Orthostatic Hypertension?

[mkoven]

Just got my records from my recent hospitalization for chest pain and sob while walking.

the notes say I did not demonstrate "orthostasis" because my bp didn't drop when standing.

In fact, it rose quote a bit-- lying-- 116/62 hr 80, standing 149/64, hr 100 (after three minutes)

Nothing was made of this. I did tell the doctor at the time that I felt bad the longer I stood. but he wrote that I had a normal response.

But isn't this still an abnormal autonomic response, even if usually my bp drops? Did he just have no understanding of how bp swings in ans dysfunction???

I don't know what happens to "normals" when they stand, but I imagine the changes would be less marked, no?

[MightyMouse]

you doctor just didn't get that those of us with autonomic problems can have dysregulation of bp, not just low bp. Mine often rises for quite a while, then it can really plummet.

Nina

[mkoven]

How frustrating. It seems like there's such a narrow, textbook definition that he used. I told him I have ncs, and when he didn't see a drop, but a rise, ruled that out as the cause of my symptoms.

BTW, just got the results of the ambulatory bp test. with the way the results are reported, I see why it's not useful. they reported my mean daytime, morning, and nocturnal bp and hr. All of which are unremarkable, Nothing about the highs or lows, or intervals over which things go from high to low. I guess the test is normally to diagnose "whitecoat hypertension." But that's not why it was ordered for me. I was therefore declared "normotensive."

[Maxine]

My BP goes up when I'm crashing. If some of these docs would just THINK, and possibbly REVIEW the history a little, the BP can swing high, especially when the sympathetic nervous is trying to compensate for the OI. It's not just a "black and white" thing. There's grey areas.

I actually feel much sicker when my blood pressure swings high. When it's really low I certainly DO feel bad, but it's more tolerable then sitting there shaking and gagging the whole time because my sympathetic nervous system won't settle down.

As Nina said, ANS dysfunction affects the REGULATION of BP. Any Doc that just thinks ANS dysfunction just causes LOW BP is ignorant.

I feel for you. I know how frustrating this can be. One of the doctors who examined me for SSDI was very excited to exclaim the I had POTS-------------------->without the tachycardia! He made this very astounding discovery by taking my pulse both sitting and standing that day, and it just so happened that in that 60 second time slot my heart rate was in the normal range, so therefore it must ALWAYS be normal.

It's pretty scary that some of these doctors are allowed to practice medicine--------

Maxine :0)

[bellaluna]

You can add me to this list too- I also get this way, and I've read that people with the hyperadrenergic form can also tend to have hypertension instead of the hypotension. And I've experienced the exact same narrow-mindedness from doctors- if it isn't low, then it must not be causing my symptoms... WRONG! That is what I hate the most about doctors- everything is this or that, it can't be something in between, and if it is something that doesn't seem to make sense, or something that is unusual, forget about it. They won't be able to help you, you'll pretty much be wasting your time, energy and money.

It's maddening at times.

Mary

[goldicedance]

In Dr. Low's 1995 (1994?) POTS article, he points out that there is a subset of POTS where the blood pressure can be high. Moreover, as we know increase in blood pressure is not the hallmark of POTS, rather it is an increase in heart rate. Moreover, I don't think one doctor's characterization does not unmake POTS.

I always feel like I would have more respect for a doctor if she/he could just admit that he/she does not know or understand the mechanism of POTS. We would all be alot better off!

Lois

[mkoven]

For me, typically I get a drop in bp, without too much change in heartrate. But it does seem, like Nina says, when I'm really out of whack, I can swing high, and sometimes get tachy. Usually my heartrate does not look too potsy. My bp just drops. But then there are the times when it does go up. 100 hr is not serious tachy, but for me, it is unusual. And I should add that before I went to the er, and was hesitating, my bp was 83/46. So that's a wide variation in a short period.

But the larger point that, yes, the ans regulation is the issue. and that means erratic control of bp and heartrate. I wish that er doc could have thought outside the box a little. I don't know if that would have changed his decision to admit me, but flagging the abnormal orthostatic reaction would have been helpful. And why am I always the one to suggest measuring bp and hr in multiple positions? I wish that there were more general awareness of ans stuff and its manifestations.

it seems that all that I can accomplish locally is to rule things out-- which is still something, I guess. No one around here seems able to rule things in/really diagnose/explain.

[goldicedance]

Michele,

From what my prior POTS specialist told me:

- 3 minutes is not enough to see the full POTS explosion (implosion?)

- It is not unusual for the BP to rise as the HR is rising as your system tries to compensate for the change in BP. Then it falls (as Nina says).

Thus, the poor man's TTT, should certainly last more than 3 minutes!

Perhaps doctorguest could comment on this.

Lois

[delphicdragon]

That's one of the more confounding things with me. The doctors don't seem to get that a high BP can be just as bad, if not worse, than a low one. When I feel really shaky and cold my BP is usually wicked high (160/100) but generally it's much lower (90/50 or less). Doctors tend not to look at the BP though because the tachycardia is SO dramatic (pulse from 80 to 130+ on standing). I don't dare take a medication for the high BP as God only knows what that would do to me. One thing I find that helps though in those instances is a little red wine and laying down. That usually drops my BP back within "normal" range.

A tilt table should ALWAYS be longer than three minutes. Perhaps explaining what you are feeling to the doctor might help. I've found that saying to him I have chest pain generally gets him to pay attention instead of just telling him that I feel bad.

Good luck to you.

Sara

[Jersey Girl]

Me too, unfortunately. Martha

[jump]

I've had similar problems with doctors.

My doctor keeps referring to my "normal" tilt-table test where my hr went from 58 to 140 and my bp went from 120/88 to 90/60 to 155/85. Call it what you will, but that's definitely not "normal"! All the doctors I've met around here seem to think a TTT is only diagnostic if your bp drops and you faint, which didn't happen to me. Luckily they believe TTT's often give "false negatives," and they consider me to fall into this category. Although maybe if they took the time to read the articles I've given them about POTS they wouldn't have so many false negatives.

jump