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When postural tachycardia really is postural

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Edited by Annie Storkey, Friday, 12 Jun 2020, 12:14

It's been over 12 weeks now since I developed Covid-19 and although I recovered from the infection in just over 2 weeks I still have the post-viral complication of presumed postural orthostatic tachycardia syndrome (POTS). I've blogged already about some of my symptoms (as a lecturer in health I'm somewhat fascinated by how the body behaves!) but today I thought I'd focus on something I've only recently noticed - the affect of posture.

I noticed several weeks ago that I occasionally got mild air hunger (large intake of breath) when sitting at my computer, and that this apparently was common in POTS. It's a very odd symptom, given the condition, as the tachycardia occurs to improve oxygenation when standing. Clearly both responses are to improve oxygenation but they are very different.

But last week when I took a break from work/study, I found myself sitting at the kitchen table hunched over my iPad and getting increasingly lightheaded and gasping for breath. It was quite distressing as it felt like my breathing was deteriorating, when until then I had only noticed it getting better. I then realised that it improved with better posture, which would explain why I had it then but not sat on the sofa with the iPad in my hand. Interesting that it's positional, I thought, and carried on with life.

Then on Tuesday I did my yoga class. Until recently my post-covid fitness levels haven't allowed me to do a whole session without tachycardia but I'm now walking several miles a day and feel much fitter. I was pleased to do a whole class of mainly standing poses and have no tachycardia. But wait, I have postural tachycardia and can get a fast pulse just from lifting my arms up -why was it okay to do standing yoga? I suspected that the strict yoga posture was the answer and reflected on my walking tachycardia. I had noticed recently that my tachycardia when out for a walk is better when I'm thinking about it but my pulse starts galloping when my mind wanders, only that day it had suddenly leapt from 104 to 135 for no apparent reason. Was it because my posture dropped?

I tried it out today and worked really hard on my posture when walking; chest out, shoulders back and down. And my pulse stayed below 110 (normal walking pulse) throughout my 2 mile walk. Now, this might be because I walk slower when concentrating on posture but I've ordered a simple back brace and will explore this further. It might be a breakthrough at managing my pulse rate.

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Getting better

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Edited by Annie Storkey, Friday, 12 Jun 2020, 11:58

Today my postural tachycardia seems much improved. It is normal both standing and pottering around the house and when I went for a walk it was within the normal bounds of light exercise (some rise is expected). What was most significant is that it dropped down to normal immediately on rest, which would seem to me to indicate a normal response to exertion. It even has slightly improved when walking upstairs, though it still doesn't like me raising my arms (getting dressed always causes tachycardia). I've also been less fatigued the last few days, despite walking further, and I managed nearly 2 miles this morning.

Obviously I know this might not last; I got covid nearly 10 weeks ago and know how symptoms vary from day to day. But these are all hopeful signs that my routine of increased fluids and increasing light exercise are helping.

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Postural Orthostatic Tachycardia Syndrome

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Edited by Annie Storkey, Friday, 12 Jun 2020, 11:58

My tachycardia is postural, my resting pulse is around 65 and it goes up to 90 when I stand up - when I first noticed it was up to 128 just walking around the house. It is exacerbated by exercise (walking upstairs can raise it to 110, going for a walk to 125, once 150), raising my arms (carrying laundry downstairs or sitting to chop vegetables raises it to 125, even brushing my teeth raises it), heat (gardening on a warm day made it 140), and eating (rise to 90 when seated). Alcohol sometimes exacerbates it, caffeine doesn’t and might well improve it.

The paramedic on my second trip to casualty did a seated and standing pulse and BP and suggested Postural Orthostatic Tachycardia Syndome. I have since researched this (I am an ex-nurse) and it fits my symptoms and circumstances, especially as a post-viral autonomic response. I have instigated suggested lifestyle changes including increased fluid intake, slow transition on rising, wearing light compression running leggings, gentle yoga and taking a daily morning walk with regular rests and water. 

I think water intake has had an enormous effect. Taking water 20 minutes before getting up in the morning has resulted in a normal pulse on rising. I can now, most days, walk around the house without tachycardia as long as I keep my fluid intake up. My morning walk pulse is gradually improving too. Arm raising is still an issue but I am aiming to increase my upper body strength with seated and supine yoga.

I have to avoid fatigue, though. If I push myself too far I can get fatigue for the next few hours or even the next day. The best solution for the tachycardia is to sit on the floor cross legged, that results in an immediate drop in pulse. If I am outside I stand with legs crossed.

Obviously I am in a better state than many people recovering from covid as I was not hospitalised and did not spend my symptomatic two weeks on bed rest so my body is not very deconditioned. I am well enough to do my usual online teaching job and carry out activities of daily living despite my tachycardia. But I thought I would share my experience of dealing with post-covid tachycardia in the hope that it might be useful for other people.

(Hopefully once I’ve beaten the tachycardia I can find a solution to my strange lung pressure issue! I can’t bear high air pressure and get air hunger, especially at rest. I’m hoping increased exercise will lead to greater lung expansion)


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