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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31334
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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My GP dismissed the pusle but I spoke to thr bps

Resolved Question:

my pulse went as low as 34 and then up to 135 on my 24 hr ambulatory monitor while my bp went as high as 177. My GP dismissed the pusle but I spoke to thr bps and I have been made an urgent appointment (I faint several times). My 24 houe ecg was normal though so another cardiologist dismissed the findings. I am going to see another one due to the bradycardia and erratic pulse but what I want to understand is, can I have a normal ecg and still have heart rate problems (the second cardiologist hadn't seen my 24 hr low reading so when I asked him what else would be causing the dizziness, fainting,and shortness of breath he said it could have been asthma, which I told him I don't have. I personally think it was the high blood pressure causing the problems if it wasn't the pulse on the occasion. Would love to hear your thoughs as still getting faint and dizzy and felt he didn't believe me.
Thank you.
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 4 years ago.



You should be evaluated for the following which are the commonest cause for fainting or syncope;


1) bradyarrhythmias; this is sudden slowing of the heart. it is mainly due to sinus and atrial node dysfunctions. Sick sinus syndrome is a prototype of these arrhythmias and is a major cause for syncope / fainting. Your second cardiologist is likely to consider this diagnosis.


2) neurocardiogenic mechanisms; this is fall of the blood pressure suddenly due to a sudden sympathetic failure (failure of the autonomic nervous system). It can be accompanied by shortness of breath.


3) carotid hypersensitivity syndrome is an exaggerated response to carotid sinus stimulation. In some studies almost 50% cognitively normal people who had experienced fainting were diagnosed with carotid hypersensitivity.


4) orthostatic hypotension is due to failure of autonomic nervous system and related heart regulatory mechanisms.


Please feel free for your follow up questions.


I would be happy to assist you further, if you need any more information.


Dr. Arun
Dr. Arun Phophalia and 3 other Health Specialists are ready to help you
Customer: replied 4 years ago.



Thank you for your answer, it was helpful. I wanted to mention though that I had a stress echo done and the cardiologist thought it was one point he thought he saw something but then played it in slow motion and said it was ok.


So, according to your reply, I could have a normal ecg and still suffer from fainting due to my blood pressure which is one thing I wanted to know. I did look up about sick sinus node earlier but surely this would have shown up on the echocardiogram wouldn't it? Are there certain things that don't show up because they are intermittent? I thought there would still show some damage there.

Thank you.

Expert:  Dr. Arun Phophalia replied 4 years ago.
You are very welcome.

On one side you have persistent issue and on another side all the investigations are normal. So definitely there is something, which is unidentified by the present investigations. So your cardiologist would have to keep a clinical diagnosis like bradyarrhythmias or your ambulatory monitoring EKG has to be extended for 7 days or more. That may identify an event which may be able to point the cause.

Good luck.
Customer: replied 4 years ago.

Thank you but this is still not quite answering all of my questions.

If you could just help me with the following then I think I'm done;


I understand the bradycardia/sick sinus syndrome but I thought the echcardiogram would have shown that up. Is that not always the case? And just to point out, you answered earlier saying that low blood pressure can cause shortness of breath. I have high blood pressure. I get profuse sweating, headaches and fainting-can the dizziness/fainting be attributed to high or is it only low blood pressure? I have just measured it three times in a row and it was 138-148/85-95 which is quite good for me, it is usually higher, and heart rate was 90-95 (and been at rest) and I have palpitations but pulse is only slightly high. Can the rapid heartrate, ie, when it goes up to 135 as shown on the 24 hr ambulatory - heart rate 34-135, cause symptoms like lightheadedness and weakness and stumbling, I feel like my legs go weak and I fall a lot and I don't know why.


Thank you.

Expert:  Dr. Arun Phophalia replied 4 years ago.
You are most welcome.

Echocardiogram may not diagnose the sick sinus syndrome. EPS or intracardiac electrophysiology study is the specific test for it.

Fainting is not likely due to high blood pressure in your case. Just a momentary low blood pressure (which is difficult to diagnose as it becomes normal immediately with the fainting or lying down) can cause dizziness and fainting. A rapid heart rate of 135 can be responsible for the lightheadedness, weakness, stumbling etc (so do the low pulse rate). Any extreme of pulse rate decrease the cardiac output (amount of blood pumped by each beat and per minute) and thus the symptoms.

It is privilege assisting you.

Dr. Arun

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