If your pulse is dropping into the 40s at night something is wrong. I'm glad you've spoken with your cardiologist about this. Hopefully, a 24-hour monitoring test will give you and your doctor some clues as to what is going on.

I actually was experiencing the opposite. My heart rate was increasing into the 90s at rest and in the 60s with activity. After a CPET and 48-hour Holter monitoring test, I was diagnosed with a form of dysautonomia called inappropriate sinus tachycardia. Dysautonomia is quite common with Sjogren's Disease, the cause of my PAH as well. Since starting on metoprolol succinate, a beta blocker, the symptoms are pretty much controlled now.

Good luck!

At the moment, I am not on any oxygen. We are trying to get to the bottom of some of the symptoms I am experiencing. I have just bought a wrist pulse oximeter which should arrive in a few days so that I can actually monitor my O2 saturation throughout the night. In the meantime, my pulmonologist has asked me to have a repeat 24 hour ECG just to make sure there is nothing going on with my heart. I think she is just eliminating things to be sure that the problem is caused by my medication. She is then in a position to put forward a case to be able to try me on something else. At the moment, the protocol in Cyprus for IPAH is Sildenafil and Bosentan and this can only be changed if there are some "serious" side effects!

As I say, the lower blood pressure is to be expected because that is what Sildenafil does by opening up the arteries around the body. It is the lowering of the resting heart rate that is a puzzle. I have spoken to my pulmonologist and she has asked for me to have a repeat 24 hour ECG which I have arranged. In my last one, the lowest my heart went to was 50 bpm. My own tracking has now shown it typically below 45 bpm at its lowest, and occasionally below 40! I think the pulmonologist wants to make sure nothing new happening with my heart before she concludes that this is all medicine related - in which case we will have to consider changing to a different regime which needs approval from the powers that be!

Lori, I have had a 24 hour ECG. Heart rate dropped to 34 bpm, but the cardiologist is not worried because there were no signs of things like high grade AV block, arrhythmias, heart pauses, or pAF , and other than the IPAH, I am pretty fit and healthy!!! My resting heart rate has always been on the lower side when resting during the day. I have to admit that until this diagnosis, I never measured it at night. Anyway, at night it drops periodically down to 34-36 bpm, but it is only temporary. Normally the average at night is around 50 bpm as well. Anyway, thanks for your concern!!

I am really hoping it wont mean even more medication!!! I am more hoping that my pulmonologist will put me on alternatives - there is evidence that the Silfenadil/Bosentan is not the best option given all the advancements there have been in the treatment of IPAH.