tried propranolol for the orthostatic stuff starting about four months ago. my neuro suggested it after tilt table confirmed the POTS piece. standing HR was hitting 130-140 routinely, which was making any upright activity basically impossible. it worked for that.
genuinely - HR on standing dropped to the 90s. standing tolerance improved maybe 30%. but the fatigue got worse. not a little worse.
dramatically worse. i’m a PT, i know beta blockers reduce cardiac output, i knew this was a possible mechanism going in. i still didn’t expect how much heavier everything would feel. brain fog thickened too.
the cognitive stuff that had been improving slightly just… stopped improving. so now i’m managing one system better and another system worse, which is basically the ME/CFS experience in miniature. every intervention has this cascade quality where fixing one thing costs you somewhere else.
orthostatic intolerance down, PEM up. it doesn’t feel like progress, it feels like rearranging. my cardiologist says give it more time. my neuro says the fatigue is probably baseline, not the propranolol.
has anyone worked through this specific trade-off, and did it eventually stabilize, or did you switch to something else for the POTS piece?