has anyone experienced this?

[greenwood112]

No one can figure out what is going on with me.  It's very frustrating and I'm starting to wonder if it is just a problem with my cympathetic nervous system.  I have very frequent tachycardia but I return to normal at night time.  I feel that it drops as soon as I lay down, be it night time or not but my internal medicine doctor dismissed me saying this was normal.  He doesn't have a tilt table so I haven't had that type of test.

What I have had is multiple EKG's and a stress test.  My baseline heart rate for the stress test was 120 bpm.  So tachycardia appears to be my normal, according to that.  I got up to my maximum heart rate very quickly which he said would normally indicate that I was out of shape except that I was not at all winded or tired yet and my blood pressure remained low.  After the stress test by blood pressure immediately returned to 97/? but my heart rate did not come back down to baseline.  He decided to unhook me at 140bpm and said it should have come down by then for most people.  He is testing me for a pheo but suspects that I simply have a fast heart rate due to my size (I am 5 feet tall and very slender and light) and said that children have fast heart rates.  The only thing with this theory is that I didn't have this fast heart rate prior to two years ago.  I'm now 32 so I don't know why I would develop a faster natural heart rate in my 30's.  Also, my mother says that for the past year or two there has been a change in my personality and I am either hyper or off and nowhere in between.  I am edgy and tense and was never like that before, always being the laid back child.

After that bit of background, here is my direct question:  Does anyone else reach a max heart rate quickly and not have it return to normal right away?  Is this typical of any condition or syndrome?  Am I to believe it is my size and leave it at that?

[LivingInHope]

There are also life style adjustments that are made such as using a shower chair, and sitting on the edge of the bed for a little instead of just popping out of bed.  Some use compression stockings.

[AireScottie]

Well, there are different medications to try.  Some people respond very well, others don't.  A lot of people are on a low dose of beta-blocker to lower their heart rate all the time.  Also, a lot of us eat more salt than normal or take medication to make our bodies retain salt, because that increases blood volume, which is the problem for some people.

[greenwood112]

If I were to find out that it is a positional issue and not size, is there anything I can actually do about it?  Maybe it doesn't matter what we think the cause it because I'll just have to live with it anyway?

[AireScottie]

I'd say find a new doctor.  I wasted years thinking the doctor knew best.  Once I started looking for doctors who knew what was going on, I realized that many doctors are clueless and actually don't want to learn anything new.  They think nothing has changed since medical school.  A good doctor should have an open mind to anything reasonable.  And there are a lot of studies by legitimate doctors in legitimate journals showing that dysautonomia exists.  Lastly, he might be the doctor, but it's your body and your life.  No one should have more control over them than you!

[laurab2818]

POTS/dysautonomia sounds like a possibility. Unfortunately, most drs. are not very knowledgeable about dysautonomia.  This does not stop them from expressing strong, uninformed opinions which can be intimidating and confusing.  You need a good evaluation to get good treatment.  

There are resources here in the Health Pages, I think, to help you find a dr.

Hope this is helpful.

[LivingInHope]

Merck's website says plasma free metanephrines has up to 99 % sensitivity, urinary metanephrines are not as sensitive at about 95 percent.  Measurement of catecholamines in urine is nearly as accurate it says ( I believe it is saying nearly as accurate as urinary metanephrines.)

You could try using an omron cuff, if you have/acquire one, and lay for 10 minutes, then take your pulse manually and take your BP with the machine.   Then stand and after two minutes, take your pulse manually and then use the machine.  You can take it while still standing every few minutes.  I've learned the machine is not always to be trusted when it comes to pulse.   If your pulse rate goes up by more than 30 beats per minute (and you're not having a panic attack), you should suspect you have postural orthostatic tachycardia syndrome (P.O.T.S.) and push for a referral to someone who is able to perform a tilt table test.  If you've never taken your pulse before & want to know how, I'd be happy to tell you.

Private message me if you want some convincing proof to show your doctor to convince him there is such a thing as P.O.T.S..  Or if your doctor has a closed mind, I'd seek a second opinion doctor who has an open one.

[acesew]

I don't think he should be saying it is because of your size.  I am 5'5 and have gained weight (currently at 150).  My HR increases quickly at times, but will take a long period of time to slow back down.  Yesterday I had a spell with tachycardia and it took over 30 minutes with me laying flat and being very still to get it back down and the funny thing is, everyone tells me that I have the pulse of a runner.  It usually stays around 55-60 bpm.  (Which for me even an increase of about 10bpm makes me feel funny).  I think you need to switch doctors or get to a cardiologist that will work with you.  The cardio dr can also do a TTT.  Hang in there and keep pestering them.  You are paying their bills not the other way.  Don't take no for an answer.  I had to learn this from about 8 years of trying to get somewhere with my diagnosis.  I am sure some of our other members will agree with that also.

[greenwood112]

He is doing a 24 hour urine test for catecholomines.  He doesn't think that it will show anything but is just being safe.  Is this a non-gold standard test?

I don't think he will be willing to refer me out for a tilt test since he doesn't give the impression that he believes people can be position-sensitive.  He is pretty sure it is because of my size and a negative cats test will prove it to him.  I just don't really feel that this is the issue but he's the doctor not me.  It almost has me hoping I do have this pheocromocytoma thing just so that something can be done to stop this!  That's pretty pathetic, really.  Things are just really acting up on my lately and none of it seems connected.  I wish it would stop.

[LivingInHope]

It is good that your doctor is testing you for pheochromocytoma.  I hope he has ordered the plasma free metanephrine test, considered to be the most sensitive test for detecting them out there.  Your doctor, since he does not have a tilt table test should refer you to an electrophysiologist that does.  Postural orthostatic tachycardia syndrome often displays itself in the third decade of life, I was told when I was diagnosed with it.  Iron deficiency, even when your CBC is normal, from my own experience can worsen tachycardia symptoms.  I often get hyper myself.  On my first tests (I was anemic at the time), my heart rate went up very quickly on the stress test and nuclear medicine test, but came down normally after sitting/laying.  I wouldn't blame it all on your size.   I have small bones, though I am taller than you.   And you are not a child at age 36!