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Heart Disease (Expert Forum)
Exercise induced hypertension
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Exercise induced hypertension
by runnertom, Apr 16, 2006 12:00AM
Happy Easter! I am a 57 man who has posted before. I was shocked 3 years ago to find I had an LAD blockage at the bifurcation that was bypassed with the LIMA and a venous graft. It has been my obsession for the last three years to understand what caused it in the absense of family history, smoking, BP, high cholesterol, etc. I have been a very heavily involved in running, cycling, and racing for the last 35 years. My cardiologist is likewise baffled that someone with HDL of 60 would have CAD.
In my last visit, I suggested to him that all my stress tests have noted exercise induced hypertension, with my systolic hitting 225 to 230 at peak workload. I wondered whether this could have been a factor in the blockage. He didn't know, but offered to do an echo to compare with a 2 and 4 yo echos to see if there have been any changes. Indeed there was! Comparing to a 4 year echo, my posterior ventricular wall along with the septum have marched steadily upward from high normal of 1.0 cm to 1.5 cm. He put me on Zestril (ACE inhibitor) in spite of some info I had dug up on the internet saying that Norvasc (calcium antagonist) was the first line treatment for exercise induced hypertension. He said Zestril has been shown to reverse LVH and wanted to go that way.
Comments? Is it possible that I was the unknowing author of my own problems with all the heavy exercise? Do I need to cut my exercise volume and intensity now? Is Zestril the best approach? I can't get past the feeling every time I work out that I am shortening my lifespan rather than prolonging it.
In my last visit, I suggested to him that all my stress tests have noted exercise induced hypertension, with my systolic hitting 225 to 230 at peak workload. I wondered whether this could have been a factor in the blockage. He didn't know, but offered to do an echo to compare with a 2 and 4 yo echos to see if there have been any changes. Indeed there was! Comparing to a 4 year echo, my posterior ventricular wall along with the septum have marched steadily upward from high normal of 1.0 cm to 1.5 cm. He put me on Zestril (ACE inhibitor) in spite of some info I had dug up on the internet saying that Norvasc (calcium antagonist) was the first line treatment for exercise induced hypertension. He said Zestril has been shown to reverse LVH and wanted to go that way.
Comments? Is it possible that I was the unknowing author of my own problems with all the heavy exercise? Do I need to cut my exercise volume and intensity now? Is Zestril the best approach? I can't get past the feeling every time I work out that I am shortening my lifespan rather than prolonging it.
Doctor's Answer
by CCF-M.D.-MJM, Apr 16, 2006 12:00AM
Hi Tom,
Try to be too obsessed by your CAD. There are somethings we just don't understand yet and CAD in people with no apparrent risk factors is one of them. There is no clear answer.
He said Zestril has been shown to reverse LVH and wanted to go that way. Comments?
I am not familiar with data suggesting that norvasc is first line for exercise induced hypertension. Is the from a reputable journal, is a randomized study? I think an ACEI is reasonable.
Is it possible that I was the unknowing author of my own problems with all the heavy exercise?
I have never read anything to suggest that heavy exercise increase the risk of CAD.
Do I need to cut my exercise volume and intensity now?
Again, there is not data to suggest this would help decreae your risk of further CAD. Usually too much exercise is not our concern, most people are under rather than over active.
Is Zestril the best approach? I can't get past the feeling every time I work out that I am shortening my lifespan rather than prolonging it.
It is good quetions, there is no clear answer that I know off. This would be very difficult to organize a randomized trial.
Sorry I can't be of more help. Thanks for posting.
Try to be too obsessed by your CAD. There are somethings we just don't understand yet and CAD in people with no apparrent risk factors is one of them. There is no clear answer.
He said Zestril has been shown to reverse LVH and wanted to go that way. Comments?
I am not familiar with data suggesting that norvasc is first line for exercise induced hypertension. Is the from a reputable journal, is a randomized study? I think an ACEI is reasonable.
Is it possible that I was the unknowing author of my own problems with all the heavy exercise?
I have never read anything to suggest that heavy exercise increase the risk of CAD.
Do I need to cut my exercise volume and intensity now?
Again, there is not data to suggest this would help decreae your risk of further CAD. Usually too much exercise is not our concern, most people are under rather than over active.
Is Zestril the best approach? I can't get past the feeling every time I work out that I am shortening my lifespan rather than prolonging it.
It is good quetions, there is no clear answer that I know off. This would be very difficult to organize a randomized trial.
Sorry I can't be of more help. Thanks for posting.
Thank you for your comments. They are very helpful to at least know that someone appreciates my plight. I guess one of my biggest fears is that I will end up looking like a fool in that friends and family who are more moderate exercisers have always thought my exercise habits to be a bit extreme (although in my circle of riding and running companions I am certainly not). The other thing is through this forum and by casual aquaintance I have run into a number of others in a situation similar to mine-am I like the guy who figured out that ulcers were caused by a virus? At this point I am just looking for the know to turn that will arrest my CAD and allow me to continue my favored activities.
I have read the literature and many studies about ACEIs and CCB's. For now, I will follow the doc's recommendations. I will be pushing for a followup echo at my next visit, although six months may be too early to see any progress.
Tom
I am in the same boat. No history, triathalons, eat right, no smoking or drinking. BUT the collateral vessels around my LAD blockageclearly saved my life from my initial MI. They performed wonderfully again several months ago when my stent restenosed after 2 years. The only clue I had was nausea during a hard training run.
HAd the cath done in mid February and 1 month later I was back up to my original miles.
I don't see any real drop of with exercise except I limit my weights to 125lbs and my speed work HR needs to stay in the 170 range.
Otherwise, keep doing the stress testing, eating right and have fun.
I too have exercise/stress induced hypertension. The first time I was aware of this was during a Stress Thallium when they ended the test with a BP of 220/65. I had no chest pains during this rise on the threadmill but had a horrid headache. I was not given any BP meds then but I should of been.
I was told to tell any doctor/anesthesiolgists about this rise in BP should I ever have surgery as this can happen again with surgery.
Well, I forgot and a year later, I had a kidney stone removed and had a general. What should of been an out patient procedure was all but this. In the recovery room, I would not wake up and my BP was 220/60 again for hours. No one bothered calling in the anesthesiolgist or the kidney doctor and I was pumped full of Benydryl. I was admitted for overnight (fellow on call made that call). The next morning I looked in the mirror and my lips were blue. I asked about this but never got a straight answer. This is when I think I had my heart attack. I was not EKG'd monitored for the overnight stay so there was no way to know on paper. (I think blue lips mean lack of oxygen)
What I am getting at is that "any" kind of stress can bring up the BP if one is prone. Even driving the car in heavy traffic, I was told.
I also now have stents in the LAD and RCA. I was told it was caused by years of undiagnosed elevated BP that was not treated.
I then got all copies of back EKG's from years earlier and took them to another doctor. He spotted that starting in 2000, the EKG's listed as normal showed LVH....thus contributing to the blockages and now an obstruction in the Left Ventricle.
Mantels: You mentioned Collaterals. How did they find these?
I have asked my Cardiolgist about these and he approached the Cath doctor to review his cath on tape to see if I was growing collaterals in the distal LAD where the severe blcokage is (Heart attack area) but the Cath doctor told him he did not have the time to do it and asked the GP to do it....The general Cardio doctor said he did not know how to read the Cath disk. I am now in Limbo.
Mantels: You mentioned that your stent restenosed after 2 years. Was this a Coated stent or a bare metal stent? Were you on Plavix the whole time and the stent closed up? I am still on Plavix (18 months now) but would like to get off that stuff.
Thanks for any help...
I will stay on Plavix as long as they let me.
I bleed alot if cut, but restonosis is worse.
I was told by genetisist that sometimes the arteries of the heart get roughened up bu having a virus early in life. In my early 20's I had a real bad case of mono. It could be true. It is the only risk factor I have found.
I have been running for 30 years and over that time the collterals have grown. My heart cath dr. told me. I ran with an MI for several miles and I ran 2 months ago with a 100% clogged LAD. So thank goodness for collaterals.
All those years of work on the roads and track paid off. Not necessarily with the times i wanted but they probably saved my life, twice.
Yes, restonosis is worse than the Plavix but with Plavix they are now finding yes, it keeps the stents open but it also harbors the growth of new healing cells.
Plavix is also a surgeon's nightmare if they have to do surgery for any reason on a Plavix patient. I have to be off Plavix for 5 days next month to control bleeding and cardio is concerend that being off will trigger 'soemthing'...)-:
I am sending my heart cath disks to another heart center and they will view them to see if collaterals are growing. My Cath doctor said he was tooooo busy to view the cath disk and does not remember if he saw collaterals or not. He wins the award for being the nicest, kindness, compassionate, level headed, Cardiolgist in the country. RIGHT!~! He needs a spanking. LOL
Wishing you good days ahead.