Is this POTS or another type of Tachycardia?

[ChrisD]

POTs has always been a mild syndrome for me, not causing severe nausea and dizziness/fainting etc. More just OI and a bit of a funny head upon standing + 30BPM HR increase.

But a couple of weeks ago I took a high dose intensive course of PRObiotics and started to experience a couple of issues e.g. I became Dairy intolerant for 3 days (IBS-D) which I don't usually have. Then over the past week I've had increasing Tachycardia/POTS which has become quite intense.

My usual HR resting is: 60BPM, sitting: 70-80bpm, standing: 90-100bpm, walking: 115bpm
But it has gone up to: 80-90 Resting/Sitting, Standing: 105-110bpm and Walking 120bpm+

Additionally to HR, my heart is thudding and chest can become quite tight/strained which is uncomfortable and unsettling. I actually remember having something like this when I first became ill with ME after an infection - I had an ECG and it revealed Sinus Tachycardia which was put down to 'anxiety' yet later in my research i realised that a lot of infections can cause this.

I have read some advice to lay flat to relieve it but interestingly when I lie down it is as bad as 90BPM. According to this page: http://www.potsuk.org/types_of_pots It makes it more likely to be IST - Inappropriate Sinus Tachycardia.

My diagnosis is ME/CFS from the NHS but I do have positive Armin labs results for Borrelia, Mycoplasma, CPn, Coxsackie. So I have a theory that the probiotics may have charged up my immune system and rattled these infections, or its just rattled my immune system, OR because I have leaky gut there is either some die off or translocation of bacteria into the blood stream.

High dose Vitamin C helps to lower HR by about 10BPM for a few hours, so I feel that this could be something viral/bacterial.

Any other ideas? Usually I am mostly housebound but able to go out a few hours a day for walks etc. but at the moment I am totally housebound because if I do any exercise it flares the POTS up really badly and I can't sleep.

 

[pibee]

many POTS patients have also high resting HR. Especially hyperadrenergic which is more linked to MCAS.

For IST you need to have daily average 100+ even during night (from what I remember)

but your POTS seems borderline, you should also check your standing BP to see if it drops, as it could be OHypo and not POTS.
or do a proper tilt table test.

 

[ryan31337]

My cardiologist diagnosed me as POTS with features of IST. I assumed it was sneaky talk to justify prescribing Ivabradine, but I later discovered there is literature suggesting IST and POTS overlap, thought of by some as two points on a spectrum disorder.

Your description is very typical of an acute POTS flare for me. In my case usually a viral infection/reactivation, or just payback from doing too much the day before. My resting HR will increase in those scenarios.

 

[Leah_Heisel]

My cardiologist diagnosed me as POTS with features of IST. I assumed it was sneaky talk to justify prescribing Ivabradine, but I later discovered there is literature suggesting IST and POTS overlap, thought of by some as two points on a spectrum disorder.

Your description is very typical of an acute POTS flare for me. In my case usually a viral infection/reactivation, or just payback from doing too much the day before. My resting HR will increase in those scenarios.

How have you done on Ivabradine? I've only been diagnosed with ITS and have been on low dose metoprolol for about a year. It works in keeping heart range down but I feel like it has contributed more fatigue to my already fatigued state.

 

[ryan31337]

Hi @Leah_Heisel,

Ivabradine has been excellent for me, way better than beta blockers. It really helps combat that wired-but-tired anxiety feeling, and keeping topped up on Ivabradine with a later dose definitely controls the dawn phenomenon issue that used to spike my HR early morning and keep waking me up from 6am.

Bisoprolol didn't do that so well, plus it either worsened or didn't help shortness of breath, chest pains and cold extremities.

I've just started augmenting with Pyridostigmine now too, as neuropathic issues have since been confirmed. Although my resting symptoms are far better, I'm still struggling to remain upright for as long as I want, so hopefully this might give me a further boost.

All the best,
Ryan