Are these POTs symptoms?

Jemima37

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I remember a few years ago it was suggested here it sounded like I had pots but I didnt want to even consider it as fInting is a huge phobia of mine.

Anyway 2 Novembers ago I started struggling with very bad anxiety and panic attacks. 12 hour panic attacks it was awful. One evening my father in law had a heart attack and my husband had to leave me, of course, and I suffered a severe panic attack when on my own. A few hours later once I felt up to walking my feet went all hot, red blotches and burning feeling just across the toes and on the top of the foot about 1/4 of the way up. Odd but I assumed it was due to inactivity that night. Since then it's happened every single night for 2 years, some nights less than others but this year its definitely not been as bad as last year, the redness and heat is milder than back then. My gp had no clue what it could be but it sounded like a rare condition called erithyromyalgia.

Last year after months of bad anxiety, flu and tonsilitis within a few months of eachother I became very fatigued and hit a major crash. I was bed ridden for 9 months with bad fatigue, and with it the anxiety was still pretty bad.

This year I've made progress with my mental health but physically I've still struggled with my physical side but its definitely improved. Last year I could barely walk around and didnt go downstairs for months at one point, hubby had to bed bath me. Now I can go downstairs but every time I do, within 5 minutes I feel it. One symptom I've had since last year is i get very breathless at times on activity. My gp isnt concerned and puts it down to the cfs. It's better this year than last but here's an example.

I was downstairs today doing our tree, I've been decorating it since last week. I am doing 5 minute trips downstairs and resting on my bed in between. I have to do the same to make my lunch. Put lunch on, go rest for half an hour to recover then go dish up. Constant pacing to avoid crashes or these weird symptoms when active. Today after 5 minutes i got my usual symptoms. My heart rate went up, head feeling all swimmy so I immediately panic I will faint, my lower legs and feet feel (this is hard to explain but they feel tight and like I cant stand up anymore or have to move them) but like they're tight or stiff and I feel the need to grip my toes into the ground to stay upright and sometimes my feet flare and feel warm, sometimes even blotchy. Usually my foot symptoms are mostly in the evenings once under warm bedding but sometimes they flare on activity during the daytime. I panicked and ran upstairs to my bedroom, lay down and heart rate was 100. BP was fine, it always rises once I've been on my feet. It was I think 128/82 today I had a similar attack last week doing the tree and my heart was 115 and it took a while to return to normal that day.

Today the BP came down quickly once resting but it was 98/58 after 5 minutes and for me thats a little low. My normal bp is about 107-111/68 ish. I get really out of puff too after being on my feet for more than 5 minutes and once resting that calms down as long as I dont get afraid of it and then it's fine again. I never get breathless when resting or doing say 2 -5 minutes on my feet but once 5 or over it'll kick in, I feel warm and then those symptoms above begin. It just feels like a complete inability to be upright for more than 5 minutes and i never had this before with cfs. I cant even sit upright on a chair for more than 2 minutes. I feel I have to lie down propped up again.

After Googlling I see it sounds like POTS so I'm wondering does it affect any of you with the symptoms I have? It hits me every time I'm active around the house and if I walk about or do chores too much (never anything strenuous) I can feel like I'm crashing by 5pm. I truly feel though that these daily symptoms when walking around are ruling my life and I had cfs for a year before this all began and never had these symptoms. I'd feel weak after going out or after doing too much at home but none of the burning feet, feeling shimmy and like my legs are tightening, breathless and I feel I need to lie down quick.

I'm sorry this is so long. I'm complex l know lol.

Thank you
Jem
 
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ahmo

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@Jemima37 From my scanning of what you've written, it looks like it may be POTS. [it's much easier to read if you break up large paragraphs, thanks.]

I have what I label "POTS-lite". A bit smaller variance in my lying/sitting BP than what's commonly suggested for the diagnosis. But last year I was getting symptoms almost every afternoon as I did my food prep, and it then progressed to AM and PM. For me, it includes light headedness, clammy/sweating, nausea, and usually increased heart rate. Also low or mid back ache. I'd have to lie down w/ legs up for about 10 minutes to feel better. POTS is likely another autoimmune symptom, of which I have many. Sorry I can't give you references, not on my regular computer.

MY GP suggested compression stockings, medium strength. As soon as I started using them, I never had another episode. I've been going without the stockings over the last 2 weeks, first time in a year. I seem to be ok. 2 things have changed for me. I've been seeing an extremely skilled TCM herbalist for 6 months, and following on from the improvements this has created, I've been finally getting a bit more exercise. When I think about it, I'd guess it may well be that the herbs have affected my immune system, calming it down. Which has been one of the goals.

I have no idea whether POTS is another ailment that most docs don't recognize. You might google POTS from the search prompt at bottom of the main forum page. On that page you'll also see this category: Autonomic, Cardiovascular, and Respiratory. Good luck.
 

Jemima37

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Thank you for your help. Much appreciated.

I wasn't sure where to post this so thanks for the link to the other page.

I just can't have the tilt table test, I cant get there to have it done anyway with the cfs currently but I'd panic for sure so I'm just living with this at the moment. I just wasnt sure if it could be pots of my bp rises after activity with all the other symptoms too. From what I read bo drops when upright. Mine rises and my pulse too but then I get all the other pots symptoms. Strange.

Thanks again.
Jem
 

ryan31337

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South East, England
Hi @Jemima37,

Everything you describe is absolutely typical of POTS in my experience. Erythromelalgia is one of the common skin manifestations, likely linked to the Small Fibre Neuropathy that is often underlying all of it.

However, you really need a proper cardiorespiratory workup with symptoms like that. Its pretty awful that the GP hasn't recognised these symptoms are something new and must be investigated to rule out other causes.

I had a similar experience: long-standing CFS diagnosis that eventually became more and more disabling with new and different symptoms. It got to the point that I could not actually do enough to trigger my typical CFS PEM, because I would get breathless/dizzy/anxious/pained/exhausted before reaching my CFS limits.

The good news (assuming it is POTS/SFN) is that there are medications to help and a better acceptance of the burden vs CFS. If you find the right specialists you will get much better care.

fainting is a huge phobia of mine...I just can't have the tilt table test...I just wasnt sure if it could be pots of my bp rises after activity with all the other symptoms too. From what I read bo drops when upright.
Protocols differ from doctor to doctor, generally you won't need a tilt table test unless you have a history of fainting. A shorter Active Stand test is enough to diagnose POTS in most cases - this just involves standing for 10 minutes with a blood pressure cuff on your finger. You'll have a bed behind you and a couple of nurses to help you back down if you feel faint. Its quite uncommon in POTS to faint in this situation, usually your sympathetic system & BP go into overdrive to keep you upright, albeit with a lot of dizziness, pain and anxiety!

To meet the diagnostic guidelines for POTS, blood pressure should normally remain consistent, though it is very well accepted that many of us with POTS will have orthostatic hypertension (BP goes higher the longer we stand to keep us upright). If it has any prolonged drop upon standing you would be looking at a different diagnosis.

Feel free to send me a PM if you want any info on UK doctors. The support and specialist centres exist, but you must seek them out, your local consultants will very likely be useless.

Hope that helps.
Ryan.
 

Jemima37

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UK
Hi @Jemima37,

Everything you describe is absolutely typical of POTS in my experience. Erythromelalgia is one of the common skin manifestations, likely linked to the Small Fibre Neuropathy that is often underlying all of it.

However, you really need a proper cardiorespiratory workup with symptoms like that. Its pretty awful that the GP hasn't recognised these symptoms are something new and must be investigated to rule out other causes.

I had a similar experience: long-standing CFS diagnosis that eventually became more and more disabling with new and different symptoms. It got to the point that I could not actually do enough to trigger my typical CFS PEM, because I would get breathless/dizzy/anxious/pained/exhausted before reaching my CFS limits.

The good news (assuming it is POTS/SFN) is that there are medications to help and a better acceptance of the burden vs CFS. If you find the right specialists you will get much better care.


Protocols differ from doctor to doctor, generally you won't need a tilt table test unless you have a history of fainting. A shorter Active Stand test is enough to diagnose POTS in most cases - this just involves standing for 10 minutes with a blood pressure cuff on your finger. You'll have a bed behind you and a couple of nurses to help you back down if you feel faint. Its quite uncommon in POTS to faint in this situation, usually your sympathetic system & BP go into overdrive to keep you upright, albeit with a lot of dizziness, pain and anxiety!

To meet the diagnostic guidelines for POTS, blood pressure should normally remain consistent, though it is very well accepted that many of us with POTS will have orthostatic hypertension (BP goes higher the longer we stand to keep us upright). If it has any prolonged drop upon standing you would be looking at a different diagnosis.

Feel free to send me a PM if you want any info on UK doctors. The support and specialist centres exist, but you must seek them out, your local consultants will very likely be useless.

Hope that helps.
Ryan.
Thank you Ryan

I've had these symptoms since last year, I'm still here thankfully. I'm ok if its minimal exertion and fine at rest. BP and pulse fine. It's been on extended standing ans acittiy that triggers it, some days minimal symptoms, other quite intense but I've noticed its later in the day after several episodes of activity that the symptoms tend to be worse later in the day when I'm doing things around the house.

I've posted before about how bad my agoraphobia has become the last 2 years so I cant get to a hospital for intense investigations. My gp understands this but now I'm worried incase I've a cardiac issue and could die. Lol. That's not your fault, its mine for developing such tlktnense agoraphobia these 2 years. I had agoraphobia back in 2012 and 13 after my brother attacked me but I got over it. It then returned early last year once my anxiety returned and cfs symptoms got worse as a result I ended up locking myself away because I couldn't face the world if I was struggling just around my house to walk about.

My biggest fear has this being a heart issue and it would be my fault for not having further tests or if I'm doing my heart damage if my BP raises on activity but my gp assured me it wont as everyones rises with exercise and the heart is very strong.

I never have heart pain, palpitations etc just those symptoms on activity after 5 minutes. I have done the 10 minute test myself and I could barely do 7 minutes haha. My heart rate was raised as was my bp and I felt too dizzy and faint. Tight legs and feet. Awful I'd be far too wncious to do this in a medical environment as I once had an extreme panic attack in my doctors office due to these symptoms.

I probably sound like a raving lunatic and now I'm worried I do sound a mess that I cant get to appointments. Which I have posted about before.

Thank you for your help.
Jem
 

ryan31337

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Hi Jem,

Sorry that its been affecting you so much. I can relate, I was always the most laid-back guy until the POTS issues really ramped up in my mid-twenties. Before that I was always chilled and level headed, despite CFS and severe migraine really disrupting my life for over a decade.

Once the POTS kicked in I really struggled with all these sensations of pressure, anxiety, phobias, negative thinking etc. Thankfully in my case it really is just physiological, once I got started on a POTS treatment regime they became manageable or went away entirely.

The one time I came off my main POTS medication (Ivabradine) for a few days to prep for a CPET, the issues all came back twice as bad and I was on the verge of having a panic attack for the first time in my life! So it really put it into perspective how disruptive that side of the POTS was, and how much better I was on the POTS meds. I really do hope for you that something simple like Ivabradine could also make you feel so much better mentally as well as physically.

Didn't mean to worry you re the cardiac investigations, it sounds very much like POTS to me but it would be negligent to not exclude other things first. Also, don't worry too much about the POTS investigations - if you are that symptomatic it will be clear immediately, your body will just go through all the stages that much quicker than someone else. I did have a tilt table test and only lasted something like 6 minutes before being brought back down, but the results were completely typical for POTS and that was all the evidence needed. The same thing would apply for the Active Stand I'm sure.

Hopefully with the right doctor you could find some way to have the bare minimum tests required to trial a medication? The guy I see often looks after very, very severe EDS patients and I'm certain they wouldn't be able to manage a lot of the tests I did. I'm sure there would be a way forward for you too.

Ryan
 

JES

Senior Member
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1,395
POTS is defined as an increase of BPM of 30 or more when standing, that's the simple diagnostic and can be done in a TILT table test, but isn't necessary IMO.

The much more difficult thing is to understand what triggers is, what treatments can help and what subtype of POTS you have. Some type of POTS responds to gradually increasing activity, others to compression or increased salt+water. Sometimes just a beta blocker is enough to manage the heart rate. If sympathetic overdrive is the cause, pyridostigmine may help. The hyperadrenergic (or likely autoimmune) type of POTS that I have with findings of specific autoantibodies, which goes along with ME/CFS symptoms, unfortunately responds poorly to any of these treatments.
 

ryan31337

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South East, England
@JES is right, POTS is just a common end-point from a number of underlying causes that need to be treated differently.

Clinically however, its not that helpful to think of POTS as having 'subtypes'. These are largely research distinctions. In practice the dysfunctions that contribute to POTS overlap to some degree in many cases, so there is usually benefit to be had from treating it from all angles: hypovolemic, neuropathic, hyperadrenergic, deconditioned etc.
 

Jemima37

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Thank you both so much.

I do believe its pots. My husband does too and I'm guessing its come from having CFS for over 3 years and decondrioning. I'm more active now than I was but very deconditioned and unfit.

Today I've been downstairs a few times to do lunch, put the washing on, finished my tree... and just now I went downstairs to do a few little chores and take some photos of my tree and wham it hit. I felt woozy swimmy headed, breathless, panicked and so my heart rate went up, legs and feet felt full and stiff and hot face and body. I then raced up the stairs feeling all woozy and panic kicked in. My pulse was 110 when I lay down straight away. BP was raised but I was panicked and i ran upstairs lol. BP came down after 3 minutes and pulse started to once i was lying down too. Crikey I felt hot and our of puff its rare I get these turns as I call them but last 3 days I've had 2 of them ans both times been after me being active for 10 minutes or longer doing the decorations. I'm fine if I do just 5 minute too downstairs, last year I couldn't do 1 minute. My body just always wants or needs to be lying down its ridiculous.

Can you gave pots without bo dropping when active? Mine increases slightly ir sometimes like just now its 138/88 but once I lay down and rested it was back down to 116/68.

Are the feet symptoms I described typical of pots too?

I am a little shaken but I am pretty sure they're pots turns as within minutes once I reat symptoms calm but I can be left shaken up and anxious for a while Fter. Like I am now lol. I've had these since last year and they calmed a lot once I stopped being so active and started again at 1 minute walks about, and built up to 5. Now after about 10 minutes I feel terrible but theres been some improvement I guess lol.

Thank you both again. I will speak to my GP soon about the pots test.

Julie
 

ryan31337

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Hi Julie,

Yes, blood pressure drops are not a defining feature of POTS. They may happen in some people when the compensatory mechanisms get overwhelmed but its not something that's needed for diagnosis.

How you describe a feeling of fullness/tightness/stiffness in your legs is exactly how I would describe it. Very common to see that, along with pooling of blood in the lower extremities. When your feet/legs are red like this you might notice that if you press your finger against them the skin will blanch, and remain white for a few seconds. Getting breathless and overheating when upright is classic stuff too.

See what your GP thinks but don't be too disheartened if you don't get much help. Also, definitely don't let them or any other consultant tell you it is soley due to deconditioning - there is a lot more at play than that. Again I do think for proper care you need to cherry pick the right specialist, which can be done on NHS or privately but you will likely have to lead that. Unless your GP has had another patient that's been to these specialists, they won't know how to deal with you.

Cheers,
Ryan
 

Jemima37

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UK
Hi Julie,

Yes, blood pressure drops are not a defining feature of POTS. They may happen in some people when the compensatory mechanisms get overwhelmed but its not something that's needed for diagnosis.

How you describe a feeling of fullness/tightness/stiffness in your legs is exactly how I would describe it. Very common to see that, along with pooling of blood in the lower extremities. When your feet/legs are red like this you might notice that if you press your finger against them the skin will blanch, and remain white for a few seconds. Getting breathless and overheating when upright is classic stuff too.

See what your GP thinks but don't be too disheartened if you don't get much help. Also, definitely don't let them or any other consultant tell you it is soley due to deconditioning - there is a lot more at play than that. Again I do think for proper care you need to cherry pick the right specialist, which can be done on NHS or privately but you will likely have to lead that. Unless your GP has had another patient that's been to these specialists, they won't know how to deal with you.

Cheers,
Ryan
Thank you so much Ryan. My husband said he will ress this thread tonight and he is going to book an api tent for us with my GP to discuss POTS. Is it only a specialist that can diagnose it? I just cant do the 10 minute standing test so I'm not sure what she will say. I just hope its mot my heart but now I'm anxious if ppts is dangerous lol. My anxiety, I apologise. Its run away with me since being unwell.

Is pots typical with cfs and usually what causes the pots?

I'm biggest fear is fainting, I dont knowi why but its terrified me ever since I became chronically ill. My anxiety latches into it and at one point I was terrified to move or walk around my house, I cab still get like that to be honest. Do all people faint with pots? Scares me to death.

Thanks again. You've educated me and reassured me a lot.

Jem
 
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JES

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I had a 30 minute standing tilt-table test performed during a time when I had severe POTS symptoms. I didn't faint despite feeling barely well enough to walk a few hundred meters to the test and back home. Fainting in POTS seems to be rarer than intuition would expect, so I wouldn't worry about it at all unless you are driving a car or doing something where you risk putting other people in danger.
 

Jemima37

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Location
UK
I had a 30 minute standing tilt-table test performed during a time when I had severe POTS symptoms. I didn't faint despite feeling barely well enough to walk a few hundred meters to the test and back home. Fainting in POTS seems to be rarer than intuition would expect, so I wouldn't worry about it at all unless you are driving a car or doing something where you risk putting other people in danger.
Thank you. I gave up driving last year just incase as I'd often feel the motion triggered me to feel woozy and I hated that responsibility with my children in the car. I never go out now either really because I cant stay active long enough to but I'm ok about it. I'm a home girl. I go in the garden to see my rabbits and for now I accept that's all I can do. I popped in a shop a few months ago and felt fine but paid for it afterwards. Its definitely my symptoms that cause my anxiety because if I woke up tomorrow symptom free I'd not feel anxious walking around. The symptoms are awful.

We have an appointment soon with the GP, hubby booked it tonight when he stopped to pick up a prescription. Hoping she can offer some reassurance it's not my heart or anything.

Thank you for reassuring me about the fainting, it's been a huge fear of mine for a while now.
Jem
 

ryan31337

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South East, England
Is it only a specialist that can diagnose it? I just cant do the 10 minute standing test so I'm not sure what she will say.
A knowledgeable GP might be able to recognise the symptoms of POTS, but they shouldn't make a diagnosis because it requires a cardiologist to exclude other causes of similar symptoms.

A cardiologist may be able to recognise the symptoms, exclude other diseases and diagnose POTS, but there is no guarantee they will know how to treat it effectively.

It's a relatively recent discovery and awareness is poor, doctors are not taught about it and the drugs that can be useful were not originally made for POTS, so can only be prescribed by those very experienced and willing to take on the responsibility. That's why you need to see a specialist in POTS.

You must try and do what you can with the testing, you won't be able to get any help if you refuse all investigations. The worst that will happen is you'll have a funny turn in hospital and end the test early. You might still have enough data from the test to the make the diagnosis, and you'll be the absolute best place with nurses and doctors all around to make you feel better! If you don't work with the doctors you won't be able to get any treatment and I can't stress enough how much improvement some POTS patients can make with the right care - its definitely worth a bad day for.

Is pots typical with cfs and usually what causes the pots?
The answer to that is complicated, we don't know enough about either condition. A good CFS doctor will be aware of POTS though and recognise when new & different symptoms that are more specific to POTS are appearing that could be treatable.
 

Jemima37

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407
Location
UK
A knowledgeable GP might be able to recognise the symptoms of POTS, but they shouldn't make a diagnosis because it requires a cardiologist to exclude other causes of similar symptoms.

A cardiologist may be able to recognise the symptoms, exclude other diseases and diagnose POTS, but there is no guarantee they will know how to treat it effectively.

It's a relatively recent discovery and awareness is poor, doctors are not taught about it and the drugs that can be useful were not originally made for POTS, so can only be prescribed by those very experienced and willing to take on the responsibility. That's why you need to see a specialist in POTS.

You must try and do what you can with the testing, you won't be able to get any help if you refuse all investigations. The worst that will happen is you'll have a funny turn in hospital and end the test early. You might still have enough data from the test to the make the diagnosis, and you'll be the absolute best place with nurses and doctors all around to make you feel better! If you don't work with the doctors you won't be able to get any treatment and I can't stress enough how much improvement some POTS patients can make with the right care - its definitely worth a bad day for.


The answer to that is complicated, we don't know enough about either condition. A good CFS doctor will be aware of POTS though and recognise when new & different symptoms that are more specific to POTS are appearing that could be treatable.
Thank you so much Ryan.

I know, I do need to try and help myself but the last 2 years my world fell apart and feeling so unwell I've struggled to attend appointments. Really struggled due to seeking so dreadful and the panic it causes me. Extreme panic attacks.

I'm really hoping it's not a heart condition other than pots.

Thank you again.
Jem
 

ryan31337

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Location
South East, England
You're welcome. I didn't mean to condescend or downplay your anxiety, I know first hand how horrible it can be. I just know POTS is different from CFS in that there are treatments and you could be one of the lucky ones that gets a lot better, it would be awful if you were to miss out on the possibility of that for one reason or another.

Best of luck,
Ryan
 
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