Low pulse, high(ish) blood pressure?

Hi,

First thing to say is that I'm getting all of this checked out, firstly at the GP and then if I can't get refrred by paying for a proper cardiac aseessment.  More on that below.  I just want to know whether anyone else has been through anything like this.

I'm 40, 6ft 2 and 80kg and pretty fit.  I've been running for years - 25+.  I enjoy it, I always have.  When in training, I can do a mile comfortably in under 6 minutes, 10k in about 40 minutes and have done half marathons in 1.28.  I had my VO2 max tested last year and it was 62.2 ml/kg which I think is pretty high.  My resting pulse on waking is about 45, my max HR is 160.  Never seen it above that, even chasing people up hills flat out.  We'll come on to my BP below.

Things have been coming off the rails a bit recently though and I'm wondering whether anyone else has experienced this.

I had a great winter of training but in late Feb broke my 5th metatarsal in a pothole.  In an air-boot for a few weeks and it's all healed up nicely I think.  However, that enforced a 8 week layoff with no running.

Towards the end of that layoff, I had a panic attack.  Completely out of character and no obvious trigger - I was laying on the sofa on a Saturday evening.  Pulse up to 120+ (high for me), sweating, horrible.  I called a neighbour as I was convinced I was dying and was looking after the kids but couldn't get through so went and sat on the doorstep in the hope that somebody would find me.  After 10 minutes of fresh air on the doorstep the pulse came down and I gradually calmed down.  All a bit odd but I put it down to not being able to run and general stress - "one of those things".

I got back into my training routine.  Once the foot was better I hit the training quite hard from a standing start - putting in a week with 22 miles (5m x 3 and 7m x 1) and then a 26 mile week with an extra 5m run in.

None of the runs were hard runs - all fairly gentle ~8min miles.

Last week, I trained twice on the Wednesday.  5m run into work, 5m run back.  Heavy legs on the way in but on the way back I felt great - could have run for ages.  Went to bed, all fine.  Next day I was at work when I suddenly felt terrible.  Wobbly, dizzy, a real "out of body experience".  This went on for over an hour until I decided to head home.  I headed for the doc who after an initial conversation seemed to get very "interested".  He took my BP 5 times and it settled at about 140/85, pulse was 52.

Could it have been the combination of a strong coffee, my job becoming a lot more stressful than it was, overtraining the day before and in the prior 2 weeks and being on the back of a chesty virus thing?

I'm going back for an ECG on Monday but I'm convinced that all is not well....a low pulse, highish BP - not a great combo as far as I can make out.  I've also had the odd moment when I've been driving (usually on a motorway on a long distance drive) when I've suddenly thought to myself "hang on, I don't feel all there" which has usually passed quickly but is very disconcerting.  

I've never had any chest pains or anything like that altough I did once feel decidedly faint and had to have a lay down when I was doing kettleballs at the gym about 5 years ago....I also get the odd moment when my heart feels a bit "fluttery" but it's not frequent and I think not generally uncommon.  When I did the VO2 test last year my heart rate did show an odd pattern.  It shot up to 160 with very little provocation and then came right back down and then followed what I was expecting in terms of gradually rising trajectory.  I was wearing a Garmin HR monitor and there is some chat about there being problems of this sor

Interesting post. I've had a lot of cardiac problems including SCA and OHS but I also get what I diagnose as panic attacks. I'm glad you are having some tests done and bear in mind that your aerobic fitness is a complete red herring! Don't let any medic tell you that you can't have any CHD/CAD because you are fit. A couple of years before my SCA I had a series of dizzy spells in the office that I never got checked out, I think after a while they were generating panic attacks and it got hard to tell them apart, or what the first one really was.

Where did you have your vo2max test done, was it at a sports facility or a hospital?

You've acronymed me there.  SCA, OHS, CHD and CAD.....what do they stand for?  Is SCA - Sudden Cardiac Arrest, OHS - Open Heart Surgery, CHD - Coronary Heart Disease and CAD - Coronary Artery disease?  If so, bloody hell - you had a heart attack?  What happened, were you exercising?  How long ago?  How old are you?  Were there other symptoms immediately beforehand?  Are you OK now?  Did they find the cause?

My VO2 max was done at a sports facility by a guy who has worked with a number of Olympians (Cracknell etc.) as well as 3000+ regular punters like me.

Yes I had a cardiac arrest just after finishing a race, then I had to have an emergency bypass op. Arteries completely blocked. But I was still posting reasonable times (not quite as quick as yours mind). Once the main arteries block you get collateral growth - lots of little secondary arteries grow to work past the blockage. This is how you can still look like you are ok on the outside!

So are you having a stress test or just a rest ECG? Keep us posted on how you get on. Hope I'm not alarming you with my tale but its best to err on the side of caution.

Do you have a baseline BP reading to compare with? Like, do you know for sure that the 140/85 reading isn't just your normal BP? I know a lot of very thin and fit people whose normal BP is higher that that and they don't have any blood pressure related health problems. 140/85 is a bit on the high side, but not too awful. I'm NOT saying you don't have a problem, just wondering if it's necessarily related to your blood pressure...

A temporary high BP could defo be related to a week of too much training, stress at work and a high caffeine intake. I take my pulse and BP regularly and notice quite large fluctuations depending on how hard I've been training recently and whether I'm agitated about anything.

Like, my blood pressure is usually 110/65 or so and my resting pulse is 55. If I do a really hard training session then check myself a few hours after, while my pulse remains elevated at anything up to 85, my BP usually shows a corresponding drop and has often been as low as 99/50. Conversely, if I've rested for a few days, my resting pulse might be 50, but when it's that low, my BP seems to sit higher and could be as much as 120/70. Just mentioning this as an example...

I'd definitely get all the usual things checked out but wonder if you're maybe just stressed due to the enforced layoff and worrying about the first panic attack to the point where you're nearly giving yourself another one. Either way, hopefully you'll get it sorted out soon. Doesn't sound nice...

Being a runner and someone who has suffered from panic attacks for 13 years this sounds to me like panic and anxiety with a false garmin reading thrown in for good measure.

Overtraining and coffee both give me panic attacks, the release of masses of endorphins from exercising can induce panic its very very common. Anyone can tell you that training hard at night before bedtime can stop them from sleeping this shows you how severe the rush of endorphins is. If it can keep a person who doesnt have anxiety awake then its sure to induce panic in someone who does.

Of course I am not a doctor and this is just my opinion but would be great to find out how you got on at doctors.

Good luck

John

Elstead, do you drink alcohol?  I have found that alcohol even in small quantities makes all the symptoms you describe much worse.

I have found that eating well, exercising hard and avoiding alcohol and caffeine gives you the best opportunity to feel less stressed.

John - I do, but not much.  When I was really suffering with the anxiety I used to have a glass of wine in the evening but only one glass.  It did help.  I've stopped that now.  Not through any particular health related reason but just because it's not a habit I'm in and life has calmed down.  My wife doesn't really drink so it's easy not to.

I like a night out, and will occasionally have a few beers but nothing major.

I've not noticed any particular relationship between drinking and anxiety but I haven't been looking.  I'll keep an eye out and see whether there is something there...

Thanks

Elstead good to hear you don't have any real problems.  I had a tachycardia episode on a half marathon last year so as well as having a whole load of tests at the cardio dept at hospital I have spoken with quite a few staff there and done lots of reading so have a good backround knowledge now of the heart, blood pressure and various relationships they all have with each other. Also the effect exercise has on all of them.

I missed your very first post on here back in May and I would say your BP is a bit high but to measure it accurately most doctors now want you to do it at home over about a week, at various times of the day so they can get some good averages. Lots of people have a high reading in a surgery.  Your pulse is not exceptionally slow, exercise does slow it anyway but they only really start to take notice of low readings when they get below 40 and other things could be causing it apart from fitness.

The one thing I would say do is continue to wear a HRM but as you pointed out be aware they are susceptible to spikes and also they need a good contact, when they do your ECG they stick the electrodes to you not just splash them with water.

Hope all continues to go well

My BP is often 90 for the lower figure - probably averages in the upper 80s   The doc always looks a bit quizically at me, but not done anything yet.

Interesting that you say that low pulse rate with high BP is not a good combination my rest HR is usually 50.. but can be 40 at real rest.  I'd always assumed that it would be worse if my pulse rate was also high.  No?

Run Wales, the one thing most people on this site are likely to have is a lower than average heart rate because of exercise. In the main this is good and indicates the heart is pumping more efficiently.  40bpm is probably the first point doctors will want to know why it is so low, but people that have exercised continuously for sometime will not be a concern to them.  BP is a whole different thing and varies at different times of the day, after strenuous exercise, when you eat, what you eat, caffeine and alcohol intake, when you talk even. That's why doctors now prefer to get averages across a period of time.  I believe the perfect reading is 120/80 and they start to look to take some action if the upper figure is above 140 and the lower above 100.  If you exercise regularly, eat healthily, don't excess on salt, alcohol or caffeine and you are not well overweight you should be there or thereabouts and certainly most doctors can do little in the way of advice about lifestyle changes to help.

Elstead, your story and problems have similarities to mine. We're identical weight and height, similar fitness, albeit I'm 42. I don't think you should worry too much about the BP, but monitor it. 

I had an incident on the evening I ran the G South Run (oct 11) where I woke up at 11:30pm with a fast heart rate, sweating, numb fingers and toes, felt like I was having an out of body experience, lasted about 15 mins. Had some blood tests, BP checked, nurse said nothing was wrong. All OK until Jan this year, started feeling very ill, this passed in days but then felt very tired, got chest pains and pains in my left arm. Went back to GP had blood tests, BP was up to 140/80 /Pulse 53 in the surgery, but all often much higher at home. Dr said I was I had post viral fatigue and costocondritus (inflammation of the ribcage). I've seen a lot of different Doctors, specialists, a nutritionist and had a Bupa ECG up to 144 BPM (85% of  heart rate) cardiac report was OK, so, it's all been put down to ME. It's been 6 months now and I started training again 4 weeks ago, just slowish runs, nothing under 7min miles. BP is around 130/78 now, I can't say I feel great, despite eating huge amounts of veg, virtually no alcohol and being gluten free, pains in left arm have been put down to a blocked lymphatic system. The thing I'm most concerned about is my pulse after exercise, it's late 40s to early 50s in the mornings, goes up into 70s & 80s when I stand up and move about, but takes hours to return to normal after a 30-60 min run. If is finish a run at 165bpm it will drop to 11x in a minute, and back into the 80BPMs within 10 mins, but I can't get much below 80 until the next morning. I assume this is because of the 5 month lay off - welcome comments from anyone here! 

Anyway, point being Elstead is that many of us have busy lives, high pressure jobs, children and have sporting goals (age related for me), and occasionally the body gets worn out and run down and we need to listen to what our bodies are saying. Could it be that when you injured yourself you dropped your calories to compensate for the lack of training? If so, this can do more harm than good. Hope you're all sorted now and this was just a glitch.

Just thought I'd feedback...  I had one of those 24hr blood pressure monitors last week.  Averaged over this time, the average was 138/83.  It seems that the 'white coat effect' is in play for me - as I've never seen a single reading, taken by a nurse/doctor, as low as that for 15-20 years. When I take it myself at home, I get higher readings than this most of the time..  and occasionally a bit lower.

So, having the BP test  'surprise me', rather than me anticipating it, gets lower results. A little up on the absolute ideal, but nothing to worry about (actually, as I write this, the scientist within me thinks "Hmmm...  I bet all the stats about what is, and what is not, a safe BP, are based on BP results taken by doctors and nurses...  so maybe 138/83 is less safe than the charts suggest!!"

Also, a point the doctor made was that I'm getting good periods with lower blood pressure...  She said that (within reason) it was better to have periods of higher BP and other periods where your heart can relax... rather than a continuous slightly raised BP.

It seems that the 'white coat effect' is in play for me - as I've never seen a single reading, taken by a nurse/doctor, as low as that for 15-20 years. When I take it myself at home, I get higher readings than this most of the time.. 

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