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Lower Standing Heartrate But Feeling Worse?


Foggy01
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Has anyone ever had their standing heart rate decrease from what it was before, supposedly an improvement, and yet feel worse?!

My standing heartrate is lower than it was a few months ago but I feel a lot worse. A lot more lightheaded and sometimes dizzy. I feel generally weaker, fatigued and more "out of it" and foggy. Things are going numb a lot more and going tingly and stuff a lot more but my standing heartrate is lower than it was a few months ago!

Has anyone experienced this? It's like I have more and worse symptoms of POTS but it's supposedly improved if you just went by the standing heartrate number! My resting heartrate is the same as always (high), so it doesn't seem like my heart has gotten any better (like a larger stroke volume or left ventricular mass).

I don't know what to make of this. Lol. Am I better or worse? Objectively I'm "better" but I feel a lot lot worse.

Hope someone else has experienced this paradox. I'm at a loss.

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Absolutely! Have very much the same situation as you describe. Has made me wonder if the tachycardia was a compensatory mechanism for something else going on and by getting that "controlled" it's made the something else that much worse. ???

My POTS doc says he sees this in a subset of his patients but doesn't have any explanations for it.

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Absolutely! Have very much the same situation as you describe. Has made me wonder if the tachycardia was a compensatory mechanism for something else going on and by getting that "controlled" it's made the something else that much worse. ???

My POTS doc says he sees this in a subset of his patients but doesn't have any explanations for it.

Oh god thank you for sharing your experience. I hate feeling so alone with these freaky symptoms. I'm glad there's not just one but many others out there with this (I'm assuming since your doc seems to have experience with this). By the way was your tachycardia reduced by beta blockers? Mine has gone down by itself but I feel worse.

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I found this to be true also. It also increased my pooling and edema to get my tachy more under control. NE constricts the blood vessels and if you lower NE levels then you will have more vasodilation. That would explain why there is more pooling and edema. But, for the length of time that I had less tachy ---it was sure nice not to have those fast heart rates and the anxiety that brings. But, I do think that the NE surges may be a compensatory thing with us. I think with time, we will find that many things that we are doing with POTS will have consequences.

Issie

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For me, there is no correlation between how I feel and what my standing HR is. I had a confirmation of this yet again not long ago. A couple of weeks back I wasn't feeling well, so I checked my vitals. They were perfect! My BP was great and my standing HR was 69 (which kind of scared me LOL!). The very next day, I was full of energy but my standing HR was 141. Go figure... All I can think is that the tachy compensates for something else that's at play.

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My take on this is: The tachy (fast heart rate) appears to be the body trying desperately to increase blood flow to the heart and brain. It speeds the heart rate up to try to get the blood and oxygen to where it needs to be. Lower the tachy down too much without fixing the issues with blood flow and/or blood pooling - you create more issues for yourself.

Issie

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My take on this is: The tachy (fast heart rate) appears to be the body trying desperately to increase blood flow to the heart and brain. It speeds the heart rate up to try to get the blood and oxygen to where it needs to be. Lower the tachy down too much without fixing the issues with blood flow and/or blood pooling - you create more issues for yourself.

Issie

My thought exactly. And is also why I don't understand why beta blockers work for people.

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My take on this is: The tachy (fast heart rate) appears to be the body trying desperately to increase blood flow to the heart and brain. It speeds the heart rate up to try to get the blood and oxygen to where it needs to be. Lower the tachy down too much without fixing the issues with blood flow and/or blood pooling - you create more issues for yourself.

Issie

My thought exactly. And is also why I don't understand why beta blockers work for people.

Because not all POTS is the same. In many tachycardia is compensatory but in others its caused by NE upregulation through increased sympathetic drive. In others there is parasympathetic deficits which allow symp to dominate; others beta 1 supersensitivity.

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