brachycardic episodes?

[MomtoGiuliana]

I am still doing well and not having any symptoms of huge significance, but I think I do have a new symptom--episodes of brachycardia. The episodes are short, and I don't generally notice any other symptoms along with it. This has been going on for months, actually. What seems to bring it on is if I suddenly sit down after standing for awhile, or after exercise--at times--if I sit down promptly after exercise (e.g., at work--run up the stairs and back to my desk and sit down). Has anyone else experienced this? I use a low dose beta blocker, but not regularly--as needed. I seem to be most symptomatic with POTS in general in the days following my period, so generally just use it then.

Anyway, I am curious if anyone else experiences these episodes. I am not scheduled to see my specialist again til this summer.

Other than being more careful about making sudden changes of position, I don't know of anything else I can do to prevent this--and I suspect it is not anything I really need to worry about at this point.

However, any thoughts or experiences with this appreciated!

I know my specialist told me that he has seen POTS patients go from tachy on standing to months or years later brachy on standing. This is a little different, what I am experiencing, but maybe this is the stage I am at. It's a mystery to me and definitely a new challenge to go from trying to figure out how to slow one's hr to the opposite.

Katherine

[Guest tearose]

Hi Katherine!

I do get episodes of brachycardia and they come on after sustained increases in my activity levels or at the end of a day when I sit down in the evening to relax. They bother me more than the fast rate actually because it is as though I have to remind myself to breathe or get back into better rhythm. I take these as a sign that I must grab some of my electrolytes. To bring myself out of the feeling I either jump in place two or three times or wave my arms over my head a few times. I know it sounds silly but it is what I do for immediate relief.

It usually passes as quickly as it comes on. There are times they herald the oncoming of a cold or virus too.

I am surprised sometimes that as I am relaxing in my chair it is my heart rate monitor that will beep and almost "alert" me to the fact that my heart rate is so low! It is as though it wakes me up to the fact that I am having brachycardia and otherwise may not have even known. The beeping will suddenly make me sit up and look at my watch and by going through those motions I will see my heart already coming back up. I go into alarm below 40.( and above 140.)

My "normal" brachycardia beeping levels are between 35 and 37. Only rarely have I gone below that and I DID tell my doctor about those. They in fact were just at the onset of a sinus infection before I even ran fever.

You know the drill...if it does begin to bother you then don't hesitate to check it out!

take care, tearose

[Gena]

I get erratic heart rates throughout the day. I get bradycardia often in addition to the tachy. I feel like Tearose mentioned-- having to remind myself to breathe. And the electrolytes help that too. I often go as low as the mid-high 30s when I sleep . During the day I can run in the 40s and then jump up to a high heart rate for no reasonl. My doctor said the bradycardia was no danger to me. I have gotten used to this symptom and it doesn't alarm me. But you can always have it check out if it's too bothersome. Hope you feel better soon.

[JLB]

I don't know which is worse, the brady or the tachy. I get slow and irregular HBs often after I eat - sometimes, I feel like I can't breathe with the brady.

I'm sure you know this already, but be careful of getting dizzy.

[yogini]

Hi Katherine,

I get bradycardia sometimes too. How is your BP when you are having the bradycardia? For me, it has happened when my BP has climbed too high and I am able to bring my HR back by reducing my salt intake (and/or florinef when I was taking florinef). Other times I have reduced my beta blocker by 1/2 pill (but I take mine every day). These suggestions probably don't apply to you.

Anyway, I am glad that this hasn't been a big problem for you and that you are continuing to do well.

-Rita

[RunnerGirl]

Hi, Katherine. I know you have a good EP and he's probably told you this - but it's worth reiterating if only to ease your mind. Bradycardia in and of itself isn't much to worry about IF YOU AREN'T SYMPTOMATIC. If you aren't feeling majorly dizzy, faint, fatigued, etc. while experiencing bradycardia, and it is a transient event (ie, your HR will still respond if you decided, during one of the episodes, to get up and do jumping jacks or run up the stairs again, etc.) - I wouldn't think there would be any cause for alarm.

I, too, experience bradycardia along my old friend tachycardia. In part, I think the brady is from my athletic conditioning (everyone likes to cite Lance Armstrong's resting heart rate in the low 30s - both a function of genetics and the phenomenal efficiency of his heart acquired through his training). But my resting heart rate fluctuates tremendously, and has since the onset of my ANS troubles. While I can always tell if I'm tachy, I rarely if ever know I'm brady, unless I happen to check my pulse. That makes me think brady is totally normal for me. In short, no symptoms = no worries, in my book! :-)

There IS something called sick sinus syndrome, where the HR can rapidly cycle between brady and tachy. But SSS is usually accompanied by other hallmark symptoms and signs, including a blunted HR response to exercise. (As we know, most of us here have just the opposite - an EXAGGERATED HR response to exercise.) The sinus node is basically shot in this condition and severe cases usually require a pacemaker.

Also, just an aside, a sometimes dramatic post-excercise drop in BP and HR can be amplified by beta blockers, even at a low dose. Your body is working hard to maintain a high BP and HR to support your activity level, and stopping suddenly (particularly if the exercise has been especially long and/or intense) can cause the bottom to drop out of both. Blunting the effects of that post-exercise adrenaline (through BB) can make the situation worse. Gradual cool downs (even from something like running a flight of stairs) may help with this.

I hope you continue to feel well (save these little episodes of brady)! Keep us posted!

RunnerGirl

[MomtoGiuliana]

Thanks so much everyone, for your responses.

I seem, like many of us, to often have a heightened awareness of my heartbeat. So I notice both excessive tachycardia and the short-lived brady, but usually without other symptoms these days. tearose--like you say, improving fluid and electrolyte intake always seems to even things out at least a bit!

Katherine

[Guest tearose]

Hey Katherine, hope you have been feeling less symptomatic. I usually forget, but every couple of years my internist makes me do a 24 hour holter monitor to get a picture of "how low I go". This will be good to have in your file as you "grow older", to see if anything is changing over the years that is too subtle for you to notice. If you haven't had this in awhile, at your next "well girl check up" ask to do one!

take care, tearose

[MomtoGiuliana]

Tearose--good idea. I am particularly interested in what might be happening while I am asleep. The thing is this stuff is SO variable that a 24-hour monitor might not be terribly informative? I mean I have days where my hr seems absolutely normal all day, and others where it is suddenly all over the place again. It is definitely all tied up with my menstrual cycle and fluid intake.

Well, something to ask my specialist about when I seen him this summer!

Katherine

[avais1]

I get the bradycardia in the morning, before I get out of bed, after I stretch. My rate gets really slow, and I have to wait a second or two for it to come back to normal. I can get a little lightheaded when it does it sometimes, but I have always had this, so I don't really notice it anymore.

[guvna2004]

Yes i get this to. Happened just 20 mins ago. I was lying on the chair, i got up to answer the door and felt my HR lower, i opened the door and lay back down, and it went fast, im posative i was controling my HR. Todays been a bad day, i have been feeling awful, but thats my own fault for no sleeping last night. If i come back from a shopping trip and then come in and sit down i can feel my heart rate rising.

[morgan617]

I get bradycardic when I sleep. It wakes me up sometimes. It gives me more fatigue I guess from not sleeping well, but that's about it. morgan

[RunnerGirl]

I mean I have days where my hr seems absolutely normal all day, and others where it is suddenly all over the place again.

This also describes me, to a T, Katherine. However, unlike you, I haven't found any particular pattern or triggers to explain the abnormal days. I just KNOW there has to be SOMETHING (hormonal or endocrine, dietary, etc.) that causes my episodes, but I just haven't been able to figure it out and suppose it may be too subtle to ever pin-point. But I do keep trying!

RunnerGirl