Low Blood Pressure and Heart Palpitations: Key Insights

Low blood pressure and heart rate, but noticeable palpitations?

Hello, Director: I usually take 1 tablet of Moxonidine 5mg and half a tablet of Bisoprolol 5mg daily.
(Previously, I only took one tablet of Moxonidine daily, but after my blood pressure remained between 135-150, I added half a tablet of Bisoprolol, which I have been taking for almost a year.
In the last six months, I have lost 7-8 kg and occasionally experience dizziness and palpitations.) : My blood pressure is 105-125/60-75 (heart rate 60-75).
For the past two weeks, I have suddenly experienced frequent palpitations that have persisted.
It occurs almost all day and affects my sleep at night.
Sometimes my readings are 109/57 (68), 109/65 (56), 119/59 (70), and 130/67 (79).
Strangely, I still feel palpitations even with low blood pressure (diastolic pressure) or a heart rate below 60 or around 60, which can be quite uncomfortable, accompanied by hand tremors, a tight feeling in the back of my head, and difficulty breathing.
Recently, I sometimes feel dizzy and my hands may go numb.
Last week, one morning at 11 AM, while lying in bed, I suddenly felt numbness in my right hand.
When I stood up and raised my hand, it felt weak and drooped about 30 degrees, but it improved after trying twice.
In the evening, I experienced a slight numbness in the tips of my left hand fingers.
The next day in the afternoon, my blood pressure was 129/65 (80), and I felt uncomfortable with palpitations.
: Q1.
Is it normal for diastolic pressure and heart rate to be below 60? If so, why do I still experience palpitations (with a noticeable heart rate) and discomfort, sometimes having difficulty sleeping at night and feeling like I need to breathe harder? Q2.
Is there a normal range for systolic and diastolic blood pressure and heart rate? What should I pay attention to? Q3.
With palpitations and discomfort, diastolic pressure and heart rate sometimes below 60, and occasional numbness in my left forearm and palm, along with tightness in my neck, what tests should I undergo? Q4.
The doctor also prescribed Fludiazepam (Erispam-S) 0.25mg, advising me to take it if I feel uncomfortable.
However, if my blood pressure is 105/60 (heart rate 62), can I take this medication? Will it lower my blood pressure and heart rate further? Thank you for taking the time to respond amidst your busy schedule.

SAN, 50~59 year old female. Ask Date: 2016/10/13

Dr. He Dongjin reply Cardiology

Hello, please stop taking Pulse Advantage for weight loss as it has helped lower your blood pressure.
There is no need for such a high dosage; with a blood pressure of 105/60 (heart rate 62), you can take 0.25 mg without further lowering your blood pressure or heart rate.
You may consider taking half a tablet of Bisoprolol once or twice a day depending on your blood pressure levels.
With the addition of Erispam, your blood pressure should ideally be between 120-140/60-90, which may be more comfortable for you.
If you are experiencing palpitations, discomfort, or if your diastolic pressure and heart rate occasionally drop below 60, it may indicate that the medication dosage is too high.
Sometimes, you may feel numbness in your left forearm and palm, and tightness in the back of your neck.
If there is no improvement, it is advisable to visit a neurology clinic for further evaluation.
Changhua Hospital cares about your well-being.

Reply Date: 2016/10/13

More Info

Understanding low blood pressure and heart palpitations can be quite complex, especially when considering the various factors that contribute to these symptoms. Based on your description, it seems you are experiencing a combination of low blood pressure (hypotension), bradycardia (slow heart rate), and episodes of palpitations, which can be concerning and warrant further investigation.

Q1: Is a diastolic pressure and heart rate below 60 normal? Why do I still experience palpitations?
A diastolic blood pressure below 60 mmHg and a heart rate below 60 beats per minute (bpm) can be considered normal for some individuals, particularly if they are physically fit or have a lower baseline heart rate. However, the presence of symptoms such as palpitations, dizziness, and discomfort indicates that your body may not be tolerating these levels well. Palpitations can occur for various reasons, including anxiety, electrolyte imbalances, or even the effects of medications like beta-blockers (e.g., Bisoprolol) that you are taking. It's essential to monitor these symptoms closely, as they can sometimes signal an underlying issue that needs to be addressed.

Q2: What are the normal ranges for systolic and diastolic blood pressure and heart rate? What should I pay attention to?
Normal blood pressure is generally considered to be around 120/80 mmHg, but this can vary based on individual health conditions and age. Systolic pressure (the top number) typically ranges from 90 to 120 mmHg, while diastolic pressure (the bottom number) should ideally be between 60 and 80 mmHg. A resting heart rate for adults usually falls between 60 and 100 bpm. Given your readings, it’s crucial to pay attention to how you feel during these episodes. If you experience significant symptoms like dizziness, fainting, or severe palpitations, it may indicate that your blood pressure or heart rate is too low for your body’s needs.

Q3: What tests should I consider for my symptoms of palpitations, low diastolic pressure, and bradycardia?
Given your symptoms, it would be prudent to undergo a comprehensive evaluation. This may include:
1. Electrocardiogram (ECG): To assess your heart's electrical activity and identify any arrhythmias.

2. Echocardiogram: To evaluate the structure and function of your heart, especially considering your history of valve issues.

3. Holter Monitor: A 24-hour ECG monitoring can provide insights into your heart rhythm over a longer period.

4. Blood Tests: To check for electrolyte imbalances, thyroid function, and other metabolic conditions that could contribute to your symptoms.

Q4: Can I take Fludiazepam (Erispam-S) with low blood pressure and heart rate? Will it lower them further?
Fludiazepam is a benzodiazepine that can help with anxiety and may have a sedative effect. However, it can also cause further sedation and potentially lower blood pressure and heart rate, especially in individuals already experiencing hypotension and bradycardia. It is crucial to consult your physician before taking this medication, particularly given your current blood pressure of 105/60 mmHg and heart rate of 62 bpm. Your doctor may need to adjust your medication regimen or monitor you more closely to ensure your safety.

Conclusion
In summary, your symptoms of low blood pressure, bradycardia, and palpitations warrant a thorough evaluation by a healthcare professional. It’s essential to communicate openly with your doctor about your symptoms and concerns, as they can provide tailored advice and treatment options based on your specific health needs. Regular monitoring and appropriate lifestyle adjustments, such as staying hydrated, managing stress, and possibly adjusting your medication, can also play a significant role in managing your condition. Always prioritize your health and seek immediate medical attention if you experience severe symptoms.

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