Postural Tachycardia Syndrome (POTS) Diagnosis and Treatment: Basics and New Developments

[Allyson]

not sure if I posted this already?

http://crm.cardiosource.org/Learn-from-the-Experts/2013/02/POTS-Diagnosis-and-Treatment.aspx


A

 

[xchocoholic]

Thanks. This is the first time I've seen anyone provide a list of exceptions to using a POTS dx.

My understanding was that the dx was based purely on a 30 pt jump in hr after standing for 10 minutes.

My education on this is several years old so things may have changed. Or maybe I misunderstood.

I have OH and POTS so according to this I don't have POTS.

Maybe this criteria was used to isolate those who could exercise seeing as that was promoted so heavily ?

tc .. x

 

[Sea]

@xchocoholic just like ME/CFS there are some different criteria for POTS and some disagreement among doctors as to what is and what isn't.

Some say if you have OH then the tachycardia is a normal compensatory response rather than something wrong, and so they would say not POTS. The orthostatic tachycardia in the absence of hypotension is when they would say there is something wrong that they would label POTS. These doctors would still recognise OH as an autonomic dysfunction, just different from POTS.

Other doctors will diagnose POTS if there is orthostatic tachycardia regardless of what the blood pressure is doing.

 

[taniaaust1]

The orthostatic tachycardia must occur in the absence of other overt causes of orthostatic tachycardia (e.g., acute blood loss), medications that impair autonomic regulation, or other chronic debilitating disorders that might cause tachycardia (e.g., anemia, diabetes with known autonomic neuropathy, systemic infectious or inflammatory conditions, hyperthyroidism).

Going by that definition, they'd rule everyone out of having POTS who has ME as its a chronic debilitating disorder which may cause this symptom.

Ive seen POTS listed and a coexisting issue of diabetes. If they dont want to call this issue POTS in such a case.. what are they going to call it then? Kind of ridiculous when its the same issue happening with the heart but just has different coexisting illnesses attached to it.

When this "cardiovascular deconditioning" from bed rest is prevented by supine or semi-recumbent exercise combined with volume repletion, the orthostatic intolerance is completely prevented.30,31 Therefore exercise training is a reasonable first line therapy for many patients with POTS.

umm well I can say I still had severe POTS back when my ME wasnt so bad and I was able to exercise
Seems the article is wanting to make it sound like POTS is just caused by deconditioning. I wouldnt pay too much attention to this article.

I think POTS is another condition the psychologists probably would like to get their hands onto.. and have all POTS patients do GET and if they cant.. tell them they are causing their own illness by not complying with treatment.
..............

POTS definitions other then the amount of increase of the heart beat which seems to nowdays be standardised.. vary. Some in their defintions say you have to also have a certain level of norepinephrine happening too.

Anyway.. the most common definitions seem to be just based on heart rate.

 

[ahimsa]

So many different opinions on terminology, diagnosis, cause, etc. It's hard to keep up!

Personally, I like the Medscape article about Orthostatic Intolerance (primary author Julian M Stewart). It has several sections:

Intro page - http://emedicine.medscape.com/article/902155-overview#aw2aab6b2

Types of OI - http://emedicine.medscape.com/article/902155-overview#aw2aab6b3
Scroll to the bottom for his definition of "Chronic Orthostatic Intolerance." An excerpt from this section:

In chronic orthostatic intolerance, patients are ill on a day-to-day basis. Chronic orthostatic intolerance may be confused with syncope because chronic illness is sometimes punctuated by acute syncopal episodes. However, this is unusual during real life (albeit common during artificial testing environments), and the author's work suggests no increase in the incidence of syncope above that in the general population. The physician should rely on the patient's history to determine whether chronic illness is present. Thus, chronic orthostatic intolerance is defined by a history of symptoms of orthostatic intolerance present on a day-to-day basis. Defining symptoms of chronic orthostatic intolerance include dizziness in all patients, with high incidence of the following conditions:

• Altered vision (blurred, "white outs", "black outs")
• Fatigue
• Exercise intolerance (frequently post-exercise malaise)
• Nausea
• Neurocognitive deficits
• Sleep problems
• Heat
• Palpitations

A large proportion of patients also experience the following symptoms:

• Headache
• Tremulousness
• Difficulty breathing or swallowing
• Sweating
• Pallor
• Other vasomotor symptoms

These symptoms are divisible into symptoms of sympathetic activation and symptoms of reduced cerebral blood flow.

Info on POTS - http://emedicine.medscape.com/article/902155-overview#aw2aab6b7

From the summary page:

Orthostatic intolerance is common but often misunderstood. Investigation of the condition is an evolving field of integrative physiologic study. Acute orthostatic intolerance is characterized by simple faint. Despite its ubiquity, scientists do not yet understand why particular people faint. Chronic orthostatic intolerance, characterized by postural tachycardia syndrome (POTS), has been demonstrated in adolescents. POTS, however, remains a heterogeneous entity, likely of varied etiologies. Until better understanding is achieved, treatment remains more guesswork than science.

 

[Valentijn]

Some say if you have OH then the tachycardia is a normal compensatory response rather than something wrong, and so they would say not POTS. The orthostatic tachycardia in the absence of hypotension is when they would say there is something wrong that they would label POTS. These doctors would still recognise OH as an autonomic dysfunction, just different from POTS.

This corresponds pretty well with my symptoms. I have OI constantly, but only get POTS-level tachycardia upon standing on rare occasions - usually after being way too active. So I'd guess that during those episodes I'm having POT (Postural Orthostatic Tachycardia) as a symptom, but without meeting the requirements of the "syndrome", hence not POTS.

I suppose you could look at it as being similar to some people having chronic fatigue, yet most definitely not having Chronic Fatigue Syndrome. Instead of having the syndrome, people are just having a symptom.

 

[xchocoholic]

I was looking at these exceptions as being like denying a diabetic had neuropathy because it's a known consequence of being diabetic.

Learning I had POTS everytime I stood up for no more than 10 minutes was HUGE.

It completely explains the heart racing, sweating, have to lay down now feeling, petite mal and sob that GOES AWAY after I sit for a few minutes then lay down.

OH, verified via pmttt, didn't make me feel this way. I only get a little light headed after 3 minutes of standing. But about 10 minutes after standing, the shit hits the fan.

Not telling patients how POTS can affect them is a HUGE mistake.

tc ... x