Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXX!

Welcome back and thank you for asking on HCM!

I would like to explain that your doctor has suggested a rationale opinion. Besides having the underlying treatment, this should be investigated further with a fibrogastroscopy.

This postprandial hypotension is caused by an exaggerated interaction of digestive, nervous (vegetative nervous system playing an important role) and circulatory system.

I also have suggested you some tips to avoid this postprandial blood pressure drop, which is an exaggerated effect of blood redistribution triggered by food intake:

-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 lie down to avoid this condition (blood pressure usually occurs 30-60 min after eating).

Regarding your post exercise hypotension, again vegetative nervous system appears an important actor on the scene. Some kind of orthostatic intolerance seems to be responsible.

Coming to this point, for a better investigation of a possible vegetative dysfunction, a Head Up tilt test would be advisable.

If orthostatic intolerance is confirmed, then some preventive measurement would be helpful (taking plenty of water and other fluids), avoiding antihypertensive agents especially during strenuous exercising, avoiding prolonged standing up position, hot and overcrowded environment, etc).

You need to discuss with your attending doctor about the above mentioned issues.

Hope to have been helpful to you!

In case of further uncertainties, do not hesitate to contact me directly on the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Best regards,

Dr. Iliri

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Brief Answer:
Diagnostic tests are necessary.

Detailed Answer:
Dear XXXX!

Taking Prilosec will not improve your postprandial hypotension. You need to check your digestive tract with fibrogastroscopy and also investigate orthostatic intolerance with Tilt test.

No specific medications, besides the above mentioned tips.

Best regards,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXXXXX

Regarding zantac and pepcid ac they have a similar action with prilosec, but milder effect on your stomach.

As I explained before, like prilosec, they are not going to help with your post prandial hypotension. They can just relieve heartburn from gastro esophageal reflux or gastritis.

Ranexa (ranolazine) is an anti-anginal medication prescribed to treat chronic angina (coronary artery disease).

I would like to know the reason for which you have been prescribed this drug.

Common side effects of Ranexa include dizziness; spinning sensation; nausea; vomiting; stomach pain and dyspepsia; dry mouth; weakness; ringing in your ears; slow, fast, or irregular heartbeats; shortness of breath, etc.

So it can cause adverse effects on your stomach and on blood pressure.

The other drug (metadorim), it may be miswritten. Could you pleas write it again, so I can give an opinion on this other drug too?

The fast heart rate after drinking sugar coke may be also related to postprandial hypotension. As I explained before hyper-caloric food and rapidly digested carbohydrates (like sugar coke) can exacerbate postprandial hypotension, resulting in a compensatory reflex tachycardia.

Hope to have clarified some of your uncertainties!

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

Greetings!

Dr. Iliri

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Brief Answer:
Pheochromocytoma is not your case at all.

Detailed Answer:
Dear XXXXXXX

Pheochromocytoma causes episodes of uncontrolled paroxysmal extremely high blood pressure (up to the values 200-250 mm HG of systolic blood pressure) and extreme tachycardia, sweating,tremor, pale skin, headaches, etc.

So it has nothing to do with your complains and your clinical situation.

You should believe me as this is part of my daily clinical practice.

I recommend you to be careful and not to draw premature conclusions. You need to discuss with your attending doctor and to follow some of the above mentioned advises explained in during our long thread.

Please just review them.

Hope to have fulfilled all your expectations and clarified some of your uncertainties!

Best regards,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXXXXX

Thank you for the information provided.

These symptoms would really raise the suspicion of a pheochromocytoma.

But as you don't have these symptoms any more, this diagnosis can be excluded.

You should know that a pheochromocytoma does not resolve spontaneously. It is a tumor, which grows and its symptoms get worsening if not operated.

So relax. There is nothing to worry about a possible pheochromocytoma!

Regarding these previous episodes of high blood pressure, further tests may be needed to establish the cause.

A thyroid disorder could mimic this clinical scenario (thyroid hormone levels are needed to exclude this cause).

An autonomic nervous system dysfunction would cause a similar symptomatology too ( a head up tilt tests and some immunological tests are necessary to rule in/out this possibility).

Hope to have been of help!

Wishing a nice weekend,

Dr. Iliri

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Brief Answer:
Advice as follows:

Detailed Answer:
Dear XXXXXXX

Coming to this point I would suggest you to closely monitor your blood pressure (several times daily) to explore your real BP trend.

Regarding your fears about a possible pheochromocytoma, though I would totally exclude this possibility, let check the levels of the 24-hour urinary fractionated metanephrines, so you could be finally relieved from those doubts.

Wishing you good health!

Regards,
Dr. Iliri

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