Exercise-Induced Hypoxia: Insights from Cardiology

Q: Exercise-Induced Hypoxia: Insights from Cardiology

Hello Mr. <br>Lin： Common internal organ issues associated with lower limb edema include heart failure, renal dysfunction, or liver cirrhosis. <br>Other causes may include local circulation problems, high dietary salt intake, and many others. <br>If cardiac, hepatic, and renal fu

Exercise electrocardiogram hypoxia

Dr.
Huang: Hello, I have been experiencing swelling in my right foot after getting out of bed for a long time, but it only extends up to my ankles.
In the morning, my feet are normal when I first step on the ground, but they gradually swell throughout the day, and this pattern repeats daily.
I consulted a cardiologist who arranged for a cardiac ultrasound and a stress test.
The ultrasound results were normal, but the stress test showed signs of hypoxia after running for three minutes.
Blood tests for cholesterol, blood sugar, triglycerides, BMI, blood pressure, and heart rate all came back normal.
The doctor assessed my condition as moderate but did not rule out the possibility of pseudohypoxia.
However, he prescribed Kankun 1.25 mg to be taken once daily.
Dr.
Huang, my blood pressure has never exceeded 120; do I still need to take this medication? Will it cause my blood pressure to drop too low? Thank you.

Mr. Lin, 60~69 year old female. Ask Date: 2022/07/15

Dr. Huang Yinghe reply Cardiology

Hello Mr.
Lin: Common internal organ issues associated with lower limb edema include heart failure, renal dysfunction, or liver cirrhosis.
Other causes may include local circulation problems, high dietary salt intake, and many others.
If cardiac, hepatic, and renal function tests are normal, it is advisable to maintain appropriate exercise and a low-sodium diet.
If edema symptoms remain severe, further examination of peripheral vascular circulation may be warranted.
An exercise stress test indicated myocardial hypoxia; therefore, it is recommended to manage cardiovascular risk factors (such as smoking cessation, controlling hypertension, diabetes, and hyperlipidemia, as well as dietary and exercise adjustments).
Additionally, it is important to monitor for symptoms such as chest tightness or shortness of breath during activity.
If these symptoms are frequent, consider undergoing cardiac catheterization for further evaluation.
Concor 1.25 mg is a low-dose beta-blocker that should not significantly affect blood pressure; it primarily slightly reduces heart rate and decreases myocardial oxygen demand, making it a reasonable choice for treating myocardial hypoxia or heart failure.
If you have any concerns, it is advisable to consult or discuss further with your physician.

Reply Date: 2022/07/15

More Info

Understanding exercise-induced hypoxia is crucial for evaluating cardiovascular health, especially in patients presenting with symptoms such as dyspnea, chest tightness, or fatigue during physical activity. The exercise electrocardiogram (ECG) is a valuable tool in this assessment, as it can reveal underlying ischemic changes that may not be apparent at rest.

In your case, the exercise ECG indicated signs of hypoxia after just three minutes of exertion, despite normal resting values for cholesterol, blood sugar, and blood pressure. This suggests that your heart may not be receiving adequate oxygen during increased physical demands, which could be indicative of underlying coronary artery disease (CAD) or other cardiac conditions. The fact that your echocardiogram results were normal is reassuring, but it does not entirely rule out the possibility of ischemia during exercise.

The interpretation of your exercise ECG showing hypoxia could be due to several factors. First, it is essential to consider the possibility of "false positives," where the ECG may indicate ischemia due to factors unrelated to coronary artery disease, such as anxiety or other physiological responses to exercise. However, given your symptoms and the findings, it is prudent to take these results seriously.

Regarding the medication prescribed (康肯, or Kanchen), it is essential to discuss the necessity and potential effects of this medication with your healthcare provider. Kanchen is often used to manage conditions related to heart function and can help improve blood flow. However, if your blood pressure is consistently low (not exceeding 120 mmHg), there may be concerns about the medication causing hypotension. It is crucial to monitor your blood pressure regularly while on this medication and report any significant changes or symptoms such as dizziness, lightheadedness, or increased fatigue.

In terms of lifestyle modifications, regular, moderate exercise is generally beneficial for cardiovascular health. However, given your recent findings, it may be wise to avoid high-intensity workouts until further evaluations are completed. Engaging in low-impact activities, such as walking or swimming, can help maintain cardiovascular fitness without putting undue stress on your heart.

Additionally, it would be beneficial to explore other potential causes of your symptoms, such as anxiety, which can significantly impact heart rate and perceived exertion during exercise. If anxiety is a contributing factor, addressing it through counseling or relaxation techniques may improve your overall exercise tolerance.

In summary, while your exercise ECG indicates some level of hypoxia, it is essential to interpret these findings in conjunction with your overall clinical picture. Continuous communication with your healthcare provider is vital to ensure that your treatment plan is appropriate and that any medications prescribed do not adversely affect your blood pressure or overall health. Regular follow-ups and possibly further testing, such as a cardiac stress test or coronary angiography, may be warranted to clarify the underlying cause of your symptoms and guide treatment effectively.

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