Ramipril and Slow Heart Rate

[theolocke]

Hello, I am a 31 year old male in relatively good health.  I have been told by my GP that have anxiety disorder and have had some problems with that.  However, after having a number of episodes while exercising, during which my heart rate would "jump" up, I decided visited my cardiologist.  I had an exercise stress test, which came back normal, and an echocardiogram.  Overall the echo was fine.  My EF was 53% and and the summary said I had sinus tachycardia (my heart rate averaged 101 during the echo, but I was nervous and had been running around campus all morning, going up and down stairs, etc.).  In addition, the results stated that I have borderline global hypokinesis.  The size of my left ventricle is normal, but it isn't moving optimally.  I have always had high blood pressure readings, generally over 130 and in the upper 80s, sometimes over 140 (when I went for my follow up the reading was 152/87).  As such my cardiologist has put me on 10mg of ramipril.  I have been on it for two weeks now with little side effects.  However, my "resting" pulse rate is always in the 60s now, and sometimes hovers in the upper 50s if I am just sitting and doing course work.  Is this normal?  Also, from what I have read, it seems most people start on a dosage lower than 10mg.  Is 10mg kind of a high dosage to start at?            

[kenkeith]

Thanks for your response.  It appears you are taking good care of yourself and an interest in your own helath condition is commendable.

[theolocke]

Thank you Ken.  I'll be sure to talk to my cardiologist about this.  I did have blood work done April, and my cholesterol was fine; I don't remember the numbers offhand, but I do recall that they were well below the acceptable numbers.  I'm at a loss at this point.  I think I've caught some things with the event monitor.  I called my cardiologist's office and they said just to keep exercising and they would call and let me know if I need to stop.  However, I am concerned about the high diastolic reading.  I check it right after I stop jogging, usually I jog for no more than two minutes straight, walk, repeat.  Most often my diastolic reading is in the 90's, but sometimes it gets above 100.  My resting diastolic is always in upper 60s to lower 70s, especially since I've been on Ramipril, so I'm a bit alarmed at the increase during exercise.  I checked my blood pressure as soon as I stopped jogging, standing up, and with my arm resting on the back of a bar-stool at a 90 degree angle; I try to emulate the way they measured it during my stress test, during which my diastolic never went above 90, that was in April.  I was trying to see if the irregular heart beat symbol would come on so that I would know when to record an event.        

[kenkeith]

You are introducing the subject related to exercising physiology.
We know that blood pressure dynamics during exercise are well established. When heart rate increases with exercise systolic blood pressure  rises steadily during exercise. Within certain parameters this is a desired effect.

Systole BP may rise from 120 mmHg during rest to greater than 250 mmHg. At the same time, little change is noted in diastolic pressure. Typically there is very little change or a drop less than 10 mmHg. At the rest phase of the exercise bout, the systole BP should drop back to normal values within a few minutes.

The increase in diastolic blood pressure at peak exercise is significantly higher in patients with hypercholesterolemia. Among the patients with coronary artery disease, the diastolic blood pressure also increases during exercise.  Diastolic pressure should not vary by more than 5 to 10 mm of mercury because this represents pressure in the system when the heart is not contracting. A significant elevation in diastolic blood pressure during exercise could be an indication of a serious health issue or malfunction within the cardiovascular system.

Hope this helps give you a perspective.

[theolocke]

Is a BP reading of 190/106 too high right after exercise?

[theolocke]

I recently took a trip to the ER.  I was jogging, lightly and not in the heat, and when I stopped, I got a quick, funny feeling in my abdomen.  I immediately checked my pulse, and my heart was beating chaotically; it felt like it had stopped beating, then beat about three times and stopped again, then started again.  My BP was around 208/102.  I went to the ER, and it happened again while I was there, but before my ECG; nothing happened on the ECG.  Also, chest x-ray was fine and my blood work, which include an electrolyte check, was fine.  The ER doctors said the only concerns were my blood pressure, about 158/90 in the ER (not an emergency) and fast heart rate (probably due to nerves).  They both said what I experienced were more than likely PVCs and that I need to schedule for an event or holter monitor; I just had a stress and echo in April.

I do not have insurance.  My question is:  how much do these things cost?  How much is the holter?  How much is the event monitor?  

[kenkeith]

If your ejection fraction (EF, % of blood pumped with each heartbeat) is 50 to 70%, there may not be much of a problem, however, the doctor should have an understanding of the underlying cause for the hypokinesis so the imparirment can be treated.  The echo report should give the EF percentage.  It seems hypokinesis would not provide a negative echo test, but if the report shows a normal EF (50-70%) there may not be an issue!?

[theolocke]

Thank you Kenkieth.  I have a feeling he'll just tell me I'm fine and to exercise.  The hypokinesis comes from "left ventricular systolic function is borderline reduced."  Other than that and the trace insufficiencies, the echo was fine.  At this point I'm not sure if I'm just not being a hypochondriac or maybe I should get a second opinion.  My doctor doesn't seem to want to listen to me; maybe he thinks I'm nuts.

[kenkeith]

If you had a normal stress test and echo what is the source of the hypokinesis diagnosis?

Ramibril can cause your symptoms. The recommended dosage to start is 1.25mg. Increase every 3-4 weeks if needed.  Also, a blood test should be given to confirm kidneys are functioning well and that there is no imbalance of electrolytes.

You should contact your doctor as there appears to be instability of the cardiovascular system

[theolocke]

I might also mention that the results of my echo stated I had "trace mitral regurgitation" and "trace aortic and miral insufficiency".

[theolocke]

Thank you everyone for the responses.  My heart rate is back to "normal".  Moreover, I seem to have noticed a decreased heart rate while doing yoga and walking.  By decreased, I mean before it would be in the 120's now it is down around the 90's to upper 90's.  Even better is the fact I really feel like I have more energy and feel less run down. My blood pressure is always below 120/80.  I had a follow-up with my cardiologist this week and mentioned that a couple of times after jogging the irregular heart rate detector on my Omron BP 710 blood pressure monitor flashed; the manual for the detector states,

"An irregular heartbeat rhythm is defined as a rhythm that is more than 25% slower or 25% faster from the average rhythm detected while the monitor is measuring the systolic and diastolic blood pressure."  

I also mentioned some mild dizziness after I stop jogging.  He didn't seem to be bothered by either and told me to drink lots of water.  I also asked him if I should worry about pushing it while I exercise, and he said, "no."  

However, this morning I was checking my blood pressure (109/64, pulse 81) and the irregular heart rate symbol came on - I had just woken up, I had not done anything physically strenuous.  I did some jumping jacks, checked it again (142/81 pulse 102), and the irregular heart rate symbol came on, again.  I checked my BP five minutes later, 118/71, pulse 72, and no symbol.  I have also noticed that when I first start jogging I can hear my heart pounding in my head, but it goes away.

I'm a little worried, and I am contemplating calling my cardiologist back and seeing what he thinks about me wearing a Holter monitor.  I did have a normal stress test two months ago, and my echo was fine, except for the borderline hypokinesis.  Is it possible that the Ramipril is lowering my blood pressure to much and that is causing an arrhythmia?  Is it the hypokinesis?  Should I just relax and listen to my cardiologist?                

[kenkeith]

QUOTE: " My EF was 53% and and the summary said I had sinus tachycardia (my heart rate averaged 101 during the echo, but I was nervous and had been running around campus all morning, going up and down stairs, etc.).  In addition, the results stated that I have borderline global hypokinesis.  The size of my left ventricle is normal, but it isn't moving optimally".

An aspect of your condition requries an explanation from your doctor.  Hypokinesis indicates your heart cells have been compromised.  That condition is usually due to ischemia (blocked vessels), but your normal EF indicates it is not a serious condition.  However, you should get an explanation.  Hypokinesis can cause shortness of breath, fast heart rate, etc.

[ed34]

A diastolic of 60 is too low really. It's on the border for hypotension. Suggested optimum is 120/80. After fatty or salty foods you can expect 130/85. Anything up to 90/60 is classed as hypotension. When jogging, do you warm up first and cool down at the end? How long have you been jogging?

[theolocke]

Thank you for the responses.  The medication has been effective in reducing my blood pressure, it is always in the 110-125/60-75 range now.  Moreover, my heart rate during yoga is down by at least 20 bpm.  However, I still cannot seem to getting my jogging heart rate down, and I have recently been having problems with dizziness right after, and sometimes during,  I stop jogging, something that did not happen before I started the meds.  I'll have to ask my doctor during the follow-up.  

[ChatterAlly]

I take Lopressor & Norvasc to lower blood pressure and treat spasms, & was put on an additional dose of Atace 10mg.  I was started on 10mg and took that at night because I take the other 2 in the morning.  I was switched to the 5mg and this worked much better for me.  With the 10mg I could tell my blood pressure and heart rate would fall more than it should. I agree with Ed & KenKeith with the regard to starting with the 2.5 mg.  Take care, Ally.

[kenkeith]

A heart rate greater than 100 is considered abnormal by test standards and may not indicate tachycardia, but a normal response due to circumstances.  Sinus tachycardia indicates the heart rate is derived from the normal source, and not from an abnormal source, and that could indicate an abnormal arrhythmia.

The usual dose of ramipril is 2.5-20 mg a day as a single dose or two divided doses. Patients taking diuretics or who have renal artery stenosis (narrowing of the arteries going to the kidney) may require lower doses. Your doctor should be aware and adjust any dosage accordingly.

Thanks for sharing and take care.

[kay2486]

you bp may be high because of you being nervous, your pulse seems fine the meds will reduce your pulse too aswell as your bp, your doc will know best what to start you on,

[ed34]

You state what your heart rate is now, but what about your blood pressure. If your blood pressure is high and is then put to normal, your heart will not have to work so hard to push blood around your system. However, I had very high blood pressure for years and was also put on Ramapril. My blood pressure was higher than yours and I was on 5mg daily which seemed to be too much, it was reduced to 2.5mg. The only way to establish if the dosage is incorrect is to get your blood pressure measured. You say "with little side effects", which side effects are you getting? are you getting light headed? getting lots of headaches?