Symptom Question

[Bob in Texas]

During the last several days after waking up in the middle of the night to go to the bathroom as soon as I stand up and get out of bed I nearly blackout. Never had this feeling before almost like I am losing my balance. I am use to getting off the couch and getting very dizzy and always have to take it a little slower. This night thing is a new one....anybody relate.....

Bob

[Pam Alexson]

Well it can happen at any time day or night. Is getting up in the middle of the night a new thing w/ your start of meds and increase? It happens to me day, night, morning, evening , middle of the night, around the clock and sometimes I am amazed that it doesn't happen at all sometimes. I can relate!

Some of it is probably the meds and how it slows your heart rate down, lowers your BP and old ways of moving and doing things need to be adjusted to the slower more relaxed heart that they have instituted changes in.. and sometimes it is a vagal response when you get up quickly and the vagus nerve is stimulated as the diaphragm moves. The vagus nerve runs along our diaphragms.

Some of it is just how HCM is and what happens because our hearts do not perform as they would normally and they are not made normal.

http://en.wikipedia.org/wiki/Vasovagal_episode

[gfox42]

Hi Bob,
Yes, this is pretty familiar; I've had a fair amount of experience with both mechanisms that Pam mentioned.

The first mechanism Pam mentioned is often called orthostatic hypotension. I'm going to guess (and it's only a guess) that's what's going on. The reason for my guess is that it's easy to imagine that with a stiff left ventricle and meds (like beta blockers) that slow your heart rate, sometimes when you get up the blood pressure in your head just isn't up to what it should be. I've had this happen many times, since being diagnosed with HCM, and not very many times before.

But vasovagal responses are also a possible cause. The reason I'm suspecting this is less likely (though coincidences do happen) is precisely that it'd be mighty coincidental for you to suddenly develop this problem. That said, vasovagal syncope (fainting due to this mechanism) can occur. In people without HCM it's "not dangerous," which is to say that while they might hurt themselves if they faint and fall (or faint behind the wheel, etc.) it's not otherwise considered to be a real danger. In HCM patients, though, it can be dangerous.

So what should you do? A couple of suggestions:

Try to get up slowly! This is a lot harder to say than to do, because we have a lifetime of habit to overcome.
Talk with Dr. Maron (that is who you see, isn't it?) about this. It's possible that some adjustment in your meds is worth considering.
Stay well hydrated! This won't have any effect on vasovagal problems, but it should be helpful with orthostatic hypotension.
When it happens, try to keep your head down and try to remember to do the compression exercises on the page Pam pointed to.


While there are various treatments for vasovagal syncope, most of them are recommended only for people who are fainting a lot. A whole lot, that is. The docs I've talked to (including my HCM specialist) all just say that there's not much that can be done at present, for most people.

Gordon

[harrisb01]

Hi Bob
I have some experience with this. My "head rushes" actually diminished after my being on a beta blocker for a few months. I'd like to add to the practical advice.
Get in the habit of ALWAYS sitting at the edge of your bed before slowly standing up! This may have more to do with my own episodes diminishing than anything else. Also, I look (use a nightlight) to be sure my path is clear, as I worry about falling. I have cats. Do what you need to do to keep yourself safe!

Of course you should discuss the medical implications with your doctor.
Barbara