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

Discussion in 'Problems Standing: Orthostatic Intolerance; POTS' started by Allyson, Jan 28, 2014.

  1. Allyson


    Australia, Melbourne
  2. xchocoholic

    xchocoholic Senior Member

    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
  3. Sea

    Sea Senior Member

    NSW Australia
    @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.
  4. taniaaust1

    taniaaust1 Senior Member

    Sth Australia
    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.

    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.
    Last edited: Jan 29, 2014
    ahimsa and xchocoholic like this.
  5. ahimsa

    ahimsa Rarely on PR now

    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 -

    Types of OI -
    Scroll to the bottom for his definition of "Chronic Orthostatic Intolerance." An excerpt from this section:
    Info on POTS -

    From the summary page:
    SOC and Sea like this.
  6. Valentijn

    Valentijn Senior Member

    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.
  7. xchocoholic

    xchocoholic Senior Member

    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
    ahimsa likes this.

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