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What Causes Dizziness With Lower BP?

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Posted on Thu, 3 Jul 2014
Question: been dizzy for year bp is 90/60 laying down and heart rate goes up to 180 standing up i have pots syndrome need help
doctor
Answered by Dr. Shafi Ullah Khan (7 hours later)
Brief Answer:
No atenolol, rest management explained

Detailed Answer:
Thank you for asking!
I understand the trouble with posture intolerance and associated with tachycardia, headache, palpitation, sweating, nausea and near syncope with any posture change from sitting to standing.Now the management depends on the type, whether primary or secondary, and there are non-pharmacological and pharmacological options we all are gonna discuss that.
Here is complete description of what pots is .POTS is defined as orthostatic intolerance associated with tachycardia exceeding 120 beats per minute or an increase in the heart rate of 30 beats per minute from baseline within 10 minutes of changing the posture from a lying to standing position, in the absence of long-term chronic diseases and medications that affect the autonomic or vascular tone. There is no drop in blood pressure; it may even rise in the upright posture. Patients experience symptoms such as headache, nausea, tremors, sweating, palpitation and near syncope.
failure of peripheral vascular resistance to increase sufficiently in response to orthostatic stress, and, consequently, venous pooling occurs in the legs resulting in decreased venous return to the heart. This is compensated for by an increase in heart rate and inotropy.
The most common primary form of POTS is called the 'partial dysautonomic' form and i believe you have this type.
POTS is mostly followed by viral infections, trauma, surgery and after pregnancy.
Lets discuss the management.
1)If you are using any of the following medicines then abruptly discontinue them.
You are using atenolol and that itself causes and worsens POTS so discontinue it and start a more friendly antihypertensive.
Alpha blockers
Beta blockers
Gangion-blocking agents
Angiotensin-converting enzyme (ACE) inhibitors
Calcium channel blockers
Nitrates
Diuretics
Monoamine oxidase inhibitors
Tricyclic antidepressants
Phenothiazines
Ethanol
Opiates
Sildenafil citrate
2)Avoid Dehydration, take plenty of fluids.At least two litres a day.
3)Avoid alcohol
4)Keep salt intake to (3–5 grams/day)
5)Do Aerobic exercise of the lower extremities to augment the skeletal muscle pumps , it will help.
6)Use compression hose extending up to the waist.
7)Discuss the following meds with your doctor and let them decide what is best for you.
Exercise
Erythropoletin
Hydration + increase salt intake
Octerotide
Fludrocortisone
Labetalol
Midodrine
Clonidine
Methylphenidate
Bupropion
Selective serotonin reuptake inhibitor (SSRI)/Serotonin and noradrenaline reuptake inhibitor (SNRI)
Get in touch with your neurologist to sort out the type of the POTS with some work up like Hyperadrenergic pots, or secondary due to a cause. If you are young and have a POTS after some trauma like surgery or viral infection or pregnancy then it will resolve in 2 to 5 years maximum. If it comes up to be hyperadrenergic then you may need lifelong treatment.Get to your neurologist and stay in touch with them.Let them decide what is best for you.
Take good care and dont forget to close the discussion please.
May the odds be ever in your favour.
Regards
S Khan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shafi Ullah Khan (1 hour later)
So atenolol is not good for pots what is for heart rate another beta blocker cause if i dont take the atenolol hr is 150 and im dizzy
doctor
Answered by Dr. Shafi Ullah Khan (30 minutes later)
Brief Answer:
Labetalol with many other medicine

Detailed Answer:
Thank you for getting back to me!
labetalol is advised and recommended for the POTS. Use clonidine and midodrine and other medicines i mentioned in my previous answer to help the tachycardia. No other beta blocker than labetalol are advised.
Take care
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3613 Questions

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What Causes Dizziness With Lower BP?

Brief Answer: No atenolol, rest management explained Detailed Answer: Thank you for asking! I understand the trouble with posture intolerance and associated with tachycardia, headache, palpitation, sweating, nausea and near syncope with any posture change from sitting to standing.Now the management depends on the type, whether primary or secondary, and there are non-pharmacological and pharmacological options we all are gonna discuss that. Here is complete description of what pots is .POTS is defined as orthostatic intolerance associated with tachycardia exceeding 120 beats per minute or an increase in the heart rate of 30 beats per minute from baseline within 10 minutes of changing the posture from a lying to standing position, in the absence of long-term chronic diseases and medications that affect the autonomic or vascular tone. There is no drop in blood pressure; it may even rise in the upright posture. Patients experience symptoms such as headache, nausea, tremors, sweating, palpitation and near syncope. failure of peripheral vascular resistance to increase sufficiently in response to orthostatic stress, and, consequently, venous pooling occurs in the legs resulting in decreased venous return to the heart. This is compensated for by an increase in heart rate and inotropy. The most common primary form of POTS is called the 'partial dysautonomic' form and i believe you have this type. POTS is mostly followed by viral infections, trauma, surgery and after pregnancy. Lets discuss the management. 1)If you are using any of the following medicines then abruptly discontinue them. You are using atenolol and that itself causes and worsens POTS so discontinue it and start a more friendly antihypertensive. Alpha blockers Beta blockers Gangion-blocking agents Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers Nitrates Diuretics Monoamine oxidase inhibitors Tricyclic antidepressants Phenothiazines Ethanol Opiates Sildenafil citrate 2)Avoid Dehydration, take plenty of fluids.At least two litres a day. 3)Avoid alcohol 4)Keep salt intake to (3–5 grams/day) 5)Do Aerobic exercise of the lower extremities to augment the skeletal muscle pumps , it will help. 6)Use compression hose extending up to the waist. 7)Discuss the following meds with your doctor and let them decide what is best for you. Exercise Erythropoletin Hydration + increase salt intake Octerotide Fludrocortisone Labetalol Midodrine Clonidine Methylphenidate Bupropion Selective serotonin reuptake inhibitor (SSRI)/Serotonin and noradrenaline reuptake inhibitor (SNRI) Get in touch with your neurologist to sort out the type of the POTS with some work up like Hyperadrenergic pots, or secondary due to a cause. If you are young and have a POTS after some trauma like surgery or viral infection or pregnancy then it will resolve in 2 to 5 years maximum. If it comes up to be hyperadrenergic then you may need lifelong treatment.Get to your neurologist and stay in touch with them.Let them decide what is best for you. Take good care and dont forget to close the discussion please. May the odds be ever in your favour. Regards S Khan