Speed Of Pulse Increase With Standing

[erik]

What I'm wondering is if an "instant" response like this might be more likely related to "baroreflex" trouble, NET deficiency, specific style of denervation, etc. as opposed to a "slower pooling" that drives a person orthostatically hypovolemic (with compensatory HR response). Or maybe "pooling" can happen instantly too, I don't know, just looking for any trends or associations here.

A little detail (not necessary if just interested in the poll, feel free to skip): In "the literature", it seems that POTS can involve a slow steady rise beyond the supine + 30bpm level and/or 120bpm. In my case, my HR adjusts instantaneously, as in within a few seconds. If coming from bradycardia, my pulse will double or even triple instantly (40 --> 120 in a few seconds isn't unheard of for me, but rarely over 120 so no severe tachy). It almost makes me think of some arrhythmia where the sinus fires twice all of a sudden (or was firing only half when I am bradycardic) rather than a steady "ramping up" of sympathetic activity rate or hormone release... but that's another topic unless it rings a bell for any of you. When I lay back down (from poor man's torture test)... my HR is again instantaneously slower (in fact slower than the initial supine value for a few minutes, which I think is quite normal since a slow acting response was probably fighting the tachycardia).

[mvdula]

would like to vote, but none of the options fit for me. mine shoots up fast......but it doesn't settle down fast at all. in fact, i wonder about this symptom bc i think maybe it's a clue to something too - after walking upstairs, etc. my HR does not come down for a while - lying down does not fix this. not a fun feeling.

[jump]

The "shooting up fast" nature of my hr has made it harder to get medical attention/diagnosis.

When I go from sitting to standing (or, heaven forbid, lying down to standing), my hr shoots up between 30 and 60 bpm immediately. This lasts for about two minutes, and then sometimes it will slow down to a 20-30 bpm increase from the supine rate, and then kind of increase and decreases for the time I stay standing. The initial sharp increase makes me very dizzy and out of breath, but some doctors don't consider this POTS - they ONLY consider POTS an increase of at least 30 bpm after 5 minutes. I do often have a 30+ bpm increase after five minutes, but it oscillates: like, if I start out at 60 bpm, when standing it will immediately go up to about 110 or 120; then at minute 5 it might be 80, and minute 6 might be 90 and then minute 7 might be back down to 80, minute eight back up to 100. If the doctor or nurse takes my reading at the time when it's at 80, they say I'm asymptomatic (because it's only a 20-bpm increase from 60). Honestly, the initial jump from 60 to 110 is way more disorienting, but doctors seem to think this somehow doesn't count as POTS.

When I initially developed symptoms, this didn't happen. My hr would simply go from 60 to 120 and stay there. But being on meds seems to have made this up-and-down thing happen that comes on after about 5 minutes of standing.

[erik]

mine shoots up fast......but it doesn't settle down fast at all.

Option #2 is probably close enough in this case. "Up fast, meander down." or thereabouts.

When I initially developed symptoms, this didn't happen. My hr would simply go from 60 to 120 and stay there. But being on meds seems to have made this up-and-down thing happen that comes on after about 5 minutes of standing.

Yeah, they do say normal folks can have that initial jump... however it seems clear that this is due to your meds helping (and maybe even some healing if lucky I hope the doc used wise overall judgment of the whole picture in your case and made the diagnosis... otherwise sans meds and in a solid flair would do the trick, I'm sure!

I have a mixed situation too. Have bouts of OH, not to mention the NMH-like thing (or delayed OH) after 10-15 minutes which may or may not count, and then the bradycardia which can itself contribute fatigue and such! I could end up with a label of OH, POTS, OI, NMH, CFS-P, whatever combo. Perhaps OI or just "dysautonomia" (which my doc now uses) covers it all anyway. My diagnosis for POTS was actually helped by being on fludro, which although it blunted my HR (since part of that is from a compensation for BP drop), it demonstrated that there was still plenty of HR increase left over to qualify! Treatment is still pretty similar so I'm not worried about exact labels. For all I know, I might just have a psychogenic condition like PTSD with unusually bad physical presentation (HPA axis distortion)! I gave up caring about labels or implications and just figure finding something that helps is a step in the right direction!

Thank you all for your answers.

[Chaos]

So I have to say, I REALLY REALLY wanted to vote for some of your more entertaining options but didn't want to skew your results. But you do know how to tempt a girl.

Currently, my HR jumps up at least 30 BPM instantaneously upon standing. As I stay up for the 10 minutes on some days it'll go up another 20 BPM, usually peaking at about 8 minutes. It will drop back almost instantly to the same or lower reading upon going back to supine. Being on Beta blockers and midodrine seems to keep it closer to an increase of 30 BPM range and I don't get as symptomatic, e.g. trembly, short of breath, vision changes, palpitations etc as I do without the meds.

Currently, even if I have an increase from say, 58-118 during the 10 minutes of standing, it will usually drop to 96-104 when I start walking around the room. If I stand still and dry my hair though my HR will go up to 140 on "bad" days. {On those days I figure I've gotten my aerobic activity done for the day:) } This seems to indicate to me that at least part of my issue must be blood pooling. That and the fact that I can watch my veins pop out and my feet turn dusky purple. But I find your inquiry as to whether the "instantaneous" nature of the changes indicates more of a NET deficiency or baroreflex problem etc. to be interesting. The blood pooling doesn't explain the instantaneous part of the HR change, but for me would explain the slower increase that occurs after the initial first big jump.

Thanks for the poll. It'll be interesting to watch the answers as they come in.

[potsgirl]

Hi Eric~

What a great idea for a poll. Like Chaos wrote, it was tempting to vote for some of your 'fun' answers. You've got a great sense of humor, and it's nice to have you among us.

[erik]

I was cautious to aim for "mild chuckles" or less... especially in lieu of the recent post about laughter making people more sick. I apologize if anyone suffered an inadvertent belly laugh, incontinence, or spitalemesis. Definitely not likely with the above modest material... but you never know. I always laugh hardest at the lamest jokes for some reason... and any excuse to say "foolio" is always welcome

...you do know how to tempt a girl.

Yeah, I get that a lot. I do got some mad autonomic game... ithankyou. I have to be careful how I use it... especially amongst ladies who's hearts flutter & sputter so easily.

[MommytoSJEA]

my heart rate shoots up and then stays there. Its doesnt slow down again until I sit down and rest for an extended period of time. It stinks and I hate it. No meds have ever been able to help it.

~Kelli

[lmt033167]

I'm a mixed bunch of confusion I have NCS/OI & heart problems.

Most of the time, my hr/bp shoots up crazily (for me) only to drop to nothing in a blink and I'm grappling for something to hold on to until it steadies, other times hr/bp shoots up and stays there sometimes for hours. Sometimes the simple act of turning my head or position causes these things to happen too.

I have a pm/icd and when I get it interrogated they ask what were you doing this day? I look in my journal and tell them. Of course then they say, Oh that's not supposed to happen [ya think?] hmm maybe related to ANS dysfunction? then it's ahhhh that would explain it

[bellgirl]

Foolio... like the new word!! Gotta keep our sense of humor Bystolic helps, but I am still symptomatic at strange times, erratic heart rate when I exercise, maybe because of the decreased pooling during activity, flushing or adrenaline rush when I wake up, or at night when I'm tired, I can be tachy, heart pain or tremulous, too. All in all, I am much better, especially in the afternoon; not as dizzy, on clonazepam. I can sleep, and that's imperative

[peregrine]

Looking at my TTT data, I went from 80bpm to 120bpm in less than 30 seconds, but took a while after lying back down to get back to something normal. In my case, I do have pooling issues (I first felt those about 2 minutes in), but the doctor says I also have some hyperadrenergic issues - she said that the TTT "started hyperadrenergic and then you added some pooling on top of that." Don't know if that info helps you out, but that's what she said was happening in my case.

[Sif]

Mine was going from an average of 75 bpm on sitting to 140+ on standing in under 15 seconds and would increase further when I started moving. I'm not sure if it eventually settled or not, my body wouldn't let me be upright long enough to find out, lol. It went back down to normal again about 30 second to a minute after sitting back down so at least it's easy enough for me to get some relief.

On meds, it still acts the same but the increase is only by about 30-40 bpm and decreases even faster when I sit down. It doesn't seem to get much worse unless I exert myself.

[bunny]

Does anyone's heartrate actually jump instantly? I notice it most when I am stopping exercise (ie: running to catch the train). My heartrate may be in the mid 100s while I'm running but within a few seconds of just standing there or just sitting down, my heart rate will go from ~140 down to 70 in one heartbeat and stay at 70, then dropping back down to my resting 50s after 5 or so minutes. It doesn't happen all the time, but often enough. I usually feel short of breath & nauseated when this happens.