drwhiz,

Thanks for your question.  In view of your history of high blood pressure I am concerned about these episodes of chest discomfort which should be considered a symptom of heart disease until proven otherwise.  Your elevated readings during the episode may be a reaction to the chest discomfort and/or slow heart rate, and not the cause.  I am not that concerned abut your pressure because it normalizes shortly after the episode resolves. 

Your slow heart rate, on the other hand, may be related to the discomfort in one of two ways.  You may be having a problem with your natural pacemaker and your rate slows from time to time.  This will provide less blood to the coronary arteries that feed the heart muscle, and if you have coronary artery disease, this slow heart rate may cause chest pain, or angina.  Also, as a response to the slow heart rate, your heart may be trying to compensate by pumping harder and raising your pressure.  Another mechanism to consider is angina that is caused by a blockage in the right coronary artery may affect the natural pacemaker and slow the heart beat.  This is because this artery also supplies blood and oxygen to the pacemaker.

And, of course, a combination of all of the above is another consideration.

I recommend you move up your appointment to be seen as soon as possible.  Should you develop chest discomfort that lasts more than 10 minutes, and/or your heart rate slows to 40's again, I suggest you go to the emergency room for an evaluation.  If your heart rate slows any further, you are in danger of losing consciousness.  It is always best to be safe.  Until seen, avoid any strenuous activity. 

 Best wishes and feel better.

Martin Cane, M.D.