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Different diagnosis

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Nemesis, Dec 16, 2016.

  1. Nemesis


    one of my doctors said I have pots the other one said Hyperadrenergic POT
    I have hypothyroidism, heat sensitivity, dysautonomia run in my family , my mother has it, my sister also but not like my symptoms, my symptoms gradually worsened but now is better
    Always standing increase my blood pressure but never increased diastolic more than 85 which the reason my 2nd doctor said Hyperadrenergic pots beside my hemeglebic migraine - I cured from it- light trigger rapid heart rate
    I can't do exercises unless laying in the bed if I stand and bend my knees or sit in the floor when I stand and when I climb stairs oh my god very rapid heart rate headache, if I went outdoors I get fatigue standing alot make me dizzy, heat sensitivity, medication sensitivity, strange things my heart rate fast during urination
    No carcinoid no pheochromocytoma unfortunately in my area we don't have standing measuring norepinephrine test so how I can know which one is right?
  2. Hip

    Hip Senior Member

    POTS is the main disease, then POTS is divided into three different types:
    • Low flow POTS (similar to hyperadrenergic POTS)
    • Normal flow POTS
    • High flow POTS (similar to neuropathic POTS)
    So if one doctor says you have POTS, and the other thinks you have hyperadrenergic POTS (low flow POTS), then they may be both right.

    It's very easy to diagnose POTS, but diagnosing the right type is more tricky.

    Here are some notes I copied from various sources on low flow POTS (similar to hyperadrenergic POTS):

    Symptoms of low flow POTS:
    Vasoconstriction while lying down.
    Blunted vasoconstriction responses when standing.

    20% of POTS patients are low flow.

    "Most low flow POTS patients are female. Two forms of low flow POTS:
    • Elevated angiotensin II variety (almost always exclusively female).
    • Norepinephrine transporter (NET) deficiency (more equal in terms of sexes)." 1

    Dr Stewart's study that says low flow patients with high angiotensin II are exclusively female. 1

    "Low-flow POTS is characterized by pallor, so if you are pale you are probably low flow." 1

    "Low Flow POTS with elevated angiotensin II correlates with receptor hypersensitivity — there is an increased response to norepinephrine because increased angiotensin II through impaired catabolism causes increased oxidative stress and less nitric oxide available for neuronal activity where its chief role is to dampen sympathetic outflow. So these patients have an excessive response to relatively normal norepinephrine levels, vasomotor nerve failure, absolute hypovolumia, pallor from reduced cutaneous blood flow and reduced body mass index. And almost all of the patients are female." 1

    "Hyperadrenergic POTS patients report significant tremor, anxiety, and cold sweaty extremities when upright. Many will report a significant increase in urinary output after being upright for even a short period of time, and over half suffer from true migraine headaches. The hallmark of this form of POTS is that in addition to orthostatic tachycardia they will often display orthostatic hypertension." 1

    Neuronal nitric oxide activity, but not endothelial nitric oxide activity, is reduced in low flow POTS. 1

    Some Low Flow POTS Treatments:

    Dr Julian Stewart uses the ARB drug losartan for patients with low flow POTS and high angiotensin II.

    "Apparently NO supplementation won't work because the deficit in this case is neuronal rather than endothelial bioavailability." 1

    Nitrates may offer benefits. 1

    Ascorbate (vitamin C) increases blood flow in low flow POTS. 1
    Last edited: Dec 16, 2016
    ryan31337, PatJ and Nemesis like this.
  3. Nemesis


    Hip likes this.
  4. Nemesis


    My doctor yesterday said that I can't take any Tachycardia medicine because of my vasomotor any medication will dilate my blood vessel

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