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Brachycardia And Tachycardia?


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Yesterday, I was diagnosed with POTS based on my symptoms and my TTT showed my HR was at 124bpm for the 20min duration of the test that I was tilted. Anyways, last night while I was walking at a store, I started to feel strange and my heart felt like it was pounding, so I checked my hr and it was at 50bpm, I kept checking, and it was anywhere from 45bpm-55bpm, while I standing upright, in between walking. Is it possible to have POTS AND Bradycardia? Or is it possible I have something else going on? I was very nervous about going to sleep last night, in fear my hr would drop even more once I laid down/fell asleep. I was prescribed a beta blocker yesterday, but haven't gotten the prescription filled. I am afraid now that it will cause an even lower hr when it drops down. Not sure what I should do?

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Yes, this happens with a lot of us. Mine could hit those lows usually while sleeping and would show on my waking bp/hr. I'd have low bp at times along with the low hr. However, if you do get syncope or presyncope after you've been upright, then there are usually symptoms also, for me it is a sign I'm about to faint.

Your TTT test did not take you syncope? Also you don't say what happened with your blood pressure. That is important to know to.

Beta blockers can be tricky it would be good to know which one and how much.

Have they done any investigation into the cause of why you are having pots?

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My BP didn't drop, they didn't tell me what the exact numbers were, but said that my BP went up with my HR. I did not faint during my TTT, I have never fainted before, but have been very close many times.

This cardio that diagnosed me, did not do any investigating, just simply said what I have is POTS, and gave me the prescription. He prescribed me Toprol XL, 25mg, but is having me try 1/2 a dose to start with.

I am thinking I need to move on from him and find someone more familiar. I asked him about my body temperature fluctuating(sometimes it will be very low, and others it will be a bit high), and he looked at me like I was stupid and said that would have nothing to do with POTS, so I mentioned that it also had to do with the autonomic nervous system, then said Oh, yes, well I guess it could be part of that. I felt like I know more of the basic info on it all than he does.

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Sounds like you are on the right path with thinking about changing docs.

I have both bradycardia and tachycardia depending on the day. Have just gone thru a week of HRs in the 50's most of the time with not being able to get it over 90 even when doing the same walk that the week before had me at an average HR of 135. Then yesterday, it suddenly flipped back to being in the 120s while I dried may hair. According to my POTS neuro it's not uncommon for those of us with autonomic issues to have both as well as BPs that go all over the map.

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Yes mine goes low as well and when it first happened i felt like you - anxious to go to sleep. I also felt breathless with it and very uncomfortable with it but this does not always happen. BB's are out for me as they drop it too low and give me the discomfort but my hr probably wouldn't stay at 120 like yours.

Did you say this happened after the tilt test - I think if I have a prolonged period of tachycardia a period of brady follows.

I agree your doc should have known about the temp control along with all the other ANS disturbances.

Hope this helps - and like most things with pots it will probably all change tomorrow.

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I had brady and tach rhythms since being diagnosed. I had a pacemaker put in recently for rates in the 30's. I take atenolol which controls my tachy rhythms pretty well but was dropping my HR too low.

Brye

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mama_destiny,

I agree with Chaos about the doctor change. I think you should trust your instincts - at least get a second opinion.

I would definitely make sure that your doc is aware of that incident before taking the beta. I had the same thing happen last week (hr in 40's while up and about) and it has happened a few times before. I know my hr sometimes goes into the 40's when asleep (which I have been told is ok), but I hate it when it goes there when I'm up and around. It makes me feel strange too and like I need to cough/ sort of a choky kind of feeling. I recently saw an ep/cardiologist and she told me that with my lows she wouldn't even consider a beta blocker. What is your resting hr usually? Most of the time my resting rate is in the 50's. I can handle the tachy much better than the 40's.

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If I were you, I would suggest not getting that prescription filled until you talk with another doctor, who knows more about the whole autonomic nervous system. That is a very low heart rate walking around. I've had low heart rates like that with beta blockers before, but not without them, and especially not walking around.

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I had my low HR's before I started the BB but when they did start it I was in the hospital on a heart monitor 24 hours a day. I would be careful too about starting with a HR that low when up walking around.

Brye

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Oh yeah all over the place.

Careful on the BB's, I tried to take a 1/4 dose of atenolol when I was first diagnosed and after 2 weeks my bp was also low low low and HR was lower than ever.

Now I take Toprol, only as needed when very tachy, a 1/4 pill. Only do this a couple times a month.

I wore a month long continuous records monitor and my heart rate was from 42-137.

Just recently did an overnight oxygen test. Wore the monitor for 10.5 hours.

My oxygen dropped to 90 a few times, when my HR dropped. While sleeping my heart rate was 42-98.

I don't have apnea so I know it's not that.

That seems to go with how my TTT went. Rest HR of 63, after being tilted for 13 minutes my BP was 40/17 and HR was 117. They immediately dropped me, as I was just on the verge of pass out, and my HR shot back down to 50.

My PCP has recorded me as low as 32 and as high as 176.

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mama destiny, If you haven't already get a copy of your full medical record from this doc and make sure it has the documents they made during your tilt table test. It will be a chart showing what happened every few minutes. True pots does not effect the blood pressure it will stay the same even if your hr goes up. Other forms of dysautonomia will show the bp dropping or rising alone with the HR. Dropping usually means you are hypotensive too, rising BP will usually mean you are hyperadrengenic. Those are separte diagnostic findings from pots alone.

During your TTT did they check your catechacolines ( epi, norepi, dopamine). Most hypers get elevated norepi, most hypos don't show any rise. On your test did they try to stimulate syncope by give nito or isoperol? If they didn't do that they did not evaluate you for full syncope, as that should be the second part of a ttt, especially if you do get near syncope in real life. That is how I am and my first pass out was on the ttt, but it reduplicated all the symptoms I get in real life when this happens.

If they haven't done at least a 24 hour heartrate monitor that is something you might want to ask for because it can reveal more then just pots. Hope this helps.

You might posts to see if anyone in your area knows a good doc for you to see. Also have found that Ratemds.com is a good resource to see what other patients experience with their docs. Good luck and take care.

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i get bradycardia and tachycardia too :) . my usual heart rate at rest is around 100 or 110bpm and while on my feet it goes to 140bm and above (goes to 190-200bpm when i exercise). but my resting heartrate likes to drop into the 40's but as soon as i stand up it pops up to my usual 140bpm. i get really sleepy when my rate is low, so i keep a close watch of my heart when i'm tired, just to make sure it doesnt go low enough that i'm in any danger :)

fi

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