Recent symptomatic drop in blood pressure, looking for ideas on how to investigate

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Woofmutt
New Member


Date Joined Mar 2009
Total Posts : 7
   Posted 5/13/2015 2:42 AM (GMT -6)   
The short version of this story is, secondary to a mild reaction to Rocephin (ceftriaxone, 3rd gen. cephalosporin abx), my normal, lifelong blood pressure has gone from a predictable 115-125/75-80 to a positionally influenced 90-120/60-75 in a few months. I am at an impasse as far as further testing ideas.

44 yr old male. [edit - aside from the med mentioned above, no meds taken or rx'ed prior to or in this history]

To recap briefly - 3 months ago was on 4th dose of course of rocephin. have used in past. this time an existing rash on my chest got irritated within 1 hour, and 1 hour after that had back-to-back pvc's near end of sex (this has not happened in well over a decade if ever). 10 hours later, after sitting at desk (reclining executive chair) 2 hours, developed severe shortness of breath, lightheadedness and loss of ability to concentrate at all, and a sense of a 'band' being held against my forehead, temple to temple (not painful, just there). from that time on have been susceptible to less severe incidents of same, almost always while sitting. On occasion, there has been notable partial paresthesia (bilateral) of forehead area going into sides of face, top of head, neck to c4/5 level approx at most extreme instance.

a month after this, noticed climbing stairs was immediately causing the band-across-forehead symptom, altered sensation in right arm followed by right leg, and within some minutes of stopping, right chest/back pain.

at times, lying prone or slightly inclined has provoked palpitations and/or arterial pulse irregularities.

have done following tests -

important to note that I have metal in my body and cannot have an MRI.

ct normal thorax/cerv/head, CTA thorax and head, 1 month into history. regular stress test 1 month in,
nuclear stress test 3 months in.
Holter worn though no stairs climbed in the available data, 1 month into history.

Lots of blood work including autoimmune-related tests. All blood work normal, cta's normal, stress tests normal though nuclear stress test did have 54% ejection compared to 58% 14 months prior.

Have been repeatedly measured by rn's at 90/60-100/70 bp now. sometimes sistolic gets up into 110s. on occasion when I was extremely symptomatic with the shortness of breath/dizziness/band on forehead, was taken at 90/60. it has raised eyebrows at doctors' offices, but no suggestions on how to localize cause of bp drop.

since the last stress test last week, the hypotension-like symptoms, including altered sense of balance, have been much more prevalent, nearly constant to some degree. I have read about both orthostatic hypotension and neurally mediated hypotension, but have not a specialist familiar with them. regarding the 'blood pressure cuff on arm' sensation while climbing stairs and at other times, I have read about intermittent claudication but am not sure what I am reading reasonably matches my profile. I am also unsure what else needs to be looked at as possible causes.

I have also read about angina and aortic valve issues with regard to my very fast onset of symptoms when climbing stairs. I don't know if the pre-stress test echo would have caught any aortic valve issues. (would it have?)

Looking for ideas on what to look at here. Assumption is, given presentation of symptoms within hours of the rocephin reaction, that there is a relationship. Sudden variable hypotension, positional component, prevalence worsened after exertion in stress test (my greatest exertion in 2 months).

I guess my question is how to back-engineer possible causes, based on what is excluded by test history. I think if I can narrow down issue on blood pressure, I may get some answers on the rest of symptoms (avoiding climbing/stairs presents an ongoing obstacle).

A rheumatologist recently suggested I had fibromyalgia, based solely on meeting 11 of 18 pain points. I am a bit hesitant to get into such a broad diagnosis as sole avenue of investigation.

Any ideas appreciated.

Post Edited (Woofmutt) : 5/14/2015 8:08:45 AM (GMT-6)


theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 20227
   Posted 5/14/2015 2:33 AM (GMT -6)   
hi woofmutt 11 -18. i would. the chronic fatigue elements of this condition and what they call the fibro fog is worth investigating. in terms of other heart investigations an ultra sound echo may be a good thing. in terms of blood pressure and such, has your doctor thought about a change in medication? hoping this helps. i have chronic heart disease, but i am somewhat a learner driver. other members will come on with more information. take care.

ah, just remembered, has your doc actually ruled out postral drop? if you mentioned it forgive me. i have low vision.
THE HAPPY TURTLE.

my conditions are mere aspects of me, they do not define me.
'

Woofmutt
New Member


Date Joined Mar 2009
Total Posts : 7
   Posted 5/14/2015 9:08 AM (GMT -6)   
Hi, thanks for your reply.

Forgot to mention in this history that taking no meds at all since the ceftriaxone and no meds prior to that either.

As far as postural drop, it has not been addressed yet (it will, hopefully) but reading it over, it seems distinct from my presentation - an example, I will sit down, and over coming minutes begin to get lightheaded etc. as described above. as I read it, orthostatic hypotension seems to be a reaction to change of position, e.g. stand up from prone position, experience sudden bp drop and related physiological effects, which will then slowly normalize (if you dont pass out and fall down)?

In my case the biggest issue as far as that part goes is sitting, particularly either leaning forward OR in a reclining office chair (e.g. 30-45 degree recline from perpendicular).

Reading over fibro fog references quickly, one thing I do not see mentioned in reference to it is acute episodes of hypotension - (which has been repeatedly measured during my episodes). Not sure if that is a definitive exclusion - FMS/CFS seem to be fairly inclusive diagnoses.

Post Edited (Woofmutt) : 5/14/2015 8:15:56 AM (GMT-6)


theHTreturns...
Elite Member


Date Joined Mar 2009
Total Posts : 20227
   Posted 5/14/2015 2:54 PM (GMT -6)   
i am now out of my depth. sorry. i hope others come on to help. maybe there is no cause and effect from a pharmacological stand point, the fms / cfs would be best discussed with a doctor that specializes in this. all the best. ps, just a learner driver on these types of things, but i have an interest in chronic heart disease as i have have it. double by-pass, diabetic, blah blah blah.
THE HAPPY TURTLE.

my conditions are mere aspects of me, they do not define me.
'
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