Exercise Induced Hypertension?

[49er]

...that's why I thought I would run it past this group.

Yeah, like following the above advice and trying beta-blockers.

Maybe you can get your heart to stop altogether.

Morbius,

Care to clarify?

Sorry if I am not picking up on something obvious.

49er

Obvious!?

Beta blockers slow heart rate therefore are contraindicated in bradycardia. 33 is a horrible bradycardia (and you have to use 33 because no guarantee O2 therapy will be continuous or even if it is consistently effective0 and 57 is still bradycardia anyway.

So now I'm thinking there's an underlying conduction defect (or she's a marathoner, which I doubt). In the case of fixed HR, that BP response would be about right:

http://www.ncbi.nlm.nih.gov/pubmed/8149531

But if it were EI-H, then there is probably underlying cardiac disease:

http://content.onlinejacc.org/article.a ... id=1127709

but the guy doesn't seem too excited about that, so he's sure there isn't (but why?) or just doing turbodx.

So the next question would be:

What were all the other monitored parameters doing during this time?

Thanks for clarifying. And as usual, you're asking some great questions.

[Morbius]

Beta blockers ...obsolete

Although they are good to prevent getting a panic attack if you have to like give a speech in front of a big crowd.

[Morbius]

Beta blockers ...obsolete

Although they are good to prevent getting a panic attack if you have to like give a speech in front of a big crowd.

Assuming you don't pass out from the resultant bradycardia.

[Morbius]

Beta blockers ...obsolete

Although they are good to prevent getting a panic attack if you have to like give a speech in front of a big crowd.

Assuming you don't pass out from the resultant bradycardia.

Also I think they debonify, but I need to look that one up.

[M'ohms]

Well, Morbius, you've lost me. I know my doc said if I couldn't tolerate the BB, then it would be out of my system in 48 hours.

I left the office with more questions than when I went in. Doc was called to the hospital for an emergency so he didn't spend his usual time with me. You're right that he didn't get too excited about my dx, saying that everything else looked normal. It doesn't make sense to me. While not a marathon runner, I'm not a couch potato either. I'm in better shape than average for a 60 year old.

Just like I want to get to the bottom of my desats and bradycardia (insisting on a visit to the cardiologist), I want to find out why I have EI-H. There's a mystery in me somewhere.

I will continue to wear my pulse-ox at night to keep an eye on my HR. At this point, I'll try to find out answers to some of the questions you rose. Thank you.

[Morbius]

Well, Morbius, you've lost me.

There are 2 things that happen in order to stay alive:

• Oxygen gets from the air and into the blood; and
• Blood is pumped to organs and periphery.

I'm in better shape than average for a 60 year old.

If you're on supplemental oxygen...

Anyway, there are 5 factors that come into play in blood flow:

• Heart rate
• About of blood pumped per beat
• Integrity of the blood vessels (vascular resistance)
• Pressure on the other side of the vascular bed
• Blood pressure

This relationship is demonstrated in the formula (heart rate x stroke volume = cardiac output):



and influenced by

[Morbius]

So now I'm looking at that heart rate of 33 (which in it of itself is major panic because it shouldn't go below 40 (the backup electrical system should bail you out).

Back to the schematic, with that profound bradycardia you have an almost insurmountable amount of ground to make up if you don't want to crumble in a heap and go flying off the treadmill (see staying alive, above).

So something is weird. Was that HR of 33 just a tiny blip (such as a compensatory pause after a PVC)(a harmless event if they're infrequent)?

Seeing HR in the stress test will offer additional insights.

A sinus arrhythmia? But getting to 33 is asking a LOT (I got that and am lucky to get to 44. Awake, anyway).

Meanwhile:

http://content.onlinejacc.org/article.a ... id=1137296

http://stroke.ahajournals.org/content/32/9/2036.full

http://dgim.ucsf.edu/heartandsoulstudy/ ... s.2010.pdf

Clearly, EI-H is good (or not).

[M'ohms]

Clearly, EI-H is good (or not).

I hear you. The studies that you cited are eye-opening. I sort of assumed that my desats were a result of SA, and my fear is that my heart has been damaged as a result, but maybe my heart is the guilty party in this situation, not SA. I wonder if supplemental oxygen will help or not.

So something is weird. Was that HR of 33 just a tiny blip (such as a compensatory pause after a PVC)(a harmless event if they're infrequent)?

While it does not represent a large portion of my nightly reports, the lows are not blips either. Last night, of example, my BP stayed around 40 for between 10 and 15 minutes straight (O2 stayed around 85 for the same period). My total nightly averages are in the low 60's (64 or less). Stress test showed no PVCs, according to doc.

I'm in better shape than average for a 60 year old.

If you're on supplemental oxygen...

Point well taken! What I meant to say was that I am more active than the average 60 year old. I take care of our hilly 4 acre property and a large garden during growing season and use an elliptical during the off-season.

[DeadlySleep]

Are BP and HR getting crossed up here? I have had a few Sunday afternoon drinks, so maybe it's just me.

[M'ohms]

Yup, I got it wrong. I was looking back at some pulse-ox reports and should have said HR, not BP. I haven't bothered with BP readings because I always check out within normal range when it is checked. Instead, I have been watching spO2 stats because of desats and of course, that also records HR! Thanks for catching that.

[Morbius]

And my point is

Metoprolol is contraindicated in sinus bradycardia...

so if we're playing around in 30s and 40s that would certainly qualify.

[Morbius]

Speaking of which, on any other drugs?

[M'ohms]

Only taking Levothyroxine 137 mcg (no thyroid) and estrogen patch Vivelle-Dot 0.01.

[wildboar]

25mg metoprolol is beginner dosage. I've been on 50mg for a couple years now. They put people on 100-150mg just for migraines, I don't know how you'd be able to get out of bed.

[49er]

Saw cardiologist yesterday about this and was put on 2.5 mg of Bystolic due to my past horrific problems with Coreg. BP and HR are definitely related to exercise as yesterday, everything seemed fine until I took about a 15 minute walk and it stayed elevated for way too long, including when I was at the doctor's office.

Scheduled for stress test next week and hopefully, with the Bystolic, I will get clearance for my 3/19 septoplasty. But if I don't, then I guess it is better to be safe than sorry.