Sudden Blood Pressure Spikes and Related Symptoms

Questions regarding sudden abnormal increases in blood pressure leading to coma?

Hello, doctor.
I have a normal weight, do not smoke or drink, and lead a normal lifestyle.
I have a habit of running marathons and participating in triathlons.
My blood pressure and heart rate tend to be slightly low due to family genetics.
In early February of this year, after experiencing diarrhea for two days, I accompanied my father to a clinic on February 6.
Shortly after sitting down, I saw stars and then fainted, requiring emergency transport to the hospital.
They conducted an ear temperature check, X-rays, blood tests, and an electrocardiogram, all of which showed no abnormalities.
Since I only had diarrhea, I was prescribed gastrointestinal medication and sent home.
On February 8, still feeling unwell, I visited a nearby clinic and was diagnosed with Influenza B.
I also experienced swaying while standing with my eyes closed, but I recovered after taking antiviral medication.
However, on the morning of February 22, a colleague noticed a burst blood vessel in my eye, and I felt slightly dizzy throughout the morning.
The school nurse measured my blood pressure at 140/100 and 140/110, and advised me to seek medical attention.
By noon, I experienced visual disturbances again and nearly fainted, leading to another emergency visit where my blood pressure was recorded at 166/113.
I was given a red pill for palpitations, and other tests including X-rays, blood tests, electrocardiograms, and cardiac enzymes were all normal.
My ear temperature was over 37 degrees Celsius.
That afternoon, I saw a neurologist who performed a brain vessel auscultation, cerebellar tests, and an abdominal ultrasound, all of which were normal.
However, my blood test showed slightly elevated liver enzymes at 74.
The neurologist prescribed liver medication, an anti-nausea drug, and circulation medication, and provided Lesyn F.C.
(6 mg) as a backup.
After returning home, my blood pressure normalized, but the next day, February 23, it rose again to 159/111 with visual disturbances.
I took half a tablet of Lesyn F.C.
(6 mg), and everything returned to normal.
From February 25 onward, my blood pressure remained stable between 100-120/70-85, with a heart rate of 70-80, which is normal.
In summary, my usual blood pressure and heart rate are normal, yet I have experienced several sudden spikes, all while sitting calmly.
I have visited the emergency room twice, internal medicine twice, and neurology once, undergoing numerous tests, but no cause has been identified.

My questions are:
1.
Could it be that due to my father and brother's illnesses, I have been overworked caring for them over the past six months, leading to a cold and diarrhea, and that resting adequately will resolve the elevated blood pressure?
2.
Should I further investigate the elevated liver enzymes and diarrhea with a gastroenterologist?
3.
Should I consult a cardiologist regarding the elevated blood pressure, burst blood vessels in my eyes, and swaying while standing with my eyes closed?
4.
Or could this be stress-induced autonomic nervous system dysregulation, and should I continue to see a neurologist?

Mai Ke, 40~49 year old female. Ask Date: 2018/02/25

Dr. He Dongjin reply Cardiology

Hello, during stormy weather, the sea is certainly not calm, and the waves can be quite large.
Your father and brother have been falling ill one after another, leading to overexertion, colds, and diarrhea, which has put them in a very unstable condition.
Naturally, your blood pressure is also unstable; it’s unrealistic to expect it to remain steady when you feel so unwell.
Experiencing dizziness and seeing stars, almost fainting, is likely due to exhaustion and weakness at that moment.
If everything has returned to normal now, you can start with observation.
Later, follow up with a hepatobiliary and gastrointestinal specialist to monitor liver function tests.
You are likely experiencing autonomic nervous system dysfunction due to stress.
If you still feel unsteady when standing with your eyes closed, it would be advisable to consult a neurologist.
Take care, and we are concerned about you at Changhua Hospital.

Reply Date: 2018/02/25

More Info

Understanding sudden blood pressure spikes and related symptoms can be complex, especially when multiple factors may be at play. Based on your description, it seems you have experienced episodes of elevated blood pressure, dizziness, and other concerning symptoms, which can be alarming. Let's break down your situation and address your questions.

1. Stress and Overwork
You mentioned that you have been caring for family members who are ill, which can undoubtedly lead to physical and emotional stress. Stress is known to have a significant impact on blood pressure. When the body is under stress, it releases hormones like adrenaline and cortisol, which can cause temporary spikes in blood pressure. This could explain the episodes you experienced, especially if they occurred during or after particularly stressful periods. Adequate rest and stress management techniques, such as mindfulness, meditation, or even light exercise, may help in stabilizing your blood pressure.

2. Elevated Liver Enzymes
Your blood tests indicated slightly elevated liver enzymes. While this may not directly correlate with your blood pressure spikes, it is essential to investigate further. Elevated liver enzymes can be a sign of liver inflammation or damage, which could be due to various factors, including viral infections, alcohol consumption, or medication side effects. Consulting a gastroenterologist or hepatologist for a thorough evaluation of your liver function is advisable, especially since you experienced gastrointestinal symptoms like diarrhea.

3. Cardiovascular Evaluation
Given your episodes of high blood pressure, particularly the readings of 166/113, it is prudent to consider a cardiovascular evaluation. While your heart tests (ECG, echocardiogram) came back normal, it may be beneficial to monitor your blood pressure regularly and possibly undergo further testing, such as a 24-hour ambulatory blood pressure monitoring. This can help determine if you have episodes of hypertension that may not be captured during a standard visit.

4. Autonomic Nervous System and Anxiety
The symptoms you described, including dizziness and the sensation of "seeing stars," could also be related to autonomic nervous system dysregulation, which can occur due to stress, anxiety, or fatigue. The autonomic nervous system controls involuntary bodily functions, including heart rate and blood pressure. If you suspect that anxiety or stress is contributing to your symptoms, it may be beneficial to consult with a mental health professional. Cognitive-behavioral therapy (CBT) or other therapeutic approaches can be effective in managing anxiety and its physical manifestations.

Conclusion
In summary, your situation appears to be multifaceted, involving stress, potential liver issues, and cardiovascular concerns. It is crucial to take a comprehensive approach to your health. Here are some steps you might consider:
- Follow-Up with Specialists: Continue to work with your healthcare providers, including a gastroenterologist for liver concerns and a cardiologist for blood pressure monitoring.

- Stress Management: Incorporate stress-reducing activities into your routine, such as exercise, meditation, or hobbies that you enjoy.

- Regular Monitoring: Keep a log of your blood pressure readings and any symptoms you experience. This information can be invaluable for your healthcare providers.

- Lifestyle Adjustments: Maintain a balanced diet, stay hydrated, and ensure you are getting enough rest.

By addressing these areas, you can work towards stabilizing your blood pressure and improving your overall health. Always consult with your healthcare provider before making any significant changes to your health regimen.

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