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Diagnosed with orthostatic hypotension, weeks after PVI

Cheevs profile image
30 Replies

Hello,

I had the pvi ablation some 3 weeks ago. Had dizzyness after standing up for 2-3 years i believe (feel like going on 2mad diet routine helped it), but didnt have lower blood pressure on record. Usually it was always 120/60 or 120/70.

I thought that the dizzyness was maybe from the heart not working right and that the ablation will help it, but that was dead wrong..

Now not only iget dizzy when standing up, but my bp is always low, 110/70, 100/60 and even as low as 85/70. On top of that, around a wekk ago i started noticing that the veins on my legs, especially the big one on the inside of the leg (around the ancle) are getting bit, really big and i can even see and feel some that i would never see, im not thin enough for that to be possible.. My legs feel like wet sponges, feel like im walking on sponges, numb feet, warm feeling at times, also have a warm feeling in my stomach. Also numb feeling in my hands..

Did a couple ecg-s, good. Blood and urine tests, good. Today was in er because my cardiologyst is on a vacation, so the lady doc said to ghe nurse when she told her to get my blood, neurologic something, so i geuss she wanted to see if there is some underlying neurological cause, but it was good..

The problems, other than the dizzyness really started after the ablation.. I somehow gotten loose, when i bend forward a bit, my belly os kind oh hanging, the skin doesnt seam right, its like an old mans and im 40yo, 82kg on 187cm height or so. But just lately it seams like i just lost the "power that was keeping me together" :)

Of corse, dont feel great in the heat, strong sun, which never bothered me. I was heat resistant and coild be in the sun at +40c..

Literally feel like this will burry any hope for my life ending up good. Last year got a diagnosis of spondilodegenerative changes in my cervical spine (arthritis) and straightened lordosis. Already had arthritis in my hands..

I really need this to be a temporary problem.. I was reading posts here, with many people saying that low bp after an ablation is normal and it will bounce back, so thats a big hope..

Anyway, would be thankful for any input and suggestions on this..

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Responsable profile image
Responsable

Hi, there!

Low blood pressure seems to be your major concern. It can be caused by two things. One is, your heart rate is shifted down (say 40 to 50 bpm), so the output of the heart is low, causing low system pressure. The other is, ejection fraction of your heart is shifted down, so, despite normal HR (say 60 to 80 bpm), the output is low and you suffer. I am afraid that the combination of the two is also possible... Have you checked these two things recently? If yes, what are the values?

Cheevs profile image
Cheevs in reply to Responsable

Hey!!

Idk where can i see my ejection fraction? Im looking at my ecg-s but didnt notice anything like that. On my most recent ecgs, i had a Hr of 63 and 69. In the ones before that it was usually in the low to mid 50s and on my holter that i had a while back, the lowest was 36. I think i used to have a low hr often but i dont think it was a problem. Never really had low bp or these problems associated with it, wel not since the last few years with this dizzyness.

Now i feel like im old. I literally went from tight to saggy in a couple weeks.

If the ejection fraction is not on the ecg, how do i determine it? Is there a test that can be done?

Oh, i forgot to say. The er doctor heard me out, i said i believe i have OS hypotension and she said ghat i gave myself the right diagnosis, but didnt do any tests.. i guess its right..

Responsable profile image
Responsable in reply to Cheevs

Hi!

Been offline, so late with the reply... I see that you have been well advised about ejection fraction, so nothing to add. If you are bradycardic for prolonged period of time, as you said you were (even to 36 bpm), it is more likely that you may have increased BP than reduced BP. But the rule is that there are no rules... You will examine it yourself after the suggestions you received.

As for the way you feel lately, many people have reported similar symptoms in the period after an ablation. It is likely to be transient, so let's hope for the best!

Cheevs profile image
Cheevs in reply to Responsable

My bp was always as far as i can remember 120/60 and more recently 120/70. I remember a long while ago, some 15 years or more when i was having some minor surgery, my HR was around 45 i think and they said that my HR is low and asked how i feel, but i was ok. They said that people who are in sports usually have a very low resting HR and asked if i was doing sports, but i wasnt really doing much.. They said its normal.. I believe my HR was normal for me. The 36 number was the lowest measured on holter and that was some 6 months after i had my afib episode. The holter was good, doc said just a couple skipped beats, but whats interesting, the day after the holter my heart started to act up again..

No, my BP is clearly decreased now. I never once had a bp measured lower than 120/60 prior to ablation and never had it measured higher than 120/70.. Its very possible that i already had ortostatic hypotension, but i believe that it would only drop my bp after getting up.. Now it seams that my bp is constantly low and after getting up, lower than before..

Sure hope its transient :) I literally aged like 20 years in a couple weeks. My skin is loose. I lean forward and my belly sags, the skin looks like an old mans saggy skin and i was looking like i was in my 30's tops before the ablation. Just not enough pressure in me to keep it all together i think..

Anyway, thanks for your input. I really appreciate it. Will update the thread when i have something useful. Maybe it helps someone. one thing is for sure, i shouldnt have done this ablation. I would strangly advise anyone who has afib, you really have to have it and it has to be persistant and after all options failed, like lifestyle changes and healthy living, meditating and such.. Then ok, but still have to take in account other factors like possible problem with BP, which is potentially much worse problem than fibrilation..

Responsable profile image
Responsable in reply to Cheevs

I understand your disappointment with the ablation. If you type "Increased BP after ablation" in the search field, you will see that a "normal" picture after an ablation is reduced HR and, at the same time, increased BP. That is why your case is a little puzzling me...

As for other symptoms, you can see that, after an ablation, people may have deteriorated vision, increased BP, reduced HR, numerous PVCs, brain fog, abdominal problems (bloating), sore skin etc. etc. What you have described, as a very quick deterioration of the health, looks to me very much like "Chronic Fatigue Syndrome".

If I do not ask too much, was there any activity or event that might have triggered arthritis you mention. Say, severe stress, unusual physical activity or physical overload, anything you can remember. My father started having serious issues with his stomach at the age of 38, after a very big stress he was exposed to. During the rest of his life, his BP was at the level 90/60, but he never fainted or complained about being dizzy. Lived to be 81 yo.

Cheevs profile image
Cheevs in reply to Responsable

Yeah, bummed out by the whole thing.. But i did find some studies saying that there could be damage to the vagal system during the ablation, that could lead to OS hypotension or even POTS.. But in my case, seams like i already had it and ablation just sunk me completely, so now low bp all day long for me.. Also many post here about low bp anfter balation, and ppeople saying takes time, but a lot of them never get back to us and say, hey its 5 months now and all is well, so idk what the outcome was..

I was finding adrenal fatigue while googling my symptoms.. Im in a depression for almost 5 years. Basically my life and the security i should have gotten from life is ruined and the relaity is that im sick and have no security and thats making my current situation more grim.. I fear a lot about my future basically, not just my health which is first but also just surviving. Dont have a social care system here that would be the safety net, so its hard being sick..

Looking at the syptoms of chronic fatigue synndrome and some correspond while others dont. I have fatigue from my life and situation. Just mental fatigue from thinking about it daily and not having the good times to recharge my batteries, but it could be adrenal. Many sympotms correspond with it..

¸I will mention it to my cardiologyst, but its kind of difficult. They are specialist for their field and maybe i need someone who can see the bigger picture better. My general doc is saying its above his head. Im just hoping its a temporary loss of bp for whatever reason, but i really need that bo back. I cant really live a normal life like this..

Oh, the arthritis in my hands happened after working a lot and doing some excercises that were too hard on the hands.. . Had this inflamation and its just happened.

The shoulder injury happened working with a very big pneumatic hammer.. I got bad pain but i continued to work other stuff. Couldnt lift my arm up but i worked on pills.. So it got really bad and i couldnt even bring a sppon to my mouth. My head was hangig down from pain.. I guess it caused the damage to my c-5-c6..

Responsable profile image
Responsable in reply to Cheevs

I have a son, 42 years old... I wish you from all my heart to feel better soon, very soon!

Cheevs profile image
Cheevs in reply to Responsable

Thank you!!

Cheevs profile image
Cheevs in reply to Responsable

I was just reading the forum and saw some posts about Pulsed-Field Ablation, which i then googled and saw that its actually available in the hospital i had the RF ablation.. I vaguely remember the doc saying at the end of it that there is this method too and that it doesnt hurt but its not as precise or something like that..

I just feel like i have really bad luck for some reason. Maybe things would have been different if they did it with this method..

CDreamer profile image
CDreamer

Suggest you head over to the AA STARS website and read up about managing low orthostatic BP.

api..org/files/download/b73...

I was prescribed Pyridostigamine for another condition and haven’t suffered Orthostatic BP since, having had the problem since childhood as I am also hypermobile = lack of collagen. Ablation made things a whole lot worse for me as it exacerbated everything else so in that respect it could have been linked.

My HR always went sky high because of the low BP.

It would be good to get to the cause but in the meantime - good tips on managing it in the leaflet.

Cheevs profile image
Cheevs in reply to CDreamer

Thanks for the info. Im not sure yet if i want to go the route of medication now, since its still early after my ablation, but i do worry that this problem will stay and i worry mostly for the veins in my legs, since i can see them popping out and feel like worms going through them, i guess its the feeling of them expanding..

Will read it and hope that it wont be necessary.. I still hope this is just some adjustment phase..

MikeThePike profile image
MikeThePike

Hi there, it's entirely possible the ablation was to blame especially if it was an RF or Cryo ablation. These technologies are not very good at selectively targeting tissue and collateral damage to very sensitive heart structures may occur. It also may be that you need to give your heart more time to heal. 3 weeks is simply not enough time. Why not give yourself 3 or 4 months and see how you feel then? Extra medications may not be needed and may just complicate things further. Perhaps you just need to give your heart more time to heal.

Cheevs profile image
Cheevs in reply to MikeThePike

I would give everything i have for this to be true and my condition going back to normal. I feel like i didnt even need this ablation and yeah it was an RF ablation, well PVI to be exact..

Im bummed out cause i was telling my cardiologyst that i have this problem with dizyyiness after standing up and he said its not from the heart and i already had issues with arthritis in my neck and he said it could be from it.. But later on, i just googled and its so easy to diagnose OS hypotension.. I feel like he should have diagnosed it and warned that the ablation could disrupt something and make it worse..

I wish i could go back and just not do it. Only had one recorded afib episode. Feel like most of the problem i had were in synus rhytham and just palpitations and such from a lot of stress, depression and so..

MikeThePike profile image
MikeThePike in reply to Cheevs

"I feel like i didnt even need this ablation". So why did you go ahead with it? Sometimes it's best to learn to live with a condition than seek intervention.

Cheevs profile image
Cheevs in reply to MikeThePike

I wasnt sure if i was having fibrilation really. I had one case on record, when i ended up in er.. The doc said that once you have it, its most likely coming back and i would have various heart issues, but looking back they were not severe enough to go through with this. I could have easly deal with it with rytmonorm. I would sometimes just take 1/2 pill and it would be ok. Sometimes 3x 1/2 a day and all is good..

I worried that the problem would get worse and more dificult to treat. Saw some video of this cardiologyst saying the best way to resolve it is to have an ablation early. Then was loking at strok and how severe it can be from this.. Also i live alone with my cat and my mom was here at that time. She cake as i wasnt feeling great and i needed her help. Was worried that i would get another episode of fibrilation during the summer when my work is most important..

All in all it was a big mistake and i believe i jumped the gun but also my doc did. He kind of acknowledged it after the surgery saing that yea, we only have this 1 case of recorded fibrilations.. And maybe my problem is more stress related. Before he was saying to, no way its just stress..

Big mistake to do any surgery before so much is done to diagnose and take other things into account.. Also surgery in the summer period is a big mistake.. I expeted this to be a very routine thing, but it ended up lasting hurs and i think the doc burned like 50 times, each time 4 seconds.. Its not really a little thing..

MikeThePike profile image
MikeThePike in reply to Cheevs

I am sorry my friend. I understand that sometimes we get scared and panic. I think maybe your cardiologist was too quick to perform the ablation without doing further checks and diagnosis. RF ablation is a generally safe procedure only if the surgeon has the necessary experience and skill. They are basically taking a fine tipped soldering iron into your heart. That requires extreme skill. Some cardiologists don't have much training and make mistakes. Anyway, you have to move forward and try to be positive. Why not give yourself a few more months and see how you feel then? Best wishes.

Cheevs profile image
Cheevs in reply to MikeThePike

This cardiologist is young, but people talk about him very well. They say he's one of two best cardio guys at that hospital and i really liked him..

Yeah, it seams like i need more time to get any conclusion, but whats worrying me a lot is these veins on my legs, beside just keeling over at some point of course. I feel them getting bigger and they do. i see them even though i shouldnt really, so i worry that this period of low bp will leave me with bad veins in my legs for life, even if the bp returns back to normal, fearing that the veins will stay and im just hoping for some solution or that it just gets better. I swim and after it i see that they flatten out and are not visible.. But walking and standing is no good, so im not much less active than before.. Tried to find some info on belly suddenly being loose and loose skin, but couldnt really other than pregnancy and age.. But it was like within 2 weeks or less even for me..

Well, dont have any good options really, other than give it time. Would be nice if i could just not stress about it, but i do.. I wasnt well before this either so not surprising that this dented me in badly..

Thanks buddy, i appreciate the support

ozziebob profile image
ozziebob

I'm not sure it's relevant to your current problems, but you did ask about where to find your "ejection fraction" ... it is measured during a transthoracic echocardiogram and you can read it's estimated value on the Report sibsequently produced. You might need to ask for a copy of the Report from your GP or relevant cardiologist/EP, but here in UK such Reports are easily available to patients.

Good luck with getting your horrible orthostatic hypotension addressed properly.

Cheevs profile image
Cheevs in reply to ozziebob

Hey, thanks for that.. I had an ultrasound of the heart when i was doing tests before this ablation and the doc said that the heart was healthy and everything looking good.. I dont know if he would see the ejection rate from that ultrasound?

But other than that i have nothing.. If the rate is lower now, any chance of it bouncing back to normal? If not, any way to fix it?

ozziebob profile image
ozziebob in reply to Cheevs

Yes, as I said, anyone who reads your "heart ultrasound" (transthoracic echocardiogram) Report will see your (left ventricle) ejection fraction (LVEF).

As for the meaning of different ejection fraction estimates for you, that requires you obtain a unique individual answer from your medical experts.

I am no expert in these matters, but I can share what was written in my 2 positive echo Reports. The first Report included ... The LV systolic function by ejection fraction is normal (EF 60-65 % by visual estimate), and the second Report included ... LVEF = 66%.

As for your question about "improving" your LVEF ... yes, and this is mentioned frequently on the Forum.

I recommend, if you want to learn more about the "ejection fraction", to use the HU Search 🔍 option at the top of any HU page. Here's a start with the past Posts on this subject listed by using this search option ...

healthunlocked.com/search/p...

Good luck, bob.

Cheevs profile image
Cheevs in reply to ozziebob

Thanks Bob, reading a bit about it.. Just wanted to ask if there is some 3rd factor? I know that its not my heart rate. My ejection fraction was good i would think before the ablation.. So, if its not it, what else could it be? I saw a lot of posts about people saiyng they have or had lower bp after ablation and others saying that it just takes time to get back to normal.. I really hope im in that group and that its just too early to conclude much..

CDreamer profile image
CDreamer in reply to Cheevs

It could be damage to the ANS - which controls BP, HR and bunch of non cognitive functioning - that’s why I suggested reading up on all the pages on the link I gave. It may be a matter of elimination to trace the root cause.

ozziebob profile image
ozziebob in reply to CDreamer

I couldn't get your link to work ... does the link as Posted work ok for you?

Cheevs profile image
Cheevs in reply to CDreamer

I tried to open it now, but like bob, i couldnt open the link.. Was at the local er again, wanted to ask them if they have an ultrasound, but unfortunately no. They took my bp. 90/65 i believe and my HR was above 70 i think..

CDreamer profile image
CDreamer

If you have this symptom it could be that blood is pooling in your legs. Raise your feet when you sit and wearing pressure socks may help. Also ensure you pump your legs as you would on a long flight to restore circulation. I would suggest you get this checked out.

Cheevs profile image
Cheevs in reply to CDreamer

I do pump my legs often. Dont have the stockings yet, but seams like i will need them.. Not sure how to check it out. Didnt get no real feedback from the doctors. They just dismiss it as oh its hot outside so thats why you see veins on your legs when they shouldnt be visible..

The one guy there where they gave me the IV said that i could do an ultrasound of the veins, but i dont think its the right thing to do. Will ask for it anyway, but i feel like i need some test of the vagal system, juts dont know how its tested..

Ppiman profile image
Ppiman

The numbness and hotness in your feet and elsewhere could, I suppose, be mild peripheral neuropathy, so perhaps ask your GP about this if it doesn't slowly settle. It isn't so very unusual, but you are a bit young for it. It can create other symptoms but all of these usually calm down after a "flare up" and then leave you in peace or with, say, one or both feet feeling hot or tingly (as if you have socks and maybe gloves on).

But, above all, you are still recovering from the ablation. The scars take a good while to heal and in that time the heart won't likely be performing as it should. I suspect that your BP readings won't concern a doctor. Orthostatic hypertension has a range of causes and is quite common. I gather. My friend gets it and it is likely linked to his persistent AF. The intra-arterial blood pressure that likely matters most cannot be measured and, if there are ectopic beats or whatever (post ablation idiosyncrasies, for example), the changes might be transient but perhaps sufficient to cause the brief light-headed and dizzy feelings of OH.

As for your EF, really - you can surely forget it. You are fine or you would have been told otherwise. The echo scan shows enough for your doctor to know that, as you've been told, all is well. Anything over 50% is deemed normal and I guess most people are 55-65%. I am tall, have a larger heart as a result, I suppose, and mine is in the low fifties - all normal.

You are a good weight and height and live in a fine and most beautiful part of the world, so try to remain positive and perhaps take yourself out into the lovely Croatian countryside, maybe with a bird guide in your pocket or on your mobile phone (the Cornell Labs one is free and quite excellent as it can detect and identify bird song), add in a good pair of binoculars to look out for the wonderful birds and animal life you are still lucky to have around you.

From what you have said, all will be well in the fullness of time, I wouldn't doubt for one moment.

Steve

Cheevs profile image
Cheevs in reply to Ppiman

Hey Steve,

i written down peripheral neuropathy and will talk to doc about it. I found that dizzynes and drop of bp is also one of the problems caused by it.. I have an appointment with the neurologyst soon, for my cervical spine problem, but now i will talk to them about this whole situation too..

Thanks for the info and the suggestion to relax a bit from this. maybe i do that at some point. Cant go far from home now due to work, but could visit an ornithological park that is actually quite close to me. We do have a very active bird life here. Even have swans here, so yeah it is beautiful.

Really hope its just a temp thing and that it will just pass.. If it does, im quitting alcohol fully. I drink a beer or two, but ditching it completely if this gets better. And trying to ditch vaping and will surely ditch fully if this gets better. I really want my health. Every bit of it..

Thank you again and have a nice day!!

Ppiman profile image
Ppiman in reply to Cheevs

Without question, we all need to keep our weight and blood pressure inside normal parameters. From my reading over the years, these are the two key things that we have some real control over and which accompany ill health more than any other. Of course, may non-cardiovascular diseases can come out way, too - but those two are the key ones. Even covid now, and some other viruses, it seems, are really only able to home in on people with high BP. It brings cellular changes like nothing else.

I think an occasion beer is good. As for vaping - I don't think anyone really knows but it sounds an unhealthy choice to me.

Steve

Cheevs profile image
Cheevs

Hey peeps, my mom brought me a BP monitor while i wait for deliver of a new one from amazon.. My bp sitting down only 96/57 and pulse 72 but after standing up 96/44 and 88 pulse. Never saw my diastolic so low. Of course i got dizzy when i stood up..

Was never this worried in my life.. I thought i had it bad with the arthritis and arythmia, but low bp is worse than them all put together..

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