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joyagh

Can Someone Looks At My Hr/bp Numbers; Is This Typical Of Pots?

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Since I haven't received an official DX yet, and my tilt table test showed "no sign of POTS" (not sure if it's b/c I didn't faint - don't know what my HR went up to), I've been measuring my own HR & BP when I'm symptomatic with an Omron wrist BP & HR monitor. I finally did a couple proper "stand up" tests and got a HR increase of 39 and 35 BPM, but they stabilize around 80 BPM after standing a few minutes. Resting rate was 60 BPM in each test. Is this typical of POTS? My HR goes to 110-130 and I get dypsnea with minimal exertion .

Thanks for any interpretations.

Here are the numbers:

first stand up test

resting: 60 BPM, BP 108/60

stand up; 99 BPM, BP 124/76

2nd stand up test

resting: 60 BPM, BP 108/61

stand up: 95 BPM, BP 110/76

2 minutes still standing: 80 BPM, BP 129/76

3 minutes still standing: 76 BPM, BP 119/81

then I tested my HR/BP when I bend forward horizontally, because after I stand up from such a position I usually get tachy of around 110+ but when I bend forward again to rest and catch my breath my HR goes down immediately.

bent forward: 68 BPM, BP 151/89 (high)

upright from bending: 82 BPM, BP 115/71

bent forward again: 65 BPM, BP 115/83

upright from bending: 80 BPM, BP 116/76

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Im no expert but the criteria for POTs is 30 beats or more from reclining to standing, so i guess the answer would be yes, i had a very high up prof be prepared to dx me on the spot with POTs on my first consultation with him counting my pulse laying down then standing up.

Hope this helps

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Did you stand up on your own or was it a TTT? I don't think I got the 30 BPM increase on the TTT although I never saw the results, but I do when I stand up on my own. Also, my HR seems to stabilize somewhat lower after being up for a few minutes, although if I start to do anything it goes back up again. Do you know if the HR is supposed to stay 30 BPM+ over resting for a POTS DX?

thanks.

Im no expert but the criteria for POTs is 30 beats or more from reclining to standing, so i guess the answer would be yes, i had a very high up prof be prepared to dx me on the spot with POTs on my first consultation with him counting my pulse laying down then standing up.

Hope this helps

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I'm pretty similar to your numbers and I was diagnosed with POTS. Although my TTT results were so crazy from my day to day vitals. Usually I'm in the 70s lying down and 95-105 standing up. When I consulted my cardiologist he said yes that's pots and it doesnt have to be a sustained rise in HR either. Although most literature says a sustained HR of 30+ or above 120bpm. Mine usually fluctuates When I stand so who knows... Do you have other symptoms?

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Oh yes, I have a whole host of symptoms, which are relieved somewhat with the abdominal binder;

extreme fatigue & sleepiness; very fast heart rate & pounding pulse when doing anything; constant palpitations; shortness of breath/feeling winded after the simplest of chores; dizzy; frazzled; scattered; spaced out; exercise intolerance; stressed; uncoordinated; muscle aches and burning, etc...

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Are your symptoms relieved by laying down? I would try and get a 2nd opinion??

I agree with this. Plus, can you get a copy of your TTT results? Mine was broken down minute by minute over 10 minutes and showed exact numbers for BP and heartrate. I wouldn't accept just "no sign of POTS" - I'd want to see exactly what happened. My heartrate started at 72 and hovered between 92 and 100 until the 9th minute, when it went to 108. It was technically POTS, but not very dramatic and so my results were interpreted as "mild orthostatic intolerance." However, this doesn't reflect what happens at home - getting up in the morning my heart can go as high as 140's and 120's just moving around during the day. I wouldn't give up on this idea just yet.

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I'm no expert but looking at the numbers, I would say no pots. Correct me if I am wrong people but I thought the heart rate has to rise by 30 minimum but be at the minimum of 120 (anything less than 100 is not classed as tachycardia) so if your low numbers were noted on the TTT, maybe this is why they could not call it POTS because of the lack of tachycardia?? There may be a small drop in HR but then would rise high again and remain that way until you either faint or sit back down.

Maybe it isnt POTS but as another poster said, it could be another form of orthostatic intolerance.

Mine ranges from 60-70 laying then goes to 135-180 on standing, it may drop very slightly, but then it will just get faster and faster and then remain at the top number until I have to sit or fall down. Mornings are always the highest tachy times when I get silly high HR's.

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yes - symptoms totally relieved lying down.

@ Tinks - heart rate rises by 30 bpm *OR* goes to at least 120 (if resting rate is more than 90) to classify POTS. sustained standing increase is not necessary to be POTS.

Are your symptoms relieved by laying down? I would try and get a 2nd opinion??

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I dont understand how they classify then as everyones HR rises on standing then drops doesnt it? How come mine goes faster and faster and then stabilises at a high point?

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I dont understand how they classify then as everyones HR rises on standing then drops doesnt it? How come mine goes faster and faster and then stabilises at a high point?

I think you are right that a slight rise in HR is typical, but a 30 bpm rise is not normal from what I understand.

I think the other thing to keep in mind is that there is great variability of symptoms from person to person, that all falls under the "umbrella" of the POTS diagnosis.

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I agree with Mom to Guiliana, that everyone is different and that as long as your HR increases by at least 30 bpm when you stand, that's technically the diagnosis for POTS. Mayo believes that the definition also includes a BP that stays about the same, or within 10 to 15 points higher when you stand. I've been diagnosed with 'severe autonomic dysfunction' (among other things) because my HR goes up by 30 to 65 points, but my BP drops into the 70s and low 80s when I stand.

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How soon after standing are you taking the first measurement? If you don't wait one minute, you will get unreliable numbers. EVERYONE has a jump in heart rate and blood pressure when they first stand up, then it settles down. Your 2 and 3 minute heart rates and blood pressures are heading back to your baseline (rather than heart rate increasing further) so without knowing anything more about whether or not you were symptomatic, I would say that your second test looks completley nomal.

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Here is an article that addresses normal changes that occur from sitting to standing:

http://www.ncbi.nlm....v/books/NBK402/

Normally, assumption of the upright posture is accompanied by a slight decrease in systolic pressure, usually 10 mm Hg or less, and a slight increase in diastolic blood pressure, usually less than 5 mm Hg. These changes in blood pressure may be accompanied by a physiologic increase in heart rate of 10 beats per minute or less.

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I still find this number 30, weird! So 25 bpm is normal but 30 isn't.. But it's really 10bpm is normal? Kinda weird. I've read conflicting studies that say it has to be a sustained rise, and some say an initial rise. I guess it just depends on if your symptomatic. I never knew I was having tachycardia.. Just felt anxious, my HR goes from 70 ish to 105 ish in the first 10secs of standing then hovers between 85 to 95 depending on the situation (time, heat, etc) but I'm hardly symptomatic... And I was diagnosed Pots. I still suggest getting a second opinion, maybe with an ANS doc?

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I found this definition in a article I was reading recently;

"The hallmark symptom of POTS is an increase in heart rate from the supine to upright position of more than 30 beats per minute or to a heart rate greater than 120 beats per minute within 12 minutes of head-up tilt.

so it isn't really based on immediate results....and another misconception many have including doctors is that BP isn't always an indication for diagnosis....you can have high or low blood pressure with POTS.

Bren

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mytwogirlsrox;I agree with you and one of my specialis'st said basically any rapid rise in heart rate from sitting to standing over like 10 bpm isnt really normal.... I mean makes sense right? all you did was stand up and your heart jumps like 20- 30 beats??? definately not normal......

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If it stabilizes back down to 80 bpm in a few minutes, in my opinion (I am not a Dr) it doesn't sound like POTS. For me my HR stays up (and keeps going up the longerI am on my feet). I have never heard the rule of 120. for POTS it is a 30bpm increase, but it needs to be sustained.

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This is from the 2011 consensus statement - and since most of the important POTS researchers are listed as co-authors, I'd go with this definition. Note - it says for those with a low resting heartrate these criteria may not apply. "Low" is considered below 60 - so you're right on the border again.

Postural Tachycardia Syndrome Definition

The postural tachycardia syndrome (POTS) is characterized by a sustained heart rate increment of

C30 beats/minute within 10 min of standing or head-up tilt in the

absence of orthostatic hypotension. The standing heart rate

for all subjects is often C120 beats/minute. These criteria

may not be applicable for individuals with low resting heart

rates. For individuals aged 12–19 years the required

increment is at least 40 beats/minute. The orthostatic

tachycardia may be accompanied by symptoms of cerebral

hypoperfusion and autonomic overactivity that are relieved

by recumbency.

Clin Auton Res (2011) 21:69–72 71

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I believe I am stating the obvious, and correct me if I am wrong, but it still seems it should be noted that in addition to either/and or both of:

A rise of 30 points in HR from Lying to Standing

Over 120 HR Standing

one needs to have symptoms to be diagnosed with POTS. I realize that is obvious, as no one would be seeking help if they did not have symptoms.

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My resting pulse is very low (50-56) and on my tilt at 10 mins I only went to 99 from 52 (evenutally climbing to 135). The way my dr. explained it to me is this: Basically, normal people have a rise in hr (be it 10 or even 20 bpm) when they first stand up but they stabilize pretty quickly and then it goes back down to maybe 10 or less above resting. Potsie hearts just keep going up and up and up because our bodies aren't moving blood where it needs to be so our hearts have to work harder and harder to counteract the gravity that's pulling our blood away from our hearts and brains. For some of us, our ANS overreacts to this and pumps out too much adrenaline to compensate and our bp goes up and we get the hyper symptoms. For me, I get hyper (high bp) following a sudden drop in bp. So my tilt goes from 90/60 to 100/82 to 122/89 to 65/44 and then suddenly 145/98 (and it kept climbing).

A TTT will get false-positive results more often than a standing test (there is research to back this), so both are useful. My hr jumped from 55 to 95 on standing test in the neuro's office, which wasn't as dramatic but both hr and bp climbed. If you have both climbing and not stabilizing, and you are symptomatic, I would think pots is likely and a second opinion necessary.

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