### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am 60 yrs old, 5 ft 5 in, and 197 pounds. I have had high blood pressure for the last 9 years and for the last 5 months I have had heart rate increases up to 140; for which I went to the hospital and after a couple of tests [one of which was the nuclear stress test] told me that my heart is fine. I am now wearing an event monitor and have had a few episodes of heart rate over 100. My normal heart rate has been 80 for several years. Last night my bp went down to 106/57 and this morning it has been ranging between 112/81 and 134/80 but the thing that concerns me is that my heart rate is ranging between 74 and now it is down to 60. I take two Metoprolol (50mg) per day plus a Losartin/HCT 100-12.5 mg once per day. I also get very weak spells. Is it possible that the bp meds are causing this problem?

### output:

Hello, current BP medicine can cause low pulse rate but not high pulse rate.  If you have episodic high heart rate then it can be a cardiac arrhythmia like PSV or atrial fibrillation, in which heart rate suddenly goes up and also suddenly decreases. Blood pressure falls during these episodes and one has dizziness, fainting, blackouts, sometimes syncope. Usually ECG is normal as it is usually done in between the episodes. ECG done during episodes will show abnormality. You will need 24 hour holder monitoring and event monitoring which you are having and we'll probably get answers out of it.  Also, hemoglobin and thyroid test should be done. Ln order to abort such episodes you should try to cough hard. Is there any stress or anxiety associated. You can discuss with your doctor regarding reduction in dose of metoprolol as pulse rate is low.  If none of the above is successful then last option is of electrophysiologist studies which is invasive test which can diagnose and treat the arrhythmia permanently in most of the cases.