Brief Answer:
Your symptoms are not related to any blood clot or cardiac disorders

Detailed Answer:
Hello XXXX!

It is nice to hear from you again in HCM!

I read your question carefully and understand your concern.

There is nothing to worry about any blood clot.

I would exclude any cardiac disorders related to this symptomatology (based also on your performed cardiac tests).

Your symptoms seem to be related to postprandial hypotension, which is an appropriate decrease in blood pressure after eating.

You should know that digestion is a complicated process which requires coordination between the digestive, nervous and circulatory system.
So after eating the blood supply to the stomach and small intestine increases, while in some other organs like the skin, the brain, other abdominal organs, etc it decreases slightly because the vessel constriction.
During this process the heart begins to work harder, to maintain an appropriate blood flow to the other organs (physiological tachycardia after eating).

In some persons (due to genetic factors or normal aging) the heart and blood vessels do not react as they should, leading to an inappropriate decrease in blood pressure in all organs, except the small intestine and the stomach. This situation causes dizziness, lightheadedness and fallings.

It may be a genetic predisposition, after a large meal from the abdominal distension or related to a hiatal hernia.

I recommend consulting with the gastro-enterologist and performing a GI endoscopy to rule in/out the above disorder.

I would also advise some tips to help prevent this situation from repeating:

-     Take a glass of water 15 minutes before eating
-     Take smaller meals, more frequently during the day (large meals trigger postprandial hypotension and tachycardia)
-     Reduce rapidly digested carbohydrates (white bread, desserts, potatoes, beverages pass quickly through the stomach to the small intestine, contributing to an exacerbation of postprandial hypotension)
-     Take some rest after eating. You can sit or lye down to avoid this condition (blood pressure usually occurs 30-60 min after eating).

Hope to have been of helpful!

I am at your disposal for any other questions, whenever you need!

Best wishes,

Dr. Iliri

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Brief Answer:
I reassure that a cardiac disorder is excluded.Further tests should be done

Detailed Answer:
Dear XXXXXXX

I would like to assure that a cardiac disorder is absolutely excluded by your performed tests.

Your clinical symptomatology seems to be related to a gastric issue and anxiety.

I recommend consulting with the gastro enterologist and perform the GI endoscopy.

It is also necessary to closely monitor your blood pressure during the day. I recommend measuring your blood pressure in sitting and standing up position (after 5minutes standing up). If there is a decrease more than 20mm Hg in your systolic blood pressure during standing up, compared with sitting position, this would be indicative of orthostatic hypotension, which may mimic this clinical scenario.

A head up tilt test would be necessary to rule in/out this disorder.

Hope to have been of help!

Feel free to ask any other questions, whenever you need!

Best regards,
Dr. Iliri

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Brief Answer:
It is important to exclude some metabolic disorders

Detailed Answer:
Dear XXXXXXX

I would like to explain that difficulty in excercising may be related to different metabolic disorder, including dehydration or a gastric disorder.

Besides the above mentioned tests, I would recommend performing some blood lab tests like:

- a complete blood count ( for chronic anemia)
- inflammation tests ( PCR, fibrinogen, sedimentation rate)
- kidney and liver function tests
- fasting glucose (sometimes disorders of glucose metabolism can mimic this symptoms)
- thyroid hormone levels (a thyroid dysfunction can lead to low blood pressure and difficulty in exercising)
- cortisol plasma levels ( to exclude possible adrenal gland disorder)
- blood electrolytes (including Calcium, Potassium, Magnesium).

These tests are needed to rule in/out any possible metabolic disorders related to this symptomatology.

If all the above mentioned tests result normal, the most probable diagnosis would remain anxiety.

Hope to have helped you with your uncertainties!

I am here, happy to answer whenever you need.

Greetings,
Dr. Iliri

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Brief Answer:
The above scheduled differential diagnosis is advised.

Detailed Answer:

Hi again XXXXX!

Regarding your lowering BP trends, I insist to perform the above mentioned differential diagnosis.

Meanwhile, I would like to assure you that your inter-arm blood pressure difference of 10 mmHg is quite normal. So nothing to worry about!

Wishing you a good health!

Regards,

Dr. Iliri

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Brief Answer:
Serious great vessel disorders are excluded.

Detailed Answer:

Dear XXXXX!

As you had a normal CT angiogram and cardiac ultrasound, serious great vessel disorders are excluded. So, just relax!

Coming to this point these inter-arms BP differences have no clinical significance, as I said you before.

To investigate a possible responsible cause for your complains, it it necessary to perform a visit to your gastroenterologist.

Wish you a good health!

Dr. Iliri

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