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Forum Name: Hypertension

Question: Sudden spike in BP


 manonmclellan - Fri Aug 29, 2008 12:09 am

Hi - I'm a 48-year old female, normal bp 117/78, very steady bp, even through 5 pregnancies, never went over the 120/80, very healthy, low cholestolerol, normal sugar levels (not diabetic) etc. etc... non-smoker, mild exercise, eats very healthy, but still can lose some weight - doesn't seem to want to come off! Six weeks ago, a Saturday, was feeling sick, cold sweat, shaky inside feeling, discomfort left chest and shoulder area... Blood pressure had spiked to 170/117... went to ER, did a cardiogram - found borderline (something, can't remember what it was called!!)... 3 weeks later, sent me for a stress test and heart scan - blood pressure had come down a bit by then, 127/91... stress test/heart scan was normal... today, 6 weeks later, bp is back down to normal for me, 117/78, but have almost daily chest/shoulder discomfort... I was walking 5.5 kms per day, fast walk up until 6 weeks ago, find I'm too short of breath now... always seem to have some kind of burning 'aching' sensation in chest... my husband says he's certain I have sleep apnea - he says I stop breathing during the night - scares him to death he says, he says just when he goes to wake me up, I finally take a breath... I know that I've woken myself up a few times, feeling like I forgot to breath - wake up panicky...

Any ideas what caused this bp spike and this chest/shoulder discomfort that's still there?
 John Kenyon, CNA - Tue Sep 02, 2008 11:17 pm

User avatar Hello -

While you've gotten a pretty definitive green light from the negative stress test and nuc scan, it would seem something is still not quite right. It may not be heart related, however. First, though, the issue of the blood pressure spike at the time of the chest and shoulder pain: this often happens in such a setting due to anxiety (some people are what are known as "hot reactors" and situational anxiety can cause a brief, marked spike in blood pressure such as you exhibited at the time).

You did all the right things and although the stress test and nuc scan are very useful, they do not constitute the "gold standard" for corornary disease diagnosis -- this is done only via cardiac catheterization and angiogram. Still, in a step-based diagnostic process, the angiogram would probably be contraindicated unless your stress test had shown some significant abnormality. Nothing showed up, so unless your symptoms continue or increase, there is a great likelihood that you're ok in the heart department.

If you do, in fact, suffer from sleep apnea (and it is usually discovered by a spouse, for obvious reasons), then you are at some increased risk for heart disease. From your description of the nocturnal episodes it sounds as though you may have sleep apnea or you may be experiencing nocturnal panic attacks. Still, the fact that you can no longer sustain your former level of exercise without symptoms is troubling, and I think you'd be wise to bring this to the attention of your primary physician, along with the possibility of sleep apnea (diagnosis of this is usually accomplished via a sleep study). But there's more...

What's happening could be as simple as an orthopedic problem which is causing the pain and some restriction of ability to inhale properly, or it could be as off-target as atypical, exercise-induced asthma, which often can cause chest tightness and pain (due to use of accessory muscles). If this latter is the case, it could also explain your episodes of nocturnal breathing difficulties. For the record, both nocturnal and exercise-induced asthma are very often secondary to gastric acid reflux disease (GERD), which is often missed early on as the cause. This is also well-worth exploring, especially since you have done so well with all your cardiological exams.

To sum up: unlikely but possible occult heart disease, possible anxiety disorder, possible sleep apnea, very possible combo of anxiety/hot reactor profile plus asthma secondary to GERD.

Hopefully this will give you something to bring to your doctor's attention, since something is definitely impairing your exercise tolerance compared with the recent past. Probably not heart disease, probably not sleep apnea, very possibly anxiety and GERD. All need to be considered.

Best of luck to you. Please do keep us updated.

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