Tuesday, March 6, 2018

Tachycardia


I am asked how I treat tachycardia since I recommend the avoidance of beta blockers. The goal of treatment is to correct aberrant physiology to the extent it is possible.  Tachycardia is a compensatory response which is maladaptive.  In general, initial therapy should target circulating volume (fludrocortisone/Florinef) and try to increase constriction of the blood vessels to improve perfusion - blood flow to brain and vital organs.

Midodrine is the most commonly used drug. Another option is Northera, FDA approved for central dysautonomia. It is an analog of norepinephrine and should promote constriction of blood vessels.  The two drugs work by different mechanisms. If we apply these solutions tachycardia may abate. Sometimes we need a beta blocker. Beta blocker are generally not the first drug prescribed for POTS.  Instead of beta blockers a novel drug approved for CHF, Corlanor is said to decrease heart rate without lowering blood pressure. This may be a good idea if low blood pressure is a concern.

Patients with cardiac symptoms should be evaluated by a cardiologist. Not necessarily to diagnose POTS but to exclude other organic issues:  electrical conduction issues, dysrhythmia, valvular heart disease and others. A tilt table test is not a bad thing. It may be uncomfortable and simply not needed in many cases.

Lyme can cause carditis, heart block and other cardiac complications.

These comments are for general information purposes only. If you have symptoms of concern please visit your personal physician for an evaluation. 

5 comments:

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Christian said...
This comment has been removed by the author.
Christian said...

Hmm. Why do you recommend avoidance of beta blockers?
Do they make your typical patient worse? Immune surpression?
I don't get it.

Lyme report: Montgomery County, MD said...

Beta blockers don't fix what is wrong, i.e. getting enough blood flow to brain and vital organs. Increasing volume and constricting blood vessels addresses the "pathophysiology," what is making one sick. If these therapies work the heart rate will be reduced. Beta blockers are added after other therapies are tried first. Beta blockers may make things better or worse.

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