Very low pulse - High BP and palpitations - confused!

I am 40 year old male, non smoker and I keep fit with regular exercise. My diet is reasonably well balanced and I eat fruit and veg and avoid too much fat and never add salt etc.

I have always (for as long as I can recall 15+ years)had a very low resting pulse rate of about 40 bpm (sometimes drops as low as 36).

I started experiencing palpitations about 4 or 5 years ago. They come and go, but when I get them they can be constant and very distracting. When I sought treatment my BP was high at the doctors. Over the past 3 years I have kept on eye on it and basically it’s normal when I am relaxed at home 125 to 135/80 give or take a wee bit, but it takes very little stress or exertion for it to rise. Every time it’s taken at the surgery it’s in the region of 160 to 170 over 90 to 100 but my pulse remains low at 45 bpm or so.

I had tests done with a 24 hour heart monitor, treadmill and echocardiogram. Nothing came up, although on initial inspection by the heart specialist he though he heard a murmur and suspected Mitral Valve Prolapse. He later diagnosed this was not the case after my tests and advised that the palpitations were probably something I would have to put up with.

I resisted several attempts to get me onto BP tablets, because I was convinced my home readings showed BP wasn’t the route cause of my problems. I feel something else is driving it. As far as I am concerned it’s not a lifestyle issue. The only thing I do which goes against me is enjoy a few real ales 3 or 4 nights a week, but not excessive quantities, 2 to 4 pints. Life’s only real indulgence!

Over the past few months my palpitations have been almost daily and it doesn’t seem to take much for me to get a stress headache. I had a further ECG done and it came back normal except for high BP and my doctors said it showed early signs that my muscles within the heart were larger because it’s working too hard. Kidneys, liver and thyroid were all normal. He has put me on 2mg of Perindoril. I don’t take any other medication except an inhaler before sport for astma.

I know something needs to be done keep my BP in check when I feel under pressure, but I can’t help but feel there’s an underlying cause that’s not being found. Can anyone advise on possible alternative reasons for what is happening to me?

[is_something_wrong]

As long as the heart rate increases properly with exercise, and you don't get symptoms like dizziness or tiredness, there is nothing to worry about. A sign of good heart health and strong pumping capacity.

You could ask for another echocardiography (if this was a long time ago) just to see if your heart is enlarged (fairly common with high blood pressure).

People tend to think there is a correlation between high heart rate and high blood pressure, and opposite. There isn't. Well, if adrenaline provokes the heart rate, it will often cause harder heart beats too, and constricted blood vessels, causing high blood pressure, but a low heart rate can also cause high blood pressure. If your heart pumps 150 ml 40 times a minute, instead of 75 ml 80 times a minute, the blood pressure must be higher :) When the stroke volume is this high, a little blood vessel constriction can cause higher increase in blood pressure than otherwise.

Alcohol in the amount you mention shouldn't increase your blood pressure.

Please be aware that blood pressure can greatly increase even with stress you aren't aware of! My blood pressure is (at rest, in bed) 110/60. After dinner it's often 125/70. At the doctors office it's 140/80 and at the cardiologist it's 150/90. Before connecting to EKG it's 160/110. (I hate EKG's because I've learned to interpret them myself and my cardiologist thinks I'm crazy).

LVH signs on EKG can be false, but I'd do another echo if I were you. Possibly a 24 hour blood pressure monitoring. If that would turn out to show high blood pressure, there are medications that handle HBP without decreasing your heart rate that you could consider.

[Jerry_NJ]

I am not sure there is a relationship, but the low HR may cause the heart to beat harder, raise the BP, not sure.  I do know a low HR and low BP causes dizziness.  The down side of the little I do know is that most (all?) BP lowering drugs also lower the HR, which you can't tolerate I'd guess.   I know in my own case of too high a HR and normal BP the beta blockers initially caused my BP to drop too low, causing dizziness. Happily later the BP came back to low normal - then too the HR lower also lost some of its "edge".  It seems the old body tries to adjust to medications to counteract them, not sure on this point either, but seems to be true for me.

Sorry I don't have anything to really help, seems you've had all the expert advice and tests, which doesn't leave much else to go to ... unless someone here has a clue, hope so.

Good luck, and welcome to the Heart Rhythm community.

[PaulFT]

Thank you for the feedback.

I hope the medication doesn't lower my HR by much otherwise I will be keeling over. The doctor immediately discounted beta blockers for the palps for this reason, so he was aware of the low HR issue.

The bit that he was confused by was that low HR usually meant low BP, so it seems I am a bit of an odd ball in that regard.

[Bromley]

Hi. I think the first thing I would do is --- when you can --- remove variables that might be contributing to the problem. You don't have to give up your 2-4 pints forever, but it might be worth it to save 'em whilst you try to figure this one out.

If your heart rate is low and you feel palpitations. It might be:
1. normal. People in good shape have lower heart rates. Lower heart rates lead to more PVC's.
2. bradycardia. Unlikely if you dont have symptoms.
3. first degree heart block. (unlikely if you had an EKG and it was normal).
4. something I am not smart enough to suggest because I am not a doctor.

I am pretty sure the size of the heart is usually gauged by the echocardiogram not the ecg though. High BP, and other causes, can lead to changes in the heart muscle. Dilated or hypertrophic cardiomyopathy are examples of such changes. Some times these problems run in families; sometimes athletes have problems with em. The echo is something they use to identify these problems.

If I were you, I think I would cut back on ale for a while and see what happens. If you have high BP and thickened heart muscle, I cant imagine alot of ale would help. For me, 2-4 pints would be way over my limit, especially if done more than one time per week. (But I am a light weight).

regards,

[is_something_wrong]

As long as the heart rate increases properly with exercise, and you don't get symptoms like dizziness or tiredness, there is nothing to worry about. A sign of good heart health and strong pumping capacity.

You could ask for another echocardiography (if this was a long time ago) just to see if your heart is enlarged (fairly common with high blood pressure).

People tend to think there is a correlation between high heart rate and high blood pressure, and opposite. There isn't. Well, if adrenaline provokes the heart rate, it will often cause harder heart beats too, and constricted blood vessels, causing high blood pressure, but a low heart rate can also cause high blood pressure. If your heart pumps 150 ml 40 times a minute, instead of 75 ml 80 times a minute, the blood pressure must be higher :) When the stroke volume is this high, a little blood vessel constriction can cause higher increase in blood pressure than otherwise.

Alcohol in the amount you mention shouldn't increase your blood pressure.

Please be aware that blood pressure can greatly increase even with stress you aren't aware of! My blood pressure is (at rest, in bed) 110/60. After dinner it's often 125/70. At the doctors office it's 140/80 and at the cardiologist it's 150/90. Before connecting to EKG it's 160/110. (I hate EKG's because I've learned to interpret them myself and my cardiologist thinks I'm crazy).

LVH signs on EKG can be false, but I'd do another echo if I were you. Possibly a 24 hour blood pressure monitoring. If that would turn out to show high blood pressure, there are medications that handle HBP without decreasing your heart rate that you could consider.

[Bromley]

From the Mayo Clinic:

Question
Alcohol: Does it affect blood pressure?
Does drinking alcohol affect your blood pressure?
Answer
from Sheldon G. Sheps, M.D.

Drinking too much alcohol can raise blood pressure to unhealthy levels. Having more than three drinks in one sitting temporarily increases your blood pressure, but repeated binge drinking can lead to long-term increases.

Heavy drinkers who cut back to moderate drinking can lower their systolic blood pressure (the top number in a blood pressure reading) by 2 to 4 millimeters of mercury (mm Hg) and their diastolic blood pressure (the bottom number in a blood pressure reading) by 1 to 2 mm Hg.

If you have high blood pressure, avoid alcohol or drink alcohol only in moderation. Moderate drinking is generally considered to be:

    * Two drinks a day for men younger than age 65
    * One drink a day for men age 65 and older
    * One drink a day for women of any age

A drink is 12 ounces (355 milliliters) of beer, 5 ounces (148 milliliters) of wine or 1.5 ounces (44 milliliters) of 80-proof distilled spirits.

Keep in mind that alcohol contains calories and may contribute to unwanted weight gain — a risk factor for high blood pressure. Also, alcohol can interfere with the effectiveness and increase the side effects of some blood pressure medications

[PaulFT]

Thanks for taking the time to reply.

Tiredness - no, only if I get lack of sleep, although I've never been a real full of life type who can't sit still. I can sleep till the cows come home if I could!
Dizzyness - nothing that has made me go light headed, although I get a flash when I have palpitations. It feels a bit like there's a missed beat and for that split second my head's short of blood / oxygen.

I do feel sure my BP is driven by stress. Home readings are within normal range, but any bit of anixety and it goes up. In the doctors it will be 170, yet 20 mins later, back at home, normal again. I feel poweless and whilst calm 10 moments beforehand, it always shoots up, yet the pulse stay lowish.

On my next visit, I will ask about a 24hr bp monitor, as that will give a better indication of what is going on and probably should happen before I'm treated with Perindoril.