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Heart Rate Hit Around 200 - Anomaly?


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Well, this afternoon I was in a bit of a rush, stressed, and was an hour or so late on my Midodrine. A bit dehydrated, too, so overall pretty bad for POTS moment.

Well, my HR flew up to 203 (monitor). I had to 'squat' for a minute, drop it to around 120s, and then it varied from 100-150 (more tolerable).

I was able to get to my Midodrine, hydrate, etc. and while not having a great day (more symptomatic/higher rates than usual) I am more stabilized.

So this was my most 'extreme' flare-up.

At what point do you really get concerned about the HR? Mine was really bad for a few, but I got it under control. And it would've been more stressful trying to get help in ER and explain POTS than knowing what I can do to treat it. Obviously if it continued in the 180-200 range I would've had to do something.

But geez. It's hard to remember you are so sensitive to things, you know? I'm just so glad it wasn't hot out. And I want to avoid this kind of thing in the future. This as my 'worst' day since I had the flu last winter...and the doctor warned me about that (180 when I stood up on flu was not a surprise).


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Well, I am always concerned about my heart rates, but unfortunately, the 200 range is nothing too uncommon for me. However, my heart rate only hits that high either while trying to exercise or during a surge in which I experience a heart rate that high for only a couple of minutes.

What helps me is running my hands and face under very cold weather.

Are you on a beta blocker? While I have never gone to the ER for one of these episodes (because like you said, we know what's worth), I would definitely speak with your doctor about it.

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well....while i'm sorry that you were feeling particularly cruddy & don't want to minimize that or your concern, for many of us a heart rate of 200 for a short period of time while in the midst of activity &/or with "stressors" on board (no meds, rushed, stressed, low on fluids, etc) would hardly even catch our attention or, for that matter, the attention of the doctors treating us. perhaps a bit hard to believe but true non the less. it's simply part of the territory that comes with POTS/ dysautonomia for a lot of people. chances are you have had a heart rate that high yourself on occasion too, but it was before you had a monitor so weren't aware that it was happening so most likely you just instinctively did what you needed to do to take care of yourself (i.e. sit/ lay down, have something to drink, etc) &, while you knew you had a rough day or period of time, you didn't have something concrete (the high heartrate) to be worried about so in some ways it was less of an issue.

if a heart rate that is significantly higher than what is typical for you AND you feel significantly worse than anything that's "normal" for you AND it lasts for an extended period of time in a way that doesn't respond to intervention (taking your regular meds, making sure you're hydrated, lying down, etc), then it's definitely worth mentioning to your doctor at your next visit. if you're especially concerned, if it's something that starts to happen more often, etc & you don't have an appointment in a time that you're comfortable with then it's not unreasonable to call the office for a sooner appointment &/or, depending on how your doctor's office & communication w/ him/her is set up try to talk with your doctor &/or his/ her nurse in the interim. nothing you've said so far gives any indication that it's anything that can't generally be dealt with at an office visit &, even as you explained yourself, you had several stressors that contributed to what happened & how you were feeling so, if i had to make a guess, most doctors (at least those who understand dysautonomia/ POTS) would "treat" you by telling you to do all you can to avoid those triggers. i'm not saying this to sound flippant &/or to minimize how you feel/ felt but rather am just trying to point out to you that even in your post where you expressed concern & asking a question you were, in fact, at the same time giving yourself answer(s) as to why you felt the way you did. only you know your body & how you feel/ felt in regard to when it's time to touch base with your doctor, but sometimes when people get a heart rate &/or blood pressure monitor seeing certain numbers can make something seem like more than it would otherwise be without the accompanying data.

if you're wondering about when/ if the ER is something that needs to be considered, that is a decision that ultimately can only be made by you &, ideally, your doctor. many times, though, due to liability concerns, doctors are "required" to send patients even when there is little need; this is even more likely to happen when there is anything happening that is even slightly related to the heart &/or if/ when a patient talks to &/or sees a physician that isn't their standard treating physician, i.e. after-hours or on a day that one's standard treating physician isn't available. over many years of personal experience, hearing from others on DINET & in other venues, i can honestly say that i've never heard of someone not going to the ER when s/he should have but have heard of LOTS of instances of people going when it really wasn't necessary. this doesn't mean that going was/ is always wrong....it can provide reassurance &/or ensure than things really are okay when there's no way to know otherwise, & i would obviously never want to be the one responsible for keeping someone away from an ER trip that is really needed, but truly unnecessary visits are, as many people know, costly in a myriad of ways...physically, emotionally, etc. so while i'm far from someone who is anti-ER - i wouldn't be here today without the life-saving interventions an ER can provide - i do consider myself to be pretty conservative in regard to what dictates a decision to go.

getting back to the high heart rate issue, though, and away from my ER soapbox of sorts, how long a higher heart rate lasts, in combination with what one is doing at the time, definitely plays a role in what it does/ doesn't mean. if a person's HR is 200 & that person is climbing multiple flights of stairs the entire time then that is obviously vastly different than if the same person's is sitting in a chair & their heart rate jumps from 80 to 200 for "no reason" & stays at 200 or even gets higher for an extended period & that person has trouble breathing & lays down & the heart rate keeps getting higher & there is chest pain; the second scenario is understandably more concerning. i realize than many/ most scenarios aren't quite as extreme - in either direction - but none the less i'm sure you see the point i'm trying to make. in "real life" things more often fall in a gray area and, as such, aren't quite as clear, but the same logic follows. so.....are there situations when a high heart rate could - in theory - dictate emergency intervention? of course. but, on the balance, in those with POTS/ dysautonomia who, most likely, have had pretty extensive cardiac work-ups in the process of diagnosis and, as such, know that their hearts are, despite all else, quite healthy, it's fairly unlikely, especially if/when the unpleasant signs/symptoms subside with appropriate intervention (sitting or lying down, resting, fluids, getting to an appropriately cooler/ warmer place, taking prescribed meds, having a snack, etc.)

i seem to be in a wordy mood of sorts this evening & think that i could have said what i intended in about half the space/ time/ words (or less), but hopefully you'll still be able to figure out what i was/ am trying to get at! i hope it helps you feel at least a bit more at ease.

take care & hope this evening finds you feeling better....

<_< melissa

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Guest tearose

Let me preface this by saying this is my opinion from my experience. You have to know a few things. What is the high that is your usual and how do you feel at 203?.

Any time you have chest pain that is severe, takes you to your knees and a heart rate that high, do call for help.

That is high but not unusual for a "spike" as long as you can immediately break it. Do you have SVT or PSVT? These should be an exception and not something you have regularly. My rates go too high rate uncompressed and so I live in compression. Compressed, I normally run between 70-140. if I get to 145, my alarm is beeping and I am starting to think of the best intervention. I feel terribly once I am at 160 and if ever I was there consistently over several hours, I would be concerned.

Exercising is different. I am allowed to go a little higher but if I have chest pain or a funky run of beats I will stop and squat and get my self in balance again. If this continues, stop exercising. If you can get it to resolve, try exercising a little more. As long as you don't have continuous chest pain too. Right now, the air is cold and I have been a bit more busy so today my heart rate spiked while exercising and then I was arrhythmic so I stopped and now I will wait a couple of days before pushing to exercise again.

Heart rate variability is an issue you do need to address with the doctor. Know what is your personal high and low numbers are for your activities.

best regards,


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My monitor sometimes picks up random electrical signals which screws up the reading. Being around anything electronic can do this. Not saying your heart rate wasn't 200, but something to be aware of. The next time you get such a HR, you may want to manually check your pulse to make sure the reading is correct....and if it is really 200, I would at least call the dr.

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I just read through all these posts and I really want to thank you all for *really* taking the time to listen to me. I have no where else to turn sometimes...and it's wonderful there are people out there who care.

My normal 'bad spike' (low on fluids, going up stairs carrying something, walking in high heat/humidity on a bad flare-up day, flu/viral infection) is usually around 180. I am used to that enough, and it's not for an extended period of time. It's no fun, but I deal.

So today with the 200 I felt more dizzy than usual and you are right in that, yes, before my monitor there may have been times it flew up to 200 for a couple of minutes. I think just 'seeing' the 200 was a shocker. By squatting for a minute and getting back to 120 within a minute or so I was fairly certain it was POTS. No real 'chest pain' or other symptoms. I knew the beat was fairly steady, too. Obviously if it kept flying up and up I'd have called 911 if none of my usual 'tricks' worked.

I'll only have had POTS diagnosed since last January. It got 'worse' probably about a year ago, when I really took notice something was off. Just going through all the seasons/weather changes/etc. has been an experience in and of itself.

There are days when I sit and it's in the 70s/80s and other days 90s to 110. There are days when I stand and it's 95-110 and other days 105-125. So on a 'flare-up' going to 185 isn't a shocker. My doctor knows that's about my 'high' and he's told me to sit down, lie down, whatever I need to do. I haven't tried the cold water, that may be a good thing while at work, so thank you.

Years ago I had an SVT (not PSVT, they confirmed). My rate got 'stuck' at 260. I had to call 911. I was otherwise healthy enough, no POTS, and that was a very different feeling than today. They had to give me Adenisone (sp?) to stop it and then I had an ablation. I developed POTS (they think) about two years after that after catching a virus. I'm still seeing my EP who did my ablation and he is 99% sure there is no connection to my ablation and POTS as they were so far apart and I remember wearing a doctor-reviewed heart monitor before my ablation and someone would've noticed POTS-Like symptoms.

So. It's weird I've had both...but today was much more "POTS" feeling than "SVT."

Is it weird any kind of anxiety can up my HR about 40-50 BPM? I've noticed any time I get extremely nervous/anxious/stressed it makes things go almost out of control. I need to learn to control that (at least somewhat) so any tips are helpful. Now I just try to sit or lie down and think this will pass, it's ok, this will pass.

Thank you again for all your help and kind words. It means a lot.

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wanted to tell you that my heart rate has gotten up above 200 (once or twice.... or maybe more) mostly when i have to run or something. (have to is the key word here- i normally dont run unless it is a must :) ) It always freaks me out! but my cardio reminds me that even when my heart rate is at max for a short period of time it isn't going to explode! i think as long as it goes back down it isn't a problem. I would just think it would be bad if it goes up and does not come back down. It is very scary though!!!

i would talk to your cardio about it next time you see him or maybe just call and talk to an RN-

take care!!!!

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I have a Polar brand, the cost was around $150. It works well (little to no interference with electronics), my doctor likes the accuracy of it, and the chest band isn't terribly uncomfortable. One gets used to it.

I had to pay out of pocket, insurance won't cover it. You may be able to pay using Flex Spending Account (FSA) is it's medically recommended. I've seen plans like that.

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I think most of everyone else already covered it, but a HR of 200 is not necessarily a go to ER moment. It is more about the other symptoms you are having AND how long it lasts. If it is sustained than, yes it may become time to go to the ER. I go over 200 sometimes, but or less it was for a matter of minutes without decreasing and with a lot of symptoms I probably would not go to the ER. But, if the symptoms are there and it is not coming down- yes, ER is the way to go. My sis has had that happen a few times with runs for hours at 200-250+.

Hope you are feeling better! :huh:

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I think lots of people have essentially said the same things - If you are experiencing a symptom that is totally new to you and you are really worried and it doesn't settle in a few minutes with your normal "helps" then the ER is a sensible thing to do.

Before dialing for an ambulance you should do the usual things to help POTS symptoms - rest, sit down or if that doesn't help lie down and prop your feet up (gets the blood to your brain). Various manovers like squatting / marching in place, crossing legs and clenching let & butt muscles can be done if you are out in public and don't want to lie down! Cold water on your wrists is a good idea as it cools the blood there and tricks the body into directing the blood more to the centre of the body. Another thing that has been proven to help is medical trials is drinking 500ml of ice-cold water (this probably diverts blood away from your stomach meaning more blood for the brain and central organs).

Someone told me that at med school they were told to "always treat the patient not the numbers" (look at HR or BP measurements or blood test results etc but at the end of the day it is how the person looks and feels that is important).

Take care,


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