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Heart & Cardiology/high to low blood pressure

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Question
I am a female 72yrs old had two heart attacks in 05 had two stents put in and a pacemaker/defib. In 2010 had pacemaker replaced and when it wouldn't stay in pocket,so bad that when I would bend over it would have fallen right out if I didn't have skin. At that time the doctor said he was going to cut my chest muscle open and put it in there.But I said no way until he ran all the tests to see if I really needed it, after all the tests it was determined that I didn't need it anymore so it was removed.Now I am having episodes of really high blood pressure it will be 179/93  but when I lay down it goes down pretty fast to about 110/60 and I will be very dizzy also I get out of breath just taking a shower.So far my cardiologist doesn't seem worried but she doesn't have to live her life trying to clean your house and having to lay down every 15 minutes or so in order to get things done.I am very concerned and would like to know what things should be done to find out what is causing this. Please let me know what you think. Thank You  Pat

Answer
Hi,

Your symptoms are called orthostatic changes in blood pressure. Basically, the underlying mechanisms your body uses to adapt to a standing position are a little faulty, and a condition called dysautonomia is often the cause. I wonder if you are on blood pressure medications, certain of these medications are best avoided in this setting, such as diuretics. The use of TED hose stockings may help, also ensuring you are adequately hydrated. Its also of note that if the symptoms are affecting your quality of life it may be more prudent to be less aggressive with blood pressure control. I'm nor sure why you have a defibrillator, but if it is due to heart failure, some of the medications in treating that may cause orthostasis also. In your next visit, i would bring up these issues and also impress the fact that the symptoms are affecting your quality of life. I would suggest you take a bp diary where you record your sitting and standing blood pressures with any heart rate changes, and also the same during any symptoms you may have.

Hope that was helpful,


Knowledgeability - 5 Clarity of response - 5 Politeness - 10 Nomination - No Prestige Point - 0
Comment - Sorry but you didn't really give me any info I didn't already have and you didn't read my question throughly or you would have seen that my pacemaker/defib was removed permently.


I have a busy day to day schedule and gain nothing personally from being on here and do this as a way of maybe helping people who don't have access to physicians or information. I often answer the questions at 2-3am and no matter how many questions i get (hundreds, most private hence not shown on the pubic site) i make an effort to answer them all in a detailed manner as possible. If you look through the answers i try to provide as compared to the few line answers most give you would have an appreciation for that fact and the effort involved on my part.

I'm surprised and disappointed at your interpretation of my answer. Your rating of 5 is both surprising and the first time i have had such a rating despite literally hundreds of hours answering questions here. In honesty it makes me question the value of my service here. Its easy for one person to discard the effort put in, and out of annoyance question the knowledgeability and clarity of someone who deals with these topics on a day to day basis.

With regards to your question. I of course realized you had your pacemaker removed given the detail you went in to regarding its removal, and meant 'had' a defibrillator, the reason being is that if it is due to cardiomyopathy then the underlying function can greatly influence the evaluation and management of the orthostasis. An ejection fraction of 20 is vastly different from the usual of 55. I told you what i tell my patients with orthostasis. I review the medications initially to ensure none are contributing. I run blood tests to ensure normal metabolic functioning including cortisol and TSH. I ask all patients to bring a blood pressure diary to assess patterns and importantly heart rate response, as a tachycardia form of orthostasis can be treated differently. i am less aggressive with bp in this setting and find that ted hose have made a big difference. You could have simply replied with some of these answers?

I am sorry that you are facing these symptoms, dysautonomia is highly frustrating and also frustrating to treat. We all want our patients to do well and enjoy a good quality of life, and often patience and a detail oriented approach is required. Dysautonomia is one of the most difficult conditions to evaluated and treat in an office setting, never mind the internet, and i simply tried to get some of the key points across. Sorry i couldn't tell you anything you already knew.  Im sorry you felt the need to question my knowledgeability and clarity of response and provide a harmful rating that hurts hundreds of hours of genuinely well intentioned and free work. But most importantly i hope you get to the bottom of your symptoms and enjoy a better quality of life soon.

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

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Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

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http://blog.myheart.net

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Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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