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How much tachycardia is normal when standing? Do I have POTS?
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How much tachycardia is normal when standing? Do I have POTS?

I am a 36 year old male. I have lightheadedness and dizziness that happens when I stand up after lying down. At first I thought it might be orthostatic hypotension and I started taking my blood pressure and pulse before and after I got up.

The blood pressure actually goes up slightly. I feel my heart racing and pounding in my chest when I get up though. On the 7 times I checked it, my pulse went up 32, 46, 38, 44, 49, 34, and 31 beats immediately from lying down to standing.

The pulse increase of greater than 30 beats only lasts for the first 2 minutes or so, but then it starts dropping below the 30 extra beats after that. Within 5-10 minutes, I feel a little less dizzy and the pulse is about 15-20 beats higher than lying down.

Question 1: Is a 30 to 50 beat increase in pulse a normal response to standing up or do I have POTS (Postural Orthostatic Tachycardia Syndrome) or something else?

Question 2: If this is not normal, what other conditions besides POTS could cause a rise in the pulse like this?

Question 3: Does the 30+ increase in pulse have to be sustained for more than 2 minutes for a POTS diagnosis?

Please help! Thank you for your time.
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9 Comments Post a Comment
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1124887_tn?1313758491
Your description reminds me of my problem earlier. It seems like you may have, in lack of a better word, some anxiety connected to standing up. This is more or less confirmed by the fact that your blood pressure increases when you stand up. This is a normal response, but it would probably not happen with POTS.

That said, it would be useful to know your blood pressure before and after standing up.

To answer your questions (well, I can only suggest because I'm a patient, not a physician):

Q1: Hard to say. An increase of 30-50 beats is diagnostic of POTS but in your case I suspect there are other factors, that you are afraid when you stand up, you measure the heart rate and you expect an increase. Higher anxiety = higher "target" blood pressure. When you stand up, your blood drops to your abdomen and legs, so the body often tends to increase heart rate when trying to increase blood pressure.

Q2: See above.

Q3: I think so, but I'm not completely sure. The fact that your heart rate normalizes is another reason that I believe my explaination can make sense.
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967168_tn?1343732745
I commented in the Dysautonomia forum so please check there =)
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1670856_tn?1316777368
Well im not gonna play all genius and all. But as something_wrong explained i sounds kinda normal.
(not meaning this doesnt bug me at time :S "anxiety" diagnosed)-

But yeah, ive been told that some people, who have some fear of the heart and such.....
when they raise their fingers to the neck to measure their pulse they can actually effect the heart beat. Cause your worried in some way that you might discover something. So your heart beat goes up due to anxiety.
Also. . . When some measure it, we tend to start breathing differently.
I know when i get checked at the doc i start trying to control my breath to a certain tempo.
(sorry my explanation *****. )
But yeah. . . .Best to do would be getting someone else to measure it. Or getting a device that can record it with not sounds.
(the sound will indicate to you how it beats. )
You need to be oblivious to the heart rate until you look at the result.

Also as mentioned. . . When going into a standing position your body does many things. Sends more blood to certain areas. One of the reasons some people get light headed when standing up to quick,.

But like i said. I am by no means a doctor or anything like it, so would just suggest to get someone else to make the test than yourself.
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143746_tn?1301278422
Thank you all for your replies. My understanding is that POTS often occurs without a decrease in blood pressure. Also, I noticed this effect long before I had any idea what was going on and before I started taking my blood pressure. It is not something that I necesarily expect to happen. It just happens and I don't have feelings for it one way or another. I have never fainted and am not afraid of fainting. I took an anxiety index, it was low, and I am pretty sure I do not have anxiety. The times when the pulse goes up most is after exercise, after meals, after being in heat, and when dehydrated. Occasionally I do not notice the effect at all. It is always when I am well-hydrated, the temperate is cool, and I haven't eaten recently. From everything I have looked at, this all seems to be consistent with POTS. It all started 4 months ago after a viral illness.
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1124887_tn?1313758491
OK, you have given the diagnosis.

In every situation you mention, the blood pressure is lower and available blood is less. The only way the body can increase blood pressure is to increase heart rate.

In my case, this is also increased after viral illnesses, and it can sustain for a long time.

What you describe are normal phenomena. I would stop measuring the heart rate, it's probably less prominent when you don't pay attention to it.

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143746_tn?1301278422
Thank you. I agree that any added stress isn't going to help things! I have stopped taking the pulse ... I was just trying to see what kinds of things affected it most.

I am trying to do the things you are supposed to do ... more fluids and salt, smaller meals more frequently, and being more careful about exercise and warm conditions, and it does seem to be helping. Taking a quick cold shower instead of a warm shower makes a huge difference!
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1670856_tn?1316777368
been a while, but yeah cold showers are actually pretty good for ya. (not like in a "oh it helps your health" kinda of way).-
but when body gets a cool down, the blood travels to the inner organs to keep them warm, which the "smart" people say aids you in many ways. Getting you more in tune with your body.

But just wanted to add. . . You said more fluids and more salts.-
Salt. . . Most of the public get to much salt. . . I think its 6g at the max for a day. And almost everything we eat is injected with salt.
Just wanted to make you aware of that. So look at what your average meals are for a day and see how much salt is in it- Youll most likely find you dont need to add salt.

(I dont add salt to anything now, since i know i get it from other foods).-
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1124887_tn?1313758491
Good answer :-)
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967168_tn?1343732745
If it is PoTS or another ANS dysfunction, dr's say use salt liberally, sometimes as much as 10,000 mg or more daily. I've questioned this practice since being dx with NCS/OI in August 2009, but every doctor I've seen, says salt and fluid loading such as this is the medical recommendation for ANS issues.

This year the American Heart association lowered their 2005 recommendation of 2,300mg of sodium daily, down to 1,500 mg of sodium daily for the average American because of the the risk of negative health outcomes with high blood pressure.  (I believe it's less for patients with heart disease but I can't find that info)

Having said that, there is a question about excessive sodium intake such as doctors recommend in ANS patients; can it adversely affects the heart, kidneys, and blood vessels and if so why is this practice so commonly used among doctors?

My personal decision was to live with the lower blood pressure issues I suffer and cut out the salt intake; which really ticked doctors off and they told me there is nothing else medically they can do since I won't heed their advice :P
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