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HR Spikes When Standing But Drops if I Start Walking


jim28

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Hello,

First time poster here. A typical scenario is  I'm sitting on the couch for an hour and then stand up. My HR might immediately jump from say 65 to 100, and then within a few seconds it might be 110 or even 120.  But as soon as I start walking it will start dropping down to the 80's or 70's. Then if I stop walking and remain standing, it might go up again. If I sit it will come right back down. This doesn't happen every time, maybe once or twice a day and usually in the morning but has happened later in the day as well.  I have taken my bp in the standing position during these HR spikes but it's either normal or more often elevated.  I do not feel dizzzy, etc. and probably wouldn't realize something was wrong except if I was checking my pulse or wearing a chest monitor.

In addition, for the past few months,  I'm also having two or three documented SVT attacks a week. These attacks are very different from the sitting to standing scenario just described. With the SVT,  my HR will suddenly spike from normal to 190 for a period of one to ten minutes, and is not related to changing from sitting to standing. The SVT episodes end as quickly as they started. One second my HR will be 180 and within a second or two it will go back to 65. The EKG's are also different. When my HR elevates from sitting to standing, the EKG shows normal sinus rhythm and the return to normal when sitting is gradual.  The EKG with the SVT attacks shows the SVT pattern. I have a Kardia ekg device so it's been easy to document.

Does the sitting to standing HR behavior sound like POTS? Or could it be somehow related to SVT or even a normal reaction to standing after sitting for a prolonged period of time? I also read there is something called inappropriate sinus tachycardia (IST) but maybe that's just an umbrella term including POTS.  I started noticing these sitting to standing elevations over a year ago but it's probably been going on a lot longer. I'm a 71 year old male, normal BMI, walk daily, eat healthy, and have stopped caffeine and alcohol. Currently not taking any meds. I also have 5 to 10 ectopic beats per minute (PACs) which are probably triggering the SVT episodes. Any help is appreciated.

Jim

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Have you been diagnosed with Dysautonomia and or SVT?  What happens when you stand for 10 miuntes without walking?  Generally with Dysautonomia your HR goes up when you stand and stays up whether you are walking or standing still for 10 minutes it should stay up.  Also you indicate you don’t feel symptoms and most of us feel worse-much worse - in an upright position.  

Though some with Dysautonomia have SVT,  Dysautonomia itself involves normal sinus rhythm.

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Hi Yogini, The ekg's I took with my Kardia have been diagnosed as SVT. It's a difficult diagnosis because by the time most people get to the ER the episode is gone, but with the Kardia you can catch it while it's happening. I mentioned POTS at my last EP visit and he sort of shrugged it off but at that time I really didn't explain to him what was happening with standing as I outlined in the post. I will mention it again next time I see him. I have never tried standing ten minutes without walking because I get freaked out when my HR hits 110 or 120 so I either walk or sit down. But like I said, this doesn't happen all the time, maybe once every day or every other day. But like I said, walking does bring the HR down so maybe not dysautonomia, but what then? Inappropriate Sinus Tach? Dehydration? Old age? During these episodes my sinus rhythm is normal. During the SVT episodes I am not in normal sinus rhythm. One thing I've read is that ablation is not a good idea if you have Dysautonomia but what if you have both SVT and Dysautonomia? I'd hate to think that ablation is off the table for my SVT.

Jim

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I'm not sure of the exact mechanics of this, but it's more stressful on the body to just stand rather than walk around - you can find a lot of stuff on line about it.  It makes sense to me, since the TTTs test people in the standing position for so many minutes (I've heard 3, 5 and 10 - I've had poor man's 5) and not while they're walking. 

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I feel worse standing than walking, if I stand and get symptoms I have to walk or I pass out. If I walk too much though - I pass out too. But @jim28 - in your case I would totally consult your cardiologist. And about ablation: it will not help POTS and may even make it worse, but in your case you have SVT, which changes things. Ablation is what many cardiologists recommend for SVT, so - again: these questions should be answered by your cardiologist. 

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21 hours ago, jim28 said:

Hi Yogini, The ekg's I took with my Kardia have been diagnosed as SVT. It's a difficult diagnosis because by the time most people get to the ER the episode is gone, but with the Kardia you can catch it while it's happening. I mentioned POTS at my last EP visit and he sort of shrugged it off but at that time I really didn't explain to him what was happening with standing as I outlined in the post. I will mention it again next time I see him. I have never tried standing ten minutes without walking because I get freaked out when my HR hits 110 or 120 so I either walk or sit down. But like I said, this doesn't happen all the time, maybe once every day or every other day. But like I said, walking does bring the HR down so maybe not dysautonomia, but what then? Inappropriate Sinus Tach? Dehydration? Old age? During these episodes my sinus rhythm is normal. During the SVT episodes I am not in normal sinus rhythm. One thing I've read is that ablation is not a good idea if you have Dysautonomia but what if you have both SVT and Dysautonomia? I'd hate to think that ablation is off the table for my SVT.

Jim

A doctor can confirm but  no doctor has ever advised me that a HR of 110 or 120 while standing is dangerous.  It might indicate dysautonomia (or not) but it is generally nothing to be scared of.  

Many of us have had HR of 160 or 170.  My doctor treated me with meds for this, but he was not scared for my life.  If you have SVT I assume you've had an echocardiogram and a full range of tests to evaluate your heart.  

In order to determine whether you have dysautonomia you'd need to stand still to see if your HR comes down.  (If it really starts to go up and up and you feel uncomfortable, just sit back down.)  I suspect that it will come back down if you keep standing still and that the walking does not make a difference.   If you are worried or scared that is also probably impacting your heart rate.

 

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Back when I was first diagnosed (4 years ago) my HR would come down when walking, as long as I was walking slowly and not exert myself. It wouldn't come down enough to make walking comfortable for me, but let's say my standing HR was 150, I'd start moving a little and it would drop down to maybe 110 or 120. If I was having a really good day, slow walking could sometimes even get my HR down to around 80-90. If I walked for too long, though, then the fatigue would cause my HR to skyrocket again. When I went to a major autonomic center for testing, it was explained to me that this does happen in POTS with some people, especially those for whom blood pooling is a big issue. When standing, the blood pools in the legs quite rapidly. When you start moving your leg muscles, be it doing counter maneuvers, walking, etc. it helps counteract the blood pooling and push the blood back up to the heart. That's why many of the counter maneuvers for POTS involve standing with legs crossed, tensing leg muscles, and so on, which can help send blood back to the heart, increase BP, and reduce tachycardia.

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