Managing Blood Pressure Fluctuations After Heart Procedures: A Patient's Journey

Q: Managing Blood Pressure Fluctuations After Heart Procedures: A Patient's Journey

Hello： Electrophysiological procedures primarily affect the electrical conduction pathways within the heart, and blood pressure is generally not impacted or may be better controlled due to the improvement of post-operative arrhythmias. <br>Blood pressure can fluctuate due to envi

Hypertension and Blood Pressure Instability

Hello, Doctor.
In May 2015, I was diagnosed with coronary artery sclerosis.
In July and October 2020, I underwent catheter ablation procedures for atrial flutter and atrial fibrillation, respectively.
Currently, I am taking the following medications: Eplerenone (half a tablet twice daily), Concor (one tablet twice daily), and Lisinopril (one tablet twice daily).
I also take one tablet each of Torsemide and Brilinta daily.
I previously had no significant sleep issues, but since retiring in 2018, I have found it more difficult to fall asleep, taking about one to two hours after going to bed.
This has been quite distressing.
My blood pressure used to be around 120, but after the ablation procedure in 2020, my systolic pressure occasionally rose to 150 for several months before returning to normal.
However, since starting Lisinopril earlier this year, my systolic pressure has sometimes dropped to around 100.

With the onset of hot weather at the end of June and the ongoing high temperatures since late July, I have experienced discomfort in my head and chest three times, lasting several hours, with my systolic pressure consistently above 150 during these episodes.
I have also experienced similar symptoms during cold fronts in the winter over the past two years.
I would like to ask if the ablation procedure could lead to dysautonomia, causing elevated blood pressure during extreme cold or heat, and if this condition could persist for life.
Additionally, since the medication Torsemide lists insomnia as a side effect, could this insomnia also contribute to elevated blood pressure? Thank you for your guidance.
I appreciate it.

AlbertWye, 70~79 year old female. Ask Date: 2022/08/10

Dr. Huang Yinghe reply Cardiology

Hello: Electrophysiological procedures primarily affect the electrical conduction pathways within the heart, and blood pressure is generally not impacted or may be better controlled due to the improvement of post-operative arrhythmias.
Blood pressure can fluctuate due to environmental factors, emotions, or various stressors; therefore, temperature changes and insomnia can contribute to elevated blood pressure.
It is advisable to maintain a relaxed mood and a regular daily routine, as this can aid in long-term blood pressure control.
If blood pressure remains unstable, please consult a cardiologist for further evaluation.
Additionally, there are many causes of insomnia, often not attributable to a single factor (insomnia caused by cholesterol-lowering medications like statins is relatively uncommon).
If you are experiencing chronic insomnia, it is recommended to seek help from a psychiatrist or a neurologist.

Reply Date: 2022/08/10

More Info

Managing blood pressure fluctuations after heart procedures can be a complex journey, especially for patients with a history of coronary artery disease and arrhythmias. In your case, you have undergone catheter ablation for atrial flutter and atrial fibrillation, and you are currently on multiple medications to manage your heart condition. Your experience with fluctuating blood pressure, particularly the episodes of elevated systolic pressure reaching 150 mmHg and occasional drops to around 100 mmHg, is not uncommon among patients who have undergone similar procedures.

Firstly, it is essential to understand that the autonomic nervous system plays a significant role in regulating blood pressure. After heart procedures, such as catheter ablation, some patients may experience changes in autonomic regulation, which can lead to fluctuations in blood pressure. This dysregulation can be exacerbated by external factors such as temperature changes, stress, and even medication side effects. For instance, extreme heat can cause blood vessels to dilate, leading to lower blood pressure, while cold weather can have the opposite effect, potentially causing blood pressure to rise.

Regarding your concern about the medications you are taking, it is crucial to consider their side effects. For example, the medication you mentioned, "妥寧" (likely referring to a beta-blocker), can indeed cause side effects such as insomnia, which may indirectly affect blood pressure. Poor sleep quality can lead to increased stress and anxiety, which can elevate blood pressure levels. Additionally, some medications can cause orthostatic hypotension, where blood pressure drops significantly when standing up, leading to dizziness or discomfort.

Your experience of difficulty falling asleep after retirement may also be contributing to your overall well-being and blood pressure management. Sleep is vital for cardiovascular health, and chronic sleep deprivation can lead to increased sympathetic nervous system activity, which may raise blood pressure. It is advisable to address sleep issues through lifestyle modifications, such as establishing a regular sleep schedule, creating a relaxing bedtime routine, and avoiding stimulants close to bedtime.

To manage your blood pressure fluctuations effectively, consider the following strategies:
1. Regular Monitoring: Keep track of your blood pressure at different times of the day and under various conditions (e.g., after exercise, during hot weather). This information can help your healthcare provider identify patterns and adjust your treatment plan accordingly.

2. Medication Review: Discuss with your cardiologist or primary care physician the possibility of adjusting your medications. They may consider changing dosages or switching to alternatives that have fewer side effects, particularly regarding sleep and blood pressure regulation.

3. Lifestyle Modifications: Incorporate regular physical activity, a balanced diet, and stress management techniques such as mindfulness or yoga. These can help stabilize blood pressure and improve overall cardiovascular health.

4. Hydration and Temperature Management: Stay well-hydrated, especially during hot weather, and try to maintain a comfortable environment to minimize the impact of temperature fluctuations on your blood pressure.

5. Sleep Hygiene: Focus on improving your sleep quality by creating a conducive sleep environment and possibly consulting a sleep specialist if insomnia persists.

6. Follow-Up Appointments: Regular follow-ups with your healthcare provider are essential to monitor your heart health and adjust treatment as necessary.

In conclusion, while it is possible that autonomic nervous system changes after your procedures may contribute to blood pressure fluctuations, it is essential to take a comprehensive approach to manage your health. By addressing medication side effects, improving sleep quality, and making lifestyle changes, you can work towards achieving more stable blood pressure levels and enhancing your overall quality of life. Always consult your healthcare provider before making any changes to your treatment plan.

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