vemee

I have been on florinef for a month and I have noticed the bottom number of my bp is lower when lying down but the top number is pretty much the same. I was wondering if when florinef works if your blood pressure stays up . I have had just a few spikes of say around 155/115. I have felt a little better when the bp is up that high and my pulse goes lower but it does not last long and I return to my normal bp.

Welcome to the board. I am surprised Mayo did not do follow testing to see if you are allergic to your adrenalin. I would think they also would have done blood volume and hemadynamics tests. If your tachycardia is from pots there is a good chance the beta blocker alone will give you more orthostatic hypotension. Keep an eye on how you are feeling and don't hesitate to go back to Mayo or one of the other places that test for pots like the Cleveland Clinic.

I am at the point where I am probably going to lose my job as a firefighter. I've been out of work on sick leave for 8 months and it is the pits because all I feel like doing is lying down. When I first got on sick leave I tried to remain active but got tired of getting sick everydat and then not getting any sleep at night due to excess adrenalin. It took me 4 months to find a doctor who knew what pots was and even he did not know much about it. He said I had mild pots and this was because I was overweight. He also said that if syncope in a burning house bothered me I should get another job but he was not going to give me meds or disability. I went to Cleveland clinic after I saw him and they said I had severe pots. I also found a new doctor in Richmond that has treated pots and understands what people go through. The problem is my work is keying off what the other doctor said. I have an advantage over most people in that Virginia has a law that says if a firefighter or policeman has heart or lung problems it is the presumption is that it is work related. Orthostatic hypotension has been upheld by the courts here as a heart related condition. The trouble is the county I work for automatically denies these claims and makes people go through the court process which can delay things for a long time. Anyway I have a lot of time to think of what to do next if I lose this job. I will have to go back to school because after 12 years of firefighting and the age of 48 it is going to be hard to get hired in a job with much of a future.

I am not a doctor by any means but I think you need a new cardiologist. The difference between the diastolic and systolic is known as the pulse pressure. You might do some research on pulse pressure. I know if the pulse pressure is less than 20 it means your perfusion is inadequate. As for your drop in blood pressure at night, I do not know the cause but it does happen to me if I am not taking an antidepressent. It would happen to me as I would fall to sleep and then I would get a lot of anxiety. I thought I was still having depression so I got back on the medicine. Recently after trying to get off the drug again I found that the anxiety coincided with low blood pressure numbers similar to yours. Pot's place site does mention some antidepressents are used to combat pots. You will not get any answers from your present doctor since he does not believe in pots which does not say a lot for him. You should go to someplace like the Cleaveland Clinic for testing or one of the other big time institutions that work with pots.

I also do not think anxiety and depression causes pots. The proof I had that I was not suffering from panic attacks was when I found my blood pressure would make huge drops during episodes. As an emt I can not remember a person with a panic attack having hypotension. The anxiety I experienced during my drops in blood pressure was a normal response that happens when the brain is not getting enough blood. It is much like when a person having a heart attack tells you they are going to die just before they crash. The heart does not pump enough blood for the brain to function and as a result they feel panic and anxiety. The heart attack is not a result of the anxiety. Likewise our systems are damaged somehow so that our brains do not get a full blood supply or all the chemicals we need. From here on I need to say this is just my opinion from the web research I have done so do not take it as gospel. In an earlier post I talked about the anxiety I had at night when I got off of antidepressants, this was a result of blood pressure dropping below a systolic of 90 which is considered shock. On the " pots place" website serotonin uptake inhibitors are used as a treatment for pots. I think some of my pots is caused by a lack of serotonin because celexa takes away the night bp drops. However, even when I take the max allowable dose of celexa I still have pots. Stress hormones have been proven to shrink part of the brain I forgot the name of the part but it is hippo something, it deals with memory and learning. If the chemicals released by stress can do that to the brain what else can they damage in our neurological system? Likewise ordinary infections can cause heart attacks and nerve damage. I have better stop here because I have been sitting up too long and I can tell I'm losing my concentration. Anyway I'm going to Cleaveland Clinic next week to see Doctor Fouad hopefully she will give me the tests that I need and look for the real answers and not look for the easiest answer.

I've been treated for depression for many years. Everytime I got off the antidepressants I would get strong anxiety at night when I was trying to sleep. This summer when I started having paresthesia I got off all meds and the anxiety at night returned only this time I had my trusty little blood pressure monitor and found that when I was having the anxiety my bp had dropped below the shocky level usually with a systolic in the 80s or even the 70s. So the anxiety was due to hypocerebralperfusion. I guess the antidepressants are helping control some of my pots symptoms.

Thanks everyone for the great advice. I do have a question concerning midodrine. I have read that it does not need to build up in your system as florinef; does that mean you should see a change when you first take the pills or does it take a week or so before it is noticiable?

Laura , the new midodrine prescription is for 3 times a day morning, noon and before 6. I think that is what he meant last time but made a mistake by doing the interval by hours. Anyway my pharmacist told me the correct schedule.

I had a week last spring where I had hypoglycemia. I went to work feeling weird and took my blood sugar with a monitor we had on the fire engine and it was 38. I got the same reading with another monitor. From Tuesday to Saturday my sugar was off but not as low as 38. After that week I have not had any trouble since. I may have had hypoglycemic events a few months earlier because I felt the way I did when the sugar was low but I did not use the glucometer. I would't be surprised if a misfunctioning autonomic system would be responsible .

Thanks for all of the replies. I have been to one of the pots specialists listed on the site, they were the ones that did the 10 minute tilt test. This took place at the University of Virginia ; the staff was polite and listened to me, they also took a lot of time discussing my case. The hangup was that nothing showed up on the tilt test. The day of that tilt test I was very light headed almost drunk like. The light headedness had been going on for 2 weeks. I have a feeling that somehow affected my test . My own amateur theory is that my body's shunting system is fouled up and sometimes when my body tries to maintain blood pressure it constricts vessels in the brain instead of the areas it should be shunting from but that has no medical backup. My last tilt test was done in Central Virginia by an electro. I think he thought I was doctor shopping for disability retirement . I can not imagine why there is an opinion growing that the part of the tilt table test which causes the release of adrenalin is not that important. We all release adrenalin and if we react negatively to it then we have a problem. The good news is that soon after my post another doctor in the group said I could increase my midodrine to 10 mg. so I do not feel so abandoned by MCV. I will have to start doing poor man tilt tests again and keep a log. I was doing them this fall but never kept the documentation.

This is my first post to the forum. I am a 48 year old firefighter who has recently been diagnosed with pots. I have been having the symptoms for at least 11 years and have always felt it was an autonomic problem but was always told it was anxiety. The worst symptoms occur when I am under heavy physical stress such as in a fire, my blood pressure drops and I almost pass out.. This year the symptoms have gotten worse which has been good since I was able to have these symptoms doing normal work and could check my pulse and blood pressure. Just doing normal yardwork my pulse runs around 150, after awhile I get the nausea and near syncope which I found was during blood pressure drops. I then went to an assortment of doctors who had no idea what pots was and probably did not believe me capable of taking my own pulse. I went t o one university to be tested for pots and expected the full 45 minute test but instead got a 10 minute test with a panic attack diagnosis. Usually I can become symptomatic within 10 minutes but not that day. I went to another university and was able to produce the standing- supine heart rate difference in the doctor's office. A tilt test done by the associate found pots. Florinef was prescribed but did not work. Midodrine at 5mq /8 hours was next but did not work. Orginal doctor gave me another tilt test, pulse went from 72 supine to 128 tilted within 30 minutes. Nitro was given and I passed out and had mini convulsions after a few minutes of the second tilt . Dr. who was barely present during the test said they look at the first part of the test more than the 2nd part and I might have mild pots. He said I did not need medication and could return to full firefighting duties. So I guess when I pass out in a fire I am really not unconscious.