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can you have orthostatic hypotension and POTS at the same time?

Discussion in 'Autonomic, Cardiovascular, and Respiratory' started by datura, Mar 23, 2018.

  1. datura


    Sorry if this has been asked before, I'm having trouble finding an answer. If you have a diagnosis of orthostatic hypotension, is it possible to also have POTS? I'm reading that with POTS, you get tachycardia upon standing without the drop in blood pressure. I have orthostatic hypotension but it's been suggested to me that I should look into doing a workup for POTS. I'm dizzy all the time. My heart rate goes from 80 bpm lying down to 110 bpm after standing for a minute.
    Edit: Just tried monitoring HR again after lying down for 5 mins, was 80 bpm. Stood up and took it again at 2 minutes, was 118 bpm. Not sure if I'm doing that correctly...
    Last edited: Mar 23, 2018
  2. Pizapa


    Hello, I have the same problem. It is normal that the heart rate increases to compensate the Blood pressure drop. But I have thachycardia even without a drop in my blood pressure.
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  3. anciendaze

    anciendaze Senior Member

    Yes. There are people who have high heart rates on orthostatic challenge, which qualifies as POTS. There are others who have modest increases in heart rate that do not qualify as POTS, but do have a sharp decline in BP some minutes after standing, which qualifies as neurally-mediated hypotension (NMH). Many POTS patients also experience a similar drop in BP, if anyone pays attention to what happens after the immediate orthostatic challenge.

    My own heart rate does not ordinarily reach a level to be called POTS, but I do have a drop in BP after about 20 minutes upright. When this results in syncope doctors pay attention, but otherwise ignore it. All this is associated with dysautonomia, a failure of the autonomic nervous system to respond correctly to challenges. The problem is a failure of regulation, not simply too high or too low. It is also a great way to "fall through the cracks" in the healthcare system.

    When doctors see variations in BP in elderly patients they routinely diagnose this as "high blood pressure" and prescribe medication to lower BP. They tell people "low blood pressure is good" unless it results in syncope. I've known elderly people who regularly passed out an hour or two after taking their medication. In my case the problems with syncope started in my teens without any medication.
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  4. Seven (formerly lnester7)

    Seven (formerly lnester7) Seven

    I believe so, in my case my resting BP is VERY low, and when I crash goes high ( for me) I start headaches at 130/90.
    My resting BP is 97/70 or so.
    When I got midodrine ( which can raise BP) actually stabilized. So it was not
    Really hypotension I was actually low, but got out of whack in crashes.
    I have POTs also ( besides CFs)
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  5. kangaSue

    kangaSue Senior Member

    Brisbane, Australia
    If you haven't already had this done along with a Tilt Table Test, a Heart Rate Variability to Deep Breathing test as a measure of your vagus nerve function (looking for cardiovagal dysfunction) might throw some light on the problem.
    datura likes this.

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