postural hypotension.Hi...low pulse

[rrider123]

65 yo male, 6 ft 160lb, always healthy, clean living, ran marathons, cycled centuries...resting pulse 36, max pulse while cycling 173 with 9/10 exertion. Excellent pulse recovery.
For the last month or two, dizziness episodes after sitting and standing up are increasing, much more frequent after exercise...sitting pulse 52..stand up quickly..pulse goes up to 95 in 5-6 seconds then stabilizes in the low 80's in another 6 seconds and I may or may not get dizzy. As long as 8 hours after exercise, I can get a 35 beat per minute rise in pulse from sitting to standing. This morning, after being awake for an hour...I sat ..pulse 40...got up.pulse went up to 55, then while standing, stabilized at 45. This happens with good hydration and with or without eating. Among other vitamins, I take 800 mg calcium daily for foot cramps. I was very concerned..this dizziness is annoying.
A communication with another cyclist age 60 who also has dizziness occassionally stated his pulse went up only 8 beats after cycling 45 miles.
I have no other cardiac symptoms
Cardioliogist visit..normal echo and stress test and blood workup
24 hr Holter monitor showed between 2-4 AM my pulse went down to 31 and I had three episodes of beat pauses for 2.1 seconds. My pulse variation when sitting to standing was also verified after I cycled for an hour and purposely achieved a 170 heart rate. {when I am climbing at 8/10 effort I am usually in the 130's.
I am scheduled for a tilt-table test.
My cardiologist said a pacemaker to keep my pulse from going so low is advised to be done in the next two weeks and wil be confirmed by the tilt-table test. I may also need beta-blockers.
I was shocked at his suggestions and will seek a second opinion. This cardiologist is someone I can talk too, has my interests in mind, has been practicing over 30 years...but I feel his parameters do not apply to 65 year old athletes. My concerns are a pacemaker and or beta blockers may offer no improvement to my postural hypotension and may not be necessary.
on the other hand, he said the pauses at night may get worse and I could die from this heart condition.
I am scared. I will be in Delray Beach Florida starting in October and am now in Sedona AZ. Please advise with a second opinion of an "exercise" cardiologist or cardio-physiologist or any other advise you can give.
Thank you in advance for any light or referrals you can give for this condition.
I do not want to be a "cardiac patient". But, at the same time, you have to do what you have to do.

 

[rickshaw]

65 yo male, 6 ft 160lb, always healthy, clean living, ran marathons, cycled centuries...resting pulse 36, max pulse while cycling 173 with 9/10 exertion. Excellent pulse recovery.
For the last month or two, dizziness episodes after sitting and standing up are increasing, much more frequent after exercise...sitting pulse 52..stand up quickly..pulse goes up to 95 in 5-6 seconds then stabilizes in the low 80's in another 6 seconds and I may or may not get dizzy. As long as 8 hours after exercise, I can get a 35 beat per minute rise in pulse from sitting to standing. This morning, after being awake for an hour...I sat ..pulse 40...got up.pulse went up to 55, then while standing, stabilized at 45. This happens with good hydration and with or without eating. Among other vitamins, I take 800 mg calcium daily for foot cramps. I was very concerned..this dizziness is annoying.
A communication with another cyclist age 60 who also has dizziness occassionally stated his pulse went up only 8 beats after cycling 45 miles.
I have no other cardiac symptoms
Cardioliogist visit..normal echo and stress test and blood workup
24 hr Holter monitor showed between 2-4 AM my pulse went down to 31 and I had three episodes of beat pauses for 2.1 seconds. My pulse variation when sitting to standing was also verified after I cycled for an hour and purposely achieved a 170 heart rate. {when I am climbing at 8/10 effort I am usually in the 130's.
I am scheduled for a tilt-table test.
My cardiologist said a pacemaker to keep my pulse from going so low is advised to be done in the next two weeks and wil be confirmed by the tilt-table test. I may also need beta-blockers.
I was shocked at his suggestions and will seek a second opinion. This cardiologist is someone I can talk too, has my interests in mind, has been practicing over 30 years...but I feel his parameters do not apply to 65 year old athletes. My concerns are a pacemaker and or beta blockers may offer no improvement to my postural hypotension and may not be necessary.
on the other hand, he said the pauses at night may get worse and I could die from this heart condition.
I am scared. I will be in Delray Beach Florida starting in October and am now in Sedona AZ. Please advise with a second opinion of an "exercise" cardiologist or cardio-physiologist or any other advise you can give.
Thank you in advance for any light or referrals you can give for this condition.
I do not want to be a "cardiac patient". But, at the same time, you have to do what you have to do.

sounds like your are a cardiac patient, just not getting tretment yet. I was in denial about my high blood pressure for a long time, "the silent killer". Last week I had dizzy spells four days in a row, went to the doc, have started taking a cheap diuretic and BP is way down. Now I wonder why I was in denial. Get the second opinion, then man up. I'm 62, hoping to get as old as you.

 

[richwagmn]

A pacemaker for postural hypotension???

I've had it for years. It's familial. I really only get it towards the of summer. In winter, I've never had an episode.

There are all kinds of things you can do for it (if that's all you have). Practice muscle tensing before getting up. You can raise your blood pressure enough so it's not an issue. Make sure you're hydrated and if you aren't hypertensive, adding sodium to your diet can help.

Obviously, I'm not a doctor and don't pretend to be.

But as someone who has this same condition, I know you can easily deal with it if that's all it is.

http://www.mayoclinic.com/health/or.../DS00997/DSECTION=lifestyle-and-home-remedies

 

[rrider123]

Postural Hypotension

I got a second opinion from another cardiologist. This one is familiar with Athletes. I have "athletes Heart Syndrome". No cause for alarm..heart is good..no pacemaker or meds or follow-up.
For the dizziness, he recommended hydration {which has not helped me} cand compression stockings which I have not tried. I will try muscle tensing..I take to mean, do isometrics for a few seconds with arms and legs before I get up?
Thank you guys for writing.

 

[cromagnon]

Bog standard response for strange heart issues in fit healthy athletes: electrolytes. Like were idiots that don't know about re-hydration. Clearly more research required to find the REAL reasons so many athletes end up with heart beat issues.

 

[richwagmn]

I got a second opinion from another cardiologist. This one is familiar with Athletes. I have "athletes Heart Syndrome". No cause for alarm..heart is good..no pacemaker or meds or follow-up.
For the dizziness, he recommended hydration {which has not helped me} cand compression stockings which I have not tried. I will try muscle tensing..I take to mean, do isometrics for a few seconds with arms and legs before I get up?
Thank you guys for writing.

Yes the tensing is done before you get up. It is like isometrics. You can do it such a way that no one would even notice. Crossing your legs and tensing your thighs, squeezing your arms muscles, etc. It does work.

As always, hydration is important and salt can help if you're not on a salt restricted diet.

Like I said earlier, I'm 47 and have had this for years and it gets "worse" the fitter I get but I notice it most after a hard days ride.

Glad to hear it's nothing serious.

Here's a link I found:

http://www.msnbc.msn.com/id/1181149...simple-exercises-can-prevent-fainting-spells/

 

[buzzard]

Similar, but different

First, congrats on your second, more positive, diagnosis. My experience was different, but there are similarities, so I thought I'd share. Turned out I had a heart condition. Might be useful info for someone, if not you.

I have always had trouble with orthostatic hypotension, particularly in-season when I'm in good shape, and the resting pulse drops to the mid-thirties. After a long ride, it can really be a problem, to the point that I once passed out after standing up. I wound up getting a pacemaker, but it turned out I actually had cardiac issues. A couple of years ago, at age 53, I noticed that was feeling more fatigued than I was use to. Not bad, not even enough that I was sure I wasn't imagining it. Then, in riding season, I noticed that my rides were taking a bigger toll than I was used to, and later in the season I found that I didn't seem to be recovering well from rides. As the weather started turning cooler, I noticed that my hands were cold all the time. Flash forward a couple months, I went to the doctor describing my symptoms, he discovered I had a heart block, resulting in a condition called ventricular pacemaking. In the Drs. office, my resting pulse after just sitting down was 31 bpm. I was referred to a cardiologist and had assorted tests, holter monitor, etc. My heart mostly worked okay, sped up as necessary under exertion, but at rest would slow down too much. His opinion was that I was getting hypoxic while at rest, and thus actually getting more fatigued rather than recovering during sleep. He suggested, in so many words, that I didn't absolutely have to have a pacemaker, but if I got one that just prevented my heart from slowing down as much, it would probably alleviate the fatigue and recovery issues. It's been a couple of years, now, and it definitely did that. Oddly, my fitness deteriorated so much that year, I'm only now beginning to get close to where I was and, realistically, maybe never will. I guess my point is, watch for some of those other symptoms. If they start to occur, it might be worth considering the pacemaker.

By the way, even with the pacemaker with minimum pulse set to 60, I still have trouble with orthostatic hypotension. Go figure.