Study Of Heart Rate Recovery Time In Pots

[davecom]

Research from Cleveland Clinic

http://ftp.benthamscience.com/open/tocmj/articles/V007/36TOCMJ.pdf

What I found very interesting was that the faster you "achieve POTS" the more likely you are to have a faster recovery time back to a normal heart rate upon sitting down. They speculate in the discussion that this indicates your POTS is likely centrally mitigated (as opposed to peripheral vasculature).

[Dizzysillyak]

Data was analyzed from a prospectively collected registry-

database in a study approved by the Institutional Review

Board. Subjects who presented to the Cleveland Clinic from

January to December 2007 for evaluation of symptoms of

orthostatic intolerance and subsequently diagnosed with

POTS on head-up Tilt test in the Syncope Clinic were included.

No differentiation was made between primary or

secondary POTS; patients may have had orthostatic intolerance

as the lone medical problem or in conjunction with

other potential causes of autonomic dysfunction such as diabetes.

It is standard practice in our Syncope center to not

stop the patient’s medications prior to Tilt in order to obtain

“real world” diagnostic information and to avoid problems

with medication discontinuation especially if they are indicated

for other diseases (e.g. angiotensin converting enzymeinhibitors

and beta-blockers for coronary artery disease). No

differentiation was made between ‘Early’ versus ‘Late’

POTS [3]; the HR increase by 30 bpm or to 120 bpm may

have occurred within 10 min (Early) or after 10 min (Late) of

Tilt.

Since, in our experience, the response of blood pressure

to tilt in POTS patients varies (e.g. no change, drop in systolic

and/or diastolic pressure), patients with orthostatic hypotension

during Tilt were included; however, patients with

a vasovagal response were excluded. Patients with pacemakers,

significant artifact or arrhythmias on ECG monitoring,

missing data or discrepant data (1 patient) were excluded.

I have a left bundle branch block so I would've been excluded. I really need to get this looked at further ... tx for the article. D

PS. I know from using a BP and HR monitor at home that it takes my body an hour to fully recover from hypoperfusion. My hr goes from the mid 70s to the mid 60s in the last 15 minutes of being supine and I finally start feeling healthy again. If I get up too soon, my hr jumps right back up to my POTS rate within the first minute.

[Birdlady]

This is interesting! I definitely fit this criteria. By the time they got to 70 degree tilt at CC, my HR was already 119 and I met the criteria for POTS. At the end of the 45 minutes, my HR was 150. The moment they laid me back down, the first minute of recovery, my HR was instantly 75.

I don't agree at all that if you return to normal while sitting you have a better prognosis or quality of life. I've had POTS since at least age 16 (probably as early as age 9) and I've only gotten worse with time. (I'm now 29). If your HR is instantly at 150 when you stand, then how do they come up with this idea that you have a better quality of life... It makes no sense to me. Even though my heart calms down instantly, I still feel shaky, have heat intolerance and if I overdo it too much, then the big crash comes where I have to sleep it off.

This study further pushes the idea that if your vitals are normal that POTS is essentially "turned off", which we all know is not true.

[davecom]

Great point, Dana. Where does this leave us in terms of treatments? Does a centrally acting agent like clonodine/beta blockers therefore make more sense for us than vasoconstricting peripherally with something like midodrine if our recovery time and startup time is fairly instant?

[Birdlady]

I'm surprised more people haven't posted to be honest. I haven't found any results with Florinef, midodrine, increasing salt intake and even saline IV's. Beta blockers just chill the heart out, but none of the other orthostatic symptoms and nothing gets rid of heat intolerance.

[margiebee]

I can say that in my experience, my heart rate recovers quicker after exercise now than when I first started exercising. I believe that this affect holds true for when I experience tachycardia in general now, and I can notice a difference. I feel slightly better now, at least tachycardia-wise.