sympathetic overcompensation when blood is pooling

[MikeO]

Well never considered sympathetic overcompensation as a possible cause to one of my symptoms. I do get 4 distinct issues when it comes to postural changes and hypotension but the one that gets me the most is when my body is pooling blood i.e. while driving you can feel your shoes become tighter, while hanging out on the recliner etc...

So when i go to stand up i will feel my vascular system constrict and at times quite strongly. I will feel pulsing throughout my body, feel pressure in my head and will hear whooshing that is in sync with my heart. as far as i know i do not get a compensatory change in the HR.

I am just wondering if it is possible that the sympathetic system is not kicking up the hr but overcompensates with the vasoconstriction? or if my body has adapted some other way of dealing with the change in blood distribution when my system malfunctions.   

[Pistol]

@MikeO - I have HPOTS and suffer from sympathetic overcompensation. What happens in my case is that when I stand up ( or get otherwise overly stimulated ) my BP drops due to pooling. In response the SNS kicks in - but does so in exaggeration, meaning the adrenaline levels go through the roof. That causes chaos: high BP. high HR, sweating AND chills/tremors, yawning, paleness and blue lips/toes/fingers, inability to think/talk/hear/see ... in my particular case it gets so bad that I either pass out or take seizures from so much vasoconstriction that there is nothing going to the brain. I am on high doses of calcium channel blockers ( often contra-indicated for POTS patients ) and beta blockers, in addition to many other POTS meds. But even with all thee meds the one and only treatment that significantly improved my condition are regularly scheduled IV fluids. They seem to stop the ANS from wanting to vaso-constrict, and they have been effective in preventing the worst of my symptoms. 

[MikeO]

@PistolThanks for sharing. I can relate to the chaos when the SNS does not work the way it should. I do experience taking seizures along with the leg buckling and then passing out it is a bit unnerving. I still am confused as to what my system is really doing. I know that my body does a poor job of regulating blood pressure and routinely just drops 40 hg from baseline and then slowly recovers. 

The BP's and HR have been confirmed by two tilt table tests and the ortho tests i do every time i go into the clinic. I go hypertensive when laying flat on my back "178/102"  and end up in the 120's while standing with only 3 beats per min change in HR and this is why i was diagnosed with neurogenic orthostatic hypotension.

So i do get into trouble if my day's BP starts out or goes to low and i get the arbitrary drop in BP i will hit the floor. so part of the therapy is to try and keep my bp up and stable enough so when i do get the drop it is not so low that it causes issues. New goal is not to be consistently over 140. 

We have played with meds over the last 6 mo and i can attest various combo's do have different results. I think in my case Lisinopril was the worst drug i have been on this one would get my SNS into overdrive i would get bouts of tachycardia, my digestive system would just shut down "was passing undigested food" along with the classic cough. Losartan i would break out in hives so, for now it is just my statin, beta blocker and Mestinon. for the most part i have been fairly stable, not perfect by all means but better than it has been.

Still i am puzzled by the vasoconstriction not sure if it is the SNS not working right or some other component of the NS.

Then there is the complete syncope episodes these are the worst as i usually get hurt. It does suck to find yourself lying on the ground and having no memory as to how you got there or even what you were doing prior to the event. Madison did put in a ILR so they can see what my heart is doing during a syncope event.

Thanks for listening

      

 

[Pistol]

Hey @MikeO - yep, I know everything you are describing! I too have found myself too many times to mention on the floor passed out, bruised up and even concussed. Thankfully I never did break anything - which is surprising! Many of my episodes - seizures and syncope - have been caught on ILR, one even on EEG while I was hospitalized for 5 days at an epilepsy monitoring unit! It is always the same : tachycardia and DROP in BP when fainting and tachycardia and RISE in BP during seizures. I also know the feeling of having supine hypertension - it is very scary! I hope that you have good docs and that they will find a treatment for you soon! Hang in there - I am proof that things can get better!