs about 110 over 65 or 70, but not as low as last night. I know that I have had some pauses show up on the recorder and also runs of two's and three's. I have pvc's and pac's. I just don't understand why sometimes it actually does quit a beat and then sometimes it just does extra beats and it feels more scary at times than others.
Answered by Dr. Anil Grover 33 minutes later

Upper blood pressure systolic reading of 70 is DEFINITELY LOW. However, it is almost invariably accompanied by symptoms of less blood flow to brain in form of dizziness, giddiness, and black out, pre syncope and syncope that is why I was concerned whether there could be fault with the recorder.

Assuming there is not then it becomes a reason to see doctor in Emergency Room at the earliest. Autonomic neuropathy should be considered and excluded. Ambulatory BP recording, if you not undergone before ought to be considered now.

My line of thinking when I mentioned event recorder was that your drug intake is causing lower heart rate (and lower blood pressure) still you are not getting rid of ectopy. That makes the diagnosis of bradycardia induced ectopy.
Firstly, with a particular variety of pacemaker (DDDR) upper and lower limits of heart rate are set, so that symptoms related to your heart rate are eliminated. Secondly, your cardiologist can prescribe drug(s) of choice in doses appropriate for the ectopy control without worrying about heart rate fall.

If you have further query I will be most pleased to answer.

Above answer was peer-reviewed by
Follow-up: Low BP, skipped heart beats. What kind of tests are required for diagnosis and symptoms? 3 hours later
I just checked my BP and the top is 80 and bottom is 58. I have been to the ER room and they don't seem alarmed at all with these readings. They also got the reading of the top in the 70's. What do I need to do now? My heart dr. never does seem very interested.
Answered by Dr. Anil Grover 6 hours later


Good of you for writing in and having faith in health care magic.

Please read your insurance policy there is always provision of going to different hospital ER in case of emergency. You can avail the facility and opinion of second set of Internist and request him refer to another cardiologist. Or if you have someone to help you, you can go to primary hospital of different geographical location in case of emergency and request them to call a cardiologist. I am afraid, when you have two set of opinions given in good faith, your own diagnosis is overruled.

Lastly, error of judgement does happen, but two cardiologists giving one opinion will be too much of coincidence.

Let us see when you have two different opinions. Please do not hide any investigation report or admission slip you might have from the second doctor. Believe me; doctors are trained to be objective enough not to get biased with what others say!

Good Luck

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Low BP, skipped heart beats. What kind of tests are required for diagnosis and symptoms? 19 hours later
I don't have health insurance because of pre existing conditions and when I lost my job, I couldn't find any insurance for myself. The heart dr's where I live come from another city because we are small where I reside. Most of the hospitals around here use the same heart dr. I checked my b/p a bit ago, and it is running 80/55, which it runs alot. I haven't had any Tenormin since Saturday. Is that still dangerous? I also keep freezing and have tingly feelings in my fingers which I have been having for a few weeks.
Answered by Dr. Anil Grover 5 hours later
Hi there,

No 80/55 with the recorder you have, in absence of any giddiness, dizziness, blackout, pre syncope or syncope is not XXXXXXX If it goes below that visit ER again. I am sure the other things you described can not be that bothersome for you did not mention them in previous detailed emails. It is best to ignore these for now. However, do mention these problems to the doctor, should you visit ER again. Even if you have same cardiologist visiting your town you will not have same doctor in emergency round the clock. What about my suggestion of visiting any friend or relative in some other town and going to ER there?

You may ask any question I will be happy to reply.

With Best Wishes

Dr Anil Grover
Above answer was peer-reviewed by
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