Salt For Low Blood Pressure

[Skip61]

Had bypass surgery in 2/09 followed by abalation in 3/09 for heart flutter. Since that time I have had lightheadness/dizzines on occassions. Cardilogists think it may be due to low blood pressure (avg 110/68) and recommeded I increase my salt intake. Never experienced dizziness before operations and blood pressure was about the same and everyone told me I had great blood pressure. I have increased my salt intake with minimum results in raising my blood pressure and still get dizziness on occassions. I am concerned about the salt intake as there is so much media against using too much salt.

[wh2399]

I've noticed that become lightheaded at times due to low BP as well but in my case it's usually around 105/55 thereabouts. By definition anything below 90/60 is considered hypotension with either systolic or diastolic dropping below this threshold. I found a quick salty snack or increasing hydration solves the problem quickly without a BP spike

[kenkeith]

An EF of 40 or more may be sufficient to maintain a balance of blood flow between the left and right side of the heart, but if so why the peripheral edema?  It seems to me that if the LVEF is adequate that may indicate the right side is not pumping adequately and blood serum is backed up in the peripherals.

[Mom2four85]

I had a full cardiac workup for pvc's - Ekg's, Stress Test, Echo's, Xray and CT. I was put in the hospital for an ablation for very frequent pvc's and for unexplained lifelong fainting. I had a Tilt table test to dx the syncope cause and my bp tanked hr stopped  dx: Neurocardiogenic Syncope and Orthostatic Intolerance.  

EP Study found long runs of polymorphic VT so they sent me to have a MRI, more Xrays, CT and a cardiac cath; 5 weeks prior to the Cath, my EF was 55-60% but the cath showed my EF at 40%, after the cath I had a pacemaker/icd implanted.

I've never been evaluated for risk/benefit of sodium intake because every dr has said my fainting is the important thing and my CM is not that bad and EF would go back up with treatment; which it didn't.  

I haven't really agreed with their treatment and have questioned that since and been researching daily trying to find the answers.  I do know, my cath was clean and I had 0% of my arteries with plaque or buildup and I've never used a salt shaker with the exception of holidays for cooking.

I'm going to CC in January so it will be interesting to see what a new doctor's perspective on salt loading, lowered ef's & risk vs. benefits will be or is the new dr just going to go the same road and say the same thing....

It's scary to think we listen to our doctors and may harm our hearts more in the meantime.

[kenkeith]

This is a heart disease forum and fluid retention would be deleterious to almost all heart patients.  For a doctor to tell a heart patient to increase his/her salt intake is not very good advice in my opinion.

I'm not a scholar on the subject dysautonomic disorder, nor have I had any experience with ANS deficiencies. You probably know more about the subject than people who have read about how the kidney functions, etc.  I do know that fluid retention may be helpful for for some conditions to raise blood pressure, but know that fluids retained won't be in the vascular system alone but outside as well,  and that apparently what you have experienced.  I had the same experience due a heart condition that backup blood volume in the lungs and peripherals.  It seems to me, if your heart was pumping normally and effectively there would not have venous edema for you.

Midodrine as a vessel constrictor (will increase blood pressure) that will decrease venous pooling (adds to the volume) and increase venous return.  All those condtions are not beneficial for individuals with a low rejection fraction (EF weak, heart contractions). Volume increase with a weak heart will cause fluids to back up into the lungs causing congested (edema) heart failure as well as fluid retention in peripherals.  
Increased volume adds to the burden of an already weakened heart.

Midodrine is for orthostatic intolerance, primarily in patients with autonomic neuropathies due to diabetes mellitus or Parkinson's.  Did your doctor do an evaluation and treat you based on risk/benefit ANS v. heart failure?....I don't know?.  If I had seen a doctor for my low blood pressure, and told to increase my salt intake to raise my BP that would have likely resulted in a harmful and possibly irreversable damage.  The doctor did not know I had a low EF because there were no symptoms.

Hope provides a perspective.  Take care and thanks for the question.

[Mom2four85]

Can you explain what you mean by serious consequences from not properly managing sodium intake? I know I've read salt can burden the heart, but I haven't found an answer as to what these symptoms or consequences are.  

For example: my EF was 55-60%, about 5-6 weeks later reduced to 40% (cardiac cath)and stayed there; my dr's still put me on Midodrine & 10,000 mg (10G) of salt daily and 3 cardiologists & another EP after him kept me on that regimen for over a year.

For me, I'm just concerned with the effects of meds & sodium, because a few months ago I started having swelling in my feet, legs & abdomen that worried me. I find it ironic a few weeks after I stopped meds & sodium, my swelling went down some and it was no longer painful to walk.  I have enough going on and don't want to deal with CHF because of a treatment from a doctor.

just another frustrating diagnosis from the medical community and doctors treating my symptoms instead of getting at the root of my problem - this seems the "normal" for doctors both big and small.  (I've even been to a large University here in Tampa and the EP's solution was "try her miracle drug that landed me in the ER after 1 dose)

In the dysautonomia forum you'll find most of us with ANS problems are treated with salt/water loading like this; by dr's on every scale - local dr's as well as CC and Mayo Clinic, so I'm really wondering why they prescribe this method if it's so harmful.

[kenkeith]

I had congested heart failure and low blood pressure.  If one gets into the etiology of CHF and the interaction with kidneys, the kidneys try to compensate for heart failure by retaining salt and water and thereby increasing circulating blood volume. This added volume further burdens the heart and diuretic medication is required,,,not add salt to the diet to raise blood pressure.

Frankly, I don't see another side for anyone with a low EF and it doesn't necessarily have to be in the heart failure range (EF less than 30). Someone in that range many times do not know they have a weak heart as they are asymptomatic, and to not properly manage sodium intake can overly burden the heart with serious consequences.  I've been there.

[ed34]

I can see both sides of this, but my main concern is the kidneys. Obviously salt governs how much water the kidneys hang on to, so that it can keep blood pressure up, but there is a point where the load on the kidneys can cause damage and disease to them. My main concern was, how would you know how much salt to consume, and how could you possibly keep it working accurately. I think it would be better to somehow get salt into a body in a controlled fashion, such as medication, rather than relying on a fluctuating diet. Yes each food has a label stating salt/sodium content, but do we know our salt absorption factors? Scary stuff if you ask me and a huge responsibility on the patient who doesn't have the accurate equipment to frequently run tests.

[Mom2four85]

Cindy; any clue what can happen to the heart with salt loading? I've asked on a couple of different sites and been told conflicting things.

Since I was dx with NCS/OI I took Midodrine and I agree the side effects esp along with BB's were horrible, but after I went off of them, I started bloating terrible - edema in the LE's and stomach but within 2 weeks of getting off all sodium & extra fluids, the swelling started abating.

It's the lesser of the 2 evils for sure...but I still question which is worse  on the heart - Midodrine or salt in those levels? I can't imagine 10,000 mg or more of salt being good for the heart but then again Midodrine has the same effect on the heart as salt does - raises the bp.

My bp normally stays at 90/60 and even Midodrine, salt/fluid loading doesn't raise it to where I don't have problems...

[kenkeith]

Thanks, I didn't know all of what you have stated.  But it seems to me there are tests to determine low sodium and electrolytic imbalance, etc., and the doctor should work with the patients not just state "increase your salt intake". There can be contraindicating health issues as low sodium can be due to other factors and a good doctor would/or should work with the patient for any disturbance of chemical elements of interest or lack thereof. Eat a banana to increase potasium is OK, etc. because that is not harmful.  Increase salt intake under certain conditions can be harmful.

I had low blood pressure and no one knew I had had a heart attack for some time subsequent. To increase my sodium level would have a serious mistake.  Also, there kidney disorders, that may exacerbated by more water retention with increase of sodium, etc.  I'm not a doctor, but it seems common sense would prevail by the rule of thumb don't self medicate! Any therapy should be done with a doctor's knowledge and quidance and not just told to self medicate....that's my point.

[cindy707]

The meds that are commonly used for hypotension have absolutely terrible side effects on the body...the most commonly prescribed are midodrine which is in the family of epi meds meaning that it can cause the heart to go out of control for alot of people in the form of adrenaline rushes and the second most common med is fludrocortisone and we all know what cortisone does to the body since it is in the steroid family.  Quoting again that salt is the most effective with the least amount of side effects is correct....the Mayo Clinic recommends it in treating hypotension as well as the Cleveland Clinic and Stanford Medical Center at the other side of the U.S.  I think that the bottom line is the bottom line..none of us are physicians on this site...it is our personal opinions only along with personal experiences....unless you suffer from high blood pressure the side effects of salt into the system other than electrolyte imbalance is minimal if any and injesting salt is not self medicating since it is a mineral not a man made med....in support of literally thousands of docs that recommend this as treatment in increasing salt intake in the daily intake of foodgroups i tend to agree with those that are physicians and i haven't yet read or researched anything that has stated that pts. are dying from increasing salt in their systems however we all know that side effects of any med can kill us.  The body absorbs salt naturally since the human body has about 7% salt naturally within our weight range and about 70% water....the math adds up...don't mean to be confrontational just factual....

[kenkeith]

QUOTE:   In the bigger scope of things salt is alot easier on the body then the meds ...

....Don't miss the point, a doctor who advises a patient to self-medicate with a substance (salt to raise the blood pressure is irresponsible) that could be harmfull is not very good doctoring.  

[Mom2four85]

This is commonplace for patients with ANS problems (autonomic nervous system) - some such as my dr prescribed salt/water loading, which I questioned alot.

In my case, sometimes my bp would tank so low and stay low that I fainted alot.  I still don't understand how a dr can prescribe salt/water loading for a patient with heart disease or like with me - cardiomyopathy - there is no way 10,000 mg or more of sodium can be good for anyone and there has to be some damage to the heart or your system from ingesting this daily.  They told me I could not get enough sodium and I should use AS MUCH salt as I possibly could.

Not one of the dr's I've been to in 16 months disagree with the treatment; 4 cardiologists, 2 EP's 2 PCP's do not think anything is wrong with this.  I find it questionable and after I didn't get well and kept on fainting even with their treatment; Midodrine and a pacemaker; I stopped the salt/water loading and started to feel better and some of the swelling I had developed started to diminish.

I'll take my chances with fainting and low bp, instead of killing my heart even more with salt loading - but that's just my personal opinion.

[cindy707]

Actually salt intake is one of the more common treatments for hypotension or low blood pressure without adverse effects.  Salt is bad for most people just for the simple fact that is definately does raise the blood pressure and thats why people with hypertension or high blood pressure are told to eliminate it.  In the bigger scope of things salt is alot easier on the body then the meds that are dispensed to raise the b/p but as Ed said your blood pressure is pretty well near perfect.  I don't know why a doc would want to raise it when it falls well within normal limits.  You may just be having your b/p flucuate on you depending on what you are doing at the time because when we are super relaxed the b/p drops and without knowing when the dizziness occurs i would probably bet on that.  If you are on a beta blocker the doc may just need to reduce the dosage but i would get to the bottom of it for sure and make sure that you have enough 02 filtering thru your body because that is the main cause of dizziness with people .....good luck with this.

[kenkeith]

If you are in good physical condition your blood pressure is not considered of any medical significance. In fact it is ideal. The lower blood pressure and good physical conditioning will also lower your heart rate. People who exercise regularly tend to have lower blood pressure than other people. It is also the case for many people who eat well and maintain a healthy weight.  Is your heart rate at rest close to 60 bpm at rest? I exercise regularily and that has resulted in lower blood pressure and about 60 bpm.

I agree with ed.  To engage in more salt and sodium in your system is not very good advice...depending on your general health, it may even be harmful.

Thanks for your question, and if you have any followup questions or comments you are welcome to respond. Take care.

[ed34]

Well this is confusing indeed. For one, how on earth would you know how much salt to consume. I'm sure it will fluctuate your pressure anyway. I disagree about your blood pressure being low, 110/68 is in the normal range and a good pressure. Are you on any medications, such as a high dosage of beta blockers?