Extreme & Rapid Decrease in BP and HR after Stress Test
Hello. I am a 26 year old female, normal weight (5'5" 120 lbs), and have been experiencing frequent episodes of tachycardia which is often accompanied by feeling light-headed/dizzy, numb extremities, and sometimes high BP (especially diastolic). For these reasons, I received an ECHO and stress test (treadmill) today. Preliminary ECHO results looked good. Also, stress test was going great until very end (docs said EKG was looking great). My HR got up to 190 (target was 194) and my legs were getting very tired and my chest was getting tight, so I let the nurse know this. She said can you go another 30 seconds, and I said yes (I am not big on giving up). I made it the 30 seconds then partially collapsed. My vision was blurry/black, I started hyperventilating, my hearing was really weird (everyone felt like they were miles and miles away), I was incredibly nauseous, and certain I was going to pass out. They laid me down on the exam table and had me breathe into a paper bag. They said 1 minute after exercise my BP dropped to 80/60 and my heart rate went from 180s to 78. All within 1 minute. They said dramatic and rapid decrease was abnormal, referred to this as "syncope" and promptly scheduled me for a tilt table test. I was just wondering if anyone had any insight/comments about this extreme/rapid drop in BP and HR immediately following the termination of my stress test. I greatly appreciate your time.
It sounds to me like a classic vasovagal reaction, which is probably why you got scheduled for a tilt table test (which is used to diagnose vasovagal responses).
What happens is that a certain trigger (there are at least 40 of them) causes the "brake pedal" in your autonomic nerve system to kick in. The effect is a slow heart rhythm and dilated blood vessels, which together cause a low blood pressure. When you suddenly stop exercising, the body may find your heart rate inappropriately high, and the vagus nerve kicks in. The same goes with anxiety, hyperventilation, etc.
You can read about the phenomenon here:
Those reactions are usually not dangerous, but they can be really bothersome and should (of course) be investigated by your doctor.
It's great that your echo was normal and that the rest of your stress test was fine!
Thanks so much for this helpful response! The nurse did mention it could be my particular vasovagal reaction- that mosts reaction wouldn't be quite as extreme as mine, but this may just be the way my body responds to these triggers and that (like you said) it may be unpleasant but not necessarily dangerous. Fingers crossed that this is the case! Thank you!
You're welcome and let's keep the fingers crossed!
Just a fun fact that I forgot to say yesterday: When people faint from seeing blood, it's this reaction that kicks in. The biological purpose is, when we are heavy bleeding, our blood pressure should drop so we avoid losing too much blood until we get help.
This isnt going to be much help, but I wanted to let you know something "similar" happened to me this week too!
I had a stress echo on Tuesday. My HB was ~180 (target was 165) and the last BP reading on saw while I was on the treadmill was ~180/90 (I think I was on the treadmill for another 2 or so mins after than reading). When the repeat echo was done after exercise, my BP dropped to 100/80 at one point which I think was within 1min of the test (BP cuff took measurements every 4 mins so I have no idea if it got lower than that) - I also dont know what my HR was at that time.
I exercise on a regular basis and sometimes feel like Im going to pass out during the cool down period. I also have a second degree heart block and prolonged QTc so my cardiologist is wanting to see what happens to my QTc and heart rhythm during/after exercise. I havent heard anything from the dr about the test results yet.
Do you get dizzy when standing up quickly? I often do, and was told this is a vasovagal response. If that happens to you, that "could" defintely be what is going on in your case.
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