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Bp And Heart Rate On Meds, Need Help?


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Not really sure if this is ok, or if i should do anything about it. I have had pots for 6 years so i am used to feeling awful and not going to the er or making a big deal out of stuff. i have been on propanolol and midodrine for a little over a month. it has lowered my heart rate from 200s to 120s standing, and 100s to 70-90s laying down and my bp has always been normal or dystolic being a little high but since being on the beta blocker and midodrine it has been 90/60s but when i am active upright i start having high bp. my bp hasnt changed with me taking either 3 midodrine aday (5mg) or taking half a pill2x a day. well the last few days i havent felt good, i have been really lightheaded, had tummy problems, and i kept feeling like i was going to pass out. my bp was consistently 70/50 and heart rate 150s. my concern is i never go to the er, even when i probably should. what bp is too low, and when should i seek medical attention? also now today at the doctors it was 128/86 and heart rate 140s sitting. even with being on propanolol and midodrine my heart rate and bp is all over the place it seems. any advice, thx

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Having a high heart rate and high bp is not good for your body. It could be the meds causing it, especially the midodrine, but another possibility is that you could have hyperadrenergic pots. My pots attacks initially started with a pulse of 145 and bp 130/100 which is high for me. Then they started swinging around a lot like yours is. High,low, normal etc. Sometimes I wonder if the medications aren't working against one another. The worst of this was when I was on metoplerol. I know how you feel though and it is rotten. One.minnute you feel like your bp is going to drop off forever and the next it feels like your heart is going to leap out and run down the street. My high bp, high pulse episodes made me feel much more worse than just the low bp. I think there are two possibilities you could discuss with your doctor: 1. The medication isn't doing an effective job of managing your symptoms 2. Your pots is changing in and of itself. When I was first diagnosed I was put on metoplerol to great effect and it worked for 6 months in controlling the tachycardia. Then things got crazy and I went through a lot of meds including midodrine and ended up doing the florinef ssri route. Everyone reacts different to ssri's but maybe this is something you would like to talk to your doctor about. When I took the ssri with the metoplerol my pulse went down into the 50's consistently. I must admit it was a welcome change from the high heartrates but 50 is also too low. After that, we took out the beta blocker and kept the ssri while switching to florinef. When I saw Dr. Goodman in Arizona he recommended that I add propanolol to the mix. I haven't done it yet simply because my heart rate is under control and I am functional and am worried about the swings happening again. One other thing I noticed is that too much salt and not enough plain water(not gatorade) would make my symptoms worse. Once I switched from gatorade to water I started doing better.

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POTS is unpredictable, hence dysautonomia, even with meds. Everyone is different. Sometimes I'm symptomatic with changes in my vitals, other times, I'm not. Every time I think I may be figuring it out, I'm thrown for another loop. Is someone with you, so if you really get into trouble, you have an advocate? It is definitely a balancing act with medications, as I am now seeing Lemons reply. Sometimes they work, and sometimes they don't. Right now, I'm feeling better, so my husband and I are planning a trip to take advantage of some good days. I hope that I don't change when I get there!! Listen to your body. You need a certain amount of exercise, but we only have enough energy to do so much. Are you overdoing it, maybe? I find if I pace myself, I am a lot better. It also takes your body time to adjust to medication changes, kind of a rebound effect after your body has gotten used to you lowering your dose of midocrine. That could be it. As long as your heart rate isn't really low at the same time as your blood pressure, I think you will be OK. My heart rate was 50 standing one night with a blood pressure of 80's/40's, and I thought I would die in my sleep, but I didn't. But that was also when I decided that I needed to change beta blockers. That was when I was on atenolol, (same one you are on but a different name; it was too short acting for me), and now I am on bystolic. I am somewhat "normal" now, but when I exercise my heart rate is still all over the map. Any where from 50- 180's most of the time. Take your vitals when you are lying down, sitting and standing, and after exercise. Normally my blood pressure now runs 90/50, sometimes 80/40, and my HR is somewhere from the 60's to 100 when I am not exercising. If you have low blood pressure, as long as you have some tachycardia, you should be Ok, but if your heart rate and blood pressure plummet together or go sky high together, I would suggest you getting someone to take you to the doctor. As long as one compensates for the other, that's your bodies way of trying to balance you out or function properly. It's complicated. Hope you find a balance, because it can really make a difference :).

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Sorry, correction to my previous post, propanolol is inderal, not atenolol, but the half life is only about 6 hours like the atenolol, which means you need more of it more often for it to be effective, so this could also be a part of the problem for you. Bystolic has a 12 hour half life, which is so much better for me. Ask your doctor about this, and maybe it could be of some help with your tachycardia.

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I used to have classic low BP on standing and after meals, over the last few months the low BP is only in the morning and this is when i just need 5mg of Midodrine. By the afternoon my adrenaline has kicked in, my BP naturally rises on standing with out the aid of Midodrine and then i fit the H-POTs characteristics!!!

Im now sat here thinking a year of so many drugs that haven't worked, and now Im on just 5mg of Midodrine once a day for my pots management!! Its so frustrating.

Im hopeful that i can at least try and pick out an SSRI that i just like the name of lol, maybe that will be the magic one!!!

Why are the Drs so against prescribing SSRI's? I mean the bad side effects i have had from bog standard BB were so dangerous for me I cant understand why they start shaking their heads when you want to discuss a drug that if it works and practically stabilizes your Autonomic system then what the problem. All meds have risks.

And another thing when ever i have mentioned that my POTs really has changed in this first year of being diagnosed, Drs seem to look at me as if this cant happen, but quite clearly it is with my BP alone!!

JR-

Just a quick message to you, we spoke about the fact that we both have very high resting HR few weeks ago. My cardio said today that the chances of it being an IST problem when you are already under the umbrella of POTS is very unusual and doesn't happen. I understand what he is saying, so i suppose its a positive thing that the actual mechanics of my heart are fine but the fact it runs on average at 100bpm resting still is worrying. His advice was to try Moxonidine and then maybe an SSRI.

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thanks everyone, it definitely helps to hear others. i have just not dealt with these low bps before, so i am not sure when to get help, lol. i do have hyper pots. i saw dr. goodman in may and he is the one that has me on these meds right now. i have 5 kids and a husband in the military so i really wait till i am extremely bad to go to the er. i had been feeling bad since over doing it on saturday. i didnt really do anything extensive but i stayed upright all day. i have been almost in bed constantly for the last year and a half and have just been getting more active the last few months. i was wondering if my doctor was going to want to increase the beta blocker to get the heart rate better but than i wonder if they would want me to increase the midodrine again, and it gave me a massive headache before whne they had me taking more. i will call the doctor in the morning and see what they have to say, but it is dr goodmans np since he is out of the office right now. i do know that he said if the beta blocker didnt work than he would probably try clonidine. i havent done too much research on ssri, what do they exactly do?

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Watch dr Grubb's video posted recently by Arizona Girl.. "POTS is an inability to properly regulate HR and BP." I have significant BP fluctuations, from 70/50 to 190/120, each end of the spectrum is symptomatic but in a different way. I have gotten pretty good at managing these fluctuations by adjusting medications. For me, i have severe hypovolemia and my tachycardia largely resolved with Florinef and high Na diet, but goes as low as the low 40's.

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I am not sure exactly how the ssri works as far as pathways. I know it plays huge role in helping to regulate serotnin, which is a vasoconstrictor.( http://www.ncbi.nlm.nih.gov/m/pubmed/9585103/ ) Dr. G's nurse could probably tell you more. Everyone is different, but my experience was that finding the right medications for my body created a much more stable autonomic system- with less variance in hr and blood pressure. Some medications worked for me and some did not. Going through those medications was a really tough time for me, but I am happy that I tried it because I am much more functional today because I did.

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Thanks, i have watched the video. unfortunately florinef didnt do anything for me when i tried it a year ago. i do stay hydrated pretty well except for when i am just feeling way too awful and than i get iv fluids that really helps. I know when i did my labs everything was fine with my seratonin, the only things off have been my norepinephrine being very high and my cortisol being low. the doctors think and have thought for years i am hypovolemic. i have been off and on anemic many times.. i just cant wait til i find the right combination and right dose for me to feel alive again, lol!

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