BP meds and chest pain

[Michael]

I have been a member for while. I rarely post but I'm always lurking. My question is: Have you ever experienced chest pain in association with your blood pressure medication?

My bicuspid aortic valve has been holding steady now for about 3 years at 1.2 cm2 with a peak gradinent of around 35-39 mm Hg. My aortic root is at 4.5 cm.

I have been taking lisinopril and Cardizem for my blood pressure. And I'm taking Lipitor for my cholesterol.

Until recently I have been I've OK. But in the last couple of months I've been experiencing mild chest pain. I went in to see my cardiologist and he immediately had me do a nuclear stress test and my coronary arteries are clear.

I had a CT scan to check my Aorta and it confirmed the root diameter and did not show an aneurysm.

I just had an echo last week and the results were the same. No change.

So I am baffled as to why I am experiencing these chest pains. I checked on the internet to see what the side effects were for the medications I take and I noticed that one of the possible side effects for lisinopril is chest pain. I have been taking lisinopril for over 6 years and never experienced chest pains before.

I go in to see my cardiologist tomorrow and I thinking of asking him if I can stop taking the BP medications and see if the chest pains go away.

Have any of you experienced this?

 

[Arlyss]

Hi Michael,

I was so glad to see that you are taking blood pressure medicine! People with BAVs often have "labile" blood pressure - meaning it fluctuates rapidly with stress or exercise. Do you have a blood pressure machine at home? You should take your blood pressure and record it along with your pulse a couple times each day. Exercise and stress (both positive and negative emotions!) can cause bicuspids' blood pressure to spike, and this is not good with a fragile aorta.

I would be concerned that your chest symptoms are coming from the aorta when the walls are under stress/strain/pressure. You need to find out if the aorta is the source of your symptoms, and if it is, a discussion with an aortic surgeon is in order. You want to choose the date of your surgery, not find yourself in trouble if your aorta tears.

It always concerns me when the size of the aortic "root" is quoted. Do they really mean the root? The root is the area just above the aortic valve. The ascending aorta needs to be looked at - that is higher up than the root, and is the section of the aorta that usually bulges the most in bicuspids.

In summary:
1) what is the maximum diameter of the ascending aorta?
2) are the symptoms coming from the aorta?
3) what is your blood pressure? is it peaking under stress?
4) heavy lifting raises pressure on the aorta and should not be done

You are typical in that most individuals with BAVs have clean coronary arteries. However, chest pain can come from the aorta, and when it does, it is something that must be taken very seriously. Don't let anyone treat you for anxiety - aortic pain is real.

Many physicians have little/no experience with the aorta in the chest. I suggest you find a center that specializes in the thoracic aorta and hopefully also bicuspid disease.

Here is a link that may help you
www.cedars-sinai.edu/aorta

Best wishes,
Arlyss

 

[epstns]

Hi, Michael and a belated welcome to The Waiting Room - the virtual room where many of us await our own turns at valve surgery.

I, too, have aortic stenosis and am pre-replacement. I also am taking a medication for hypertension (I take Avalide). My BP was not "that" high, but my cardio made it clear that it is especially important for patients with aortic stenosis to manage their blood pressure because although the arterial blood pressure reading may be only slightly elevated, the internal pressure within the heart may be (probably is) MUCH higher than the arterial reading, since the heart is working extra hard to push blood through the restricted valve.

So, I wouldn't stop BP meds (or any meds, for that matter) without at least some discussion with your cardio.

Good luck, and again welcome.

 

[Duff Man]

Michael, I feel like you'd be making a grave mistake by discontinuing the BP meds. There are studies that prove Beta Blockers reduce the rate of expansion of aortas by reducing heart rate and blood pressure.

I have an ascending aortic aneurysm of 4.5 cm. I get chest pain all the time, but for me it seems to improve when I take my meds. Sometimes it's just a discomfort or fullness in my chest that I know was never there before I had the aneurysm. I have similar numbers to you and I'm having the replacement done in a few weeks.

Good luck my friend. Don't stop taking the meds.

 

[Michael]

Thank you for all your responses. My concern here is what is the cause of my chest pains. I want to stop taking the BP meds temporarily to see if the chest pains go away. I'll be happy to start taking them again and live with the chest pains knowing that the meds are the source of the pain. When I took the nuclear stress, my BP was normal for the amount of stress the excercise induced (at the peak my heart rate was 126 and my BP was 140/84). I was hoping maybe someone else on this forum had experienced chest pains from taking lisinopril and it was not that unusual. Bottom line is I want to know the source of my chest pain.

 

[Ana]

Bottom line is I want to know the source of my chest pain.

You have a valid question/need to figure this out, but your way to determine if it is your meds or not, needs to be done with cardiologist approval and supervision. It is not wise to go cold turkey off meds that regulate your BP as there may be quite a bounce-back effect which may be detrimental to your condition.