LindsayWell, friends, it has been a minute. What is it about July that suddenly inspires me to post? My last post was almost exactly one year ago, and here I am again, shouting out a proof life. At a minimum, I should try to make this an annual thing.
In some instances, it’s an ominous sign if a blogger disappears for long stretches of time, generally suggesting symptoms became a full time focus. Fortunately, in my situation, it continues to be the other explanation: that my symptoms remain manageable and I have been busy with life. My full-time job keeps me very busy. I work more hours per week than I would like, which usually includes nights and some weekend time, but it is not for a second lost on me how fortunate I am that I can work. That I am able to work. There was a time where, due to POTS, I could only work 10-20 hours per week. This is so much better, and I will never take that for granted. It helps that I very much enjoy my job.
Not much is new on my POTS front…I continue to have tachycardia, bradycardia, lightheadedness, and joint pain. For the most part, those symptoms are manageable and consistent with what I have experienced for years. The exception is a minor increase in palpitations, which led to some interesting findings. I mentioned it to my cardiologist, and she ordered blood tests and a holter monitor. The blood test results showed that my cholesterol is a little higher than last year, which was expected, but not ideal. My total cholesterol, HDL, and LDL have been high for years. Many of the women in my family have similar levels. I eat fairly healthy and maintain a proportionate weight, but it’s hard to fight shit genetics. And mine are particularly SHIT. My dad had a heart attack when he was about 5 years older than I am now. I’d like to avoid a similar fate.
After my blood cholesterol results were returned, my cardiologist ordered a coronary artery calcium test – a CT scan that measures calcified plaque in the arteries. The scan was simple – it took less than 5 minutes – and I received a best-you-can-get score of zero by the end of the day. So, high cholesterol, but no plaque. Good news.
The holter monitor results were more interesting, as they showed what I have long suspected: increased heart activity at night. Bradycardia is defined as a resting heart rate under 60. My average resting heart rate is rarely above 60. I still get tachycardia when I’m moving about and standing up, but if I’m sleeping, sitting at my desk, or relaxing, it is nearly always under 60, sometimes under 50. Rarely, but has known to be under 40. My Apple Watch 0ften warns me about particularly low heart rates while I’m sleeping. and occasionally when I’m awake early morning or very cold. So, I know I get bradycardia. The lowest heart rate recorded on the holter monitor was 40, which doesn’t surprise or concern me.
That, my friends, is a gorgeous heart rate. Look how pretty she is.
The monitor results also showed normal PACs/PVCs, which I generally experience as double beats or skipped beats. That also doesn’t surprise or concern me.
According to the results, I also get ectopic atrial runs and beats. An ectopic run is an irregular heartbeat that occurs when there is a rapid burst of extra heartbeats originating from the upper heart chambers (atria) rather than the natural pacemaker. I wasn’t familiar with ectopic runs before the results, but again – doesn’t surprise or concern me.
Tachycardia (rapid heart rate above 100 bpm) generally originates in the sinoatrial node. That’s your heart’s natural pacemaker, located in the right atrium. Sinus tachycardia is the standard fast heart rate that you see even in healthy hearts, like when exercising. The ‘T’ in POTS stands for tachycardia, and generally it means sinus tachycardia. So, no surprise that it ended up on my report as well.
Atrial tachycardia (AT) is an abnormal heart rhythm that originates in the heart’s atria. It is characterized by regular, narrow QRS. It’s generally not considered normal, but can happen occasionally in normal healthy hearts. My last holter report (which was like 12 years ago) found instances of supraventricular tachycardia, which is a type of AT. So, I expected this monitor may also find some AT.
Here’s where it got interesting (fair warning: I’m using the term “interesting” quite loosely). In addition to sinus tachycardia and atrial tachycardia, there is another kind of tachycardia called ventricular tachycardia (VT). As you might guess, VT is an abnormal fast rhythm that originates in the lower chambers – the ventricles. VT produces wide QRS complexes and is generally considered more serious because it can reduce cardiac output. I have never had VT show up on a monitor before, was not aware it was happening, and was very surprised by the finding.
That graph gives me heavy “my dog was just sleeping two seconds ago AND IS NOW DOING CRAZY ZOOMIES AROUND THE LIVING ROOM” vibes.
In the above graph, my HR went from 53 to 168 in one and a half seconds. VT that lasts for more than 30 seconds can be life threatening. I only had one VT in the six day period and it was brief, so I’m not high risk right now. Some of the PACs/PVCs occurred during normal hours, but everything else – all of the abnormal rhythms – occurred between 1:00 and 5:00 am.
I don’t snore and have never been told that there is anything unusual about my sleep, like waking up gasping. I do wake up with high HRs, but that’s the result, not the cause. I may need a sleep study at some point to make sure there isn’t anything else going on at night, for now we’re trying Magnesium. Electrolyte imbalances can cause unusual rhythms, and magnesium in particular helps with sleep. I’m not expecting an obvious change, but I’m tired a lot lately, so it can’t hurt.
On another note which is health adjacent but entirely unrelated to POTS, tachycardia, and everything cardiac, I am also awaiting the results of an APOE blood test. I may have mentioned before that, as part of my shit genetics, I have an expected high propensity towards degenerative brain disease. My mom died of a degenerative brain disease and the majority of the women in her family have had alzheimers or dementia. In fact, my mom, her sister, and all of their female cousins on their dad’s side have ended up with some sort of brain disease. I don’t know for sure that it’s in my genetics, but I’d go all in on those odds in Vegas.
The APOE – or apolipoprotein E – is the gene that provides instructions for making a certain protein. Certain APOE variants are less efficient at clearing the protein from the brain. Over time, it can accumulate and lead to the plaque seen in Alzheimer’s. We each inherit one copy of APOE from our mom and one from our dad, and each can be either an E2, E3, or E4. That means there are six possible outcomes (E2, E3, E4 x 2). E4 represents an increased risk. Two E4 copies presents a substantially increased risk. It’s not a guarantee, and plenty of people have one or two E4 copies and never develop Alzheimer’s. Similarly, many people without any E4 variants develop Alzheimer’s. But it increases the risk. And I want to know my risk level.
Some of my family doesn’t understand why I would want to know. After all, it’s genetics, and there is no cure. If the test results show an increased risk, what does that change? But for me, that’s also the reason to have it done – what does it change? The truth is the truth, whether I am aware of it or not. I’d rather know and take responsibility for the things I can control to lower the risk. This isn’t an ontological uncertainty where there is no truth. The truth exists, it is known. Running the test doesn’t make what is already true, any more true. If the results show that I am high risk, that will be a hard reality to face. But it is the experience I have chosen to have in this lifetime.
Maybe in the next one I’ll do it differently.
I couldn’t decide between two Mary Oliver quotes, so I’m closing with both. God, wasn’t she wonderful??
In this universe we are given two gifts: the ability to love, and the ability to ask questions. Which are, at the same time, the fires that warm us and the fires that scorch us.
You must not ever stop being whimsical. And you must not, ever, give anyone else the responsibility for your life.
Smell ya later.
– Linds