Hypotensive

    
      Re: Re: Hypotensive
    


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Posted by CCF CARDIO MD - DLB on December 15, 1998 at 17:49:51:

In Reply to: Re: Hypotensive posted by kim on December 11, 1998 at 18:35:19:

: Thank you for your help in answering my questions.  I have a few more questions.  As I previously stated before,  I am having problems with palpitations, fainting when doing exercise (and once after walking).  I also have severe headaches with numbess and noticeable temperature difference in right arm.  I have only received a "diagnosis" of  hypotensive during exercise that makes me  faint or have near fainting episodes.  I picked up my records, and don't really understand much of what I read.   My adenosine/thallium test was normal.  My baseline heart rate was 101 and rose to 133 after adenosine had been distributed.  Resting blood pressure was 100/60, fell to 98/60.  After Adenosine had been distributed, there were EKG changes of ischemia, complaint of chest tightness, with 1 mm ST depression.  Study was normal.  My echocardiogram was also normal, with exception of  mvp.  Ejection Fraction was 75%.  Exercise Stress Test, was not "normal".  Resting hr of 110 with non-specific ST segment abnormality.  Resting bp was 100/60.  I exercised almost two minutes.  Heart rate at peak was 171 with corresponding bp of 90/60 and possibly lower. I fainted.   I recovered after one minute with a bp of 130/70.  My 24 hour holter monitor was also normal.  I did feel good however.  The highest heart rate was 116, and lowest was31.  It showed sinus tachycardia with some palpitations, but no arrhythmias.  So , can you in simple terms give me a general idea of what all that means?  Also,  I read that if the adenosine was normal, than he would put me in cardiac rehab due to extreme involuntary deconditioning.  So,  that is a little confusing.  It has only been since the exercise stress test that I have stopped exercising, per doctors request.  As I stated before,  I was in aerobics, walked to school and took stairs, mom of two very active kids.  I have only slowed down in the past month or so, but have steadily declined since May of 1998 due to the palps, fainting, headaches, and arryhthmias that I have felt.  I am 28, 5'6, 111 lbs.  Never been sedentary-ever!  Deconditioning????  Thanks.
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Dear Kim
My interpretation of your listed test results is that everything is normal, except the exercise stress test in which your heart rate went to 170 after two minutes, associated with a drop in blood pressure. This is very abnormal. The key to your diagnosis lies in the interpretation of that rhythm during exercise. I feel that the whole thrust of your workup should be to see if you have some sort of exercise induce arrhythmia. If you do, you ought to be seen and evaluated by a cardiac electrophysiologist. I would not attribute this to deconditioning.
I hope this is useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature. Specific diagnoses and treatments can only be made by your doctor. If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.