Topic: How do beta blockers help Neurally Mediated Hypotension??
Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
Can anyone explain to me why taking a beta blocker, such as atenolol, helps Neurally Mediated Hypotension, when it is normally given to lower BP??
My previous LLPA, who rx'd it for me, said that it makes the heart beat harder. But that doesn't explain it's paradoxical action very well for me. But it sure does help! In fact, I take a 1/2 dose in the am, and a full dose in the pm (25 mg), and it helps so much at night, that I am thinking I should reverse it, so I have some energy in the daytime, not just later at night!
Posts: 3771 | From around | Registered: Mar 2008
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posted
All I can tell you is that I have NMH and I take a beta blocker.. it doesn't do a thing for me, nothing does. I also take lisinipril with it. I'm still living a horizontal life.
Posts: 499 | From Indiana | Registered: Oct 2007
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posted
I just got Dx'd with NMH and my treatment is to increase liquid, salt but stop caffeine.If that doesnt help Dr said he would like to try SSRI antidepressants such as prozac becuase they are shown to help even though thats not their intended use obviously.
Posts: 29 | From New York | Registered: Apr 2008
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WildCondor
Unregistered
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Lyme is backwards, thats why! They slow down the rapid heart rate and since Lyme is backwards, it makes sense! Read more!
Backwards Blood Pressure By WildCOndor
How many of you suffer from bizarre symptoms that nobody seems to understand? Many thousands of patients, myself included, have at some point been left completely puzzled at the mystery of our unexplained medical conditions. In my earlier article, ``Quest for a Diagnosis,'' I shared my tortured journey towards my diagnosis of Lyme disease. My story represents a small picture of how frustrating it can be to pinpoint the true cause of a medical problem.
Lacking intricate knowledge of complex emerging diseases such as Lyme disease, many physicians become overwhelmed and baffled, and simply give up. Rather than spend the time to accurately diagnose you, they instead label you with something like chronic fatigue syndrome (CFS). This jumbled diagnosis gets them off the hook, and as a result you are left dumbfounded and bewildered as to what the cause of your symptoms is. In my opinion, many physicians give up easily, and ``pass the buck'' on a patient without thoroughly investigating the true nature of the patient's problem.
Before I knew I had Lyme disease, I suffered for years from recurrent spells of lightheadedness and dizziness. ``Zombie mode'' is how I used to describe the mental fog I walked around with every day. Whenever I stood up after sitting for a while, I got a ``head rush,'' and felt woozy and off balance. Hot weather, hot showers, and standing in lines often brought about an increase in my symptoms.
I developed very uncomfortable feelings of anxiety and shakiness after my ``head rushes.'' The dizziness would often get markedly worse after I ate a full meal. This was very odd. I thought the shaky feeling might be stemming from low blood sugar (hypoglycemia). Exercise was impossible due to the exhaustion I experienced afterwards. At times, this post-exertional fatigue would last for 2-3 days. I figured my exhaustion was due to the earlier diagnosis of chronic fatigue syndrome (CFS) my flock of doctors had slapped me with.
Disoriented and exhausted, my mental confusion took on the forms of difficulty in concentrating, slurred speech, and panic attacks. As time went on, I became so weak I could no longer drive my car, and I required assistance with simple tasks. My plethora of doctors decided I had Addison's disease (another wrong diagnosis) and prescribed steroids for 3 years with no resolution. According to my endocrinologist, my adrenals had shut down for ``unexplained reasons.'' It was not until I was correctly diagnosed with Lyme disease that the cause of my strange symptoms was discovered.
Being a brilliant researcher, my Lyme Literate Medical Doctor (LLMD) sent me a cardiologist to have a tilt table test. Gently remarking that Lyme patients are ``backwards'' in nature, my LLMD suspected I might have a form of autonomic dysfunction. A tilt table test is designed to help diagnose neurally mediated hypotension (NMH), also known as vaso-vagal syncope, neurocardiogenic syncope and autonomic dysfunction. The medical terms for fainting and low blood pressure are syncope and hypotension respectively. Tilt table testing is a rather simple concept, but requires supervision by a cardiologist.
I was fortunate to have a very Lyme literate cardiologist administer my test. In fact, before my test began, one of the residents in the room griped that he had never heard of babesiosis, which I listed on my patient history form. My cardiologist gave the resident a look of disappointment while remarking that he should study harder if he wanted to make it in the medical profession. Babesia microti, a piroplasm similar to malaria, is one of the tick-borne diseases that complicated my condition.
My tilt table test began with me lying flat on my back, with blood pressure cuffs on both arms, and heart monitors attached to my chest. Measurements were taken at scheduled intervals as I was transitioned from lying flat into a standing position. To prevent me from fainting, I was secured to the table with safety straps. After being raised to an upright position, and remaining there for several minutes, I was returned to a lying down position. Phase two began with an injection of Isuprel, a drug that simulates a stressful situation, thought to mimic the symptoms I was experiencing. Once the drug took effect, I was again raised to an upright position. My heart rate reached 165, and then suddenly dropped to 65 in one beat, as my blood pressure plummeted from 130/70 to 50/0. I fainted and was out cold until they stopped the test and administered the antidote to the Isuprel. Normal blood pressure is typically 120/70.
It was an exhausting experience, however, this test turned out to be one of the most significant tests and discoveries of my health journey. I had a combined neurocardiogenic and vasopressor response, a double fail. This meant that the Lyme bacteria had inflamed my vagus nerve, which is the major communicator between the heart and brain.
My cardiologist graciously explained that when a healthy person stands up, blood normally pools in the legs due to gravity. To compensate for the lower quantity of blood returning to the heart after standing, the body releases adrenaline. The adrenaline surge makes the heart pump harder and faster, thus allowing the blood to pump quickly back from the extremities to the brain and vital organs.
In neurally mediated hypotension (NMH) there is a miscommunication between the heart and brain. As you stand up, and the heart needs to beat faster, the brain ``misfires'' and sends out the message that the heart rate should be slowed down, and that the blood vessels in the arms and legs should dilate. More blood is taken away from the central part of the circulation where it is needed, and lightheadedness and syncope (fainting) can result. These symptoms occur because the brain is not getting enough blood. Although frightening, fainting can actually help the patient by returning him/her to a flat position, removing the pooling effect of gravity in the extremities, and allowing more blood to return to the heart.
My cardiologist explained that because I had both low blood pressure and the rapid heart rate (tachycardia), I would need a combination of treatments to get my symptoms under control. He recommended Atenolol, a beta-blocker designed to regulate heart rate. I had what he called ``backwards blood pressure'' and he explained how beta-blockers are normally used to control high blood pressure (hypertension).
In addition to the beta-blocker, he recommended I take the antidepressant Zoloft, plus the mineralocorticoid Florinef to help regulate my blood pressure. Florinef works by acting on the kidneys to keep increase blood volume, thereby increasing blood pressure. Along with the Atenolol, Zoloft and Florinef, my cardiologist suggested I add more salt to my diet, avoid dairy products, alcohol, and caffeine. He also mentioned how essential it would be for me to drink at least 2 quarts of water per day, and double that amount in warmer weather.
I also learned some basic techniques to help me manage my NMH better. Simple posture, it turns out, had a lot to do with the degree of symptoms I felt. Crossing and elevating my legs would help stop blood pooling in my feet. Using cooler water while showering sitting in a chair would help prevent episodes of NMH brought on by the heat. The bizarre dizziness I experienced after eating was due to the blood moving to my digestive system. Eating smaller, more frequent meals helped resolve that uncomfortable symptom. Using a motorized scooter in the supermarket, or shopping during off hours would help prevent the standing in lines that brought about the blood pooling and anxiety/shakiness. The fainting reflex could be activated whenever I stood upright for a period of time. As my LLMD later explained, the Lyme bacteria were the cause of the NMH, and the cause of the inflammation of my vagus nerve.
Determined to always seek the cause, I was relieved to gain understanding of such a commonly misdiagnosed disorder. Just to be clear, some physicians will talk about NMH as if it is a disease. Actually, it is a functional disorder that clinically indicates something much greater. In my case, in order to treat the NMH, I first had to aggressively treat my Lyme disease with antibiotics. By reducing the inflammation caused by the infection, the symptoms of NMH would, in turn, resolve. The medications and dietary changes I had to make would help control the symptoms.
Different treatments for NMH are available, and there is no single course of treatment that will work for everybody. It took several years of antibiotic treatment to get my NMH under control. I tolerated the beta-blocker and the Zoloft well. The Florinef helped me for a short while, but I had to discontinue it due to side effects. As my condition improved, the medication doses were tapered down gradually. I discontinued Zoloft, and reduced the beta-blocker to half a pill in the morning. My tolerance to heat, exercise and prolonged standing improved greatly. Lowimpact exercise with weight training and yoga gave me back enough strength to walk on a hot Caribbean beach without symptoms.
Based on my experience, I know there are plenty of folks out there suffering from NMH without a clue as to what is going on with their bodies. If you are experiencing symptoms of lightheadedness, dizziness, shakiness, brain fog, and intolerance to exercise, ask your doctor about the possibility of NMH. It might be a good idea to see a cardiologist and have a tilt table test. It has been speculated that NMH may be the cause of chronic fatigue syndrome and fibromyalgia. Although I agree that NMH causes one to feel extremely fatigued, the cause of the dysfunction must be investigated.
NMH can be difficult to explain, even to medical professionals. In simple terms, although in reality it is more complicated, you can call it orthostatic intolerance, low blood pressure, or syncope. Most medical staff should understand that basic medical terminology.
Whenever I had to list my medications for a doctor visit for whatever reason, nurses always assumed I had high blood pressure because I was on a betablocker. Time after time I had to correct that inaccurate presumption, and explain the neurological technicalities of NMH. It is sadly entertaining because the paid professionals are supposed to be taking care of me, and there I was, educating them!
As I have mentioned in previous articles, I cannot stress enough the vital importance of educating yourself about your medical condition. Ask questions, take notes, research and arm yourself with as much detailed information as you possibly can. It is my hope that my story can help you on your journey towards perfect health.
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Rivendell
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Hi, I really don't know. I was given several different kinds, and they didn't help me at all.
But, I think they do help some people. I think it depends on what is causing this disorder. The causes are slightly different in each person, and I think that it takes a clinic like the Cleveland Clinic, to figure that out. I would like to go there.
Best wishes.
Posts: 1358 | From Midwest | Registered: Apr 2009
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The rationale for beta-blocker therapy is based on both physiologic and clinical observations. Sympathetic stimulation of beta-adrenergic receptors is believed to be important in the pathophysiology of vasovagal syncope.
9 Terminal levels of norepinephrine and epinephrine are significantly higher in syncope patients compared with control subjects immediately following head-up tilt testing.
10 In addition, the time to reach a positive tilt test response is reduced in patients who receive isoproterenol hydrochloride (Isuprel) compared with those exposed to passive head-up tilt.11
Therefore, treatment directed at the beta receptor seems reasonable.
Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
Thank you, Wild Condor! That helps. I don't think I have the syncope (although not positive), but I sure have the NMH!
I never had the tilt-table test; I"m sure I would have flunked it before the meds. My previous LLPA, who worked with your former LLMD, rx'd it for me by my symptoms. My BP was always unbelievably low.
And I've had this symptom to varying degrees my whole life! I had it as a kid, passed out and everything. But I always vacationed in Montauk, and had tons of ticks on me! It only took umpteen decades and tons of doctors to find out why I had a million symptoms.
I thought that I needed Desmopressin, but when I added that last year, I had to pee every hour at least, or I literally couldn't hold it!! Weird and awful. Plus, it gave me migraines. Sigh.
[ 09-13-2009, 01:50 PM: Message edited by: Rumigirl ]
Posts: 3771 | From around | Registered: Mar 2008
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I have NCS and IST, my IST serves as a trigger to the NCS. This was the beginning of my Lyme really robbing me of my life.
I take a ridiculously sm. dose of atenolol and that helps the NCS and for the tachy I needed to add verapamil ER.
2.5 weeks after starting treatment (at that time just the atenolol and a higher dose) I had 4 days of feeling normal/healthy. I cried, because I had quite literally forgotten what it felt like.
That wonderful feeling left after the 4 days, but I was still a lot better off than before treatment.
My bp has improved with treatment. It is rarely low anymore, it's a good healthy normal. This is because my heart rate was slowed down to normal and so my heart filled and beat more efficiently.
The serious brain fog I had before treatment made me feel like I was in another dimension from others on top of the other brain fog symptoms.
To express OspA (outer surface protein A), Bb locks onto OUR epinephrine and norepinephrine. It has to downregulate that protein (OspA) in order to invade, but once in us, it is upregulated.
But...while eliminating OspA IS good, we now have to deal with Bb's OspB and the cell wall deficient (CWD) form of Bb too.
OspC is supposedly not a problem.
It takes adequate Mg to make "healthy" antibodies to Bb's OspB. Documented - Pubmed. What we are after is a "healthy" mAB CB2 = monoclonal antibody CB2.
CB2...uhmmmm...(not sure if it relates to PKCBII OR cannabinoid CB2). Though I think the first i.e., PKCBII (PKCB2)
The CWD forms (and keep in mind Bb follows the cholesterol pathway to rebuild damaged cell walls) is dealt with via osmotic pressure changes or ultrasound...to finish the job.
I think barometric pressure changes also hit that form. It has to do with the amt. of oxygen available.
More on Propranolol here (BTW...look closely at the generic form with attention to "chloride"):
Watch your blood sugar. If problematic, an over the counter supp. called "Gluco Reg" works...my mom takes it. It is chromium + lots of acids.
Or...simply take 1/2 teaspoon of cinnamon every morning. Wonderous! Cinnamon works from more than one angle too...PROCYANIDIN..though not excactly the right form.
Once again it is IMPERATIVE to reduce inflammation WHILE hitting Bb.
AND...keep pumping in probiotics.
I suspect OmegaBrite (reduces TNF alpha and IL1B), following the package instructions...
AND...ALONG WITH
3 1/2 Tablespoons of VIRGIN COCONUT OIL in divided doses (with meals) per day...(can mix with a little peanut butter to get it down).
Could work.
While all of the fatty acids in VCO are likely working together, one absolutely stands out to me (not the lauric acid), but:
C8H16O2 = Caprylic acid = octanoic acid
"caprylic acid and MCT (medium chain triglycerides) suppress IL-8 secretion"
What does interleukin 8 (IL-8) do?
MMP2 and MMP9...metalloproteinases (cleave = break apart proteins)
"MMPs are divided into collagenases, stomelysins and gelatinases; the latter group consists of gelatinase A (MMP-2) and gelatinase B (MMP-9),
which degrades denatured collagens (gelatine), native type IV and V collagens and elastine and
many more such as surface molecules and receptors."
"Our data suggest that IL-8 directly enhanced endothelial cell proliferation, survival, and MMP expression "
"MMP-2, MMP-9, ox-LDL and abnormal lipid metabolism may participate in pathogenesis of AD, in which abnormal lipid metabolism induces expressions of MMP-2, MMP-9 and ox-LDL. Oxidative stress and blood-brain barrier disruption might accelerate the process of AD." (AD = Alzheimer's Disease).
A DOCTOR (female, pediatrician) discovered VCO (virgin coconut oil) can REVERSE AD (her husband).
It's working!
I think it might be important to add also ***Very high EPA (with some DHA and vitamin E in the formula) like that found in OmegaBrite.
The "good" aspect of OmegaBrite is that they have kid's dosages too.
These are the acids in VCO (virgin coconut oil):
C6H12O2 = caproic acid
C8H16O2 = Caprylic acid = octanoic acid
C10H20O2 = capric acid = Decanoic acid
C12H24O2 = Lauric acid
C14H28O2 = Myristic acid
C16H32O2 = Palmitic acid
C18H36O2 = Stearic acid
C20H40O2 = Arachidic
C18H34O2 = Oleic acid
C18H32O2 = Linoleic acid
One by one..."google" each acid and see how it works. I think they work TOGETHER though.
Wikipedia, the free encyclopedia...will simply explain the functions of each acid.
Sorry, but the "pill" equivalent = 49 capsules per day = $$$$$$
Posts: 9424 | From Sunshine State | Registered: Mar 2001
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
j_liz,
What's NCS and IST?? And your BP is ok now?? That would be great! Mine is much better with the atenolol and Florinef, but still too low and somewhat problematic. Don't know if I need more atenolol or what. If I take more Florinef (I take 1 to 1 1/2 tabs now), it helps a lot, but gives me migraines reliably! Errrg!
(I changed my previous post: Lyme-brain struck--I said it was the Florinef that gave me problems, but I meant the Desmopressin).
Thank you, Marnie; I'll have to check out al the links later.
Posts: 3771 | From around | Registered: Mar 2008
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LisaS
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Member # 10581
posted
so Marnie is propanolol bad or good? I have been diagnosed with vaso vagal syncope. But I haven't been back to the cardiologist to get a prescription for what he was going to give me.
But another Dr gave me the prop for a fast heart beat when I was in the ER. I noticed it did calm me down. Bit I stopped after a couple days. I know I need to go back to the cardiologist, but jsut curious what that article meant.
Wildcondor, I'm so glad you posted that story, it helped me to understand now what I have. I'm gong to copy it in case anyone wants to understand NMH.
posted
Thanks Marnie, and your welcome LisaS We're all backwards
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Marnie
Frequent Contributor (5K+ posts)
Member # 773
posted
Google these words:
neurocardiogenic syncope magnesium potassium
Posts: 9424 | From Sunshine State | Registered: Mar 2001
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Marnie
Frequent Contributor (5K+ posts)
Member # 773
posted
"Backwards" reminds me of this:
Normally metals react with lots of acids to make hydrogen. There is a list of which ones react the fastest.
The key to healing is the ability to get hydrogen INTO the cells and into the mitochondria (powerhouses) and NOT have a pathogen exchange hydrogen for a mineral (as I understand it).
posted
Has anyone with NMH and Lyme ever had a problem with surgery/anesthesia or just going through the surgical process and had it re-introduce your NMH symptoms? My son just had surgery and the it went well... the problems began in the recovery room when he kept passing out and was unresponsive 4-5 times for up to 3 minutes, in the first 1.5 hours after surgery.
We never expected it as his symptoms had been fine for several years... bad timing and just an unexpected development? They had to keep him overnight as a precaution and that was wise. After several days with it all out of his system, he is much better.
I was wondering if this was something any of you had experienced?
Thanks
Posts: 89 | From NC | Registered: Jun 2008
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Rumigirl
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Member # 15091
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Hmmm. That's worrisome. I need some surgery before too long without general, I think. But my previous LLMD didn't think that it was a good idea at that point in my illness. ANd I still don't think it is. Yet another concern with surgery.
I have NMH that is difficult to get totally under control. Sometimes ok with the meds, sometimes not. Previously, I was mainly concerned about the knock to the adrenals and system in general.
Posts: 3771 | From around | Registered: Mar 2008
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After going through surgeries and procedures, some time I had trouble with near syncope and syncope. The near was the worst, because I felt like I was going to die and my hubby told me later that I look like I am (gray coloring, it scares him to death).
It seems maybe it's the different things they use to put me under. It's good to find out what was used, so if there is a next time you can tell them. I did that once, but due to the nausea, and they gave me something to combat it.
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This is because my heart rate was slowed down to normal and so my heart filled and beat more efficiently.![[Smile]](smile.gif)
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