High Pulse Low Blood Pressure: Neurally Mediated Hypotension

So, what is Neurally Mediated Hypotension and what happens to the body when you experience it? Neurally mediated hypotension, also known as neurocardiogenic syncope, vasodepressor syncope, the vaso-vagal reflex, the fainting reflex and autonomic dysfunction, is a condition which involves miscommunication between the heart and the brain. And it happens when there is an abnormal reflex interaction between the heart and the brain.

Dr Peter Rowe one of the members of the Johns Hopkins University research team says: "We think that in these patients, the heart is generally normal and the brain is normal, but the reflex interaction between the two is what is out of kilter. And what seems to trigger that dysfunction is a state of a low amount of blood in the ventricle of the heart while standing. It is either low because you've started with a lesser volume of blood, for whatever reason, or because the amount of effective blood volume that is potentially available is not getting delivered to the heart because of an excessive amount of pooling in the extremities."

But, unfortunately, Neurally Mediated Hypotension often doesn’t work alone. There are other forms of autonomic nervous system disorders that can walk hand in hand with NMH.

You see, the Autonomic Nervous System (ANS)is the master regulator of organ function throughout the body and is involved in many vital functions such as controlling the heart rate, blood pressure, temperature, respiration and digestion to name a few. When the autonomic nervous system is compromised, it can produce what appears to be a malfunction of the organs it regulates. Therefore, patients with damaged ANS will display numerous unrelated maladies. And in my case, it was hard to determine where one disorder ended and another began.

In other words, in my case I guess I got the lottery, because my chronic illness (NMH) was combined with the following other forms of autonomic nervous system dysfunction:

a) Chronic Orthostatic Intolerance:

Simply put, an individual with Chronic Orthostatic Intolerance experiences day-to-day symptoms including dizziness and often altered vision (blurred, ‘white outs’, ‘black-outs’), fatigue, nausea, neurocognitive deficits, disordered thermoregulation, palpitations, high pulse low blood pressure, headache, tremulousness, hyperpnea, difficulty breathing, sweating, and pallor.

For those who are afflicted with Orthostatic Intolerance, there is an excessive increase in heart rate upon standing, resulting in the cardiovascular system working harder to maintain blood pressure and blood flow to the brain.

It is interesting to know that it has been estimated that over a million Americans are affected, mostly young women, who experience this day to day disability. The onset of this disorder can be sudden, as in my case, and can disrupt and reek havoc on a patient’s lifestyle and capacity to work forcing them to apply for disability. And yet, these conditions are the least understood of the autonomic disorders and are often misdiagnosed as anxiety or psychiatric problems because of the nature of the symptoms.

b) Postural Orthostatic Tachycardia (POTS):

Chronic Orthostatic Intolerance is associated with Postural Orthostatic Tachycardia Syndrome (POTS). Postural Orthostatic Tachycardia is a syndrome. And as such, there is an array of symptoms that accompany it. Because the Autonomic Nervous System plays a large role in regulating certain functions throughout the body, the symptoms are widespread. Symptoms will vary from person to person and will include some of the following: palpitations, dizziness, lightheadedness, exercise intolerance, blurred vision, chest pain, high pulse low blood pressure, fainting, fatigue, migraines, blood pooling in limbs, cognitive impairment, gastric discomfort and sleep disorders among others.

The onset of POTS often follows a viral infection or other inflammatory condition. It affects an unknown number of patients, mostly female, between the ages of 12 and 50.

c) Neuropathy:

The name Neuropathy is given to a group of disorders involving nerves. The symptoms range from a tingling sensation or numbness in the toes and fingers to paralysis. And it is estimated that 35 percent of persons with HIV disease have some form of neuropathy.

Neuropathy is a problem in peripheral nerve function (any part of the nervous system except the brain and spinal cord) that causes pain, numbness, tingling, swelling, and muscle weakness in various parts of the body. It may be caused by physical injury, infection, toxic substances, disease (e.g., cancer, diabetes, kidney failure, or malnutrition), or drugs such as anticancer drugs. It is also called peripheral neuropathy.

Symptoms include disturbances of blood pressure, heart rate, or bladder and bowel control, muscle weakness, impotence; loss of balance; sensitivity to touch, tingling, extreme pain, reduced ability to perspire, constipation, bladder dysfunction, burning sensation, and inability to focus the eyes depending of which nerves are affected. It may be genetic or acquired and it can either progress slowly or quickly affecting some of the nerves or all of them causing loss of sensation and weakness. Some examples of Neuropathy are: Carpal Tunnel Syndrome, polio and shingles. Injury, toxins and even vitamin deficiency have been identified as causes of Neuropathy.

So, as you can see, if the autonomic nerves are damaged then the involuntary functions of the body may be affected causing a variety of abnormal symptoms. Although now much improved, the general symptoms I experienced because of the cocktail of neurological disorders present in my body, were triggered by a number of the most simple every day activities. For instance:

1. After I stood for long periods in line or in a shower or even if I sat for a long time. Normally when someone stands up, the blood pools in the legs through gravity and the body compensates by pumping adrenaline which leads to your heart to pump faster. But in people with Neurally Mediated Hypotension a miscommunication occurs between the heart and the brain and the brain tells the heart to slow down which takes blood away from where it is needed. Fainting put me in a flat position which helped the blood to return to the heart, but it caused fatigue and fogginess afterwards. And initially I experienced all the symptoms regardless of the position my body was in. Laying down, sitting, standing, it just really didn’t matter.

2. If I tried to exercise or exerted myself in anyway I would experience extreme dizziness, weakness in my extremities, fainting, nausea and prolonged fatigue, even after small physical activity like going to the mail box. These are common symptoms of people affected by Neurally Mediated Hypotension.

3. When I experienced changes in weather, especially when I got cold. The body can not regulate the body temperature and any change in it can immediately trigger symptoms of fatigue, dizziness, extreme drop in body temperature and nausea.

4. When I experienced any stress. Stress is probably the worse offender when it comes to trigger all the symptoms associated with Neurally Mediated Hypotension. And trying to stay stress-free in today’s environment and especially if you are ill, it is a challenge in itself. Light headedness, fainting, prolonged fatigue, muscle aches, headaches, and mental confusion can be all triggered by stress.

5. Being exposed to loud or persistent noises or music. It was difficult for me to be in a social situation or even a restaurant where there was active conversations, noise or loud music. Neurally Mediated Hypotension robs the sufferer of the ability to be among other people in a normal atmosphere because all symptoms could be aggravated by it.

6. After I ate because the flow of blood shifted to digest the food, depriving other areas of the body. It is hard to believe that something as simple as eating could cause such symptoms in my body.

7. When I read or concentrated. These simple activities allowed the arms and legs to dilate, therefore allowing more blood to pool rather than constricting when doing mental tasks. And the symptoms of Neurally Mediated Hypotension are then triggered.

8. When I had a bowel movement or needed to empty my bladder. This caused all the blood to rush to those organs triggering extreme nausea, sweating, weakness, fatigue and weak muscles.

9. And sometimes it didn’t matter what I did it would just show up. Like an uninvited guest at a party!

In other words, just about any normal function in my life could and would trigger my symptoms sometimes to excruciating levels. Even though we are all susceptible to experience Neurally Mediated Hypotension, the individual susceptibility to this disorder can be affected by the genetic make up, diet, psychological makeup and the body’s susceptibility to infections or allergies. In other words each individual’s make up will determine the severity of the symptoms and the early onset of the disorder.

In general, it is not well understood what causes Neurally Mediated Hypotension, but doctors have long suspected that its origin may be genetic because the syndrome seems to run in families. In our family there is another fairly severe case similar to mine experienced by my first cousin from my father’s side of the family and a second cousin from my mother’s side of the family who experiences milder symptoms.

NMH can be triggered in anyone under extreme circumstances. Doctors believe that potentially we could all trigger NMH if we experience extreme heat, stand for long periods of time, suffer from malnutrition or don’t drink enough fluids. Some people experience it every time they get their blood drawn. Often soldiers and athletes will experience NMH when they are exposed to certain conditions some of them actually fainting.

Oddly enough, it has been found that people suffering with Neurally Mediated Hypotension have low salt levels. In my case, I must add extra sodium to my diet and drink large amounts of fluids in order to control my illness and help raise my blood pressure. There are a number of medications prescribed to control this disorder, but even though they are successful they do not cure the problem, they simply control the symptoms. But there are things one can do to control Neurally Mediated Hypotension and other types of autonomic nervous system disorders. Since the onset of my illness over 6 years ago, I have incorporated significant changes in my lifestyle and my diet. For instance,

- Avoiding standing or sitting for long periods of time. I now use a lap top computer while reclining since sitting for more than an hour at a regular computer can trigger my symptoms

- Avoiding stressful situations

- Incorporating Yoga and Meditation in my daily routine

- Avoiding drastic changes in temperature

- Incorporating mild exercise to help pump blood back to the heart and by compressing the abdominal muscles to help reduce the amount of blood that pools in the intestinal circulation.

- Avoiding alcohol and controlling caffeine intake - this is hard for me because I love a good cup of coffee in the morning!

- Staying healthy and preventing colds and infections

- Eating a healthy diet and drinking plenty of fluids

The medications that I take and the lifestyle changes that I incorporate into my daily routine help to control my NMH and have made a tremendous difference in my life. But it is still a chronic condition with abnormal daily symptoms. At one point or another there is at least one organ in my body experiencing a deficiency in blood supply which causes some very odd symptoms. Sometimes it's electrical like shocks running through my body, other times it's burning in one extremity and other times it is a deep pain. You never know what cocktail of symptoms you are going to get for that day. You just learn to go with the flow and do the best you can.

The test that my doctor performed in order to determine if I had Neurally Mediated Hypotension was a Tilt Table Test, a specialized procedure which is always done under the supervision of a cardiologist or electro physiologist. A battery of measurements is done during the Tilt Table Test, including monitoring of the patient's heart rate and blood pressure. This is to see if an abnormal fainting reflex is exhibited.

Who would have known that when I first experienced high pulse low blood pressure it would be the beginning of a journey that would have such a profound influence in my life. Today I deal with my illness in a systematic way, following a carefully laid out plan and lifestyle. The improvement has been significant and I suspect it will continue that way as long as I don’t deviate from my daily routine of healthy living.

If you would like to learn more about my personal health experience read My Personal Health Journal Or you can read about my Symptoms

After researching several sites, I compiled a list of symptoms associated with both Neurally Mediated Hypotension and Postural Orthostatic Tachycardia Syndrome. Today research is finally catching up and many of the symptoms I experienced are now well documented. Read Symptoms Postural Orthostatic Tachycardia Syndrome and Neurally Mediated Hypotension to learn more about the medical symptoms of both disorders.

You may also like to read more about Dysautonomia

Reader's Personal Health Experiences:

Pediatric Postural Orthostatic Tachycardia Syndrome: Desiree's Story

Postural Orthostatic Tachycardia Syndrome (POTS)- Julie's Story

Dysautonomia - Katrina's Story

Postural Orthostatic Tachycardia Syndrome - Danielle's Story

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Quoteby: Dr. Thomas Fuller

Orthostatic Intolerance

http://www.nymc.edu

Orthostatic Hypotension

http://www.dizziness-and-balance.com/disorders/medical/orthostatic.html

Postural Orthostatic Tachycardia

http://www.nymc.edu/fhp/centers/syncope/POTS.htmPostural Orthostatic Tachycardia

http://www.potsplace.com/Neuropathyhttp://www.neurologychannel.com

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