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Blood Pressure Response to Exercise

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  • Blood Pressure Response to Exercise

    Hi Everybody,

    This has concerned me for some time now, so maybe you all can help shed some light on this for me...

    My blood pressure always seems to fall during exercise, but it keeps getting shrugged off as being not important. Last spring when i had my stress test in Pittsburgh my blood pressure fell by quite a bit, but the doc said that it wasn't significant because of my age (i'm 41). This afternoon at cardiac rehab, i asked the instructor to take my blood pressure while i was on the treadmill, and we found that it had in fact dropped by comparison to my starting reading. She told me however that it didn't mean a whole lot because my starting reading seemed to be a bit high.

    My questions are this: Even if my initial reading was considered high, shouldn't my BP during exercise have increased even higher from there? Let's even go so far as to say that my initial reading was erroneous... shouldn't my BP during exercise have at least been higher than my normal reading? My understanding of this is that if your blood pressure decreases at all, or even just stays the same during exercise, that this is an abnormal response.

    My concern of course is that my father suffered a sudden cardiac death in his fifties with no prior heart problems at all. We now know that he had HCM. My abnormal blood pressure response to exercise is yet another indicator in my mind that my path might well be the same, and i'd really kind of like to avoid that if at all possible.

    Anyone have any ideas about this?

    Jim
    "Some days you're the dog... some days you're the hydrant."

  • #2
    Re: Blood Pressure Response to Exercise

    Hello Jim,
    Is this BP response at this stage partially due to low cardiac endurance? Might it improve with more conditioning as you build up? Or is it just the plain old HCM THAT YOU STILL HAVE. This is how the HCM heart responds correct? Still I hear where you are coming from and it is rather a bit more distresing wondering if something could happen and you don't have an AICD. Now if I were you , I'd prbably get me one of those fancy watches that record the vitals and I would keep a VERY accurate , written record of my vitals in reference to time ,date and activities performed - just the ones that are rated G- and if your findings continue, present it with all seriousness to your HCM cardio and find out why you do not need an AICD. In all actuality why don't you have one? Refresh my memory a bit.
    Talk with you later.
    PAM
    Dx @ 47 with HOCM & HF:11/00
    Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
    Lead failure,replaced 12/06.
    SF lead recall:07,extracted leads and new device 2012
    [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
    Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
    Genetic mutation 4/09, mother(d), brother, son, gene+
    Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

    Comment


    • #3
      Re: Blood Pressure Response to Exercise

      Originally posted by Pam Alexson
      Is this BP response at this stage partially due to low cardiac endurance? Might it improve with more conditioning as you build up? Or is it just the plain old HCM THAT YOU STILL HAVE.
      Pam... i'm sorry but i'm not entirely sure what you are trying to say. I thought everyone's BP was supposed to rise during exercise, and if it doesn't then as an HCM'er that is considered one of the risk factors for sudden death. Perhaps i have misunderstood this in the past. Someone please shed some light on this for me.

      Jim
      "Some days you're the dog... some days you're the hydrant."

      Comment


      • #4
        Re: Blood Pressure Response to Exercise

        Jim,
        Please discuss this with your doctor - Dr. Lever should know about this as he is the one who saw you through the myectomy - -
        A drop in BP on stress test is a sign that must be evaluated as it could well be a risk factor for SD. There may be a reason for the drop that I do not know - your meds?? But normally it is a sign of high risk.

        Take care.

        Lisa
        Knowledge is power ... Stay informed!
        YOU can make a difference - all you have to do is try!

        Dx age 12 current age 46 and counting!
        lost: 5 family members to HCM (SCD, Stroke, CHF)
        Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
        Therapy - ICD (implanted 97, 01, 04 and 11, medication
        Currently not obstructed
        Complications - unnecessary pacemaker and stroke (unrelated to each other)

        Comment


        • #5
          Re: Blood Pressure Response to Exercise

          Hiiii Jim,
          I guess I was not too clear here. I will try to de -muddify my response. Yes Bp and pulse is suppose to rise with exercise in normal people when they put forth exertion. I believe I was probably thinking about the HCM factor that some of us have the opposite response; in which the BP and pulse go down when we exercise . Yes it is as I believe a factor to be considered in assessing risk for sudden death. Now that said there is some deconditioning left over that can play a role as for how your heart was behaving in response to excercise prior to surgery and now that you are beginning to work out and put the heart muscle through its paces. Also don't forget that depending on the doseage of your meds to slow your heart down, these are also playing a part. Your Bp &P response is effected by medication and you work against that. As you begin to build up, it will take a little time to see how your "newly renovated" heart will respond. I suggest you give it a little time and then re-asses how your heart rate and BP respond. If indeed your vital statistics continue to sink to the bottom of the pool when you ask them to respond appropriately then I would bring your findings to your Cardiologist .
          I hope I have cleared the muck out of the swimming pool. Sorry for the pool talk , I have been thinking we need to put it to bed for the season
          Pam
          Dx @ 47 with HOCM & HF:11/00
          Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
          Lead failure,replaced 12/06.
          SF lead recall:07,extracted leads and new device 2012
          [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
          Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
          Genetic mutation 4/09, mother(d), brother, son, gene+
          Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

          Comment


          • #6
            Re: Blood Pressure Response to Exercise

            Thanks guys,

            The rehab folks are getting very upset with me asking them to take my BP while on the treadmill. They say they don't do it for any of their other patients, and that after today they won't do it for me either. I realize it isn't really their job... i was actually just trying to gather data for when i see Dr. Lever next week. I did however get three good sets of readings this week during exercise:

            August 30
            Before: 142/80, During: 108/60, After: 122/74

            September 1
            Before: 120/90, During: 110/62, After: 118/62

            September 3
            Before: 102/78, During: 108/62, After: 128/78

            As far as i can tell, these are all abnormal readings. I'll be sure to discuss these with Dr. Lever since nobody to date has ever done a risk analysis on me. If this is in fact a risk factor, then along with my father's SCD, this makes two...

            Thanks again,

            Jim
            "Some days you're the dog... some days you're the hydrant."

            Comment


            • #7
              Re: Blood Pressure Response to Exercise

              P.S. I'm pretty sure my meds aren't responsible. My last real stress test was done without having been on any of my meds for three days (remember that fiasco? LoL) and my BP dropped pretty good then too. That was also prior to my myectomy, so whatever is causing it has not been alleviated by surgery.

              Anyway, thanks for the input!

              Jim
              "Some days you're the dog... some days you're the hydrant."

              Comment


              • #8
                Re: Blood Pressure Response to Exercise

                Jim, I'm with you. I thought the myectomy would get rid of the blood pressure drop. Be sure to check it out and share the response. Haven't been posting but have followed your saga. So far so wonderful! Hope the good only keeps going.

                Sue

                Comment


                • #9
                  Re: Blood Pressure Response to Exercise

                  Actually,

                  Jim it is apart of their jobs. I went to cardiac rehab for almost two years because of risk factors and my Bp was checked at rest, during exercise, and during cool down. After awhile with most they only did it once a week but because my responses were peculiar they said it had to be done every time. Also, you are paying them if a blood pressure is too much of a headache for them this may not be the safest place for you.

                  Just my two cents!

                  Mary S.

                  Comment


                  • #10
                    Re: Blood Pressure Response to Exercise

                    Jim, ask for records to send to Dr Lever that include your rhythm strips and BP readings at pre, peak and post exercise. Just tell them he wants to see them, and he will want to know what your BP is doing. This may very well be something that will improve with time, but you should not be consistently dropping your BP. It's not really necessary to check your BP on the treadmill, the peak one is good enough unless Dr Lever requests otherwise. It depends on how much you want to push them, but you already know it drops. If it drops low enough for you to get dizzy, you should already be getting yourself off the treadmill. If it were really a deconditioning response, it would more likely show an unexpected high reading for most people. If you are deconditioned, your heart is working harder and stressing those body systems, resulting in a higher heart rate and BP. If you've passed beyond that point, then it may drop. Are they telling you when you are in your target range? They should be. When you talk to Dr Lever, ask him what he wants your target rate and max rate to be. You may need a lower % of max for target than they are used to prescribing in your program. Hope this gives you some helpful ideas. Linda

                    Comment


                    • #11
                      Re: Blood Pressure Response to Exercise

                      Jim,

                      The drop in BP during exercise happened to me twice when I first started rehab. It hasn't happened in 8 weeks. At my rehab they always take my BP before, after 10 min on the treadmill and at the end after cooldown when my heart rate is back down.

                      Sept. 3 My BP at rehab

                      Before 86/64, During 116/70, After 84/62

                      Give it time Brother, Give it time.


                      I found that if I have plenty of water in me before I start and take lots of small drinks during rehab, I feel a lot better after.

                      Tigger1
                      " Real Courage Is Being Scared To Death But Saddling-Up Anyway "

                      Comment


                      • #12
                        Re: Blood Pressure Response to Exercise

                        Hey Jim,
                        You think your response to exercise is unusual? You ain’t heard nothing yet. When I start to exercise I begin to scream, then I fall down. It scares the living begezuz out of the staff, and the other patients freak out altogether. It is a sight to behold. Looks very much like a Chinese fire drill, except many of the patients wind up wetting themselves.

                        OK, now wasn’t that a fun picture to imagine? Seriously though, as I’m sure you know, I can’t exercise. In fact walking more then a few feet is becoming quite a problem. I had my chest x-rayed and they said I had degenerative arthritis in my back. I asked my PCP to order an x-ray of my lower back, as that is where most of my back pain comes from. You guessed it – a bad case of degenerative arthritis. Her nurse called and suggested I try Aleve before going to a pain management doc – or group – what all. Well, as you know Aleve is contra indicated for HCM, so I faxed her and asked for a prescription of Tylenol and Codine. I’ll find out where that goes the beginning of next week.

                        So Jim boy, (or is it Jim Bob? Are you from the south?) take copies of all the readings you can get hold of, and bring it to Dr. Lever. If he wants more, or special, readings – have him make out a script for it. There is no way the tech’s will deny doctors order’s.

                        The next time you see your alter ego, give him my regards.
                        Burt

                        Comment


                        • #13
                          Re: Blood Pressure Response to Exercise

                          Burt,
                          I also have "severe" (their word) degenerative arthritis in my spine - cervical and lumbar. I told my GP how much trouble I was having walking and he sat there writing down all the alternatives - Ultram - severely allergic, codeine - allergic, NSAIDS - contraindicated, Celebrex - possible cross allergy + ulcer history, etc. Finally he said that the only thing left was epidural steroids. He said he would normally recommend a series of 3 of these two weeks apart, but that since I was going back to China, he thought we should try two before I went. I had these. I can't say they were fun but I do think they have helped. Unfortunately, the help may be somewhat temporary, but I'll take some temporary help. It is better than none. I don't know what it would take to get them to give these to you, because I thought the cost was absolutely shocking given the few minutes they take to administer ($700 for an anesthesiologist + $3500 for the outpatient surgery room and care). I guess the decision whether it is worth the combination of cost and risk is a complex one, but at least you should know that this exists.
                          Rhoda

                          Comment


                          • #14
                            Re: Blood Pressure Response to Exercise

                            Hi Everyone,

                            Thanks for the responses, i appreciate your input.

                            Linda, i'm not sure what you mean by target range... are you refering to heartrate? We've never discussed that at rehab, so i have no idea what my heartrate has been or what it should be. I guess i could ask them, but they get pretty upset when i ask them questions. As for the peak blood pressure reading you mentioned, they don't take one... that's why i've been asking for one on the treadmill. I'll take the three sets of readings i do have to Dr. Lever and see what he thinks, but from now on they'll only take my BP before i start rehab and after i'm done. No more special favors for me! LoL. I'm just supposed to do what they tell me and shut up.

                            Tigger, i've actually been feeling great! Getting back into a regular exercise routine has really helped. My unusual BP response goes back a long ways... i'm just trying to gather data for Dr. Lever so i can be evaluated for an ICD.

                            Thanks again,

                            Jim
                            "Some days you're the dog... some days you're the hydrant."

                            Comment


                            • #15
                              Re: Blood Pressure Response to Exercise

                              Hi Rhoda,
                              Gee, it’s great to see that you’ve arrived safely and are back posting to the boards again.

                              As I’m absolutely certain you are aware - arthritis does not come about overnight, although – aren’t you a bit young to be fooling around with this stuff? I’ve had back problems for more years then I care to remember, to the point that I could not stand still but either had to move about or lean against something. I had the series of steroid shots – cortisone – around seven or eight years ago, although the shots at that time were administered almost a year apart. The first shot was a great help, the second shot was great, the third shot was. The effects of the first shot lasted close to a year, the second a tad less then six months, and the third almost no time at all. The doctor and I agreed to pursue it further would be fruitless.

                              I’d like to say a pain in the back is almost a pain in the butt, but that would be too obvious – even though my tail bone is now involved. So, here we go – I now have it in my spine, coccyx, hips and shoulders. I’d probably have it in my brain too, but I don’t use that very much. It’s mostly there as a pogo stick to help me jump to conclusions.

                              I’m not a great advocate of narcotics. I’d rather save them for when they are really needed. Around last New Years my cardiologist used three kinds intravenously to slow my heart so it could pump more efficiently, and I was grateful he had the edge of newness to help with its effectiveness. At this point I want relief more then abstention (at least occasionally) and asked for the Tylenol and codeine, however I’m not ready to go the whole pain management course – at least not yet.

                              I bought a little scooter I can fit into the trunk of my car, and I am so happy I did. I can now run around again with my wife, and have hit the malls a number of times. We’re just about to do the museum circuit in Las Vegas – want to see the Guggenheim show, the Wynn Collection, and the Monet exhibit at the Bellagio. I had to buy the scooter out of my own pocket. Both Medicare and the VA turned me down flat. – The VA even told me I should walk more. Oh well, what can you expect. They were even charging hospitalized wounded soldiers for their food.

                              Well, I’ve rambled long enough. Good to have you back to talk to.
                              Burt

                              Comment

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