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Holter Monitor Results

Michelle F.

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In preparation for going to Africa this next week, I have tried to cover all bases. Last week, I sent a quick email to my cardiologist and let her know that I have had a new feeling the past several weeks (that I've kinda ignored). When I wake up after lying down (whether nap or full-night's sleep), I feel like my heart is beating a very slow and chaotic tune. Sometimes a forceful push/pump will wake me up. Recently, I felt like that forceful push woke me up and that my heart may have stopped beating prior to it....don't know why I think this.

Anyway, I received a prompt reply that I needed to come in for a holter as soon as possible. I've never worn one, but went the next day. I wore it for 24 hours and the holter was picked up by Fed Ex from me on Monday; sent to Nebraska, I think; and I received a call from my cardiologist's office in Alabama in less than 24 hours from the time I sent the holter. The nurse said my HR was 146 when I went to bed (I'd had a caffeinated coffee because a friend suggested I do unusual things so that the doctor could see what my heart does- don't know that I should have done that though). Anyway, the next morning my HR was 34; then 51; on up to 80 and 91 varying throughout the day. These were preliminary results, so she didn't have the complete report. My orders were to decrease my Toprol to 1/2 tab (rather than 1 whole) in the morn and keep 1/2 at night. I am to call them on Monday and let them know how I feel.

I've been told I have NCS, but does any of this sound like POTS? I realize I'm on Toprol, so it may be hard to tell. Is it surprising that my HR went to 146 with a cup of coffee?! Should I be concerned about the 34 on waking up? Is there something I can do, other than changing dosage to get my HR up some in the morning? I'd appreciate any thoughts.

Thanks all!


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You could do a 'poor man's tilt table test' at home if you'd like. Do you have a heart monitor that gives you BP and HR? At the least you need to be able to read your BP - the HR you can figure out with a clock with a second hand. It's usually considered POTS if your BP stays about the same (within 10 points or so) but your HR goes up at least 30 points from lying down to standing up, within 10 minutes of standing. So if you lay down for 10 minutes, then take your numbers, and your BP is 100/60 and your HR is 60; but when you stand your numbers go to 90/55 and your HR shoots above 90, it's a good bet you have POTS. You should take your readings standing at 1, 3, 5, and 10 minutes.

Symptoms are listed on the home page of this site, and you can learn more about POTS and other dysautonomia illnesses. Hope this helps!



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Yeah, some home measurements with the BP/Pulse meter should hopefully help. Not just in spotting POTS but to get more than just a pulse picture of the heart. I think a doc will (and should) almost always start with consideration & adjustment of existing meds to explain & address symptoms. One key with the Holter info is to consider if you had symptoms timed with something it spotted... I guess it sounds like you did with the morning bradycardia. I am assuming the doc was informed of the caffeine... if not, be sure to let them know, of course!

Your list of existing diagnoses puts you in the POTS neighborhood in general... fibro, connective tissue, migraine, etc. Folks can have NCS & POTS diagnoses simultaneously... I think one article said 30% of POTS have NCS too, IIRC... or I might be mixing that with NMH or other... hard to keep them all straight! Might have expected some HR spikes through the day with POTS, but of course Toprol would tend to mute those. If POTS were added to the diagnostic mix, I suppose you still have to view the whole picture to be safe there... so it seems even more expertise is advised than normal.

Overall caffeine and it's timing against Toprol could get a little funny especially because Toprol is cardio-selective. Keeping a general eye on BP in addition to just HR is wise. Caffeine during day might be helping, not suggesting a change in anything if that's what you normally do... just keeping an eye on BP and letting the cardio doc know what that side of things is up to, as well as HR.

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I was told to some extent ignore my heart rate and blood pressure and pay attention to how I feel ( by the cardio at Mayo clinic in minn. With this said I still have a good heart rate monitor and blood pressure cuff. Not as good as a holter ( I have also done the 1 month monitoring) Anyway my heartrate has been 201 (I may have been walking up stairs) and as low as 28 (I was in Walmart).I was on a beta blocker which suprised me).

Last time I had a holter on my heart rate went up to 160 when I was brushing my teeth.

I am not sure if I would worry too much about the numbers. I would worry more about how you feel. It is also important that your heart have an overall sinus rythym. You may very well have POTS but the hard thing is you have to be off meds for a "true" test. The Dr's I saw told me that I had very liberal limits in terms of heart rate and blood pressure. Hope your feeling better and have some good info soon.

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Thanks everyone. I fainted on the "rich man's tilt table" a couple of years ago. lol (actually, it wasn't funny at all!) I was dx'd with the NCS, but I've had suspicions of POTS, though cardiologist said I was classic NCS. Anyway, she's helped me very much treating my symptoms.

With these recent bradycardia symptoms on waking, I notified her of the change. She decreased the dosage and I am a couple of days into that dosage. I did let her know about my bedtime caffeine with the holter. I usually avoid caffeine because it makes me feel so bad...increases my HR...as evidenced on the holter.

I have stopped monitoring my BP & HR at home because overall I've felt better the past several months. With things changing, I think I will spot check it. I do know that my bottom number (at rest) has increased over the past few years. It's been almost equal with my top number on a few occasions!

Thanks again,


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