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Pots Crash But Bradycardia?


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Its bin awhile but that oh so familiar POTS Crash has hit hard and fast in the last 24hrs!

Had an all time low bp (that I managed to catch) today of 61/35 during one of my usual presyncope vomiting episodes.

BUT anyone any idea of why HR wud become very low instead of the usual tachy with pots. my HR this time is very low for me....ive always had a resting hr of about 70-75 going up to 140+ standing depending on how symptomatic I am. Hr is 45-52 resting and was 67 with that low bp.

Im on florinef. 1mg ...no major change in anything recently.

I feel HORReNDOUS n will be heading for hosp if this continues...bin vomiting and near syncope all day cant get off the couch.

24hr urine sodium last week was 143mmol and potassium 45....what is normal??

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Guest Hanice

Oh man I have no idea why that would happen. Just try and be calm and have someone you feel comfortable with with you until this subsides. If it doesn't subside soon then maybe you should consider going to your nearest favorite hospital just to be safe. Or maybe the hospital which YOUR doctor belongs to. Maybe they can call him or her. Please please be well and please follow up with us here! Let us know how your feeling. I'm gonna be worried till you do! Be safe. Hugs!

I'm sorry I wasn't on sooner to see this. Hopefully someone can help better than this.

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If you was in a presyncope episode, maybe you was on your way to hitting the floor, with the low BP and heart rate. Heart rate drops when going into a faint. My HR has dropped low at times too, which is not the usual. I just think its our squiffy ways with pots.

Have just found a link re the electrolyte levels. Potassium should be max 5.0 mmol or 20mg/dl, s yours may be a bit high judging by that. Are you taking supplements or enriched foods to combat the florinef? I thought the florinef would be raisng your bp to stop the drops on standing?

http://en.wikipedia.org/wiki/Reference_ranges_for_blood_tests

Hope you feel better soon.

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s-pot,

I'm sorry that you are having such a horrible crash. I can definitely empathize with feeling so awful because of brady and low BP. The only time i had a recorded BP like yours, I was unconscious. I really hope things improve for you soon!

I don't know what causes the Brady (other than just a mixed up ANS). When I first had pots my HR was around mid 60's or thereabouts and has dropped consistently over time to settle around low 50's. I do get mid to low 40's from time to time with a consistently low BP and it definitely is one of my least favorite Pots symptoms. I get presyncope, really weak, cold and nauseated as well. All I can do is wait it out as I can't seem to speed it up when it gets stuck at a low rate.

There was a thread yesterday re: Brady by LMG if you haven't seen it yet.

Stay as hydrated as you can. I would definitely be wanting a saline IV to help with that if you go to the hospital.

Take care

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s-pot,

sorry you're having such a hard time.

With all the symptoms you have described and the HR/ BP numbers I'd head for the ER. They should be able to help you with the syncopal feelings and the nausea. Perhaps some saline IV as Peace suggested above.

The 24 h sodium and potassium levels look OK to me (sodium should be between 40 and 220 mmol/L and potassium between 25 and 125- at least these are listed as reference ranges on the paper from my latest test results). Your blood levels might be a different story though particularly since you've been vomiting.

Please keep us posted. I hope you feel better soon.

Alex

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Hey folks thanks so much everyone for the care and advice!

I gave up on tryin to keep managing it at home today n went to gp who sent me to the hospital where the usual frustrations occurred....nobody knows anything about pots or dysautonomia and even after you tell them what it os they proceed to take my bp whilst lying down for a half hour and say "oh but your bp os great there now" !!! Grrrrr!

Anyway im being kept in for fluids and a holter monitor n we'll see how it goes. I have no faith in them finding out any Whys but hoping at least 1-2litres flyid will help me over the next 24hrs to get back on my feet!

Thanks everyone! :)

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I had a crash a bit like that once; was a bad day. I could barely move, went into hospital, my body poured out insane amounts of adrenaline to keep me conscious (felt like I was cooking), passed out momentarily anyway, got sent home from hospital, and then later that evening... I just felt so bad. My adrenaline was all used up, I was freezing, felt like I had a terrible fever (was probably more like hypothermic, that's normally the way), upper body aches, close to unconscious, and my HR was in the 60s instead of going fast (low for me these days). Then I thought I was having a heart attack. After buzzing all over for a second my heart suddenly kicked into tachycardia with such force that I just yelled for my boyfriend to call an ambulance. I did feel way more conscious during and afterwards though and the tests checked out okay in hospital.

So that's the only theory I have for you - adrenaline depletion. Benzodiazepines have helped me control these crazy swings if I don't push myself too much. I've also experienced terrible vomiting at times with POTS, and it can put you into a downward spiral fast, considering how dependent we are on water and salt. Have you ever been tested for Addison's disease? If that BP was accurate, it's awfully low. My mom's bp was around that when she had an over-reaction to general anaesthesia, and the docs were kinda worried. She was pretty much in a coma. Are you sure you were...actually conscious?

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Thanks alex...they dont know a whole lot but are willing to listen n trust that I know the illness better so thats always good.

Freaked thanks for the post

I really dont fully know what has caused such a crash except I went back to work as a midwife. Most definately run on adrenaline and it seems I only manage to work for 4-5wks till I crash.

I was most definately concious....it seems my body cam tolerate very very low bps without me fainting. I took pics of the bp measurements to prove to the docs

61/41 pulse 53 at one point and 92/36 pulse 60 at another.

Holter monitor here at mo is showing hra of 58 at resting n going up to 125 at standing....they cant ever seem to catch the low bps thou.

The night nurse looking after me her best friend has POTS and was a nurse (hadto give up the job...:( for me cos I think im gna havto do the same :( )

Cannot express how nice it is to have someone looking after me this eve who completely understands and empathises with the illness. A rarity in my experience!!

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I also have the improbably LOW heartrate, normal is about 53, and i have gone as low as 44. Meds obviously can slow you down. As does dehydration. Or a flare.

At the same time ive gone tachy for no reason.

Ive been athletic my whole life, so my HR is naturally low. I keep a pulse oximeter and recommend you get one.

When i check friends HR on it, im shocked that its 75 or even up to 100 which is normal range.

Im often half their HR.

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Well the hr monitor is showing sinue brady at night down to 42 and sinus arrythmia and sinus tachy in the mornings.

Must be the flare up and dehydration cos I wouldnt say im unfit but certainly not athletic enough to claim a low HR from being fit.

Pple on here have memtioned a lowering of resting HR over time with medications.

Question is :

If you resting hr is 50-55 and your standing HR still increases by 30-40 beats...does this still come under the bracket of POTS seeing as a HR of 90 would not be considered tachycardia?

I used to have a resting hr of 70-80 and tachy up to 120 +bpm standing. The increase in beats is same now just looks less obvious cos of the lower HR.

Mine does go up to 120 from 50 at times still whem walking but jist interested in pples experience on this one!

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Yea they telling me the same here Hanice about the low HR and just that it feels pretty uncomfortable for me at night cos im so used to it being tachy.

They have been good...im on my 4th bag of iv saline n still on heart monitor. Be staying in till after the wekend n just gotta wait it out keep goin wit IVs

Im improving a bit at a time but very weak n walking to the toilet takes it outa me. Each time i tried to walk around further (cos I start thinking im bettter than I am!) Its brings on a presync episode....which for me is severe dry wretching...not nausea n I never vomit. Its some sort of vagal reflex that seems to push the bp up n my heart starts to slow....like a tripwire it seems!! Its exhausting! Pretty fed up m frustrated with POTs at the mo!!

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Having had multiple Holter monitor recordings - I have my own machine :) I can tell you that not everyone gets bradycardia at night. I have POTS, I definitely don't have inappropriate sinus tachycardia, yet I've had many episodes of tachy during the night and my HR rarely went below 70 when I sleep (despite being on a low dose beta blocker at those times).

We do tend though to have a lower heart rate at night as our bodies are more relaxed, but bradycardia is definitely not the norm for anyone...unless you're a very conditioned athlete. For us, POTSies, the brady at night seems to be part of the autonomic nervous system dysfunction.

The definition of POTS is a 30+ bpm increase in HR when going from supine to standing, so s-pot, I'd say you still "qualify" for POTS unfortunately :( , but indeed a HR of 90 isn't considered tachycardia.

Another thing you should consider is this - you're getting saline IV treatments and that's supposed to help manage some of your symptoms, particularly the rapid heart rate. In my opinion, the fact that you're staying under 100 is a sign that the saline is helping you. For what it's worth I had a tilt test while on treatment for POTS - my dr wanted to evaluate the effectiveness of my treatment and I tested negative. Really weird given the fact that the previous day my HR did some nasty things, going up to 220 bpm. The negative tilt test didn't mean I no longer had/have POTS but that I just was not symptomatic that day.

I hope you continue to improve with your treatment.

Best,

Alex

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Guest Hanice

:-( dont worry we all have our episodes. All those iv fluids are gonna leave you feeling new when you get out. Have you thought of which med that your taking might be doing that to you????

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Hanice I'm not saying that you haven't been told that. I was simply explaining my story. I don't get brady except for very rare occasions and that's due to the mestinon I'm taking (my only POTS med at the time).

Sometimes people like to generalize...and I'm sure your dr's assistant was just trying to reassure you as indeed there is nothing dangerous in having occasional brady episodes particularly if you have no symptoms that go with that.

When my HR was 220 one of the drs from the emergency team taking attending me told me that "it's normal, it could have happened to anyone". After gave him "the look" he said, "well, maybe not anyone, but you know what I mean". He was just trying to get me to relax, even though I was calmer than he was and I didn't hold it against him.

Take it easy.

Alex :)

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S-Pot,

I am going through the same thing. Had a flare Sat night and went to the ER. They debated admitting me and now I wish I would have pushed it as I came home and just feel awful. I have brady now too..going into the 40's later in the day or at night. And yes, it goes up now 40 or 50 points but that doesn't always get HR over 100 but I still feel awful. I also get the dry heaves and wretching. Had gone months without it and was up the whole night Tues night with it.

I am wondering how long this flare will last...like you was doing a bit better.

Hoping it passes for you fast. I am increasing fluids, and salt again but no big changes.

The only thing that I did different was take an epsom salt bath before my flare....maybe too vasodilating? And now I can't regulate?

Best wishes.

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Thanks Alex Hanice and LMG for your responses

Alex thanks for that re the brady...it doesnt feel right to me. My fludro was doubled 4 wks ago to. 2 after I failed another tilt table on the 0.1mg. Hr went up to 140 abd then bp crashed to 70/30 post nitro. i think the increaae in fludro mite be part of the night time brady.

My HR is still very much fluctuating above the 100...48 at rest this morning up to 117 wen walking around and went to 175 durin presync episode...nurse thought I was going into SVT. I dont kno what that is? Either way I dont think the double fludro is helping much but am out of options for other meds at mo.

Hanice

IvF are defo helping me. Just seems the ANS is seriously out of whack at the mo n even the saline boost isnt sorting it..patience n time I think!

LMG sorry you are feeling so unwell too! I havto say the iv saline does give a good boost esp with the heaving. I didnt have to do much pushing to get in bit wud have if they suggested home. Had battled for a few days...fell behind on fluids and food then cos I was heaving so much and weak and live on my own..i cudnt catch up. Was from bed to toilet everytime I tried to get anything done.

I defo understand what you are going thru n its rotten when you have been well too.

Perhaps the bath was too vasodilating...sometimes it just gets too exhausting to try n figure out the whys wen your unwell thou! I think my trigger was my job...13hrs on my feet nd stressful work. 2 night shifts seems to have sent My ANS crazy! Hope you are feeling better soon :)

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Guest Hanice

Thanks Alex Hanice and LMG for your responses

Alex thanks for that re the brady...it doesnt feel right to me. My fludro was doubled 4 wks ago to. 2 after I failed another tilt table on the 0.1mg. Hr went up to 140 abd then bp crashed to 70/30 post nitro. i think the increaae in fludro mite be part of the night time brady.

My HR is still very much fluctuating above the 100...48 at rest this morning up to 117 wen walking around and went to 175 durin presync episode...nurse thought I was going into SVT. I dont kno what that is? Either way I dont think the double fludro is helping much but am out of options for other meds at mo.

Hanice

IvF are defo helping me. Just seems the ANS is seriously out of whack at the mo n even the saline boost isnt sorting it..patience n time I think!

LMG sorry you are feeling so unwell too! I havto say the iv saline does give a good boost esp with the heaving. I didnt have to do much pushing to get in bit wud have if they suggested home. Had battled for a few days...fell behind on fluids and food then cos I was heaving so much and weak and live on my own..i cudnt catch up. Was from bed to toilet everytime I tried to get anything done.

I defo understand what you are going thru n its rotten when you have been well too.

Perhaps the bath was too vasodilating...sometimes it just gets too exhausting to try n figure out the whys wen your unwell thou! I think my trigger was my job...13hrs on my feet nd stressful work. 2 night shifts seems to have sent My ANS crazy! Hope you are feeling better soon :)

You will both be ok soon enough. Just try not to think negatively! Because you will bounce. Love you both. Dont feel bad. We all go through these stupid episodes.

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Surely a resting Hr of 46 bpm whilst sitting up in a chair at 11am in the morning cant be right!?

Went for a little walk cos im feeling stronger HR went up to 147bpm n got bad left sided chest pain (this is new) .

The HR fluctuations are massive! Im more concerned by the low HR than the tachy....its so unusual for me!

Ugh v frustrated!!

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