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3 minutes on treadmill sends my pulse to 200


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I actually fell from the treadmill today....all I was doing was WALKING with a gradient. I didn't even run!

I'm actually on the BP monitor today back home after failing the tilt test AGAIN yesterday.

The BP monitor the hospital gave me comes up with error readings everytime I faint/ get dizzy. They said on the phone today that this means when I stand, or move posture suddenly, my pulse is probably going to ofast for anything to register.

So I went to the gym as they have pulse monitors of their own; since this hospital gave me a journal to record symptoms and times of readings in, I thought I'd go and get some solid figures to be able to write down since the BP machine isn't picking them up. My pulse went up to 197 just before I fell. It also went up to over 200 on tuesday with virtually no exercise atall.

the thing is, I've seen cardiologists and they say my heart's ok. but they've never done Echo cardiographs, or exercise tolerance tests. They never really see me at my worst. I'm seeing a neurologist about POTS, but do you think maybe I should be seeing a cardiologist? I'm yet to find a caridologist in Britain who knows about POTS. Infact I don't think there *IS* one!

Anyway, back to the original question...as I was white as a shet, freezing cold and shaky after the treadmill incident, and my pulse was rocketing like that, should I tell somebody? Should I be worried? Am I going to have a heart attack? Isn't the max HR you can tolerate 220 minus your age/ That would be 197 for me...but I was going beyond that the other day. I felt ever so ill. What should I do?

Edited by persephone
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Hi Persephone,

I would definitely tell doctor your symptoms. You can also ask what kind of exercise is OK for you to do and also whether you should see a cardiologist. Even if you get a cardio who doesn't know about POTS (mine doesn't), they could still do some basic tests like an ECG. I think many POTS patients don't actually have anything wrong with their heart, it's the screwy autonomic nervous system that causes the high HR. The tests will give you more info on this.

In the meanwhile please take care of yourself and don't push too hard.


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First of all, I think this is a good question for your doctor.

Good that you are monitoring your hr, as that will help determine what treatments may be helpful. 200 is pushing it, so you definitely want to ease off when that happens. Did you adequately hydrate yourself before you began to exercise? For POTS patients, this is really essential. I wouldn't worry about a few episodes of such a high heart rate damaging your heart or being otherwise dangerous, but you don't want to keep doing that to yourself either!

Betablockers can help with these high heart rates.

Also, rather than using a treadmill (and especially walking with a GRADIENT--which IS harder on your cardiovascular system), you might try reclining or sitting exercises first.

But, again, see what your doctor recommends regarding exercise.


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The high heart rate in and of itself is rarely dangerous in the context of an otherwise healthy heart. Also, the formula you cite is just a rough estimation of the average maximal HRs for the average person. Even in non-POTSy people, maximal HRs vary dramatically and are based on a variety of factors - level of conditioning, age, and genetics. I myself have a maximal HR far in excess of what my age-predicted max would be.

For peace of mind and in the interest of being thorough, I would probably request an exercise stress test so your doctor can observe this 'hair trigger' response to exercise you've noted. They can see if you are in sinus rhythm and if there are any ischemic changes on your EKG. I would also probably request an echo, so you can rest assured your heart is structurally normal.

If all of this checks out, the hyper-reactive response to exercise is very likely a manifestation of POTS and/or IST. Despite my being a recreational marathon runner and in tip-top cardiovascular shape, I also demonstrate a very hyper-reactive response to exercise when I am symptomatic. I have overlapping symptoms of POTS and IST. The consensus is that I have a mild hyperadrengic form of dysautonomia. I say 'mild' because I am fully functional now. I have even run two full marathons with my hyper-reactive heart! I am fine, so rest assured your bout on the treadmill will not damage you. But I would definitely tell your doctor about this. I had to twist the arm of my cardiologist (who told me I was having panic attacks) to give me the stress test. Only when she observed my heart rate on the treadmill did she believe there was something very physiological in nature going on with me!

Anyway, hang in there and please follow up with your doc, if only for reassurance.

Best to you,


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Hi persephone,

I agree with the others, it does sound like a classic POTS response, although on the more severe side than the average POTS person.

I spent 13 years searching for a diagnosis and saw a total of 16 doctors, at least 8 of whom were cardiologists. Most cardiologists don't have a clue, and all but two told me that my heart was perfectly normal despite seeing heart rates over 150 on paper during ECGs, stress tests, EKGs, and holter and event monitors. Sinus tachycardia, they said.. and they claimed it was stress, or emotional problems, and that I needed to see a psychiatrist.

It is quite likely, if your cardiologists know nothing about POTS, that you will get a similar response from them.

The only two cardios I saw who saw my HR problems as a manifestation of POTS were Dr. Grubb himself and a local physician who was something of a disciple of Dr. Grubb's.

The shaky, clammy, frightened feeling you had is also typical. Your autonomic system was fully engaged in the fight or flight response, and all of those symptoms accompany this. When your heart rate is that high, it IS scary, no doubt about it, but a heart attack isn't likely.

Heart attacks happen because blood flow to your heart muscle is blocked, causing part of it to die. In your case, your heart is just beating too fast. While scary, it really isn't dangerous and certainly isn't going to bring on a heart attack.

Exercise intolerance is extremely common in POTS sufferers, and it is likely that you will have to prepare for exercise by drinking lots of electrolyte-loaded fluids and probably salt, prior to exercising. When you do start exercising, start slowly. At first, don't walk on a grade, and keep it to 4 mph or less. Do it for 5-10 minutes at first, and if your heart rate gets out of control, take a break. When you start noticing that your heart rate stays under control for the whole time - even if it's in the 150s or so, then you can speed up, and slowly add a grade to the treadmill.

After a while, you WILL be able to exercise, but you have to build up your body's tolerance to it first.

If HR is your primary complaint and BP isn't much of a problem, then beta blockers may be your doctor's first approach. Beta blockers will lower your blood pressure a bit, but they will slow your pulse a lot. That's my primary complaint, and believe me, it's a lot better than without! Beta blockers took my average heart rate from around 120-140 down to about 100.

Try not to be scared - that only makes your heart beat faster. Understand what's going on and take steps to make yourself feel better by preparing for exercise, and you'll be OK...

You'll also need to educate yourself extensively, because your doctors will probably need education. Even if they don't, you need to understand what your body's doing.

Hope this helps...


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Thanks everyone! Janet, you sound just like me! I was told that I had to see a shrink just before Christmas.

I should add that the Neurologist I'm seeing is EXCEPTIONAL; he's the only person in Britain who seems to know about POTS! So I am REALLY glad I found him. It's now that he isn't helping; he's LOVELY, it's just that I don't know when I'm due to see him again, and seeing my pulse go THAT high was quite scary.

The thing that frustrates me about all this is the fact that in 11 yearsvirtually NO ONE had the initiative to take any readings from me whilst I was standing. I've had 24 hour holter monitors and normal ECGs, and one EEK 10 years ago. But NO Exercise tolerance test....not even an ECHO! In ELEVEN YEARS of fainting, breaking bones, having my degree cut short and putting my life on hold! SO frustrating!!!

It's only because I got a machine myself that I was ever able to prove my heart beats faster atall! I haven't been able to tell a doctor yet about my pulse reaching 200 as I've only just discovered it myself, helnce the panic stricken post earlier. Thanks to everyone for info and replies, as always for listening, unlike the majority of doctors I've seen over the years! ;)

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Unfortunately, being told we need psychiatric evaluation is all too common with POTS. Docs just assume that if they, the all-knowing gods, can't see why there's a problem, that it MUST be all in our heads... that we are craving attention... that we are simply anxious or some such other malady.

While I know that hypochondriacs abound, especially in this age of information, the average person would actually prefer to be fully functional and not poked with needles and sent through radiation over and over again just to get a little attention. It's something that I think the average doc overlooks because they experiences with the hypochondriacs stick in their heads more.

And because POTS isn't a well-known syndrome, the experience is awfully common. CFS research paved a lot of the way for us, since POTS is such a huge part of that, so hopefully more docs will recognize orthostatic symptoms as physical, not mental or emotional.

What gets me is the fact that many of us have searched for answers for over a decade. What hypochondriac holds on to the same set of symptoms for that long?!

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Persephone, you've gotten some FANTASTIC responses here ... Everyone is right on the money--everything matches up perfectly with what I've read in medical literature and heard firsthand from several cardiologists. You go, girls!

I don't have much to add--other than that I want to redouble what RunnerGirl wrote about that 220 minus your age formula. That is for "average/healthy" people who want to figure out their "optimum" maximum heart rate for a cardiovascular workout; it has nothing to do with HR on a day to day basis ... and for all the reasons stated, dysautonomics have higher heart rates than the average bears'. Not to worry.

On my stress echo test, my hr easily went to 197 and they stopped the test. I could have gone much longer on the treadmill and raised my rate much higher (which tells me that with exertion, my hr typically goes above 200), but they wanted me to stop.

One question: What do you mean you "failed" the test? Failure has meaning in school--not in medical testing. You either tested positive for POTS (with a 30 + bpm increase in hr, sometimes accompanied by BP drop) or you tested negative for POTS.

It's quite possible as someone said that you have IST and not POTS--but both are dysautonomias as I understand it, and some of the treatments are the same: compression hose, salt, water = first line of defense ... then beta blockers etc. (By the way, I wear them all the time anyway, but I was told NEVER to exercise without wearing compression hose. I hope you're doing that too...)

take care,


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I get worried at the gym to because my HR sometimes rockets to 160 when im cycling for 5 mins. i bought a years membership to my gym and havn't really used it because im so worried i might collapse in the gym. My heartrate is sometimes 140+ from walking for 15-20 mins but ive got out of the habbit of checking it so i dont notice. It could be that your heart-rate , like mine, reaches 160 whilst excersising then add your anxiety and fear to that and you have 200+. If you had a weak heart i think that you would have had a heart attack or something by now, 200 for some people is fatal, but if you can handle it then your OK. i used to be a fit and healthy runner, i ran 8 miles on a subday morning and my HR was 180, with alot of skips, and irregular beats, all i did was shake them off and carry on. See a doctor just to put your mind at ease, but to be honest my personal opinion is to do light excersise, walk 5 mins, do yoga and pilates for 4 months then gradually moove up, you can only get better, after a while you will be able to cope with more. If you dont excersise often anyway and you have POTS + the fact you fear you heartrate, like mine, would definatly go past 160. Stay strong, i admire your posts and will continue to reply to them as you have helped me so much in the past. Thanx to everyone at potsplace.com without you i'd be lost.



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One question: What do you mean you "failed" the test? Failure has meaning in school--not in medical testing. You either tested positive for POTS (with a 30 + bpm increase in hr, sometimes accompanied by BP drop) or you tested negative for POTS.

I mean that I had symptoms but I didn't faint. My heart is still racing, and rising by over 30bpm so I think I'm testing positively for POTS. But it's just so frustrating that I don't faint in tilt tests when I seem to faint so much and so easily the REST of the time! grrr :)

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It sounds like you tested positive for POTS, then, but not for NMH or orthostatic hypotension. The quote below is from Chris Calder's web site; here's the URL to the whole article if you haven't seen it.


"POTS is defined as a minimum 30 bpm acceleration of heart rate from the supine to the standing position within 10 minutes or less, with a peak heart rate reaching at least 120 bpm. Some patients have heart rates that go all the way up to 150 bpm and beyond. During tilt table testing, some POTS patients have large drops in blood pressure and pass out (syncope), while other patients have only relatively shallow drops in blood pressure. A small percentage of POTS patients have no drop in blood pressure at all.

POTS is diagnosed on the basis of heart rate increase and heart waveform signature revealed by electrocardiogram, not on the basis of a drop in blood pressure, as is the case with orthostatic hypotension and neurally mediated hypotension (NMH). Neurally mediated hypotension is commonly associated with POTS, but having NMH is not a prerequisite for a diagnosis of POTS. The secondary symptoms of POTS vary significantly from case to case."

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