LindsayIt’s no secret I don’t like being on medication. I’m still skeptical about the long term effects of putting chemicals in my body. And while I appreciate not having a ridiculously high heart beat, I have to wonder about the aftermath of something that can tell my heart what to do.
Only I should be able to do that. And maybe Chuck Norris.
As you probably know, I’m on a beta blocker. Beta blockers, also known as beta-adrenergic blocking agents, block the effects of epinephrine (adrenaline) and are typically given to patients with high blood pressure. My bp is normal, but beta blockers also help reduce heart rate, which is why I take it. POTS is characterized by tachycardia when standing, and prior to beginning beta blockers, my heart rate would usually double, sometimes even triple, just by standing.
However, now that I’ve been on beta blockers for about two years, they seem to be helping a little too much, and I’m starting to have problems with low heart rates. Bradycardia is defined as heart rates under 60, however for those of us on medications that affect heart rate, that number would probably be lower. My heart rate is hanging out at mid 40’s when sitting these days, sometimes even dropping into the high 30’s. I expect it’s even lower if I’m lying down.
Heart rates that low are usually only seen in top performance athletes. And, as my chubby thighs will tell you, I am no athlete.
I am of the impression that bradycardia only becomes an issue when you feel it becoming an issue. I’m starting to think I’m there. When my hr drops, I get lethargic and might feel tingling in my face and arms. I’m slower, in almost every sense of the word. Lately it has also been causing palpitations.
I’m already on the lowest dose of atenolol (beta blocker), so I began cutting those in half. Unfortunately, it hasn’t made a difference. I’d cut them in fourths, but at that point they crumble and turn into powder, and I get funny looks when I pull tiny white powder out of my pill box.
Maybe I should stop using a razor blade to cut it and line it up on a mirror.
I have researched “natural” options that might help raise my heart rate and have found 2 options.
1) caffeine – but I already drink a cup of coffee every morning (otherwise i fall asleep at my desk), and 2) peppers – but I’m a big wimp when it comes to spicy foods.
I have an appointment with my cardiologist next month to discuss this, but I imagine my options include either trying a new beta blocker, or stopping it altogether. And while I anticipate I will choose the former, I’m seriously considering the latter.
A fellow blogger, Michelle at Living with Bob, has written a wonderfully creative post about bradycardia. Click here to check it out: Bradycardia: when your heart goes, meh.
I’m very excited about hosting a Dysautonomia/POTS get together this weekend. If you’re in the southern California area, stop by and say hello!!
“Life is like riding a bicycle. To keep your balance, you must keep moving.”
― Albert Einstein
Smell ya later.
Linds
Brady makes me feel like I am melting :/
I heart your blog! PS, I want to email you privately…..may I?
yes, of course! lindsay@dysautonomiac.com
I’ve been on propranolol ER (or initially the regular stuff) for 17 years. Also neurontin, carbamazepine, clonazepam, cyclobenzeprine, and other stuff (29 pills, and 2 insulin shots on a good day). I’ve got a bit of an advantage being an RN (unable to work for 9 years, but still licensed, cuz I worked for it ! 😀 ). I’ve seen folks who have been on a bazillion meds for ages. If one does of one pill is messed up, it takes a week to get things back on track.
The price of being vertical.
Thank you for your comment! I’ve noticed the same thing – if I switch up one pill, even one dose of one pill, it takes a while for everything to get sorted out. Frustrating, for sure!
Yeah, that was supposed to be ‘one dose of one pill’ not ‘one does of one pill’ – LOL. Fingers don’t move as fast as my head 😀
Ooh ooh I have tips on breaking pills if you still want to try to get your meds into fourths! My cat had to take these little round pills in fourths, and after crushing them a zillion times trying to use a knife, I found it’s actually much easier using your fingers. Dunno why, and I dunno what consistency your pills are, but I felt like sharing anyway. 😛
thanks for the tip! i will have to try that – the pills are small enough that it might be easier just to break them with my hands!
Hi Linds,
I am just reading your post now so I hope you get this. I was diagnosed with pots last year. I too am taking the lowest dose atenolol – I have recently cut my pill to about 1:6th of 50mg once a day as if I take it twice I wake up all tachy with adrenalin rush which is say is low hr and bp overnight.
I just wanted to know what you ended up doing about your medication?
Thankyou
Jo
Hi Jo, thank you for your comment! I am still taking 1/2 a 25mg atenolol dose daily. I saw my doctor after I wrote that post and he suggested making sure to drink even more fluids and consume more salt. The bradycardia may have had something to do with the heat, too, as it was during the summer. My hr is back up to 50’s when sitting, so I haven’t been getting the extremely low heart rates lately. I did recently stop taking an SSRI and that may have had something to do with it as well. I have recently switched from taking the 1/2 dose of atenolol at night to now taking it in the morning, as I have been waking up all tachy in the middle of the night as well. So far it hasn’t made a difference, but hopefully soon.
You mentioned also waking up tachy – have you found anything to help that?
Hi Linds, thanks for your reply!
I just take atenolol also. I was trying it twice a day – about an 8th each time (very tricky to cut haha) and that’s when I was waking with the tachy and getting worse Brady. Going back to once and almost taking a quarter mostly stops the waking in the night tachy. I would like to take mine just of a morning also but I feel too tired on it for the first 4 hours, do you?
I recently tried florinef (0.025 – 1/4) for 2 weeks but that seemed to lower everything for me – my heart rate and bp, which is why I think I started having problems with my atenolol which I was taking only a quarter a night. But my heart rate was still in the 120’s in the morning so I couldn’t stop the atenolol.
Do you take florinef also? I sometimes need to take Xanax when the adrenalin hits too bad and I get bp surges. I looked this up with florinef and I couldn’t be clear if I can take them together. What meds do you take that you find help?
Hi Jo,
I have noticed that taking the atenolol in the morning does make me more tired. I only started taking it in the morning about 2 weeks ago, so I’m still getting used to it. One cup of coffee helps, but I’m sensitive to caffeine, so I have to be careful not to overdo it. I have also noticed with taking the atenolol in the morning that I don’t sleep as well at night. I think taking it before bed made me really tired so I used to sleep better.
I have not tried florinef, but I know it is commonly prescribed to POTSies. Right now I’m just taking the atenolol. I was on an SSRI (celexa) and mestinon.
The florinef didn’t agree with me. I only tried it for 2 weeks. Started slowly as we potsies usually are sensitive to meds – 1/4 then 1/2. I was too dizzy and nauseaus. I have GI issues so that played up worse too on it so I stopped. My bp only goes low sometimes. It’s usually higher when I stand. I’ve just cut back to 6mg of atenolol a night now which is ridiculous I know! It stops the waking tachy but my heart rate at night is always under 60. I wonder if the tiredness will stop after a while taking it in the day. It also made me light headed on standing. What’s your bp usually like?
My bp was always normal. I think it went up slightly during my tilt table test, but nothing significant. While on atenolol my bp is a little low, but still within the normal range. Occasionally when I’ve been standing for a while and get dizzy and lightheaded, I feel like my bp must be low, but I’m usually nowhere near a bp monitor when that happens.
Sounds a lot like mine Linds. I’ve clocked my lowest at 100/60 but at an appt once it dropped to 90/60 I think on standing. This isn’t considered a significant drop anyway. Mine normally goes higher in standing which I’m reading is an overshoot to compensate for the other weird pots things going on when we stand 🙂
I just need to add that my quarter = your half as my atenolol pills are 50mg. I can’t get 25mg in Australia apparently so that’s tricky with dosing for pots.