fluctuating normal to very low blood pressure

[sigrae]

I am 54 wf wt 150, 15 years ago family dr. diagnosed svt.  One year later I had fainting spells and some chest pain.  Saw cardiologist, recv'd nuclear stress test, with normal findings and no indication of svt.
seven years ago I had crainiotomy to repair ruptured brain aneurysm.  I have some weakness on left side and have had good control of seizures with Phenytek, with some simple partial breaks through.

In the last 10 days I have had chest,left shoulder,arm,neck and jaw pain.  Also my normal blood pressure or 117/67 (avg) has been dropping quickly to as low as 80/58 and everything in between.  I spent 36 hours in hospital after one low spell caused fainting and paramedic had difficulty detecting pulse.Blood pressure drop is not related to body position.  It  changes when I have been sitting, standing or lying down.

I had nuclear chemical stress test that was normal. Several ekg's all normal.  I began experienceing some partial seizures in hospital, but Dr. never checked my dilantin level, which was found to be lower than normal by my neuro the next day at his office.

When the low pressure starts to rise I get faint headache that last only a moment or two.

I do take lipitor (20) cholestrol has never been over 203 and has been under 195 for years now.
Phenytek 400mg
synthroid
amitryptiline 25 mg at bedtime.

I walk one mile a day, eat healthy (just too much).
Brain aneurysm is only family health issue- 3 family members died around age 45.

Neuro, Cardiologist, and family dr. have no idea what is going on.  Any suggestions?

[Jack54]

Demand an echocardiogram and an MRI of the brain. See your endocrinologist and have your thyroid hormones checked. Make sure that your Synthroid dosage is correct.

Does your BP drop when you stand (or do you feel faint when you stand)?

[sigrae]

MRI out of question as aneurysm clip used is not titanium (big magnet, little loop of metal-bad).  I will ask for synthroid level to be checked, though it was normal two months ago at regular checkup.

BP may or may not change upon standing.  Faintness occurs only when bp drops, as said I can be sitting, lying or standing when the bp drops and I get dizzy and/or faint.

I see Neuro next Tuesday, or primary doc if needed before the.  Yesterday was tough, today has been better, but am still experiencingn (6 so far) fewer low spells today.

[Jack54]

You are taking a very potent combination of medicines. I would almost bet that some of your trouble is due to these medicines and interactions among them. Please talk with your doctor(s) about these medicines.
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SIDE EFFECTS of Elavil or amitriptyline:

Within each category the following adverse reactions are listed in order of decreasing severity. Included in the listing are a few adverse reactions which have not been reported with this specific drug. However, pharmacological similarities among the tricyclic antidepressant drugs require that each of the reactions be considered when amitriptyline is administered.

Cardiovascular: Myocardial infarction; stroke; nonspecific ECG changes and changes in AV conduction; heart block; arrhythmias; hypotension, particularly orthostatic hypotension; syncope; hypertension; tachycardia; palpitation.

CNS and Neuromuscular: Coma; seizures; hallucinations; delusions; confusional states; disorientation; incoordination; ataxia; tremors; peripheral neuropathy; numbness, tingling, and paresthesias of the extremities; extrapyramidal symptoms including abnormal involuntary movements and tardive dyskinesia; dysarthria; disturbed concentration; excitement; anxiety; insomnia; restlessness; nightmares; drowsiness; dizziness; weakness; fatigue; headache; syndrome of inappropriate ADH (antidiuretic hormone) secretion; tinnitus; alteration in EEG patterns.

Anticholinergic: Paralytic ileus; hyperpyrexia; urinary retention; dilatation of the urinary tract; constipation; blurred vision, disturbance of accommodation, increased ocular pressure, mydriasis; dry mouth.

Allergic: Skin rash; urticaria; photosensitization; edema of face and tongue.

Hematologic: Bone marrow depression including agranulocytosis, leukopenia, thrombocytopenia; purpura; eosinophilia.

Gastrointestinal: Rarely hepatitis (including altered liver function and jaundice); nausea; epigastric distress; vomiting; anorexia; stomatitis; peculiar taste; diarrhea; parotid swelling; black tongue.

Endocrine: Testicular swelling and gynecomastia in the male; breast enlargement and galactorrhea in the female; increased or decreased libido; impotence; elevation and lowering of blood sugar levels.

Other: Alopecia; edema; weight gain or loss; urinary frequency; increased perspiration.

Withdrawal Symptoms: After prolonged administration, abrupt cessation of treatment may produce nausea, headache, and malaise. Gradual dosage reduction has been reported to produce, within two weeks, transient symptoms including irritability, restlessness, and dream and sleep disturbance.

These symptoms are not indicative of addiction. Rare instances have been reported of mania or hypomania occurring within 2-7 days following cessation of chronic therapy with tricyclic antidepressants.
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SynthroidSide Effects

Adverse reactions associated with levothyroxine therapy are primarily those of hyperthyroidism due to therapeutic overdosage (see PRECAUTIONS and OVERDOSAGE). They include the following:

General: fatigue, increased appetite, weight loss, heat intolerance, fever, excessive sweating;

Central nervous system: headache, hyperactivity, nervousness, anxiety, irritability, emotional lability, insomnia;

Musculoskeletal: tremors, muscle weakness;

Cardiovascular: palpitations, tachycardia, arrhythmias, increased pulse and blood pressure, heart failure, angina, myocardial infarction, cardiac arrest;

Respiratory: dyspnea;

Gastrointestinal: diarrhea, vomiting, abdominal cramps and elevations in liver function tests;

Dermatologic: hair loss, flushing;

Endocrine: decreased bone mineral density;

Reproductive: menstrual irregularities, impaired fertility.

Pseudotumor cerebri and slipped capital femoral epiphysis

Too much Synthroid (thyrotoxicosis)  adverse reactions:

Cardiovascular

Palpitations, dyspnoea, angina Tachycardia, atrial fibrillation Cardiac failure Thyrotoxic cardiomyopathy
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What side effects may I notice from taking Phenytek?  
Side effects that you should report to your prescriber or health care professional as soon as possible:
•chest pain or tightness; fast or irregular heartbeat (palpitations)
•confusion, nervousness, hostility, or other behavioral changes (especially in children or elderly patients)
•dark yellow or brown urine
•difficulty breathing, wheezing or shortness of breath
•double vision or uncontrollable and rapid eye movement
•fainting spells or lightheadedness
•fever, sore throat
•headache
•loss of seizure control
•mouth ulcers
•poor control of body movements or difficulty walking
•redness, blistering, peeling or loosening of the skin, including inside the mouth
•sexual problems (painful erections, loss of sexual desire)
•skin rash, itching
•stomach pain
•swollen or painful glands
•unusual bleeding or bruising, pinpoint red spots on skin
•unusual tiredness or weakness
•unusual swelling
•vomiting
•yellowing of the eyes or skin

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Drug interaction checker:

PHENYTEK (PHENYTOIN SODIUM, EXTENDED) and ELAVIL (AMITRIPTYLINE HYDROCHLORIDE)
Severity: Moderate

Description: Treatment with phenytoin and amitriptyline may result in large amounts of phenytoin in your blood, which may cause more side effects of phenytoin than usual.
Using phenytoin together with amitriptyline may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If you are using both medicines together, your doctor may change the dose or how often you use one or both of the medicines. It is important to tell your doctor and pharmacist about all other medicines that you are using. Call your doctor if you have loss of balance, have jerky movements of the eye, or have muscle tremor. Do not stop using your medicines without talking to your doctor first.

HENYTEK (PHENYTOIN SODIUM, EXTENDED) and SYNTHROID (LEVOTHYROXINE SODIUM)
Severity: Moderate

Description: Treatment with both levothyroxine and phenytoin may result in levothyroxine not working as well for you.

Using levothyroxine together with phenytoin may decrease how well levothyroxine works, but using both drugs together may be the best treatment for you. If you are using both medicines together, your doctor may change the dose or how often you use one or both of the medicines. It is important to tell your doctor and pharmacist about all other medicines that you are using. Call your doctor if you feel tired, sleepy, or depressed; have weight gain, have intolerance to cold temperatures, have constipation, or have a decreased ability to concentrate. Do not stop using your medicines without talking to your doctor first.

***These interactions may make your condition worse. Your doctor may need to change your therapy. Please talk to your doctor or pharmacist about using these medicines together.