Low heart beats/blood pressure and light headed -is it a danger sign?

[nspower]

The title of my question is from one of the responses to recent post on the forum. This is exactly how I am feeling these days. Is it a danger sign?

In last ten days I have seen my pulse rate decreasing, blood pressure decreasing and for last few days I also feel light theaded. Is it a sign of worsening condition?

I had MI in 2007, a stented LAD and 35% EF. I also have an ICD. I take usual medications beta blockers, ACE-inhibitors, digoxin, asprin-clopidogrel, statin, deuratics. No other symptoms. Was doing reasonably well until recently.

I failed to get any answers from my Cardiologist. Can someone on the forum please help? Do not know what this will lead to or any precautions to be taken?

Thanks in advance.

[kenkeith]

After my heart attack 6 years ago, I was on digitek for a few months only. The known side effects of digitek: "Apathy, blurred vision, breast development in males, change in heartbeat, confusion, diarrhea, dizziness, headache, loss of appetite, lower stomach pain, nausea, psychosis, rash, vomiting, weakness, yellow vision"  I was concerned with the prescription when there was a recall.  As it turned out it was the generic "digitek" for digoxin.

Heat and humidity tend to raise heart rates, sometimes to dangerous levels, and cold and wind tend to lower heart rates
  

[ed34]

Temperature changes do have an impact. When I used to open the front door to someone in cold weather I could hardly breathe. In the warm weather I felt almost normal, but hot weather would make my body slow down. Obviously you need to make sure you drink enough fluids because this will affect blood pressure considerably. I have no idea why weather affects us, maybe its the way the body changes the route of the blood to stablilise the internal core temperature of the body?

[nspower]

Thanks Kenkeith. My reduced pulse is associated with dizziness and low BP (100/70), all happening together in last 7-10 days. Since 2007 my ACE-I dose has come down from 12.5 to 2.5 to keep my BP at 110/70. For last two days I have stopped ACE-I just to make sure my BP does not fall below 100/70.

From your reply it sounds all is well except that I need to adjust my medicines. I was concerned that low pulse/BP are danger signs, in heart parients.

I did not know that digoxin also effects pulse. I am taking it 5 days a week. Looks like I need to talk to my cardiologist if this can be stopped.

Could this be due to extreme weather conditions? We are experiencing very hot summer ahead of time in this part of world and temperatures go as high as 42 deg C?

[kenkeith]

Your heart rate is low, but it is not considered a problem when being treated for a heart disorder.  My doctor said the lower the better, but if there are side effects then the medication should be adjusted. Lowering the body's pulse effectively means the heart doesn't have to work as hard to pump blood throughout the body, it becomes a more efficient organ.

When the heart rate is too slow, most people experience disturbing symptoms, such as dizziness, fatigue and weakness and you may want to contact your doctor if you can't tolerate symptoms.  My pulse has been low but I tolerate the mediction well.  The medication that may be causing you the low heart rate can be the beta blocker and/or digoxin. Did you stop taking digoxin?

[nspower]

Thanks Ed34. My pulse rate has gradually dropped from 80ies to 70ies (occassionally in 60ies)since 2007 (MI) and the betablocker has also been reduced to half (now it is 2x12.5 carvidiliol). My BP has been maintained at 110/70. The dose of AEC-I has been reduced from 1x12.5 mg to current dose of 1x2.5 mg). The BP did go low on earlier occassions but ACE-I was reduced and BP could be maintained at 110/70.

I got my ICD interrogated last week, and it shows no episodes.

My EF after MI was about 35-38%, it went down to 25-26% in the first year. After change of cardiologist and reduction in medicines it has gradually returned to 35% (last measured in dec 2009. Until two weeks back I was feeling very good.

In last 7-10 days my pulse has come down to 60ies (occassionally in 50ies and during sleep it goes down to 40ies) and BP has also been down to 100/70. I have not checked EF lately. I feel lightheaded most of the time.

Does this indicate a worsening condition?

[ed34]

Hi nspower, sorry to hear you are starting to feel worse. Can you please give us an idea of how much your blood pressure has dropped, and perhaps what it averages now. Perhaps your heart rate too?
Has your EF been tested since 2007?
I wonder if there is a medication problem? When I had my MI in 2007, I was on 5mg of a strong betablocker (bisoprolol) which was fine to begin with. By mid 2008 I began getting low on BP and HR too so they reduced it to 2.5mg and it did the trick. It could be that if the heart starts to improve, medication has too much effect. I assume your ICD has been checked?
Perhaps someone else can throw some thoughts on this, but I have a strong suspicion it could be med related.