Managing Blood Pressure and Heart Rate Drops During Dialysis: A Patient's Guide

Q: Managing Blood Pressure and Heart Rate Drops During Dialysis: A Patient's Guide

I recommend that you： 1. Discuss the above situation further with your attending physician. 2. Alternatively, seek consultation at a medical center. Wishing you good health. Thank you!

When blood pressure drops during dialysis, resulting in a decrease in heart rate, how should it be managed?

Hello, doctor.
I have been a dialysis patient for over a year and have hypertension, diabetes, and coronary artery disease, along with mild arrhythmia.
Last year, I underwent a cardiac catheterization, which revealed that two of my coronary arteries were 40% and 50% blocked.
The doctor mentioned that treatment is generally not required unless the blockage exceeds 70%, so I have been managing with medication.

Recently, in the past month, I experienced two episodes of significant drops in blood pressure during dialysis, accompanied by symptoms such as cold sweats, vomiting, and near fainting.
My heart rate also dropped during these episodes, with the first drop reaching 41 beats per minute and the second even dropping to 28 beats per minute.
However, after stopping dialysis and resting, my heart rate returned to normal (typically around 50 to 60 beats per minute due to taking Concor).

In the past year, I have had a few instances of low blood pressure, but I had never experienced such low heart rates until these two recent episodes.
Last week, after a myocardial perfusion scan, my doctor recommended another cardiac catheterization, noting that my myocardial ischemia was 12% (first scan) and 16% (second scan).
I am concerned that if the catheterization again shows blockages below 70%, no intervention will be performed.
How should I address the issue of my dropping heart rate?
Additionally, I would like to ask about my left ventricular ejection fraction, which was 79% last year and has decreased to 72% this year.
Is it possible that this will continue to decline annually, leading to heart failure?

Mr. Gao, 40~49 year old female. Ask Date: 2023/12/10

Dr. Cai Guiqin reply Cardiology

I recommend that you: 1.
Discuss the above situation further with your attending physician.
2.
Alternatively, seek consultation at a medical center.
Wishing you good health.
Thank you!

Reply Date: 2023/12/10

More Info

Managing blood pressure and heart rate drops during dialysis can be a complex issue, especially for patients with multiple comorbidities such as hypertension, diabetes, coronary artery disease, and arrhythmias. Your situation, where you have experienced significant drops in blood pressure and heart rate during dialysis, is concerning and warrants careful management.

Understanding the Risks
During dialysis, patients often experience fluctuations in blood pressure due to the removal of excess fluid from the body. This process can lead to hypotension (low blood pressure), which may cause symptoms such as cold sweats, nausea, and fainting. In your case, the drops in heart rate to dangerously low levels (41 bpm and 28 bpm) are particularly alarming and indicate a potential risk for bradycardia, which can lead to inadequate blood flow to vital organs.

Factors Contributing to Blood Pressure and Heart Rate Drops
1. Fluid Removal: Rapid removal of fluid during dialysis can lead to decreased blood volume, resulting in hypotension.

2. Medications: Some medications, especially antihypertensives, can exacerbate low blood pressure during dialysis.

3. Heart Function: Your history of coronary artery disease and reduced left ventricular ejection fraction (LVEF) can contribute to the heart's inability to compensate for changes in blood volume during dialysis.

4. Arrhythmias: Existing arrhythmias can lead to further complications during dialysis, including drops in heart rate.

Recommendations for Management
1. Monitor Blood Pressure and Heart Rate: Continuous monitoring during dialysis is crucial. If significant drops occur, the dialysis session may need to be paused or adjusted.

2. Fluid Management: Work with your nephrologist to optimize fluid removal rates. Slower fluid removal may help prevent hypotension.

3. Medication Review: Discuss your current medications with your healthcare provider. Adjustments may be needed to prevent exacerbation of low blood pressure.

4. Dialysis Modifications: Consider discussing with your dialysis team the possibility of using a different dialysis modality or adjusting the dialysis prescription to better suit your cardiovascular status.

5. Cardiology Consultation: Given your history of coronary artery disease and recent myocardial perfusion scan results indicating ischemia, a thorough evaluation by a cardiologist is essential. They may recommend further interventions, including potential coronary angiography, to assess the severity of blockages.

Concerns About Heart Function
Regarding your concern about the decrease in LVEF from 79% to 72%, it is important to note that while a decline in LVEF can indicate worsening heart function, it does not automatically mean that you will progress to heart failure. Regular monitoring of heart function, along with appropriate medical management, can help mitigate risks. Lifestyle modifications, adherence to medications, and managing comorbid conditions are crucial in maintaining heart health.

Conclusion
In summary, managing blood pressure and heart rate during dialysis requires a multidisciplinary approach involving nephrologists, cardiologists, and possibly other specialists. Regular follow-ups, careful monitoring, and adjustments to your treatment plan are essential to ensure your safety and well-being during dialysis. If you experience any concerning symptoms, such as significant drops in blood pressure or heart rate, it is crucial to communicate these to your healthcare team immediately. Your health and safety are paramount, and proactive management can help prevent complications.

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