Orthostatic Hypotension

Orthostatic Hypotension

by Gemita - 2023-09-23 18:07:13

Hello Wazza, I am sorry to hear about this.  Unfortunately while a pacemaker will not allow a fall in heart rate below the LRL, it is usually unable to prevent a fall in blood pressure which is why some folks with pacemakers still suffer from syncope.  The tapping on the device when Rate Response is activated is already used by many here apparently, especially if they need to have Rate Response on because of Chronotropic Incompetence.

I briefly looked at your link.  Do you have Rate Response ON?  If you need Rate Response and are already using it, then this wouldn't be a problem to try tapping, but if you don't need Rate Response you might find that your heart rate might spike with Rate Response ON when you don't need it.

It will be interesting to hear what your cardiologist/EP thinks about this as a partial treatment for your Orthostatic Hypotension, but I wouldn't get too excited that it would reliably treat your condition, but perhaps I am wrong?

Tapping & Meds

by Penguin - 2023-09-23 18:27:29

Hi Wazza,

I'm sorry to read about this too. 

As Gemita says above, I'd read about 'tapping' the device to make it increase it's rate somewhere on this forum. It might work but like Gemita, I wouldn't rely on it.  Usually for BP issues the drugs mentioned in the AHA article you supplied are used, and other measures like increasing salt / water intake and compression stockings / binders may be tried as well or first.  These all increase BP or stop blood from falling to the extremities.  As Gemita says, this is the problem with orthostatic hypotension. 

Out of interest which drug originally caused the problem?  Withdrawal of a drug can sometimes cause an exacerbation of the original problem or a new one.  It may take a while to resolve if that's the cause as the body needs to adjust to the drug being taken away, particularly if it's withdrawn quickly. Lots of cardiac drugs cause withdrawal syndromes.  May be worth investigating this article which lists and explains some of the offenders. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200000/

Pacemakers have an algorithm for orthostatic hypotension called rate drop. The theory is that the algorithm catches your heart rate as it falls after BP drops, and increases it to try and stop a faint.  Basically it's doing the same job as the tapping in your article but more selectively and scientifically. It doesn't always work. 

I have the same PM as you and tbh I don't know whether or not it has a 'rate drop' function. May be worth asking your techs.  It may be better to rely on a pacing algorithm if you have one on the Abbott Assurity device rather than 'tapping'. 

Hypotension

by WazzA - 2023-09-23 18:31:11

Thank you for your response Gemita. Yes my PM is set to DDDR , my thinking was that if sensitivty was increased then an increase in heart rate would increase blood flow & BP thus redeucing any symptoms ( probably totally wrong) lol . I shall remember to let you know of my EP's thoughts & comments. 

I had no idea some folk already use this albeit for another problem. 

Best wishes & thanks again for the input.

Tapping & Meds

by WazzA - 2023-09-23 18:45:03

Hi Penguin, I have been on Bisoprolol for over 4 years & was prescribed TAMSULOSIN for an enlarged prostate after my hypotension problems were diagnosed I was taken off it & am now on a drug called FINASTERIDE which evidently takes up to 6 moths to achieve full effect. Funny as you mention increasing salt intake which was recommended to me as well by my GP.

The double vision has completely stopped since coming off Tamsulosin but still experience dizziness. I guess it's a case of monitoring progress.  

Thanks for a very informative & helpful post.

Finasteride

by Penguin - 2023-09-23 18:59:17

Common side effects of Finasteride: 

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Chills

cold sweats

confusion

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

Re: Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/finasteride-oral-route/side-effects/drg-20063819?p=1

Could the new drug be the cause?

Finasteride

by WazzA - 2023-09-23 19:11:57

Thanks Penguin, You have just shown me WHY we should question any changes to meds, I was assured  by my GP & accepted by myself that Finasteride would not affect me as the Tamsulosin did. I normally check for interactions myself but not on this occassion.

It is certainly something I will raise at my review.

Additional Reading Material

by Penguin - 2023-09-24 05:05:27

There seems to be some controversy over this drug. I remember reading about increased risk of depression / suicidality some time ago and post-finasteride syndrome, which is a syndrome of long lasting effects once the drug is withdrawn.  

This link discusses concerns about whether or not it may increase the risk of prostrate cancer.  It may be worth reading up on this drug before any discussions with your doctor and doing some internet searches on post-finasteride syndrome, if you'd like to find out more. 

https://www.ncbi.nlm.nih.gov/books/NBK513329/ 

Orthostatic hypotension ought not affect driving

by akaDM - 2023-09-24 15:25:19

Do you have episodes of low blood pressure that aren't associated with standing up?

Blood Pressure/Driving

by WazzA - 2023-09-24 15:58:32

Hi akaDM. When I was first prescribed Tamsulosin I did experience Double Vision when driving & was able to cover one eye ,which eliminated it enough to reach a safe place to stop! ( a bit luck being drunk with double vision close one eye to see straight) LOL. Very scary at the time though.

When sitting at rest I was getting readings on the low side in the range of 95/60 & stabilising around 105/80. Thankfully I,ve not experienced any Double vision since my change of Meds but do still get moments of dizziness/light headedness. Hopefully Gp's etc can sort it out, at least I have seen some improvement. Best wishes.

Low BP episodes

by akaDM - 2023-09-25 06:52:23

Hi WazzA

So the driving issue is purely the effect of medication rather than the orthostatic hypotension.

Plus the low BP sometimes.

I've often wondered about episodes of low BP. Significant risk if you also have orthostatic hypotension. I was told that mine would probably stop with the pacemaker: mostly true but have had at least one since, though I haven't had the degree of lightheadedness where I need to be very careful about standing. 8 don't have any medication aimed at it.

Tapping

by piglet22 - 2023-09-25 07:37:36

Response to exercise is probably going to be in response to a built in component called an accelerometer. They work by sensing changes in the the three axes XYZ.

Mobile phones can accurately count footsteps by analysing the complexy way in which your body moves when walking or running. I have noticed that the motion of pedalling while cycling does not register, so it can tell the difference between the two.

I would be a bit sceptical about tapping affecting rate response and just tried it out with no response. I think it's the wrong type of movement.

I'm also sceptical about certain types of GP advice. One of mine was definitely of the more rural medicine types.

His approach when I first reported early symptoms of heart block was to suggest I rubbed the area in my neck over the vagal nerve.

It did nothing other than prolong the period before I got proper treatment.

Tapping PM

by WazzA - 2023-09-25 10:35:37

Thanks piglet22. 

I've been reading a few articles & now understand that an increse in HR will not neccessarily result in an increase in Blood Pressure. So guess I will be pursuing another cure.

My PM is set to DDDR & when I tapped /drummed my PM with my fingers it did result in an increase of about 20bpm but it quickly returned to it's original rate when I stopped !  

Evidently driving a car over rough ground can trigger RR in a PM as if you are walking or exercising. Best wishes thanks again.