Why Don't We All Have Oh?

[HopeSprings]

I'm sure there's a good explanation, but I can't think of it. If our problem is pooling in the legs when we stand, why don't most of us have a drop in BP? Isn't this is the cause of Orthostatic Hypotension? A well functioning autonomic nervous system triggers vasoconstriction and prevents the drop in BP. So it would seem our ANS is working properly? Maybe the problem isn't pooling? Although I have all signs of being a pooler. Once again I'm lost.

[Dizzysillyak]

Interesting question .. I have oh and pots but don't appear to pool in my legs. I absolutely have to lay down after

eating so I thought I pooled in my gut. I have gut damage from years of untreated celiac disease.

It will be interesting to see what others say ..

Tc .. D

[MomtoGiuliana]

My bp is all over the place when I am feeling badly. I am not sure I have pooling in my legs. I believe I have abdominal pooling however.

[rubytuesday]

One thing that my cardiac specialist explained to me with the OH is that (seeing my purple feet and vienna sausage toes/swollen legs/feet from the long ride and wait to his office) was that in some cases (like this), the leg muscles/vessels are not strong enough to pump the blood back to the chest to reoxygenate/get to brain. Having EDS makes these structures even worse. So my fluids have to be moved by use of Bumex that I take every 2 or 3 days and sitting semi-recumbent keeping the legs elevated. Hypotonia is common in arms and legs with dysautonomia, so exercising to try to keep them better toned is a must. I did 2 mos. of aquaciser treadmill and now use recumbent stationary bike (per card. suggestion) to try to help toning and moving the fluid--although I don't find it to be of much benefit--I still pool and will need to get the fluid off.

[yogini]

I believe in POTS the heart tries to compensate by beating fast in an upright position to maintain BP. This compensation is imperfect - for me - I have POTS with slight OH. OH/NCS patients don't have this compensation mechanism at all, which is why they are more prone to fainting. In normal people, HR increases a little and veins constrict to maintain BP. Now that would be a dream!

[HopeSprings]

Here's what I'm understanding... people with OH (just classic OH) will not have tachycardia... BP just falls and that's it. POTS people would have a fall in BP if the body didn't compensate with the rapid heartrate - so the tachycardia is kind of a good thing? Maybe it happens (BP starting to fall) so quickly that there's no time to register any of this on a BP machine? So we're kind of pre-OH. It makes sense, but then we'd expect POTS patients on beta blockers (which I guess would hault the compensatory mechanism) to then experience OH... which I don't think is necessarily the case? Or is it? Does anyone get my thinking here?

[sugartwin]

I follow you, Naomi. And you're right about beta blockers; too much can destroy the compensatory mechanism. At the same time, a small dose can help keep the tachycardia from becoming too drastic.

This is all assuming that pooling is the mechanism of the POTS and that the tachycardia is hypotensive tachycardia. It's not the case for everyone.

[anna]

One of my boys had a TTT a month back and it picked up on OH but not POTS, but he does get Tachycardia a lot of the time, just not always it would seem!!

[rubytuesday]

Here's what I'm understanding... people with OH (just classic OH) will not have tachycardia... BP just falls and that's it. POTS people would have a fall in BP if the body didn't compensate with the rapid heartrate - so the tachycardia is kind of a good thing? Maybe it happens (BP starting to fall) so quickly that there's no time to register any of this on a BP machine? So we're kind of pre-OH. It makes sense, but then we'd expect POTS patients on beta blockers (which I guess would hault the compensatory mechanism) to then experience OH... which I don't think is necessarily the case? Or is it? Does anyone get my thinking here?

Although I have OH, I do still occasionally get POTSY only not near as rapid in the heart rate as formerly. I supposed that was why now that when BP drops and heart rate hangs in low 60s that I was told the ANS is failing.

[ramakentesh]

For most in POTS there is as others says a kind of reflex activation to alter the blood flow abnormalities and this does not occur in OH or NCS. However in other POTS there is vasomotor failure - the blood just isnt flowing rather than a classic kind of overall blood pressure proble. Also dehydration and bleeding can cause a state very similar to POTS, so hypovolumia may play a major role in many POTSies.

[yogini]

I am no scientist, but I think if you have OH or low BP for any reason, not just due to pooling the heart can beat fast to maintain blood flow to the brain. That it is the "normal" response. Although Dysautonomia is positional, Many of us have high HR and/or low BP even when lying down. I think this is because of general autonomic dysfunction. The dysfunction just intensifies when in an upright position. Also there can be an excessive increase in HR due to activity which is not positional. For example when i wear a heart rate monitor i noticed my HR can increase 30 just from rolling over lying down or sipping watter when sitting.

Although betas are commonly understood to lower BP and HR, they are actually stabilizers. In most people this means lowering, but in some people it actually increases HR and/or BP. The mechanism is very complicated, but I think for those receptive to betas, the right beta in the right dose can calm some of the excessive response. If it can do so without lowering BP too much, it helps.

[yogini]

btw, i think this is why treatments that increase BP - florinef, midodrine, stockings - sometimes help people with POTS even if they have normal BP. Boosting your BP another way takes the burden off our poor hearts.