Exercise induced Hypertension
I have lately experiencing a sudden drop in blood pressure while brisk walking. I usually walk for 5 mi at a brisk pace (2.5-3 mph). My tolerance this spring has been steadily decreasing, and I am fatigued the last 1/2 mi; lately though I have been unable to go more than a mile. I am having sudden drops in HR, from >130 to 60, and subsequently am unable to increase my HR above 65-70. I have also extablished that my BP will drop to <95/60. When this happens I feel dizzy, weak, nasea, tightness in chest, and SOB. This only happens while walking, and not on ellipticle or treadmill, but I think it is time and not distance related.
I sent the data (captured from PM and HR monitor) to my EP doc, and he shared it with the company rep. The PM checked out fine on remote monitoring, and they had me come in to make a small change to an endurance setting; however, I am still experiencing these symptoms. The engineer, and company engineers are stumped.
Background: I am 68, T1D for 56 yrs (DXD age 12), Boston Scientific Accolade PM single lead installed 12/19 for SSS. I am slightly hypotensive in AM, never drop lower than 115/70,, and on 30 mg Lisinopril. Once the PM was tuned in I have no other issues Lower limit is 60, upper limit is 150, RR and MV (set to kick in at 120) are on. Once my HR drops I am unable to get it back up some time, even if breathing hard to get the MV to kick in.
I just sent my most recent data to my EP doc and my cardiologist, and have not heard back. But I wanted to tap in to the knowledge base here. My questions are:
1. Anyone else experience or know what could be causing this (I searche the internet and PubMed, but found nothing directly pertinent).
2. Which is causative? A drop in BP or drop in HR?
3. How is it even possible for a paced heart to suddenly have a drop in BP? And then not recover?
4. Could this be vaso-vagal autonomic neuropathy? I have had some episodes of orthostatic hypotension after sitting for long periods, but it passes quickly.
5. Echo a year ago was normal. Ejection fraction >60%
Thanks in advance,