I Have An Elevated Heart Rate Or Tachycardia When I

Posted on Thu, 14 Mar 2019

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Thu, 14 Mar 2019 Answered on

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Question : I have an elevated heart rate or tachycardia when I stand or with movement. I develop this after 3 weeks of heavy menstrual bleeding. It's been a week since my bleeding has stopped but I still have elevated heart rate with movement or standing, and I feel really very very weak, tired, out of breath and thirsty. Drinking lots of water seems to help, but it's like I can't keep up. My CBC is normal high hemoglobin 13- 14. Iron levels are a little on the low side but nothing out of the ordinary, liver test, EKG normal standing and upright. BP normal but sometimes elevated.

Answered by Dr. Dr. Antoneta Zotaj (39 minutes later)

Brief Answer:
PoTS is the likely cause, details below

Detailed Answer:
Hi,

Welcome to "Ask a Doctor" service.

You seem to be having postural tachycardia syndrome (PoTS). This is a condition where the heart rate increases when a patient stands and it is due to the lack of the normal adjustments the body should do when we stand. Normally the blood vessels of the legs should constrict and prevent blood pressure fall when we stand, in the case of PoTS the blood vessels do not constrict, the blood pressure falls shortly after standing and the heart starts pounding. Other symptoms may follow like headaches, dizziness, chest pain, shortness of breath, etc.

The best test to diagnose this is tilt table test and active stand test (where your pulse and blood pressure are measured before and immediately after standing, and again 2,5 and 10 minutes after. It is good you have ruled out anemia and heart problems with a normal CBC and ECG examination.

Generally there is no specific treatment but a few things might help:
- raise up the head of the bed a little so you are not horizontal when you sleep
- stand up slowly from lying or sitting to standing
- continue to drink plenty of fluid and taking salt
- wear compression stockings to help with the blood flow in the legs
- exercise regularly especially swimming, jogging, pilates, etc.
- avoid alcohol and caffeinated drinks

Some medications that the doctor might prescribe but are still under study for the condition are: a beta blocker, a steroid or an SSRI, etc.

I hope this answers your query. Let me know if I can assist you further.

Regards,
Dr. Antoneta Zotaj

Above answer was peer-reviewed by : Dr. Vaishalee Punj