Why do I feel so faint when I start walking? Ask the GP DR MARTIN SCURR

By William On Sep 25, 2023

I faint almost every day. I get up, take a shower and everything is fine, but when I walk I suddenly feel lightheaded and sometimes have vision loss. My doctor said my blood pressure had increased slightly and prescribed amlodipine (I also take losartan). Do I need a second opinion? I’m 82.

Geoffrey Shaw, Hull.

Based on what you describe, I would suggest that you need further investigation as soon as possible. But let me add that once a definitive diagnosis is made, I am confident there will be a solution.

You say in your longer letter that your blood pressure is 120 over 68, which is excellent and indicates that your medication is working well.

However, one possibility is that your blood pressure drops as you walk. As a result, blood pools in the legs and less flows back to the heart, causing a lack of blood to the brain, dizziness and other symptoms.

Your blood pressure may drop as you walk. Blood pools in the legs and less flows back to the heart, leading to a lack of blood to the brain and light-headedness (Stock Image)

IN MY OPINION… Case is growing against ultra-processed foods

There’s been a huge amount of attention lately on ultra-processed foods, those mass-produced products made with ingredients that bear little or no resemblance to anything you find in the kitchen, and which are increasingly linked to obesity and diabetes type 2. .

And now, research is finally beginning to unravel what could make these industrialized foods potentially harmful.

Earlier this month, the BMJ published a study from France that looked at emulsifiers, chemicals used to improve texture and extend shelf life. This showed that the consumption of emulsifiers is associated with an increased risk of heart disease.

Although the mechanism is not clear, convenience foods clearly have something to answer for; and healthcare professionals should not only focus on cholesterol levels, blood pressure, smoking and body weight, but help educate people about food choices.

That doesn’t mean you should just say no to all ultra-processed foods, that’s unrealistic.

But we must emphasize the need to include plenty of vegetables and whole grains in our diet.

In short: education.

Certain medications can further lower blood pressure; For example, tamsulosin is often prescribed to men with an enlarged prostate. The drug works by relaxing the smooth muscle fibers in the prostate gland, but has the possible side effect of lowering blood pressure (since it also relaxes the smooth muscle fibers in the artery walls).

Another possibility is that when you start walking, your heart rate drops just as your muscles need more oxygen and greater blood flow.

Your heart rate (which you think is 49 beats per minute; 52 during exercise) is low for a man your age. Because it is low, there may not be enough force to pump enough blood through the body if there is extra demand.

Ask your doctor about a 24-hour blood pressure monitor, which will also give you a 24-hour recording of your heart rate (also called an ECG). This records exactly what happens when you start your daily walk.

My feeling is that those ‘funny twists’ occur as a result of your blood pressure dropping – exacerbated by your low heart rate.

Is xanthelasma something to worry about? I have them – flat yellow spots under the brow bone – and I have read that if you have this condition you will have heart disease or a stroke. Is this true? I’m 41 and have developed two in the last three years.

Annie Woods, by email.

Xanthelasmas are common, affecting up to 4 percent of middle-aged or older adults. Essentially, they are deposits of cholesterol that form on the skin around and in the eyelids.

It can be a warning sign of high cholesterol. But you are one of the 50 percent who do not have this: your cholesterol levels are normal, as you say in your longer letter.

Other risk factors include obesity, heavy tobacco use and high blood pressure.

Some medications can also cause xanthelasmas: most commonly estrogen, tamoxifen (a hormone treatment given to breast cancer patients), and prednisone, a steroid.

You say you took steroids in 2020 for a running injury – and this injury, along with the lockdown, caused you to gain weight. It may be that the steroid and/or weight is the cause of the xanthelasms in your case.

We are unsure of the significance of xanthelasmas in people with normal cholesterol levels. However, a small 2015 study published in the journal Clinical and Experimental Dermatology found that they could be at greater risk for clogged arteries than people without xanthelasma.

Xanthelasmas are common, affecting up to 4 percent of middle-aged or older adults (image)

The researchers said this suggests that rather than dermatologists continuing to treat the patches, patients should be “fully examined to allow detection and early treatment of such risk.” Since your father died of heart disease at the age of 60, this is something to consider.

I suggest that you request an annual review of your cholesterol and blood glucose levels. Buy a blood pressure monitor and record your blood pressure monthly. And try to keep your body mass index (BMI) under 30. Also increase your heart rate by exercising daily to regain your previous fitness.

Following this regimen will reduce the risk of heart disease and stroke, but the only way to improve the appearance of the xanthelasmas themselves is to have them surgically removed, or removed using cryotherapy – freezing with liquid nitrogen.

Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk. Dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context. If you have health problems, consult your own doctor.