Harmful Supine/Nocturnal Hypotension?

[Miss_muffet]

Hello,

I am a 23 year old female. 5'3", 105 lbs.

In 2011, I began having issues with rapid heart rates at rest and on exertion along with other symptoms that seemed more neurological in nature. I had a battery of tests, and all came back normal. Heart and brain totally fine.

I met with an electrophysiologist and was diagnosed with IST, and had a sinus node modification in March of 2012. It has left me with incredibly frequent low atrial/junctional ectopics, bursts of paroxysmal tachycardia, episodic bradycardia (low as 42 while awake), and as of late I am having sinus tachycardia on exertion even worse than before my ablation (upwards of 150's-160's).

More troubling, I seem to be having what I think is angina-type pain and discomfort, as well as more shortness of breath. I've had a centralized ache in my chest, an almost shooting-type pain in the left side of my neck, and pain in my upper back. I've also had at times intense pain that will seem to travel down my inner-left arm.

I have a wrist BP monitor, and I got curious a few nights ago while I was lying in bed (I hadn't been to sleep yet), so I checked my BP. It was 73/42 with my HR 85. Now I know I am a small, very young woman so having a lower BP is definitely not out of the norm. But I have NEVER seen it that low. I took it a three more times, making sure my arm was in the right spot, with similar results. It's been the same every night. If I sit up, my BP rises to the low 100's/60's within a minute or so.

My blood pressure during the day is normal: 100-115/65-80

Is it at all possible that my blood pressure is too low at night and doing some kind of damage, even with zero heart disease? Could my arrhythmia exacerbate this?

[CCFHeart MD23]

Dear Miss_muffett,

I'm sorry to hear that your palpitations and symptoms have returned despite prior treatment. Before getting to your specific questions I would strongly recommend that you arrange a return visit to your electrophysiologist so that he/she can re-evaluate your heart and heart rhythm and advise you regarding further tests and treatments. Doctors rely heavily upon patients letting us know about any change in their condition. Not making contact with your doctor limits his/her ability to properly manage your heart condition. In addition to changes in heart rhythm patients with inappropriate sinus tachycardia can experience reduced heart function and this is important not to miss because early treatment can re-strengthen the heart muscle.

When assessing low blood pressure we look not only at the number but also at (1) the circumstances in which the BP was measured - i.e. resting or with activity, (2) medications being taken (3) volume status of the patient - dehydrated? and (4) whether the patient is experiencing symptoms such as dizziness with low BP. The blood pressure and heart rate you describe are not uncommon in young patients at rest and during sleep. An increase in BP with sitting is a good sign. Changes in heart rhythm can certainly contribute to low blood pressure. Whether further investigation or treatment is required would depend upon your answers to the other questions listed above.

If the chest pain is becoming more frequent, severe, or prolonged, it is worth checking out with your family doctor. At 23 years of age you are less likely to have coronary disease. If on the other hand you have a strong family history of coronary disease (first degree relatives) and other risk factors such as diabetes, smoking, high cholesterol, or kidney disease, then you would be considered higher risk and further assessment of your chest pain would be indicated (sooner rather than later).

One last comment: the normal maximum heart rate for a 23 year old is approximately 190-200 beats per minute. Heart rates of 150-160 with moderate exertion are therefore not unexpected, although once again it depends upon the exact context in which you are experiencing this heart rate.

I hope that this information is helpful. The short answer is to check in with your local doctor or electrophysiologist so you dont spend any longer worrying about this than you need to.

Take care and good luck.