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Forum Name: Hypertension

Question: Fluctuating BP and heart rates


 teikelberry - Thu Mar 31, 2005 7:19 pm

I have found myself in a peculiar situation that no doctor has yet to successfully identify or treat. Back in January, out of the blue, my face began to burn and tingle, my throat felt constricted, I broke out in hives, my heart rate accelerated, I was light headed with flushing sensations and my bp went up to 158/92. I went to the Med Center and they treated me with Benedryl because they thought I was having an allergic reaction to something. I felt better and went home. A few days later I started having similar spell more frequently and at times with greater intensity. However, at times my BP dropped to 89/60. I went to the ER and they ran some tests and everything was fine. They instructed me to follow up with my primary doc and I did. They believed I was having some type of allergic response and they started me on steroids. That night I had an "explosion" of symptoms and also had tremors in my legs. I went to the ER and was admitted. I was on steroids for a couple of days and was then removed. They started me on Allegra and also on Troprol and Prinivil because my BP would not go down. It ranged 130-150/90's. I stayed in the hospital for 6 days while they did a ton of tests - holter monitor, ekgs, eegs, echo, blood work, urine collections, chest xrays. Everything came back fine, although the holter did capture a heart rate of 130. I was released with no diagnosis and stayed on Toprol for awhile but was taken off.

Since that time I have had random symptoms; sometimes only a few and other times all together. The main thingsat this point in time are fatigue, fluctuatin bp, and heart rate. Sometimes I feel like I my pass out. My vision is blurry from time to time and my memory seems foggy. My BP has been low (avg 90/50) and my heart rate will randomly take off, even at rest. Stress is not an issue and nothing seems to provoke it. If I'm up and about, my heart rate seems fast often. I had a tilt table test and was told it was "fine" They did not give me the drug because they didn't think it was necessary. My BP stayed consistent but my pulse did raise to 118. I had other symptoms during the test as well. They prescirbed Nadolol, which I took for one day and wound up back in the ER with an explosion of symptoms and high bp with tremors. I was taken off of it. I was recently diagnosed with low blood volume, although they are not sure if this was a cause or an effect. I was prescribed 5 grams of salt, gatoraide, and florinef. I started the florinef and after a couple of days I felt horrible. My BP was also up and I was light headed, had severe burning and tingling of my face, hives, etc..... I ended up in the ER with a bp of 154/105. After that, I saw a neurologist and he suspected that I had brain sensitivity (I did hit my head 12/31/04, but it was no severe and no concussion, although I did feel naseous and fatigued for two days). He prescribed Effexor. I was on it for a few days and could barely tolerate it. When I developed chest pains (yet to go away but docs say they are not heart related) I was taken off of it. So over the past few weeks, by BP fluctuates quite a bit, but usually low, especially when I am lying down. I don't seem to get a drop in BP upon standing (occasionally I have) but the pulse does tend to increase at least 20 beats or so.

I am a 29 year ol female who was healthly and led a full life. For the past couple of months I have had difficulty working and functioning because of my fatigue and other symptoms. At times, I feel like I am "hung over" for days and nothing seems to help. Drugs thus far have seemed to make things worse. I had tons of tests - they've even looked for carcnoid and pheochromocytoma and found nothing. My body doesn't really ache and some days I'll feel better (but not great) but in a couple of days, I seem to relapse. There seems to be no triggers. Sometimes symptoms will last several minutes while other times they last hours or days. The only history I have is that two years ago I had an excellerated heart rate but did not have any of these other symptoms. They gave me 25 mg of Toprol which I was on for a few months and then went off. I had been fine ever since. Does anyone have any ideas or thoughts on additional tests or types of doctors to see? I just want my life back. :(
 Dr. Yasser Mokhtar - Sat Apr 23, 2005 10:14 am

User avatar Dear Teikelberry,

i think you had an extensive work-up to rule out even the rare diseases.

The way your symptoms presented sounds that you had a major histmaine release in your body or stimulation of histamine receptors.

i recommend that you see a specialist in allergies if you haven't already seen one. If you are deemed to be allergic to something, you might end up having to change your work place or even where you live.

It is not easy to detect pheochromocytoma and carcinoid. i would recommend that you be seen an endocrinologist to have these tests performed in the best way possible if you haven't already seen one. Many of your symptoms point to either of these disorders. Especially the fact that when you had nadolol, your blood pressure went up and this could be a hallmark of pheochromocytoma. Increase in the blood pressure if prescribed a drug of the beta blocker group. Taking the toprol (which is a beta blocker) with nothing happening does not necessarily mean that you don't have pheo.

And i would also recommend that you have a test to detect adrenal insufficiency as well. Even though you were on florinef and it caused you problems, this does not exclude the possibility of adrneal insufficiency. These medications are best given under the supervision of an endocrinologist (in my limited experience).

i don't think that your symptoms are primarily related to the heart.

A neurologist was actually a good idea, were you tested for autonomic neuropathy? Even though these are not the typical symptoms but the fluctuation of blood pressure and heart rate might point to this condition.

No need for medications at this point unless absolutely necessary.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 teikelberry - Sun Apr 24, 2005 8:05 am

Thank you kindly for your response.

Back in January I did have a 24 hour urine test to test for pheos and carcinoid while I was hospitalized. I also had an MRI of my abdomen. Both tests showed nothing.. I recently saw an endocrinologist and he repeated the 24 hr urine and did some blood work. Everything came back fine again. The only abnormality was that my metanephrine was low, which he told me not to worry about (are there concerns here?).

Over the last several weeks, my blood pressure has been rather low ranging from 89-107/52-75. It seems to be the lowest in the morning and afternoon. My legs have been extremely achy and my feet have been extremely cold. I've had more tests on my heart - stress test and cat scan, blood work, ekg's and again, it looks fine. Just yesterday though, at around noon I had a BP 97/59 with a pulse of 83 at rest. It hovered around that area for a an hour or so and then it shot up to 122/89, pulse 90. A couple of hours later I ended up in the ER feeling weak, numbness & tingling in the left arm, and chest pressure. The first reading was 137/96. About an hour later it was back down to 93/67 and then a couple of hours later it read 107/74. For some reason, I don't seem to have the ability to regulate my BP at this point. What could be the cause?

I also recently repeated another tilt because I continue to have the episodes of racing heart, both at rest and upon standing. For instance, I'll be up and about doing normal things (i.e. shower) and my heart will go into the 120s. With this tilt, they layed me down for five minutes and then up for five minutes several times and gave me isobutronol (not spelled correctly I'm sure). My heart immediately went up 50 beats (apparently the standard is 30) and it stayed up. At the very end of the test, my diastolic pressure dropped to 42. My systolic stayed the same for most of the test. So, they gave me Lopressor (1/4 tablet twice a day). I was on it for four days and developed an extreme thirst. It was also about that time that I developed really cold feet. They took me off of it. They also prescribed Florinef again, but only .05 every other day for two weeks and then every third day. It started off ok, but I then began to have some headaches and achy legs and more fluctuation in BP, so I assumed it was the drug. I go back to the cardiologist tomorrow.

I'm not sure if I have been tested for the adrenal insufficiency. I saw a nephrologist who did a work up but I have not got the results back yet. What type of doctor normally does the adrenal insufficienty test.

I've had no neurological testing at this point, aside from physical exam. I did have an MRI of my head and cat scans which were normal. At this point, he thinks I may have some impaired nerves in my neck screwing things up. I'm not sure I am comfotable with that diagnosis at this point, but I am undergoing physical therpay in hopes of helping.

The other problem I have is a continuous burning/tingling of my face. It comes and goes, varying in intensity but I can't seem to identify a trigger.
 Dr. Yasser Mokhtar - Sun Apr 24, 2005 1:49 pm

User avatar Dear Teikelberry,

Thank you very much for the update.

i think that you should be seen by an allergie specialist. Histamine release can cause low blood pressure.

Regarding the low blood pressure, the blood pressure is not a constant number, i know that you are having symptoms with low blood pressure but there is no need to be so possessed about your blood pressure.

The adrenal insufficiency test is done by an endocrinologist.

Please, discuss the possibility that this could be a type of autonomic neuropathy with your neurologist even though the clinical picture is not typical.

If you have fatigue there is an entity called chronic fatigue syndrome and you can talk to your doctor about how this is worked-up.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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