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Slower Hr Now...what Gives?


redoctober
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My HR is noticeably slower now, even off the Atenolol...and I'm not sure why. It can go as low as mid-40's at night, and up to around 150+ when I'm exercising. My BP appears to be fine, but my HR has slowed dramatically. I can now run 4+miles without getting really winded, but I still feel like garbage with the slow HR, unsteadyness, waking at 4am, GI stuff, etc.

Is this just a POTS/dysautonomia thing? I'd be pleased with the fact that I can run without getting winded for the first time in who knows how long...but I still feel so crappy that it's hardly something to celebrate.

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It happens to me from time to time. It was slower with midodrine and beta blockers. I hope you start feeling better soon,and that is really awesome about being able to run that far!

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I have had a lot of episodes of low HR episodes while I have been lying down. This is new within the last 3 weeks. Usually when I am lying down my HR and BP is normal (I have pretty severe hypotension). When I sit or stand my HR goes WAY up and BP plummets. But lately, while I have been lying down my HR has been getting in the 30's to 50's on a regular basis and BP is normal for me lying down (usually 90/70 or a little higher). My "normal" HR is anywhere from 60-80's.. so this is quite a bit low for me and I am not sure what would be causing it to drop so low. I am not on any other new medications. The only thing that has changed is that I am currently going through the rejection phase of IVIG treatments.

Interesting, I have been wanting to post about this as well because it seems unusual. My situation is a little different as I am pretty much bedridden, do leg exercises and resistance bands with my arms, cannot walk, use a wheelchair except in the home because we do not have an accessible home so I am crawling/scooting around the house. Anytime I am up my HR gets very high... it is only lying down when my HR gets so slow. Can't quite figure it out myself. Any input for both of us would be quite helpful.

Thanks,

Jen

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My HR is noticeably slower now, even off the Atenolol...and I'm not sure why. It can go as low as mid-40's at night, and up to around 150+ when I'm exercising. My BP appears to be fine, but my HR has slowed dramatically. I can now run 4+miles without getting really winded, but I still feel like garbage with the slow HR, unsteadyness, waking at 4am, GI stuff, etc.

Is this just a POTS/dysautonomia thing? I'd be pleased with the fact that I can run without getting winded for the first time in who knows how long...but I still feel so crappy that it's hardly something to celebrate.

You need to get in to your cardiologist. 40 is too low--pacemaker material. When I was having more OH and less POTS, while the BP plunged, rather than going tachy, it now hangs in 60s--sometimes 52. My cardiac specialist told me my autonomic nervous system was failing, that I would have fewer warnings of faint and that I would probably need a pacer on down the road.

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My BP isn't plunging, though. Sometimes it's like 140/85 @ 55 bpm. So it's like the ANS balance has swung in the opposite direction. Plus I can run like 4+ miles. I still get HR jumps in the morning from 50's to 80/90 just getting out of bed, too. It's just the evening HR's that are quite low.

No matter about the BP, HR of 40 is pacer range. You need to check this out with your cardiologist.

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Are you on a Beta Blocker? I also agree with rubytuesday! I would call your doctor. My heart rate was 50 with B/P at 80/40, I was so lethargic, fatigued, and crying about nothing, and I knew I was at risk of blood clots or my heart stopping. I immediately got off my beta blocker, atenolol, but than 3 days later was put on bystolic after having severe tachycardia and a panic attack, which is working better for me; but if you aren't on a beta blocker, you definitely need some medical attention!

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Thanks for the feedback, all...I really appreciate it. I have a follow-up in 2 weeks and I will definitely inquire about this. Like I mentioned in another post...I feel like a conundrum -- I went (bike) riding with my neighbor yesterday...tortured him with all sorts of hill climbs...so my cardio stamina feels really good. Yet, my resting HR is really low at night and it makes me feel pretty bad. I was prescribed Clonazepam as well...so this certainly can't be helping the situation (slowing the CNS).

Sitting in bed this morning it was 56 bpm...jumps to 90+ just getting out of bed, and settles back down to 70'ish after 5-10 seconds.

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I wore a Holter monitor that showed my HR was consistently low - in the 30s and 40s. So, I got a pacemaker for my bradycardia. I was so tired out and could hardly walk more than 50 feet or so without becoming completely exhausted. Turned out I had cardiomyopathy (dilated) and congestive heart failure. Everyone is different, but I would check with a cardio and possibly get an echocardiogram to check out your heart function. Perhaps a Holter monitor, too.

Good luck and let us know what you find out!

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My BP isn't plunging, though. Sometimes it's like 140/85 @ 55 bpm. So it's like the ANS balance has swung in the opposite direction. Plus I can run like 4+ miles. I still get HR jumps in the morning from 50's to 80/90 just getting out of bed, too. It's just the evening HR's that are quite low.

I agree with everyone that you should get it checked but I have a feeling it isn't your heart. I think it is just your pots. I say that because it only happens in the evenings. In the evenings your vagal tone is very high which slows your heart rate. If you have dysautonomia it can slow it down more than normal. I experience the exact same episodes as you and every dysautonomia doc has told me it is common in pots. Also, to be doing that much exercise you are likely in decent cardiovascular shape. That will lower your resting heart rate even more especially at night. It is Good to get it checked in case you have av block but I would bet it is just your over active ANS.

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  • 2 weeks later...

So, I had my follow-up with Dr. Watkins with the MVP Ctr. in Birmingham...and asked him about the slower HR's. He simply said that it's a matter of conditioning...that all the exercise I was doing was lowering my resting HR. They did an EKG as well...and sitting (114/78) and standing (118/81) BP measurements...everything was perfect in his book.

Also, even though he mentioned that the BB shouldn't reduce the resting HR's any further...I've dropped it anyway for now. We'll see how it goes. He does want me to up the Klonopin a bit...given that I'm still symptomatic in a number of ways despite being able to run 4-5miles.

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I know that athletes run low heart rates but not in 30s. Am surprised no 30 day event monitor to look at things. When I went from POTS to more of the OH with dysautonomia, the cardiac specialist told me that my autonomic nervous system was failing and that I would (down the road) probably need a pacer. My BP runs low but now heart barely gets up to 120 (stark contrast from my POTS) but now the heart rate hangs in 60's to low 70s and when I do 5 miles in 25 min. on recumbent stationary bike, I barely break a sweat and heart rate may get up to 91 at most. I have caught the heart rate in 40s (but was just incidental finding and rare).

Am glad he thinks you're in good shape (heartwise). Congrats for that!

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Yeah...it's very strange. I asked him a bunch of times about it...and he discounted it as part of conditioning.

Incidentally, I just went for a 5.5 mile run...my HR just before I started was 50bpm (140/85), peaking to around 170bpm during the run, and now 81bpm afterwards. My exercise tolerance is certainly much better these days. He seems to think that my ANS is just out-of-whack.

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Mine has been running low for a long time. I've tried adjusting my beta blocker without success. It had been dropping in the 40's but these last few months it's been in the 30's consistenly. I'm having a pacemaker put in this month. I feel a whole lot worse when my HR is that low. If you're feeling well I wouldn't worry about it too much, especially after talking to your doctor about it. Way to go on the running. I will get there at some point. For now, the bike is my friend!!

Brye

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