Asked by Sean V., Rochester, New York
I'm a 21-year-old male college student, and a year ago, I had multiple fainting episodes within a few months. I was eventually diagnosed with a right bundle branch block (of no physiological relevance) and low blood pressure. I was prescribed 2,000 mg of salt each day to combat the low blood pressure. After my yearly checkup, my cardiologist said that I no longer had the RBBB. How does this disappear? While I admit the salt helps, I'm concerned it could have a long-term impact on my kidneys.
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Dear Sean: As is frequently the case, you need to have a good frank conversation with your doctor. Right bundle branch block (RBBB) is a condition in which electricity does not flow normally down the bundle of tissue that acts as a wire on the right side of the heart. This impairment of electrical conduction can slow or otherwise affect contraction of the right side of the heart. It can be a condition that can only be diagnosed with an electrocardiogram.
It occurs in otherwise healthy individuals, and when it does it usually causes no problems. It simply should be watched. In a study of men drafted into the military, one in 500 or 0.2 percent had RBBB and they can stay in the service and do very well with several decades of follow-up. On the other hand, RBBB caused by prolonged hypertension or other cardiac disease is more serious. This may require medical therapy or a pacemaker.
RBBB can be chronic and lifelong; it can also be intermittent. In some people it is related to heart rate. It is possible to have a low blood pressure caused by dehydration. This can lead to a fast heart beat and RBBB. A low blood pressure also means decreased blood flow to your brain and can cause loss of consciousness. When you are hydrated and your blood pressure is in the normal range, the RBBB goes away. You could have dehydration because of a number of reasons, most commonly heat exhaustion and too much exercise.
The added salt in your diet or, if necessary, salt supplements, can allow your blood stream to keep more water on board. This keeps your blood pressure higher. I would not worry about the added salt as long as your blood pressure is monitored occasionally and stays in the normal range. Ongoing problems with low blood pressure are rare. With age it may be less an issue for you, and working with your doctor, you may be able to stop the salt.
While added salt is a good thing for you, most adults would be best served if they avoided salt. I encourage patients to throw the salt shaker away. Many people are sodium sensitive and very prone to high blood pressure with added salt in their diet. High blood pressure over a period of years can cause heart and kidney damage and increase risk of stroke. A few experts worry that a high salt diet over a long time can play a role in the development of hypertension in people who are obese or have pre-diabetes (also known as the metabolic syndrome).
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