Persistent Head Discomfort and Slow Heart Rate: What You Need to Know

Persistent discomfort in the head for one month accompanied by bradycardia?

Hello, Doctor.
At the beginning of February this year, I started experiencing a sensation of shaking in my head.
There were two instances when I felt blood rushing to my head while standing.
At that time, I was regularly donating blood, and my blood pressure was consistently a bit high, around 160/90.
My weight was 116 kg, and after returning from vacation on March 5, my weight increased to 118 kg.
At the end of March, due to discomfort in my head, I visited a doctor who prescribed Forxiga, a diabetes medication, for weight loss (I do not have diabetes).
A week later, on April 5, I returned for a follow-up due to discomfort near my heart.
An electrocardiogram showed no issues, but my blood pressure was still high at 155/101.
The doctor prescribed Olmetec for blood pressure reduction.
I took it for two days, and on the morning of April 7, I felt numbness in the back of my head, dizziness, and tingling in my hands and feet.
A friend called an ambulance, and after examination at the hospital, the doctor said it was a side effect of the medication.
The next day, April 8, during a follow-up, the doctor advised me to stop taking the blood pressure medication.
On April 9, I stopped taking the weight loss medication; at that time, my weight was 110 kg, and I had lost about 6 kg in two weeks.
After that, I continued to feel heaviness in the back of my head and occasional shaking sensations.
On April 10 and 11, I experienced insomnia and felt a pulsing sensation in the back of my head while trying to sleep.
Starting on the 12th, my sleep began to improve, but the heaviness and shaking sensations persisted.
Because of this, I have been feeling anxious.
During this month, I had a brain CT scan due to my head discomfort, which showed no abnormalities.
I also had kidney and liver ultrasounds that were normal.
Concerned about potential kidney issues, I underwent blood and urine tests, which also returned normal results.
I consulted two doctors, both of whom said there was no problem, just that I was too anxious.
However, I continued to experience head discomfort.
Recently, I have been monitoring my blood pressure frequently due to my walking exercises, arm swinging, and reduced food intake.
I have managed to control my weight to around 100 kg, and my blood pressure is now not too high, approximately 130/80.
However, my heart rate has been consistently slow, around 40-50 beats per minute.
When I was younger, I was in good health as a pilot, and during flight crew medical examinations, my heart rate was typically around 50 beats per minute.
Recently, I saw a new doctor who said I likely do not have any major issues, suggesting that the medication may have stimulated my heart, causing it to beat slower, which affects blood flow to my brain and will take time to recover.
Lately, I have been experiencing numbness in my scalp, facial tingling, and a mild tightness in my chest, but it is not severe and does not cause breathing difficulties.
My head still feels uncomfortable at times.
Can I truly recover from this?

Alvin, 30~39 year old female. Ask Date: 2016/05/22

Dr. He Dongjin reply Cardiology

Hello, I also believe that there is nothing wrong.
I don't think the medication is affecting my heart and causing it to beat slower, which would hinder blood flow to the brain.
Based on your previous assessment, my heart rate during the aviation medical examination was around 50 beats per minute.
I still think it's just due to anxiety.
There's no need to check my blood pressure; I just need to go out and exercise, and I will feel better.
Don't worry, Changhua Hospital cares about you.

Reply Date: 2016/05/22

More Info

Based on your detailed description of symptoms and medical history, it appears that you are experiencing a combination of persistent head discomfort, episodes of dizziness, and a notably slow heart rate (bradycardia). These symptoms can be concerning, especially given your previous high blood pressure and recent changes in medication.

Understanding Your Symptoms
1. Head Discomfort and Dizziness: The sensation of your head feeling "heavy" or experiencing "earthquake-like" tremors can be attributed to several factors, including anxiety, medication side effects, or even changes in blood flow due to your heart rate. The feeling of blood rushing to your head when standing could indicate orthostatic hypotension, where blood pressure drops upon standing, leading to dizziness.

2. Slow Heart Rate (Bradycardia): A resting heart rate of 40-50 beats per minute is considered bradycardic. While athletes often have lower resting heart rates due to increased cardiovascular efficiency, a heart rate this low in someone who is not an athlete can be concerning. Bradycardia can lead to insufficient blood flow to the brain and other organs, potentially causing symptoms like dizziness, fatigue, and fainting.

3. Medication Effects: You mentioned experiencing side effects from medications like Olmetec and Forxiga. These medications can affect blood pressure and heart rate. Olmetec, an antihypertensive, can sometimes lead to bradycardia, especially if the dosage is too high or if combined with other medications that lower heart rate.
4. Anxiety and Stress: Your ongoing anxiety about your health can exacerbate physical symptoms. The mind-body connection is powerful; stress and anxiety can lead to physical sensations such as tingling, heaviness, and discomfort in various parts of the body.

Recommendations for Improvement
1. Consultation with a Cardiologist: Given your history of bradycardia and high blood pressure, it’s crucial to have a thorough evaluation by a cardiologist. They may recommend further tests, such as a 24-hour Holter monitor, to assess your heart rate variability and rhythm throughout the day.

2. Medication Review: Discuss your current medications with your healthcare provider. It may be necessary to adjust dosages or switch medications to better manage your blood pressure and heart rate without causing adverse effects.

3. Lifestyle Modifications: Continue with your healthy lifestyle changes, including regular exercise, a balanced diet, and weight management. Gradual weight loss can significantly improve blood pressure and overall cardiovascular health.
4. Stress Management Techniques: Incorporate stress-reducing activities such as yoga, meditation, or deep-breathing exercises. These can help alleviate anxiety and may improve your overall sense of well-being.

5. Regular Monitoring: Keep track of your blood pressure and heart rate regularly. This will help you and your healthcare provider understand how your body responds to lifestyle changes and medications.

6. Follow-Up on Neurological Symptoms: Since you have experienced tingling and numbness, it may be beneficial to consult a neurologist to rule out any neurological conditions, especially if these symptoms persist.

Conclusion
While your symptoms can be distressing, many factors contribute to them, including medication effects, anxiety, and your cardiovascular health. With appropriate medical guidance, lifestyle changes, and stress management, there is a good chance you can improve your symptoms and overall health. Always ensure that you communicate openly with your healthcare providers about your concerns and symptoms for the best possible care.

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