Scared By Changing Vitals. Can Someone Explain?

[Canadiangirl73]

Hi! So I've had POTS for over a year and a half now and had grown used to the way my vitals behaved: when I used to lie down my BP was low (90/60-100/70) and spiked when I stood up as did my pulse. My resting HR was in high 60s to low 70s and would be around 120-140 when standing. For about three weeks, things have been changing. My resting HR is consistently lower (not like the brady episodes I've experienced in the past), in the mid 50s, and my supine BP is now even lower (high 70s/mid 50s). What I don't understand is that my HR rarely goes above 100 upon standing anymore unless I do housework and even keeps dropping. The longer I stand, the lower it gets. I'm unbelievably confused and scared. I still get shortness of breath and major blood pooling issues (legs swell and turn red when I stand immobile), as well as chest pains and terrible hot flashes when I sit back down. I have been on the same dose of BB since June of last year (Metoprolol 12.5mg tid) which didn't use to control my HR much before. Can someone explain why my HR keeps dropping when I stand? I should add my BP remains somewhat stable whereas before the diastolic number used to get real high (100-110). I still get adrenal surges at night but without high tachy (except for once), as I posted about a month ago. I am puzzled to say the least. Is this a transient thing? Does it mean my dysautonomia is changing?

[Foggy01]

God im sorry to hear youre going through such a scary thing. Please ask your doctor about this. I have had something similar although it hasnt gone as low. My supine bp is 100/70 now at 50-60 bpm while my standing is 115/77 at 80-90. They used to be 120/80 at 90 and 135/95 at 120 before. Theres been a big change and i feel like death and have very disturbing breathing issues. The doctors werent able to explain it for me but hopefully they can for you. Good luck.

[Guest Alex]

Hi Canadiangirl,

the only thing I can think of is that you might want to ask your dr to reevaluate the amount of metoprolol you are on - particularly because you mention the lower HR and shortness of breath (these are listed as betas side effects)

I'm sorry you're struggling and I don't have better advice than this.

If it's any comfort yesterday my HR stayed somewhere between 44 and 60 for about 4 hrs - with POTS I guess there is a first for everything...

Hugs,

Alex

[Kellysavedbygrace]

I echo the others on check w the doc.

I seemed to tolerate the BBs for only a short period of time before struggling w side effects. I remember one night where I watched my HR drop to 40 and it really scared me bc my BPs were also running so low 60/40s range. After getting off the BBs I didn't have the low drops as severe. Now my low HR is in low 50s and BP 80/50s.

Incidentally after getting of BBs my tachy increased only slightly but my fatigue really improved. It may be worthwhile to discuss a BB holiday w your doc. A lot of us have had to get off of BBs because of various reasons.

[MomtoGiuliana]

For awhile I had episodes of bradycardia on standing. My specialist told me that sometimes he sees this happen in POTS patients. He wasn't concerned. Maybe you need to reevaluate the beta blocker with the help of your dr.

[AllAboutPeace]

Hi Canadiangirl,

Sorry to hear that you are experiencing this - the only thing predictable about Pots is its unpredictability It has definitely been my experience that Pots changes over time and my vitals have been in a lowering trend over the past several months (although the Florinef seems to be keeping my systolic in a stable range). Foggy01 and I were talking in a recent thread about the feeling that it seems for us that the sympathetic nervous system has 'burned out' or has stopped compensating for the OI. Like you, I still have bad pooling and the other orthostatic issues.

I totally agree with everyone else that it would be a good idea talk to your doc about the BB because of the noted shift in your symptoms. Please let us know how you get along.

*This is probably not an issue for you- but thought it might be worth a mention. Is there anything diet-wise that you have been doing differently? I've discovered a few odd reactions to things that have affected my BP and HR. For example, hours after I have a cup of coffee, my hr will go into the 40's and stay there. Also, I was mixing lemon juice in my water for the health benefits, but then noticed my already low BP was dropping significantly. It took me some time to figure this out, but I've since tested these reactions over again and got the same results. This would be soo much easier to figure out it we all reacted the same way to things.

[Canadiangirl73]

^{Thank you for your answers. I guess I should explain what's going on a little more. My HR can drop suddenly by 20 or 30 beats ( for instance, it started at 95 yesterday afternoon and ended up at 60 within 3 minutes and kept on dropping; needless to say I wasn't feeling well and sat down). It`s sort of the opposite of what usually happens with my vitals, i.e. that when I stand, it jumps instantly by 50 or 60 beats. Now, it instantly drops by several beats in seconds and I feel ill. So what scares me is that it doesn't seem to plateau but keeps dropping. I 'm seeing my doctor a week from today and will have to bring this up to her attention. I suspect it is related to my wacky ANS. As far as the BBs go, I cannot stop taking them. I also have Long QT Syndrome and many arrhythmias so the betas are a lifelong thing in my case. If it wasn't for my very low supine BP, the docs told me they would need to increase the dose to offer me more 'cardioprotection'. I haven't changed a thing in my diet: I avoid caffeine, spices, sweets, except for fruits, and most carbs (hypoglycemia issues now). P.S. : Last night I had chest pains and felt off so I checked my BP while standing: 98/84, HR 110. This is going to sound pathetic but I was happy to see my HR was higher. I just cannot make any sense of the yo-yoing HR and those pitfalls.}